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 four patients, the situation is likely to be complex and require multiple resources. Requesting additional help ensures that there are enough personnel and equipment on scene to effectively manage the situation and provide prompt care to all patients. This step is crucial for the safety and well-being of the patients and the responders. Summary of other choices: A: Calling medical control is important, but in this scenario, immediate action on scene is necessary before informing medical control. C: Starting immediate triage and treatment is important, but given the severity of the situation, additional resources are needed before focusing solely on the two ejected patients. D: Notifying the local trauma center is important, but the immediate priority is to ensure that all patients receive timely and appropriate care on scene before transferring them to a higher level of care.

Correct Answer: A

Rationale: The correct answer is A: Gray. Gray stopper tubes are used for blood samples to test for alcohol levels, such as for blood alcohol content (BAC). This is because gray stopper tubes contain sodium fluoride, which prevents blood from fermenting and preserves alcohol levels accurately. Other choices are incorrect: B (light blue) is used for coagulation testing, C (lavender) is used for complete blood count (CBC) and blood typing, and D (green) is used for chemistry tests.

Correct Answer: C

Rationale: The correct answer is C: Administer defibrillation per protocol. The patient is presenting with symptoms indicative of unstable ventricular tachycardia or ventricular fibrillation, which are life-threatening arrhythmias. Defibrillation is the immediate intervention to restore normal rhythm by delivering an electrical shock to the heart. In this scenario, the patient is hemodynamically unstable with a low blood pressure and loss of consciousness, making defibrillation the most appropriate and effective intervention to potentially save the patient's life. Choice A (Administer procainamide) is not the most effective intervention as this patient is in a critical condition that requires immediate action, and procainamide infusion takes time to work. Choice B (Administer adenosine) is typically used for supraventricular tachycardias and is not appropriate for wide complex tachycardias. Choice D (Administer synchronized electrical cardioversion) is indicated for stable wide complex tachycardias

Correct Answer: A

Rationale: The correct answer is A: "Inserting an oropharyngeal airway." In this scenario of a motorcycle crash with noisy respirations, apnea, and a hematoma in the pharynx, the patient is likely experiencing airway obstruction. An oropharyngeal airway helps maintain a patent airway by preventing the collapse of the tongue and soft tissues in the oropharynx. It does not require visualization or manipulation of the upper airway structures, making it the most suitable initial intervention in this emergent situation. Summary of why the other choices are incorrect: B: "Inserting a nasopharyngeal airway" - Nasopharyngeal airways are not recommended in the presence of facial trauma or suspected basilar skull fracture due to the risk of exacerbating the injury. C: "Performing a surgical cricothyroidotomy" - This is an invasive procedure reserved for extreme cases of airway obstruction when other methods fail. D

Correct Answer: D

Rationale: The correct answer is D because an endotracheal tube (ETT) above the carina on a chest x-ray is the most reliable indicator of esophageal intubation. This is because direct visualization of the ETT position relative to the carina is definitive evidence of correct placement. A, B, and C are less reliable signs as they can be misleading in certain circumstances. Symmetrical chest movement can occur even with esophageal intubation due to passive chest rise. End-tidal CO2 presence by colorimetry can be falsely positive in cases of esophageal intubation. Bilateral breath sounds can also be heard in the abdomen with esophageal intubation, leading to a false sense of correct placement.