15 free questions from the CinnaEMS primary assessment bank (731 in the app). Tap an answer to check it. The rationale opens right away.
A bystander says a man "had a seizure" for about 15 seconds right as he collapsed and now he is making occasional snorting gasps. What should you suspect first?
Answer: A. Cardiac arrest
Brief jerking at the moment of collapse is a common result of sudden loss of blood flow to the brain, and occasional gasps are agonal breathing, not effective ventilation. Together they are a cardiac arrest until a pulse check proves otherwise. Calling it a postictal state is the trap: it delays compressions and defibrillation for a patient whose heart is not pumping.
A patient who took an opioid is breathing 6 times a minute with a saturation of 97% on room air. The correct reading of that saturation is:
Answer: A. It is misleading; the rate is the life threat here
Oximetry reports how much hemoglobin is carrying oxygen, not how much air is moving, so it stays high for minutes while carbon dioxide climbs on a rate of 6. Treating the number as proof of adequate ventilation confuses an oxygenation measure with the minute volume it cannot see.
You are alone with an apneic adult who has a pulse, and both a pocket mask and a bag-valve mask are within reach. Many rescuers ventilate better with the pocket mask in this situation because:
Answer: A. Both hands are free to hold the seal and lift the jaw
A lone rescuer squeezing a bag has only one hand for the mask, and a leaking one-hand seal is the commonest reason for poor chest rise. With a pocket mask both hands seal and lift the jaw while the breath comes from the rescuer's lungs. A bag with reservoir oxygen still delivers more oxygen, and any device can inflate the stomach if breaths are too big or fast.
A man with long-standing COPD is confused, cyanotic and breathing shallowly with an oxygen saturation of 82%. Regarding oxygen, you should:
Answer: A. Give oxygen and assist ventilations as needed
A hypoxic patient must never be denied oxygen. Concern about reducing the drive to breathe in some COPD patients is managed by watching and supporting ventilation, not by leaving a confused, cyanotic patient hypoxic. Waiting for further decline or for his home settings delays care for a patient already showing signs of respiratory failure.
While searching for a pulse you feel a continuous buzzing thrill over a surgical join in a dialysis patient's forearm. That sensation is:
Answer: A. Flow through the surgical join, not a pulse
A surgically created connection between an artery and a vein produces a continuous hum rather than the discrete beat of a pulse, so counting it gives you a sensation that has no rate and tells you nothing about how the heart is performing. The pulse is taken somewhere else entirely, and reading the thrill as circulation lost or found puts a fiction into the circulation step.
A 6-month-old with two days of vomiting has a heart rate of 190, capillary refill of 4 seconds and is difficult to rouse. A blood pressure of 78/50 in this infant should be read as:
Answer: A. Late compensation; the other findings define the severity
Children hold their blood pressure with ferocious tachycardia and vasoconstriction until they are nearly out of reserve, so a normal reading beside a rate of 190 and delayed refill means the tank is almost empty. Treating the pressure as reassurance misreads the last number to fail as the first.
A young man found unresponsive beside drug paraphernalia is not breathing and has no pulse. As the EMT team arrives, the priority is to:
Answer: A. Start high-quality CPR and apply the AED right away
Once there is no pulse, this is cardiac arrest, and CPR with early defibrillation takes priority over any antidote. Naloxone may be given, but only without delaying or interrupting CPR, because it cannot restart a heart that has stopped. Ventilation alone is correct only when a pulse is present.
Your primary assessment of a patient with no life threats routinely takes you several minutes. The most likely reason is that you are:
Answer: A. Collecting findings that belong to later steps
The primary assessment answers whether anything is killing this patient right now, and on a patient with no life threats that takes well under a minute, so a long one is usually a history and a head-to-toe examination arriving early. The airway step is seconds, and rechecking is not the problem — a first pass that has already become the whole examination is.
A man is picking at the air and repeating one phrase over and over, but his airway, breathing, pulse and skin are all normal. Your assessment should conclude:
Answer: A. His behavior is an abnormal mental status finding
Mental status is one of the steps of the primary assessment, so behavior this far from normal is an abnormal finding in its own right and must be recorded, watched and handed over even while the other steps look fine. Calling the rest of the findings normal and closing the assessment there discards the one step that is actually abnormal, and strangeness alone is not the same as unstable.
Two workers are found down inside a grain bin, with no smoke, no fire and no visible injuries. Your first assessment conclusion should be:
Answer: A. The air inside may not support life
Two people down in one enclosed space with nothing visible to explain it is the classic presentation of an atmosphere that has been displaced or contaminated, and walking in without that in mind produces a third and fourth patient. Heat or a fall would be believable for one worker, but neither explains two simultaneous collapses in a space known for oxygen-poor air.
The mask you are holding covers your patient's mouth, nose and most of the face you were reading color from. To keep assessing him you should:
Answer: A. Look at him between breaths, not through the mask
The gap between deliveries is long enough to read the parts of the face and neck the mask does not cover and to watch the chest fall, so the assessment continues without interrupting the support. The bag tells you about resistance rather than about the patient, and lifting the mask every minute breaks the seal and the rhythm to obtain something you could have seen without doing it.
You sealed an open chest wound with an occlusive dressing. Several minutes later the patient is more breathless, anxious and has a falling blood pressure. You should first:
Answer: A. Briefly lift one edge of the dressing to let air escape
A sealed chest wound can trap air building up inside the chest, turning an open pneumothorax into a tension pneumothorax. Briefly lifting (burping) the dressing lets that trapped air out through the wound, and the patient often improves quickly. Adding layers or taping more tightly makes the trapping worse, and leaving the wound permanently open reintroduces the sucking wound you sealed for a reason.
A 58-year-old with a long history of lung disease is breathing 32 times per minute with shallow chest rise and a saturation of 84% on room air. The finding that most argues for assisted ventilation rather than a non-rebreather alone is:
Answer: A. The shallow chest rise at a rate of 32
Shallow rise at a fast rate moves air in and out of dead space, so minute volume fails no matter how rich the gas offered. A low saturation is an oxygenation number a mask can often raise, which is why it does not by itself justify taking over the work of breathing.
You are alone at a car crash with two patients: a driver who is screaming about her broken wrist and a silent passenger slumped forward with a bleeding scalp. You should first:
Answer: A. Go to the silent passenger and check the airway
A patient who is screaming has an open airway, is breathing and is perfusing her brain; a silent, slumped patient may have an obstructed airway from his head position. Checking the passenger's airway first addresses the most immediate threat. Scalp bleeding can look dramatic but rarely outranks the airway, and waiting abandons a patient who may be obstructing now.
Twenty-five minutes after a brief seizure, a woman still responds only to a painful stimulus and has not improved at all. You should:
Answer: A. Look for another cause of the altered status
Recovery from a seizure moves in one direction, so a level of response that has not improved after twenty-five minutes has stopped behaving like a post-ictal state and points instead at low sugar, a head injury, poor perfusion or seizure activity that never stopped. Continuing to wait treats the passage of time as a treatment and delays the search for a cause you might be able to fix.
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