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Army Combat Medic Exam 4
Acute coronary syndrome (ACS)
Answer and explanation
Conditions from sudden reduced blood flow to heart muscle
Myocardial infarction (MI)
Answer and explanation
Death of heart muscle from prolonged insufficient oxygenated blood
Classic ACS presentation
Answer and explanation
Chest pressure that may radiate to arm, jaw, or back with nausea
Atypical ACS presentation
Answer and explanation
Weakness, fatigue, or indigestion without chest pain in older adults, diabetics
Cardiac arrest
Answer and explanation
Sudden cessation of effective heart pumping; no pulse or normal breathing
Ventricular fibrillation (VF)
Answer and explanation
Chaotic ventricular electrical activity; shockable rhythm
Pulseless ventricular tachycardia (pVT)
Answer and explanation
Fast ventricular rhythm without pulse; shockable rhythm
Asystole
Answer and explanation
No ventricular electrical activity; not shockable
Pulseless electrical activity (PEA)
Answer and explanation
Organized electrical activity without pulse; not shockable
Dysrhythmia
Answer and explanation
Abnormal heart rhythm from electrical impulse disturbances
Bradycardia
Answer and explanation
Unusually slow heart rate causing poor perfusion if symptomatic
Tachycardia
Answer and explanation
Unusually fast heart rate compromising cardiac output
Cardiogenic shock
Answer and explanation
Inadequate tissue perfusion from heart failing to pump effectively
Heart failure
Answer and explanation
Heart cannot pump adequately; may cause pulmonary edema
Pulmonary edema
Answer and explanation
Fluid in lung air spaces causing crackles and frothy sputum
Dyspnea
Answer and explanation
Subjective difficulty breathing or shortness of breath
Aspirin in suspected ACS
Answer and explanation
Assist/administer chewable aspirin after checking contraindications
Nitroglycerin in suspected ACS
Answer and explanation
Relieves ischemic chest discomfort via vasodilation; assist under protocol
Aspirin versus nitroglycerin
Answer and explanation
Aspirin reduces platelets; nitroglycerin reduces cardiac workload
Cardiac emergency initial assessment
Answer and explanation
Assess ABCs, vitals, history; give oxygen if indicated
AED
Answer and explanation
Analyzes rhythm and advises/delivers shocks for shockable rhythms
Early defibrillation
Answer and explanation
Rapid shocks in VF/pVT restore organized rhythm
High-quality CPR compression rate
Answer and explanation
100–120 compressions per minute
Adult single-rescuer CPR ratio
Answer and explanation
30 compressions to 2 breaths before advanced airway
Adult cardiac arrest sequence
Answer and explanation
Check responsiveness, call for help, start CPR and apply AED
AED safety
Answer and explanation
Ensure no contact during shock; dry chest, remove patches if needed
Five links of cardiac chain of survival
Answer and explanation
Recognize arrest, early CPR, defibrillation, advanced care, post-arrest care
ROSC
Answer and explanation
Return of effective pulse and perfusion after arrest
Resuscitation team approach
Answer and explanation
Assign tasks, rotate compressors, minimize pauses, communicate clearly
Quality improvement in resuscitation
Answer and explanation
Review CPR/AED performance and outcomes for better care
Cardiac assessment OPQRST
Answer and explanation
Onset, Provocation, Quality, Region, Severity, Time of symptoms
Cardiac assessment SAMPLE
Answer and explanation
Signs, Allergies, Medications, Past history, Last intake, Events
Infection
Answer and explanation
Microorganism invasion causing illness
Sepsis
Answer and explanation
Life-threatening organ dysfunction from infection response
Septic shock
Answer and explanation
Sepsis with severe circulatory and metabolic dysfunction
Systemic inflammatory response
Answer and explanation
Fever or hypothermia, increased HR and breathing; non-specific
Common sepsis infection sources
Answer and explanation
Lung, urinary tract, abdomen, skin, devices or wounds
Potential sepsis findings
Answer and explanation
Infection plus altered mental status, tachypnea, tachycardia, hypotension
qSOFA warning signs
Answer and explanation
Altered mentation, SBP ≤100 mmHg, RR ≥22/min
Sepsis with no fever
Answer and explanation
Normal or low temperature does not exclude sepsis
Sepsis focused assessment
Answer and explanation
Recent infection, vitals, mental changes, perfusion, infection source
Prehospital priorities for suspected sepsis
Answer and explanation
Support airway, oxygen, recognize shock, rapid transport, notify hospital
Sepsis versus uncomplicated infection
Answer and explanation
Sepsis includes organ dysfunction; infection alone is not sepsis
Infection control for EMS
Answer and explanation
Use PPE, hand hygiene, standard and transmission-based precautions
Communicable disease
Answer and explanation
Infectious disease spread person-to-person directly or indirectly
Universal/standard precautions
Answer and explanation
Treat blood/fluids as infectious; use gloves, eye protection, safe sharps
Scene safety and PPE
Answer and explanation
Assess risk; use appropriate protection; avoid exposure
Poison
Answer and explanation
Substance causing harm when introduced to body
Toxin
Answer and explanation
Poison produced by living organism
Overdose
Answer and explanation
Excessive exposure causing harm
Ingested poison
Answer and explanation
Toxin swallowed and absorbed GI tract
Inhaled poison
Answer and explanation
Toxin breathed into lungs
Absorbed poison
Answer and explanation
Toxin crossing skin or mucous membranes
Injected poison
Answer and explanation
Toxin introduced via needle, sting, or bite
Poisoning primary assessment
Answer and explanation
Ensure safety; assess ABCs and immediate threats
Poisoning secondary assessment
Answer and explanation
Identify substance, route, amount, time; collect meds/containers
Poison control/medical direction
Answer and explanation
Contact poison center per protocol; do not delay lifesaving care
Do not induce vomiting
Answer and explanation
Vomiting can cause aspiration or more injury
Activated charcoal
Answer and explanation
Adsorbent for select ingestions; not routinely given by EMTs
Caustic/chemical exposure
Answer and explanation
Remove patient, decontaminate per protocol; protect responders
Skin poison decontamination
Answer and explanation
Wear PPE, remove clothing, brush dry chemicals, irrigate appropriately
Inhaled toxin treatment
Answer and explanation
Remove from atmosphere, support airway and oxygenation
Opioid toxidrome
Answer and explanation
Depressed breathing, decreased consciousness, often pinpoint pupils
Naloxone
Answer and explanation
Opioid antagonist reversing respiratory depression
Agitation or seizures after toxin
Answer and explanation
Protect, maintain airway, avoid restraints, request ALS
Scene evidence and containers
Answer and explanation
Bring meds/packaging safely; avoid handling hazardous material without protection
Abdominal pain
Answer and explanation
Pain or discomfort in abdomen from minor to life-threatening causes
Visceral pain
Answer and explanation
Poorly localized, dull or cramping from internal organs
Parietal pain
Answer and explanation
Sharp localized pain from peritoneum irritation
Referred pain
Answer and explanation
Pain felt distant from origin
Peritoneum
Answer and explanation
Membrane lining abdominal cavity and covering organs
Peritonitis
Answer and explanation
Peritoneum inflammation causing tenderness, guarding, rigidity
Guarding
Answer and explanation
Muscle tensing in response to abdominal pain
Abdominal rigidity
Answer and explanation
Firm boardlike abdomen from peritoneal irritation
Four abdominal quadrants
Answer and explanation
Right upper, left upper, right lower, left lower
Abdominal pain red flags
Answer and explanation
Shock, rigid belly, vomiting, bleeding, pregnancy, sudden severe pain
Abdominal pain assessment
Answer and explanation
Assess ABCs, vitals, pain details, meds, history, pregnancy
Abdominal examination
Answer and explanation
Inspect and palpate gently, starting away from pain area
Vomiting and aspiration risk
Answer and explanation
Position and suction airway; use recovery position if safe
Gastrointestinal bleeding clues
Answer and explanation
Vomiting blood, coffee grounds, dark stool, bright red bleeding
Abdominal pain treatment priorities
Answer and explanation
Maintain airway, oxygen, position for comfort, treat shock, no oral intake
Cardiac causes of abdominal pain
Answer and explanation
MI can present with epigastric discomfort, nausea, vomiting
Scenario: adult collapses unresponsive no pulse
Answer and explanation
Start CPR, activate EMS, apply AED, shock if advised
Scenario: chest pressure, sweating, SOB, low BP
Answer and explanation
Suspect ACS, assist aspirin if allowed, avoid nitroglycerin if hypotensive
Scenario: severe dyspnea, crackles, frothy sputum
Answer and explanation
Suspect pulmonary edema; support airway, oxygen, request ALS
Scenario: 70-year-old weak, irregular pulse, pale
Answer and explanation
Treat as cardiac; assess ABCs, history, monitor, request ALS
Scenario: unresponsive with gasping, no pulse
Answer and explanation
Start CPR and AED immediately; no delay for breaths
Scenario: older patient with infection and confusion
Answer and explanation
Suspect sepsis; support ABCs, oxygen, rapid transport, notify hospital
Scenario: suspected sepsis with high fever, low BP
Answer and explanation
Support ABCs, oxygen, request ALS, expedite transport
Scenario: unconscious, slow breathing, pinpoint pupils
Answer and explanation
Suspect opioid overdose; support airway, give naloxone if authorized
Scenario: swallowed unknown medication awake no symptoms
Answer and explanation
Protect scene, assess ABCs, contact poison control, do not induce vomiting
Scenario: exposed to strong chemical fumes
Answer and explanation
Do not enter unsafe area; use PPE, remove from exposure when safe
Scenario: poisonous liquid spilled on skin and clothes
Answer and explanation
Use PPE, remove clothing, decontaminate per protocol
Scenario: left lower quadrant pain with nausea, clammy skin
Answer and explanation
Primary assessment, focused history/exam, support airway if vomiting
Scenario: worsening abdominal pain, low-grade fever
Answer and explanation
Assess ABCs, vitals, consider inflammatory or surgical abdomen, transport
Scenario: severe bilateral lower abdominal pain, vomiting, high BP
Answer and explanation
Assess for abdominal emergency, monitor shock, arrange timely transport
Scenario: 68-year-old with cardiac chest pain then pulseless
Answer and explanation
Start CPR and defibrillate; do not delay for vomiting
Scenario: 14-year-old severe abdominal pain after trauma
Answer and explanation
Suspect intra-abdominal bleeding; assess ABCs, check shock, transport rapidly
Scenario: severe abdominal pain with rigid boardlike abdomen
Answer and explanation
Treat immediate threats, prevent heat loss, transport, request ALS
Cardiac arrest assessment includes
Answer and explanation
Unresponsiveness, absent normal breathing, no pulse
AED analyzes
Answer and explanation
Cardiac rhythm to advise/deliver shock if needed
Pulse check in adult cardiac arrest
Answer and explanation
Check promptly, within 10 seconds
Signs of cardiogenic shock
Answer and explanation
Hypotension, altered mentation, cool skin, pulmonary congestion
Heart failure symptoms
Answer and explanation
Pulmonary edema and breathlessness
Aspirin contraindications in ACS
Answer and explanation
True allergy or active bleeding
Nitroglycerin contraindications
Answer and explanation
Low blood pressure, recent PDE-5 inhibitor use
High-quality CPR compression depth adults
Answer and explanation
About 2 inches (5–6 cm)
Five links of cardiac chain of survival include
Answer and explanation
Early recognition, CPR, defibrillation, advanced care, post-arrest care
Sepsis includes
Answer and explanation
Dysregulated host response causing organ dysfunction
Septic shock essence
Answer and explanation
Sepsis with profound circulatory and metabolic abnormalities
Systemic inflammatory response signs
Answer and explanation
Fever or hypothermia, tachycardia, tachypnea
Sepsis suspected with
Answer and explanation
Infection plus altered mental status, tachycardia, hypotension
Infection control for EMS includes
Answer and explanation
PPE, hand hygiene, standard and transmission-based precautions
Poisoning primary assessment priority
Answer and explanation
Scene safety first
Activated charcoal use
Answer and explanation
For selected ingestions under medical direction
Opioid toxidrome key feature
Answer and explanation
Pinpoint pupils and respiratory depression
Naloxone use
Answer and explanation
Reverse opioid respiratory depression
Peritonitis signs
Answer and explanation
Severe tenderness, guarding, abdominal rigidity
Four abdominal quadrants
Answer and explanation
Right upper, left upper, right lower, left lower
Abdominal pain red flag symptoms
Answer and explanation
Shock signs, rigid abdomen, severe sudden pain
Abdominal examination technique
Answer and explanation
Inspect and palpate gently starting away from painful site
Vomiting risks in abdominal pain
Answer and explanation
Aspiration risk, maintain airway
GI bleeding cluse examples
Answer and explanation
Coffee-ground emesis, tarry stools, rectal bleeding
Cardiac cause of abdominal pain
Answer and explanation
MI causing epigastric discomfort
Scenario with suspected opioid poisoning management
Answer and explanation
Support airway and ventilation, administer naloxone
Scenario of chemical exposure management
Answer and explanation
Remove patient safely, decontaminate with PPE
Scenario of cardiac arrest with vomiting management
Answer and explanation
Do not delay CPR; clear airway as needed
Scenario of sepsis with high fever and hypotension
Answer and explanation
Support ABCs, oxygen, rapid transport, notify hospital
Activated charcoal is
Answer and explanation
An adsorbent not routinely given by EMTs
Universal precautions treat
Answer and explanation
Blood and body fluids as infectious
Scene assessment in poisoning
Answer and explanation
Ensure safety before approach
Sepsis qSOFA includes
Answer and explanation
Altered mentation, SBP ≤100, RR ≥22
Pulseless electrical activity treatment
Answer and explanation
Perform CPR, address reversible causes
Asystole shockability
Answer and explanation
Not shockable
VF shockability
Answer and explanation
Shockable rhythm
pVT shockability
Answer and explanation
Shockable rhythm
Bradycardia possible consequence
Answer and explanation
Poor perfusion when symptomatic
Tachycardia effect
Answer and explanation
Compromises cardiac output
Pulmonary edema symptom
Answer and explanation
Frothy sputum
Aspirin in ACS effect
Answer and explanation
Reduces platelet aggregation
Nitroglycerin effect
Answer and explanation
Vasodilation reduces ischemic discomfort
AED safety measures
Answer and explanation
No touching patient during shock; dry chest
Sepsis key recognition
Answer and explanation
Suspect with infection plus organ dysfunction signs
Poison vs toxin
Answer and explanation
Poison is harmful substance; toxin is poison from living organism
Overdose definition
Answer and explanation
Excessive drug or substance exposure
Routes of poisoning
Answer and explanation
Ingested, inhaled, absorbed, injected
Guarding meaning
Answer and explanation
Muscle tensing in response to pain
Abdominal rigidity indicates
Answer and explanation
Peritoneal irritation
Referred pain definition
Answer and explanation
Pain distant from source
Vomiting management risk
Answer and explanation
Aspiration
Naloxone role
Answer and explanation
Opioid antagonist
Opioid toxidrome key signs
Answer and explanation
Depressed breathing, decreased consciousness, pinpoint pupils
Sepsis prehospital priorities
Answer and explanation
Recognize shock, oxygen, rapid transport, notify hospital
Infection control involves
Answer and explanation
PPE and hand hygiene
Poison control role
Answer and explanation
Provide substance-specific advice
Activated charcoal limitation
Answer and explanation
Not routine; many exposures inappropriate
Chemical exposure management
Answer and explanation
Remove from area, decontaminate with PPE
Abdominal pain quadrants used for
Answer and explanation
Localization and reporting
EMS approach to vomiting risk
Answer and explanation
Position, suction airway, recovery position if safe
Cardiac emergency initial steps
Answer and explanation
Assess ABCs, vitals, history, oxygen if needed
Defibrillation goal
Answer and explanation
Interrupt lethal rhythm to resume organized rhythm
High-quality CPR components
Answer and explanation
Push hard/fast, full recoil, minimize interruptions
CPR adult compression depth
Answer and explanation
5 to 6 centimeters
Chest pain radiating sites
Answer and explanation
Arm, jaw, back
Sepsis cause
Answer and explanation
Dysregulated response to infection causing organ dysfunction
Septic shock signs
Answer and explanation
Severe circulatory and metabolic dysfunction
Systemic inflammatory response signs
Answer and explanation
Fever, tachycardia, tachypnea
EMS infection control includes
Answer and explanation
Standard and transmission-based precautions
Clinical signs of cardiogenic shock
Answer and explanation
Hypotension, altered mentation, cool skin
Typical MI symptoms
Answer and explanation
Chest pressure, dyspnea, diaphoresis, nausea
Atypical MI symptoms population
Answer and explanation
Older adults, diabetics, women
AED use in cardiac arrest
Answer and explanation
Analyze rhythm and deliver shock if indicated
Sequence after AED shock advised
Answer and explanation
Resume CPR immediately
Respiration in cardiac arrest
Answer and explanation
Absent or abnormal breathing
Pulse during PEA
Answer and explanation
No palpable pulse despite electrical activity
EMS poison evaluation
Answer and explanation
Identify substance and exposure details
EMS should never
Answer and explanation
Induce vomiting in poisoned patient
Scene safety in toxic exposure
Answer and explanation
Evaluate risk and use PPE before approach
Activated charcoal timing
Answer and explanation
Given early in appropriate ingestion
Opioid overdose management
Answer and explanation
Airway support and naloxone administration
Signs of severe abdominal emergency
Answer and explanation
Severe pain, rigidity, shock signs
Palpation method in abdominal exam
Answer and explanation
Gentle and away from pain site first
Vomiting in abdominal emergencies
Answer and explanation
Risk of airway obstruction and aspiration
GI bleeding indicators
Answer and explanation
Vomiting blood, coffee grounds, tarry or bright rectal bleeding
Chest pain differential includes
Answer and explanation
Myocardial infarction and abdominal causes
EMS treatment of cardiac arrest
Answer and explanation
High-quality CPR and defibrillation
Adult CPR ratio
Answer and explanation
30 compressions to 2 breaths
PPE purpose EMS
Answer and explanation
Protect responder and patient from infection
Poisoning route: injected example
Answer and explanation
Needle, sting, bite
Chemical exposure decontamination
Answer and explanation
Brush dry chemicals off before irrigation
Cardiac emergency transport priority
Answer and explanation
Rapid transport with ALS alert
Signs of shock in abdominal pain
Answer and explanation
Hypotension, pallor, weak rapid pulse
EMS sepsis suspicion signs
Answer and explanation
Fever, altered mental status, tachycardia, hypotension
Opioid toxidrome respiratory effect
Answer and explanation
Breathing depression
Naloxone administration requirement
Answer and explanation
Local protocol authorization
EMS do not delay in cardiac arrest
Answer and explanation
Starting CPR or defibrillation
Standard precautions in EMS use
Answer and explanation
Gloves, masks, eye protection
Signs of pulmonary edema
Answer and explanation
Crackles, severe breathing difficulty, frothy sputum
EMS cardiac assessment focuses on
Answer and explanation
OPQRST and SAMPLE history
Signs of peritonitis
Answer and explanation
Tenderness, guarding, rigidity
EMS abdominal pain assessment includes
Answer and explanation
Pain quality, location, onset, associated symptoms
Scene evaluation EMS
Answer and explanation
Identify hazards before patient contact
Poison control advice EMS
Answer and explanation
Substance-specific treatment guidance
EMS management of vomiting with cardiac arrest
Answer and explanation
Do not delay CPR; clear airway
Oxygen use in sepsis
Answer and explanation
Administer if indicated to support ventilation
EMS management for inhaled toxin
Answer and explanation
Remove from toxin, support airway and oxygenation
EMS poisoning secondary assessment
Answer and explanation
Obtain vitals, exam, exposure details
EMS use of naloxone
Answer and explanation
Counteracts opioid respiratory depression
EMS in sepsis transport priority
Answer and explanation
Rapid transport with hospital notification
Causes of abdominal pain
Answer and explanation
Minor disorders to life-threatening conditions
EMS abdominal quadrant names
Answer and explanation
RUQ, LUQ, RLQ, LLQ
EMS recognize Ventricular Fibrillation
Answer and explanation
Chaotic ventricular rhythm preventing effective pump
EMS adult single rescuer CPR ratio
Answer and explanation
30 compressions to 2 breaths
EMS do not induce vomiting because
Answer and explanation
Risk of aspiration or further injury
EMS treatment for caustic skin exposure
Answer and explanation
Brush dry chemicals, remove clothing, irrigate
EMS assessment for septic shock
Answer and explanation
Suspect sepsis plus hypotension and poor perfusion
EMS bradycardia concern
Answer and explanation
Can cause poor perfusion when symptomatic
EMS tachycardia effect
Answer and explanation
May reduce cardiac output
EMS for pulseless electrical activity (PEA)
Answer and explanation
Provide CPR, identify reversible causes
EMS early defibrillation importance
Answer and explanation
Interrupts lethal cardiac rhythms
EMS high-quality CPR parameters
Answer and explanation
100–120 compressions/min, 2-inch depth, full recoil
EMS aspirin role in ACS
Answer and explanation
Reduces platelet aggregation
EMS nitroglycerin role in ACS
Answer and explanation
Relieves ischemic chest pain via vasodilation
EMS cardiac arrest initial steps
Answer and explanation
Check response, ABCs, call for help, start CPR
EMS clinical signs of heart failure
Answer and explanation
Pulmonary edema with breathlessness
EMS clinical signs of shock
Answer and explanation
Hypotension, altered mentation, cool clammy skin
EMS cardiac arrest definition
Answer and explanation
No pulse, no normal breathing, unresponsiveness
EMS sepsis recognition priority
Answer and explanation
Rapid identification and transport
EMS infection control measure
Answer and explanation
Use PPE and hand hygiene to prevent spread
EMS poison inhalation treatment
Answer and explanation
Remove from exposure, support airway and oxygen
EMS opioid toxidrome features
Answer and explanation
Pinpoint pupils, respiratory depression, decreased consciousness
EMS naloxone indications
Answer and explanation
Suspected opioid overdose with respiratory depression
EMS abdominal pain 'red flags'
Answer and explanation
Shock signs, rigid abdomen, severe pain
EMS peritonitis signs
Answer and explanation
Tenderness, guarding, rigidity of abdomen
EMS vomiting management
Answer and explanation
Protect airway; suction and position appropriately
EMS gastrointestinal bleeding signs
Answer and explanation
Blood in vomit or stool, pallor, shock signs
EMS abdominal pain assessment components
Answer and explanation
Onset, location, quality, associated symptoms
EMS scene safety includes
Answer and explanation
Risk evaluation and PPE use before patient contact
EMS poison control consultation
Answer and explanation
Contact poison center for specific management advice
EMS scenario: unresponsive adult with no pulse and gasping
Answer and explanation
Start CPR and AED immediately
EMS scenario: suspected ACS with hypotension
Answer and explanation
Avoid nitroglycerin, assist aspirin, rapid transport
EMS scenario: severe dyspnea with pulmonary edema
Answer and explanation
Support airway, oxygen, request ALS
EMS scenario: suspected sepsis with high fever and hypotension
Answer and explanation
Support ABCs, oxygen, expedite transport
EMS scenario: opioid overdose with slow breathing and pinpoint pupils
Answer and explanation
Provide airway support, administer naloxone
EMS scenario: chemical exposure to skin
Answer and explanation
Wear PPE, remove contaminated clothing, decontaminate
EMS scenario: trauma with severe abdominal pain and guarding
Answer and explanation
Assess ABCs, monitor for shock, transport rapidly
EMS scenario: cardiac arrest with vomiting
Answer and explanation
Maintain CPR, clear airway; do not delay compressions