EMR – Primary Assessment — Quick Review

An EMR arrives on scene and observes a 70-year-old male sitting upright in a chair, speaking in full sentences, and appearing comfortable. Which of the following best describes what this initial observation represents?

When forming a general impression, which of the following is the EMR primarily trying to determine?

An EMR enters a residence and sees a 55-year-old woman lying on the floor, pale, and not moving. Which component of the general impression does skin color primarily inform?

A patient is found seated, leaning forward with hands on knees, breathing with visible use of accessory muscles. What does this tripod position most strongly suggest to the EMR during the general impression?

During a general impression, an EMR notes a strong smell of alcohol on a patient’s breath, an unkempt appearance, and slurred speech. Which of the following is the most appropriate next action?

An EMR responds to a report of a person down. On arrival, the patient is a 40-year-old male found supine on the sidewalk, unresponsive, with audible gurgling respirations and cyanotic lips. Which of the following correctly prioritizes the EMR’s immediate action based on the general impression?

An EMR arrives to find a 30-year-old construction worker who fell from a ladder. The patient is standing, answering questions appropriately, and denies loss of consciousness. The EMR notices a subtle change in the patient’s affect partway through the conversation. Which principle should guide the EMR’s interpretation of the general impression?

A patient opens his eyes and turns his head when the EMR calls his name. According to the AVPU scale, how would this response be categorized?

Which of the following patients would be classified as Alert on the AVPU scale?

An EMR shouts a patient’s name, taps his shoulder, and then applies a painful stimulus. The patient shows no response whatsoever. Which AVPU classification applies?

An EMR is assessing a patient who does not respond to voice but withdraws her arm when a painful stimulus is applied to the shoulder muscle. Which AVPU classification is most appropriate?

When assessing level of consciousness in a patient with a possible spinal injury, which method of applying a painful stimulus is generally preferred?

A patient is found slumped in a chair. When the EMR speaks to him, he opens his eyes briefly, moans, and then closes his eyes again. Which AVPU level best fits this patient?

An EMR finds a 65-year-old patient sitting up in bed who appears awake but answers questions with confused, inappropriate responses and does not know the current year. Which AVPU classification and related concern is most accurate?

An EMR reassesses a patient who was Alert on initial contact. Five minutes later the patient responds only to a painful stimulus, with eye opening and moaning. Which of the following correctly describes this change and the appropriate EMR action?

When approaching a conscious adult patient for the first time, which of the following communication strategies best helps establish rapport?

An EMR is caring for a 7-year-old child who is crying and fearful. Which of the following approaches is most appropriate to build rapport?

An EMR arrives at a scene where a bystander is loudly insisting the patient does not need an ambulance. Which is the most appropriate way to communicate with this bystander?

An alert adult patient states that she does not want to be touched. Which of the following best reflects the appropriate communication approach?

An EMR is assessing a patient who speaks limited English. A bystander offers to translate. Which of the following is the primary concern with relying on this bystander as an interpreter?

An EMR finds a 50-year-old male in moderate distress who becomes increasingly agitated and refuses to answer questions. His wife says he has a history of anxiety and was recently laid off from work. Which communication technique would most likely de-escalate the situation and facilitate assessment?

An EMR is on scene with a patient who appears intoxicated and is making threatening statements while bystanders gather nearby. Which of the following best reflects the appropriate approach to communication and scene safety?

An unresponsive adult is making high-pitched crowing sounds with each breath. This finding most likely indicates:

A conscious choking adult is clutching her throat and can produce no cough, voice, or breath sounds. You should recognize this as:

You approach an unresponsive patient and open the airway. As you check breathing you detect slow, gurgling respirations. What does the gurgling most likely indicate?

A 4-year-old is sitting upright, leaning forward, drooling, and will not allow you to look in her mouth. She has a low-grade fever. Her breathing is audible with a soft stridor. Which of the following best describes her airway status?

During the primary assessment of an unconscious trauma patient, you note that the chest rises with each breath but a loud snoring sound accompanies every inhalation. The MOST likely cause of this snoring is:

An adult patient is found unresponsive after a seizure. Respirations are 6 per minute with obvious accessory muscle use and paradoxical abdominal movement. The airway makes no sound. Which combination of findings is MOST consistent with a partial obstruction severe enough to cause respiratory failure?

A drowsy adult who responds to voice has faint inspiratory stridor. The trachea is midline and chest movement is symmetrical. Which finding would MOST specifically point to upper airway edema as the cause of the stridor rather than another chest condition?

Which manual airway maneuver is preferred for an unresponsive patient with a suspected cervical spine injury?

To perform a head-tilt chin-lift correctly, the EMR places one hand on the patient’s forehead and uses the fingers of the other hand to:

You attempt a jaw-thrust on an unresponsive trauma patient and the airway remains obstructed after two attempts. What is the MOST appropriate next action?

When performing a jaw-thrust maneuver, the EMR positions at the top of the patient’s head and places the fingers of both hands:

After opening the airway of an unresponsive adult with a head-tilt chin-lift, you note the patient resumes snoring respirations when your hands are removed. The MOST appropriate next step is:

A two-person EMR team responds to a pulseless, apneic adult found at the bottom of a staircase. One rescuer is performing CPR. Which approach to airway management BEST balances cervical spine precaution and airway patency for the second rescuer?

An EMR is managing the airway of an unconscious infant found face-down in a pool. Which modification to the standard head-tilt chin-lift is MOST important when applied to an infant?

A resting adult patient has a respiratory rate of 26 breaths per minute with shallow chest rise and pale, moist skin. How should the EMR classify this breathing?

When assessing the depth of a patient’s breathing, the EMR should primarily:

You are assessing a child who is breathing at 35 breaths per minute with nasal flaring and retractions between the ribs. These findings indicate:

A patient with a suspected overdose of central nervous system depressants has a respiratory rate of 4 breaths per minute and barely perceptible chest movement. The skin is cyanotic centrally. Which statement BEST describes this patient’s breathing status?

During the primary assessment you note a patient’s breathing gradually becomes deeper, then shallower, then briefly stops, repeating in a cyclical pattern. This respiratory pattern is MOST consistent with:

A construction worker who inhaled fumes is conscious, anxious, and breathing at 28 breaths per minute. Breath sounds are equal bilaterally and the chest rises symmetrically. Skin color is pink. Which assessment finding MOST suggests his breathing is currently adequate?

An elderly female is found by family seated in a rocking chair. She is minimally responsive to voice, breathing at 8 breaths per minute with deep, regular excursions and no accessory muscle use. Her skin is warm, pink, and dry. Which finding is MOST important to recognize as indicating inadequate breathing?

You are assessing a 7-year-old who fell from a trampoline. He is conscious and crying, breathing at 24 breaths per minute. You notice the left side of his chest rises less than the right, and breath sounds are diminished on the left. His trachea is midline and he has no accessory muscle use. Which conclusion is MOST accurate?

You are assessing an unresponsive adult. Where should you check for a pulse first?

A patient’s skin appears pale, cool, and clammy. Which condition does this combination most strongly suggest?

In an infant, which site is preferred for checking a pulse during the primary assessment?

You press on a patient’s fingernail bed until it blanches, then release. Color returns in 3 seconds. How should you interpret this finding?

A patient has a rapid, weak, and thready radial pulse. Which of the following is the most likely explanation for this finding?

You are assessing a patient found unresponsive on a cold day. His skin is pale and cold to the touch, and capillary refill is greater than 4 seconds. Before concluding he is in shock, what environmental factor must you consider?

During a primary assessment, you find that a patient has mottled, cyanotic skin, absent radial pulses, and a barely palpable carotid pulse at a rate of 130 beats per minute. These findings together indicate which stage of shock?

You assess a 2-year-old brought in for decreased responsiveness. Skin is mottled, capillary refill is 4 seconds, and the brachial pulse is weak at 160 beats per minute. Which action takes priority?

You arrive at the scene of a trauma and find a patient with bright red blood spurting from a wound on the thigh. What is the first action you should take?

A commercial tourniquet is applied to a patient’s upper arm for arterial hemorrhage. Which assessment finding confirms the tourniquet is functioning properly?

You are treating a patient with a deep laceration to the arm that is bleeding heavily. Direct pressure is applied, but the dressing is becoming saturated with blood. What is the most appropriate next step?

A patient has a partial amputation of the left forearm with uncontrolled bleeding despite two minutes of direct pressure. You apply a commercial tourniquet. Where should it be positioned?

During a primary assessment, you identify a patient with a groin wound producing pulsatile bleeding that cannot be controlled with a tourniquet because of its location. What is the best hemorrhage control option available to an EMR?

You are treating a patient with a tourniquet in place on the right thigh. Transport time is estimated at 45 minutes. What should you do regarding documentation and ongoing monitoring?

At a scene with a single critically injured patient, you find a severely mangled leg with spurting arterial hemorrhage. The patient is responsive and screaming in pain. Using a systematic approach, what is your first action?

When you first approach a responsive patient, what is the primary goal of your initial verbal interaction?

You approach a patient who is awake and says, ‘I can’t catch my breath.’ Which component of the primary assessment does this statement most directly inform?

You arrive at a scene where a bystander points to a man slumped in a chair. The patient does not respond to your voice. After confirming the scene is safe, what is your next action in the primary assessment?

A patient involved in a motor vehicle crash tells you her chest hit the steering wheel. She is speaking in short, broken sentences and has visible bruising across the sternum. Which finding in your primary assessment most directly signals an immediate life threat?

You are called for a patient with altered mental status. The patient opens her eyes only to pain, makes incomprehensible sounds, and withdraws from a painful stimulus. How would you characterize this patient’s level of responsiveness?

You arrive to find a 70-year-old male sitting upright with severe respiratory distress. He whispers that he has had chest pressure for 2 hours. His skin is gray and diaphoretic, radial pulses are absent, and the carotid pulse is rapid and weak. In the primary assessment, which finding represents the highest-priority immediate life threat?

You are dispatched for a ‘person acting strangely.’ On arrival, a 35-year-old female is pacing, speaking rapidly but incoherently, and sweating profusely. She resists assessment. Bystanders say she has diabetes. After ensuring scene safety, what is the most critical step in your primary assessment?

A 34-year-old male is found pale, sweating, and anxious after a motor vehicle collision. His radial pulse is rapid and weak. Which finding best indicates he is in early compensated shock?

Which skin finding is most consistent with hypoperfusion in a trauma patient?

A 70-year-old woman involved in a fall presents with a blood pressure of 90/60 mmHg, heart rate of 116 beats per minute, and altered mental status. She was previously alert. Which stage of shock do these findings most likely represent?

An EMR arrives at the scene of a stabbing victim. The patient is unresponsive, has no palpable radial pulse, and has a barely palpable carotid pulse. Respirations are slow and irregular. Which assessment finding most clearly indicates late or severe shock?

A child struck by a car is anxious and breathing rapidly. Her skin is pale and cool. Heart rate is 148 beats per minute, and capillary refill is 3.5 seconds. Blood pressure is 94/60 mmHg. What does the prolonged capillary refill most directly indicate?

A 55-year-old male is found confused and unresponsive to verbal stimuli after a construction accident. He has a blood pressure of 70/40 mmHg, heart rate of 130 beats per minute, and agonal respirations. His skin is mottled. Which finding indicates the greatest concern for irreversibility of his condition?

A young adult female collapses during a community event. She is responsive to painful stimuli only. She was reportedly stung by a bee minutes ago. Her blood pressure is 78/50 mmHg, heart rate is 118 beats per minute, and her skin is flushed and warm. Which type of shock is most consistent with this presentation?

An EMR assesses a resting adult patient and counts 24 respirations per minute. How should the EMR classify this finding?

When an EMR palpates a radial pulse and finds it is irregular and very fast, what is the most appropriate next action?

An EMR obtains a blood pressure of 148/96 mmHg in a 60-year-old male who denies any symptoms. He has no history of high blood pressure. What is the most appropriate action?

A 4-year-old child is assessed after a witnessed fall. Her heart rate is 120 beats per minute and her respiratory rate is 26 breaths per minute. How should the EMR interpret these findings?

During baseline vital sign assessment, an EMR notes the patient’s pupils are unequal. The right pupil is 6 mm and the left is 3 mm, and both react sluggishly to light. In a trauma patient, this finding most likely suggests:

An EMR assesses a 68-year-old male with diabetes and chest pain. Heart rate is 58 beats per minute, blood pressure is 100/70 mmHg, and respirations are 18 per minute. Skin is cool and diaphoretic. The patient takes a beta-blocker daily. Which vital sign interpretation best accounts for his medication history?

A 7-year-old boy is found sitting upright, leaning forward with his hands on his knees, breathing rapidly with audible wheezing. He is able to speak in short sentences. Which term best describes his respiratory status?

Which finding most clearly indicates that a patient has progressed from respiratory distress to respiratory failure?

An EMR is called to an adult male found unresponsive on the floor. After opening the airway, the EMR observes slow, gasping, irregular breaths approximately 4 times per minute. What is the correct interpretation and action?

A construction worker fell 15 feet and is now unresponsive. An EMR finds no chest rise and no breath sounds after opening the airway with a jaw-thrust maneuver. There is no detectable carotid pulse. What is the correct classification of this patient’s respiratory status?

During a primary assessment, an EMR notes that an unresponsive adult is breathing at 6 breaths per minute with shallow chest movement and a dusky skin color. What intervention is most immediately indicated?

A 52-year-old woman is found at home unresponsive. She has a history of a substance use disorder involving federally controlled medications. Her respirations are 5 per minute, pinpoint pupils are noted, and her lips are cyanotic. Her carotid pulse is 60 and weak. Which combination of findings most clearly distinguishes respiratory failure from respiratory arrest in this patient?

An infant is found unresponsive and not breathing. The EMR opens the airway, but two attempts to ventilate fail to produce visible chest rise even after the airway is repositioned. What is the most appropriate next action?

A 45-year-old male was involved in a high-speed crash. He is responsive to voice, has a heart rate of 122 beats per minute, blood pressure of 96/64 mmHg, respiratory rate of 24 per minute, and cool, pale, moist skin. He denies pain but is confused. Which combination of findings most strongly suggests he is transitioning from compensated to decompensated shock?

When assessing a patient’s pulse, an EMR should evaluate which three characteristics?

An EMR arrives to find an unresponsive adult. After ensuring scene safety and forming a general impression, what is the correct next step to determine if the patient is in cardiac arrest?

A 58-year-old male is found unresponsive on the floor of his office. He has no apparent injuries. You check for a carotid pulse for 8 seconds and feel nothing, and his chest is not rising. What should you do FIRST?

During the primary assessment of a 70-year-old female, you notice she is making occasional gasping sounds roughly every 8 to 10 seconds but her pulse is absent. How should you classify these breaths and respond?

You are assessing a 45-year-old male who collapsed at a gym. He is unresponsive and pulseless. Bystander CPR has been underway for about 2 minutes. An AED is now available. What is the correct action?

An EMR is alone with no phone in reach and encounters an unresponsive 4-year-old child at a playground. No bystanders are present. The child has no pulse and is not breathing. Which action is MOST appropriate?

An EMR assesses a 62-year-old female pulled from a cold lake in February. She is pulseless and apneic, and bystanders report she was submerged for about 20 minutes. Which statement BEST guides your resuscitation decision?

While performing the primary assessment on an unresponsive adult, you palpate for a carotid pulse. Which finding confirms cardiac arrest and obligates you to begin CPR?

An EMR is assessing an unresponsive adult and is uncertain whether a pulse is present after 8 seconds of palpation. What is the recommended course of action?

A 35-year-old male was in a motor vehicle collision and has a large open abdominal wound with visible evisceration. His airway is open, he is breathing adequately, and his radial pulse is strong. How should you prioritize this patient for transport?

At a two-car collision involving four adults, Patient A is walking and talking. Patient B is unresponsive with absent respirations even after airway repositioning. Patient C has a severely angulated femur fracture and is screaming in pain. Patient D is unresponsive but begins breathing after airway repositioning. Using START triage, which patient receives an IMMEDIATE tag?

A 72-year-old female has an altered level of consciousness, a blood pressure of 84/50 mmHg, and a respiratory rate of 28 breaths per minute after a fall. The nearest hospital is 40 minutes away. What is the MOST appropriate transport decision?

You are treating a 50-year-old male with a severe asthma attack. He is conscious, speaking in one-word phrases, has accessory muscle use, and an SpO2 of 87% on room air. Which statement BEST describes the appropriate action?

A 28-year-old female has an isolated closed tibial fracture with no neurovascular compromise. She is in pain, but her airway, breathing, and circulation are intact and she has no other injuries. What transport priority is MOST appropriate?

You are the only EMR at a four-patient adult scene with one ambulance. Patient 1 is unresponsive and apneic even after airway repositioning. Patient 2 is unresponsive, breathing 8 times per minute. Patient 3 is responsive with respirations of 24 per minute and a rapid, weak radial pulse. Patient 4 has minor lacerations and is walking and conversational. Using START triage, which patient is classified MINIMAL?

A 60-year-old male has sudden severe chest pain radiating to the jaw, diaphoresis, and nausea. His vitals are BP 110/70, pulse 92, respirations 18, and he is conscious and alert. How should an EMR prioritize this patient?

An EMR is treating an unconscious adult who needs positive pressure ventilation but does not have a patent airway despite repositioning and a jaw thrust. No ALS is on scene. What is the MOST appropriate action?

You are caring for a 6-year-old who was struck by a vehicle. The child is unresponsive, has labored breathing, and has obvious bilateral lower extremity deformities. What additional resource should be requested immediately?

An EMR responds to a structure fire with multiple victims. On arrival there are 10 patients with varying burns and smoke inhalation plus one patient in cardiac arrest. Which resource request should be made FIRST?

You are treating a 40-year-old male with an open femur fracture and uncontrolled arterial bleeding. A tourniquet is applied and direct pressure is ongoing, but blood is soaking through dressings rapidly. Transport time to the nearest hospital is 25 minutes. What additional resource should be considered?

During the primary assessment of an elderly patient with suspected stroke, you identify facial droop, arm drift, and slurred speech with symptom onset 45 minutes ago. The nearest hospital is 10 minutes away but is not a stroke center. A certified stroke center is 35 minutes away. What is the MOST appropriate action?

You are the only responder where a 30-year-old male has a penetrating abdominal gunshot wound. He is conscious with a blood pressure of 90/60 mmHg, pulse 130, and respirations 22. You are an EMR without IV skills, and ALS is 18 minutes out. What is the BEST course of action?

An EMR is treating a 55-year-old male in cardiac arrest. CPR has been ongoing for 8 minutes, and the AED has reported no shock advised after three rhythm checks. The patient remains pulseless, and ALS has not yet been requested. Which statement BEST describes the situation?

When an EMR first approaches a patient, the general impression is formed primarily by:

An EMR arrives to find a patient sitting upright and speaking in full sentences without difficulty. This initial observation most accurately indicates:

Which finding during the general impression would most immediately indicate a life threat requiring intervention before continuing the assessment?

An EMR approaches a patient who is lying supine on the ground, pale, and diaphoretic, with eyes closed. Before touching the patient, what has the EMR already determined?