You are the first ambulance to arrive on the scene of a single-car accident. As you approach the scene, you see four patients, two have been ejected from their vehicle, and two are still in the vehicle. What should be your next course of action?

Correct Answer: B

Rationale: The correct answer is B: Request additional resources, such as fire rescue, and additional ambulances to respond to the scene. This is the best course of action because, in a single-car accident with multiple patients, the scene is likely to be complex and require additional resources to manage effectively. Requesting fire rescue can help with extrication of patients still in the vehicle, while additional ambulances ensure there are enough resources to transport all patients promptly. This approach prioritizes patient care and safety by ensuring all necessary resources are available to manage the situation efficiently. Choice A: Calling medical control is important but should not be the first step in this scenario where immediate action is needed. Choice C: Beginning immediate triage and treatment of the two ejected patients might overlook the need for additional resources and proper scene management. Choice D: Notifying the local trauma center is important but should come after requesting additional resources to manage the scene effectively.

Correct Answer: A

Rationale: The correct answer is A: Gray. Gray tube stoppers are used for collecting blood samples for alcohol testing because they contain sodium fluoride, which preserves the blood sample and inhibits the growth of bacteria. This is crucial for accurate alcohol level measurement. Light blue, lavender, and green tube stoppers are used for different types of blood tests, not specifically for alcohol testing. Light blue is typically used for coagulation tests, lavender for complete blood counts and blood typing, and green for basic metabolic panels. Therefore, the paramedic would want to use a gray tube stopper in this scenario to ensure the accuracy of the alcohol intoxication testing.

Correct Answer: C

Rationale: The correct answer is C: Administer defibrillation per protocol. In this scenario, the patient is presenting with signs of unstable ventricular tachycardia or ventricular fibrillation. Defibrillation is the most effective intervention as it delivers a shock to the heart to reset the abnormal rhythm. It is crucial in cases of pulseless ventricular tachycardia or ventricular fibrillation to restore a normal heart rhythm and improve cardiac output. Administering medications like procainamide (choice A) or adenosine (choice B) would not be effective as the patient is in a pulseless state. Synchronized electrical cardioversion (choice D) is typically used for stable tachyarrhythmias, not for pulseless rhythms. Defibrillation is the immediate and appropriate intervention to save the patient's life by restoring normal cardiac function.

Correct Answer: A

Rationale: The correct answer is A: "Inserting an oropharyngeal airway" because noisy respirations and apnea indicate airway obstruction. Oropharyngeal airway can help maintain a patent airway by preventing the collapse of soft tissues in the pharynx. It does not require visualization of the airway (unlike nasopharyngeal airway or intubation methods), making it quicker and suitable for emergency situations. Surgical cricothyroidotomy is an invasive procedure and not indicated in this scenario. Fiberoptic-guided nasotracheal intubation is time-consuming and may not be feasible in a critical situation.

Correct Answer: D

Rationale: The correct answer is D because an endotracheal tube (ETT) above the carina on a chest x-ray is the least reliable sign for diagnosing esophageal intubation. This is because the placement of the ETT above the carina does not definitively confirm that the tube is in the esophagus. The ETT could still be in the trachea but positioned above the carina. Symmetrical chest movement, bilateral breath sounds, and end-tidal CO2 presence by colorimetry are more reliable signs of proper endotracheal tube placement. Symmetrical chest movement indicates bilateral lung ventilation, bilateral breath sounds confirm the presence of air in both lungs, and end-tidal CO2 presence indicates effective gas exchange in the lungs.