Patient Reassessment and Ongoing Care - NREMT EMT Level

1. During reassessment after splinting a leg, which finding means circulation is impaired?
   Answer: Refill slows from 2s to 4s Capillary refill slowing from 2 seconds to 4 seconds indicates circulation is impaired because normal refill is under 2 seconds. A faster refill is the opposite, meaning improved perfusion, not impairment. Pink, warm toes and less pain also reflect good findings after splinting.
2. After aspirin and one nitroglycerin, BP is 98/60 and pain persists. The order allows repeat if SBP over 100. What next?
   Answer: Hold further nitroglycerin Systolic blood pressure is 98, below the required 100, so you must not repeat nitroglycerin. Giving more could further lower blood pressure. The tempting wrong choice is to repeat it because pain persists, but the safety threshold is not met. Hold it and monitor.
3. After albuterol treatment, wheezing lessens but SpO2 drops to 88%. What is your next action?
   Answer: Give high-flow oxygen now Wheezing lessening means bronchospasm is improving, but the SpO2 drop shows oxygenation is failing. Hypoxemia is the immediate threat, so give high-flow oxygen now. Repeating albuterol is tempting because of asthma, but it will not correct hypoxia and can worsen ventilation-perfusion mismatch.
4. How frequently should an EMT reassess an unstable patient during transport?
   Answer: Every 5 minutes to monitor for rapid changes Unstable patients require reassessment every 5 minutes during transport due to their potential for rapid deterioration. This frequent monitoring allows for quick detection of changes and prompt intervention. Every 15 minutes is appropriate for stable patients but inadequate for unstable ones. Every 10 minutes is not a standard interval. Continuous monitoring without formal reassessment intervals lacks the systematic approach needed for proper documentation and care.
5. When reassessing a patient during transport, which component should be evaluated first?
   Answer: Mental status and level of consciousness changes Mental status and level of consciousness should be assessed first during reassessment as changes can indicate serious deterioration requiring immediate intervention. This follows the same priority as primary assessment (mental status before ABCs in conscious patients). While vital signs, treatment effectiveness, and chief complaint changes are important, mental status changes are the most critical indicator of patient deterioration.
6. During reassessment of a patient receiving oxygen via non-rebreather mask, which finding indicates the need to adjust oxygen delivery?
   Answer: The reservoir bag completely deflates during each inspiration taken If the reservoir bag completely deflates during inspiration, the oxygen flow rate is too low and needs to be increased to maintain adequate oxygen concentration. The bag should deflate only slightly with each breath. A tight-fitting mask is appropriate for proper seal. Improved SpO2 indicates effective treatment. A respiratory rate of 20 is within normal range.
7. During reassessment, which finding indicates the epinephrine is being effective?
   Answer: Respiratory effort has improved and wheezing has decreased significantly Improved respiratory effort and decreased wheezing indicate that epinephrine is effectively treating the bronchospasm component of the allergic reaction. Hives may take longer to resolve than respiratory symptoms. Nervousness and jittery feelings are expected side effects of epinephrine. Increased BP is a side effect, not necessarily an indicator of effectiveness for the allergic reaction.
8. During reassessment, which change would be most concerning and require immediate intervention?
   Answer: Patient's level of consciousness decreases and she becomes less responsive Decreasing level of consciousness in a post-ictal patient may indicate status epilepticus, head injury, or other serious complications requiring immediate intervention and possible ALS intercept. Increasing alertness is expected during recovery. Slight BP increase from anxiety is not immediately concerning. Headache is common post-ictally and doesn't require immediate intervention.
9. When reassessing a patient's pain level during transport, what is the most appropriate method?
   Answer: Use a 1-10 numeric pain scale and compare to baseline A numeric pain scale (1-10) provides objective, measurable data that can be compared to baseline measurements for trending. This is the standard approach in EMS. Yes/no questions are less specific. Observation alone without patient input is inadequate. Detailed character questions are more appropriate for initial assessment, not ongoing reassessment.
10. During transport, an EMT should document reassessment findings in what manner?
    Answer: Record complete vital signs and assessment findings at each interval Complete vital signs and assessment findings should be documented at each reassessment interval to provide a complete picture of patient trending and care provided. This creates a legal record and helps receiving facilities understand the patient's course. Documenting only changes misses important trending information. Documentation only for deterioration misses improvement or stability. Time alone without findings is inadequate documentation.
11. During reassessment of a diabetic patient who received oral glucose, which finding best indicates treatment effectiveness?
    Answer: Patient reports feeling less confused and more alert than before Improved mental status (less confusion, more alert) is the best indicator that oral glucose is effectively treating hypoglycemia. While blood glucose increase is good, mental status is the key clinical indicator. Less diaphoresis and warmer skin are positive but less specific. Vital signs may not immediately return to normal even with effective treatment.
12. A trauma patient's HR rises from 100 to 126 while BP falls from 118/76 to 92/60. This trend most likely indicates:
    Answer: Decompensated shock Rising heart rate with a falling blood pressure indicates the body can no longer maintain adequate perfusion through compensation alone. This is decompensated shock. Compensated shock would maintain a normal or near-normal blood pressure despite tachycardia, so the dropping BP here rules it out.
13. What is the primary purpose of ongoing reassessment during patient transport?
    Answer: To identify changes in patient condition and treatment effectiveness The primary purpose of reassessment is to identify changes in patient condition and evaluate whether treatments are working effectively, allowing for timely interventions. While additional history may be gathered, this is secondary. Reassessment is not for skills practice. Patient reassurance is a benefit but not the primary purpose.
14. During reassessment, his SpO2 is now 94% but his respiratory rate has decreased to 10. What should you suspect?
    Answer: Possible CO2 retention causing respiratory drive suppression in COPD patient In COPD patients, high-flow oxygen can suppress respiratory drive through CO2 retention, causing dangerously slow breathing despite improved SpO2. This requires immediate intervention such as reducing oxygen flow or assisting ventilations. The improved SpO2 alone doesn't indicate effective treatment if respiratory rate is too low. This is not a normal response and requires action.
15. During transport, an EMT should reassess a stable patient at what minimum interval?
    Answer: Every 15 minutes throughout the transport period Stable patients should be reassessed every 15 minutes during transport to monitor for changes in condition. This allows for early detection of deterioration while not being excessive for stable patients. Every 5 minutes is the interval for unstable patients. Every 10 minutes is not a standard interval. Waiting only for apparent changes is inadequate as subtle deterioration may be missed.
16. During reassessment, an EMT should pay particular attention to which area when a patient has received spinal immobilization?
    Answer: Respiratory effort and skin color for signs of positional compromise Spinal immobilization can compromise respiratory effort due to positioning and strapping, making breathing assessment critical during reassessment. Skin color changes may indicate respiratory compromise or circulation issues from strapping. While pain monitoring is important, respiratory compromise is more immediately life-threatening. BP changes from anxiety are less critical. Neurological assessment should include all areas, not just the affected distribution.
17. During reassessment of a patient with a suspected fracture, which finding would indicate a complication requiring immediate intervention?
    Answer: Distal pulse is weak and skin is cool below injury Weak distal pulse and cool skin below a fracture site indicates compromised circulation, possibly from compartment syndrome, vascular injury, or improper splinting. This requires immediate intervention to prevent tissue loss. Increased pain and swelling are expected with fractures. Requests for repositioning should be evaluated but are less immediately concerning than circulation compromise.
18. An EMT notices during reassessment that a patient's pulse oximetry reading has dropped from 96% to 89%. What should be the immediate response?
    Answer: Check the pulse oximeter probe placement and patient movement first Before making treatment changes based on pulse oximetry, the EMT should first verify the accuracy of the reading by checking probe placement, patient movement, nail polish, or other factors that can cause false readings. If the reading is accurate, then oxygen adjustments would be appropriate. Documentation without verification is inadequate. Bag-mask ventilation would only be needed if the patient shows signs of respiratory failure.
19. During reassessment 10 minutes into transport, which finding would be most concerning?
    Answer: Pulse increased to 110 with reports of increased chest pain An increased pulse rate with worsening chest pain indicates potential cardiac deterioration and requires immediate attention and possible ALS intercept. A slight decrease in BP with strong pulse may indicate pain relief. Decreased respirations to 16 with clear lungs is normal. Improved SpO2 indicates the oxygen therapy is effective.
20. During patient reassessment, an EMT discovers that a splint applied to a patient's forearm is now too tight due to swelling. What is the most appropriate action?
    Answer: Loosen or reapply the splint to restore proper circulation immediately A splint that has become too tight due to swelling can compromise circulation and must be loosened or reapplied immediately to prevent tissue damage. Leaving it tight could cause permanent injury. Ice application doesn't address the immediate circulation problem. Complete removal without proper re-splinting could cause further injury to the fracture site.

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