BLS Medical

Question 1

In situations involving a patient with abdominal pain that is believed to be of a non-traumatic origin,
the paramedic shall:

Answer 1

consider potential life/limb/function threats, such as,

a. leaking or ruptured abdominal aortic aneurysm,
b. ectopic pregnancy,
c. other non-abdominal disorders that may present with abdominal pain, including:
i. diabetic ketoacidosis, and
ii. pulmonary embolism,
d. perforated or obstructed hollow organs with or without peritonitis,
e. acute pancreatitis,
f. testicular torsion,
g. pelvic infection, and
h. strangulated hernia;

Question 2

perform, at a minimum, a secondary survey to assess the abdomen for:

Answer 2

i. pulsations,
ii. scars,
iii. discolouration,
iv. distention,
v. masses,
vi. guarding,
vii. rigidity, and
viii. tenderness;

Question 3

if abdominal aneurysm is suspected, what should you do?

Answer 3

if abdominal aneurysm is suspected, palpate femoral pulses for weakness/absence; and observe for melena, hematemesis, or frank rectal bleeding (“hematochezia”).

Question 4

Consider the possibility of airway obstruction for patients who have…

Answer 4

smoke inhalation,

anaphylaxis, epiglottitis, foreign body aspiration, or oropharyngeal malignancy.

Question 5

Common allergens include:

Answer 5

Penicillin and other antibiotics in the penicillin family
• Latex
• Venom of bees, wasps, hornets
• Seafood - shrimp, crab, lobster, other shellfish
• Nuts, strawberries, melons, eggs, bananas
• Sulphites (food and wine preservatives)

Question 6

perform, at a minimum, a secondary survey to assess,

Answer 6

a. the site of allergic reaction, if applicable,
b. lungs, for adventitious sounds through auscultation, and
c. skin, for erythema, urticaria, and edema;

Question 7

consider anaphylaxis if the patient presents with two or more body system manifestations
as follows:

Answer 7

a. Respiratory:
Dyspnea, wheezing, stridor or hoarse voice
b. Cardiovascular:
Tachycardia or hypotension/shock
c. Neurological:
Dizziness, confusion, or loss of consciousness
d. Gastrointestinal
Nausea, vomiting, abdominal cramps, or diarrhea
e. Dermatological/mucosal:
Facial, orolingual, or generalized swelling/flushing/urticaria;

Question 8

If a thoracic aneurysm is suspected, perform what?

Answer 8

bilateral blood pressures.

Question 9

When performing CPR on a pregnant patient with a uterine height at or above the umbilicus
(approximately greater than 20 weeks gestation). What should you do?

Answer 9

have a second paramedic attempt to

manually perform left uterine displacement.

Question 10

consider other potentially serious conditions that may mimic a stroke, such as,

Answer 10

a. drug ingestion (e.g. cocaine),
b. hypoglycemia,
c. severe hypertension, hypertensive emergency, or
d. central nervous system (CNS) infection (e.g. meningitis);

Question 11

perform, at a minimum, a secondary survey to assess, (stroke)

Answer 11

. head/neck, for,
i. facial symmetry,
ii. pupillary size, equality, and reactivity,
iii. abnormal speech, and
iv. presence of stiff neck,
b. central nervous system, for,
i. abnormal motor function, e.g. hand grip strength, arm/leg movement/drift,
and
ii. sensory loss, and
c. for incontinence of urine/stool;

Question 12

(Stroke) prepare for potential problems, including,

Answer 12

a. possible airway obstruction (if loss of tongue control, gag reflex),
b. decreasing level of consciousness,
c. seizures, and
d. agitation, confusion, or combativeness; and

Question 13

if signs of cerebral herniation are

present after measures to address hypoxemia and hypotension. What SPO2% you want to keep.

Answer 13

hyperventilate

the patient to attempt to maintain ETCO2 values of 30-35 mmHg.

Question 14

Signs of

cerebral herniation include:

Answer 14

e a deteriorating GCS <9 with any of the following:
1. dilated and unreactive pupils,
2. asymmetric pupillary response, or 3. a motor response that shows either unilateral or bilateral decorticate
or decerebrate posturing

Question 15

if ETCO2 monitoring is unavailable, and measures to address hypoxemia and
hypotension have been taken, and the patient shows signs of cerebral herniation. what should you do?

Answer 15

paragraph 5(a)(ii) above, hyperventilate the patient as follows:

i. Adult: approximately 20 breaths per minute
ii. Child: approximately 25 breaths per minute
iii. Infant <1 year old: approximately 30 breaths per minute. 0

Question 16

In situations involving a patient with chest pain that is believed to be of a non-traumatic origin, the
paramedic shall:
1. consider potential life/limb/function threats, such as,

Answer 16

a. acute coronary syndrome/acute myocardial infarction (e.g. ST-segment elevation
myocardial infarction [STEMI]),
b. dissecting thoracic aorta,
c. pneumothorax, tension pneumothorax/other respiratory disorders (e.g. pneumonia),
d. pulmonary embolism, and
e. pericarditis;

Question 17

perform, at a minimum, a secondary survey to assess,

a. chest, for

Answer 17

Chest, for
i. subcutaneous emphysema,
ii. accessory muscle use,
iii. urticaria,
iv. indrawing,
v. shape,
vi. symmetry, and
vii. tenderness;
b. lungs, for decreased air entry and adventitious sounds (e.g. wheezes, crackles),
through auscultation,
c. abdomen, as per the Abdominal Pain (Non-traumatic) Standard,
d. neck, for tracheal position and jugular vein distension, and
e. extremities, for leg/ankle edema.

Question 18

Once a STEMI is confirmed, the paramedic should apply what?

Answer 18

defibrillation pads due to the

potential for lethal cardiac arrhythmias.

Question 19

If, in a rare circumstance, the PCI centre indicates that it cannot accept the patient (e.g.
equipment failure, multiple STEMI patients), then the paramedic may consider what?

Answer 19

transport to an alternative PCI centre as long as they still meet the STEMI Hospital
Bypass Protocol

Question 20

In situations involving a patient with dysphagia, the paramedic shall:
1. consider potential life/limb/function threats, such as

Answer 20

a. anaphylaxis, and

b. upper airway infections (e.g. epiglottitis);

Question 21

perform, at a minimum, a secondary survey to assess,

a. head/neck, for

Answer 21

head/neck, for

i. drooling,
ii. hoarse voice or cough,
iii. nasal flaring,
iv. swelling or masses, and
v. tracheal deviation, and
b. lungs, for adventitious sounds through auscultation;

Question 22

if epiglottitis is suspected, what should you NOT do

Answer 22

open and inspect the

airway

Question 23

In situations involving a patient with epistaxis that is believed to be of a non-traumatic origin, the
paramedic shall:
1. consider potential life/limb/function threats, such as

Answer 23

upper airway obstruction

Question 24

Epistaxis perform, at a minimum, a secondary survey to assess

Answer 24

a. for estimated blood loss (e.g. hemorrhage duration, rate of flow, presence of clots,
quantity of blood-soaked materials at scene, quantity of blood vomited), and
b. head/neck, for foreign bodies in nares, and headache

Question 25

In situations involving a patient with excited delirium, the paramedic shall:
1. consider potential life/limb/function threats, such as,

Answer 25

a. asphyxia,
b. cardiopulmonary arrest, and
c. dysrhythmias

Question 26

Symptoms of excited delirium include:

Answer 26

Impaired thought processes, e.g. disorientation, acute paranoia, panic, or hallucinations
• Unexpected physical strength
• Significantly decreased sensitivity to pain
• Sweating, fever, heat intolerance, or, dry/hot skin with no sweating despite extreme
agitation
• Sudden tranquility after frenzied activity

Question 27

In situations involving a patient with extremity pain that is believed to be of a non-traumatic origin,
the paramedic shall:
1. consider potential life/limb/function threats, such as,

Answer 27

a. acute spinal nerve root(s) compression,
b. possible occult fracture,
c. soft tissue and joint infections, and
d. vascular occlusion (e.g. peripheral vessel, intra-abdominal vessel, intra-thoracic
vessel) ;

Question 28

Extremity pain, perform, at a minimum, a secondary survey to assess,
a. the affected extremity compared with the unaffected extremity, with respect to,

Answer 28

i. distal pulses,
ii. circulation, sensation, and movement,
iii. skin colour, temperature, and condition, and
iv. swelling, deformity, and tenderness; and attempt to keep movement to the affected extremity to a minimum and protect from
further injury

Question 29

In situations involving a patient with a fever (known fever >38.5°C or chief complaint of fever), the
paramedic shall:
1. consider potential life/limb/function threats, such as,

Answer 29

a. overdose,
b. sepsis,
c. meningitis, and
d. heat-related illness;

Question 30

Consideration of sepsis is typically evidenced by all of the following:

Answer 30

• Presence of fever: >38.5°C
• Possible infection suspected, e.g. pneumonia, urinary tract infection, abdominal pain or
distension, meningitis, cellulitis, septic arthritis, infected wound
• Presence of any one of:
o SBP <90
o Respiratory rate ≥22 breaths/minute, or intubated for respiratory support
o Acute confusion or reduced level of consciousness

Question 31

Fever, perform, at a minimum, a secondary survey to assess,

Answer 31

a. lungs, for adventitious sounds through auscultation,
b. skin, for,
i. jaundice
ii. rash, and
iii. signs of dehydration,
c. head/neck, for,
i. photophobia,
ii. scleral jaundice,
iii. stiff neck, and
iv. headache,
d. abdomen, as per the Abdominal Pain (Non-Traumatic) Standard; and
e. temperature

Question 32

In situations involving a patient with a headache that is believed to be of a non-traumatic origin, the
paramedic shall:
1. consider potential life/limb/function threats, such as,

Answer 32

a. intracranial/intracerebral events (e.g. hemorrhage, thrombosis, tumour),
b. central nervous system or other systemic infection,
c. severe hypertension, and
d. toxic event/exposure (e.g. carbon monoxide poisoning);

Question 33

Headache, The following signs and symptoms can indicate a serious underlying disorder or cause:

Answer 33

• Sudden onset of severe headache with no previous medical history of headache
• Recent onset headache (days, weeks) with sudden worsening
• Change in pattern of usual headaches
• Any of the above accompanied by one or more of the following:
o Altered mental status
o Decrease in level of consciousness
o Neurologic deficits
o Obvious nuchal rigidity and fever or other symptoms of infection.
o Pupillary abnormalities (inequality, sluggish/absent light reactivity)
o Visual disturbances

Question 34

Headache, perform, at a minimum, a secondary survey to assess,

Answer 34

a. head/neck, for pupillary size, equality, and reactivity,
b. central nervous system, for,
i. abnormal motor function (e.g. hand grip strength, arm/leg movement/drift),
and
ii. sensory loss

Question 35

In situations involving a patient experiencing a heat-related illness, the paramedic shall:
1. consider life/limb/function threats, such as,

Answer 35

a. heat stroke, and

b. hypovolemic shock;

Question 36

Consider various heat-related illnesses in the setting of hot and/or humid outdoor or indoor
conditions with chief complaint(s), presenting problems of:

Answer 36

• Heat syncope
• Heat cramps: severe cramping of large muscle groups
• Heat exhaustion: mild alterations in mental status, and non-specific complaints
(headache, giddiness, nausea, vomiting, malaise), with excessive sweating in healthy
adults; or hot, dry skin in the elderly
• Heat stroke: severely altered mental status, coma, seizures, hyperthermia ≥40°C
Overdose of tricyclic anti-depressants, antihistamines and β-blockers, as well as
cocaine, Ecstasy or amphetamine abuse may also lead to heat stroke.

Question 37

Heat-related illness perform, at a minimum, a secondary survey to assess

Answer 37

a. central nervous system,
b. mouth, for state of hydration,
c. skin, for temperature, colour, condition, state of hydration,
d. extremities, for circulation, sensation, and movement, and
e. temperature;

Question 38

if working assessment indicates heat stroke, provide Patient with what?

Answer 38

a. provide patient care as per paragraph 6 above,
b. withhold oral fluids,
c. cover the patient with wet sheets, and
d. apply cold packs to the axillae, groin, neck and head.

Question 39

when should a cooling procedures be discontinued

Answer 39

Monitor the patient to determine if cooling procedures should be discontinued, e.g. skin
temperature feels normal to touch, generalized shivering develops, the patient’s level of
consciousness normalizes.

Question 40

In situations involving a patient with hematemesis and/or frank rectal bleeding (“hematochezia”),
the paramedic shall:
1. consider potential life/limb/function threats, such as,

Answer 40

a. esophageal varices, and

b. gastrointestinal disease

Question 41

what are a common causes of hemoptysis

Answer 41

Lung tumours and other lung

diseases are common causes of hemoptysis.

Question 42

Hematemesis/Hematochezia, perform, at a minimum, a secondary survey to assess

Answer 42

a. chest, if hemorrhage is oral, as per the Chest Pain (Non-Traumatic) Standard, and
b. abdomen, as per the Abdominal Pain (Non-Traumatic) Standard;

Question 43

In situations involving a patient with a nausea and/or vomiting, the paramedic shall:
1. consider potential life/limb/function threats, such as,

Answer 43

a. acute coronary syndrome/acute myocardial infarction (e.g. STEMI),
b. anaphylaxis,
c. increased intracranial pressure,
d. toxicological emergencies,
e. bowel obstructions,
f. infection,
g. acute pancreatitis,
h. intra-abdominal emergencies, and
i. uremia

Question 44

If using ETCO2 monitoring, attempt to maintain ETCO2 values of 35-45 mmHg unless
indicated otherwise in the Standards. For COPD or asthma patients who have an initial
ETCO2 of >50 mmHg, attempt to maintain ETCO2 between

Answer 44

ETCO2 between 50-60 mmHg.

Question 45

In situations involving a patient in seizure (or post-ictal), the paramedic shall:
1. consider potential life/limb/function threats and/or underlying disorders, such as,

Answer 45

a. intracranial event,
b. hypoglycemia,
c. in pregnant patients or recent post-partum patients, eclampsia,
d. in patients ≥50 years of age with new onset or recurrent seizures,
i. brain tumour or other intracranial event (e.g. hemorrhage, thrombosis),
ii. cardiac dysrhythmias,
iii. cardiovascular disease,
iv. cerebrovascular disease, and
v. severe hypertension,
e. in neonates,
i. traumatic delivery,
ii. congenital disorders,
iii. prematurity, and
iv. hypoglycemia,
f. in young children febrile convulsions associated with infection,
g. infection (e.g. central nervous system, meningitis),
h. alcohol withdrawal (including delirium tremens)
i. drug ingestion/withdrawal, and
j. known seizure disorder;

Question 46

if patient is in active seizure, what should you do

Answer 46

a. attempt to position the patient in the recovery position,
b. attempt to protect the patient from injury, and
c. observe for,
i. eye deviation,
ii. incontinence,
iii. parts of body affected, and
iv. type of seizure (e.g. full body, focal);

Question 47

perform, at a minimum, a secondary survey to assess,

a. for seizure-related occurrences, such as,

Answer 47

r seizure-related occurrences, such as,

i. bleeding from the mouth,
ii. incontinence,
iii. secondary injuries resulting from the seizure, and
iv. tongue injury

Question 48

ons involving a patient with shortness of breath, the paramedic shall:

1. consider potential life/limb/function threats, such as,
   a. acute respiratory disorders, including,

Answer 48

i. partial airway obstruction,
ii. asthma,
iii. anaphylaxis,
iv. aspiration,
v. inhalation of toxic gases or smoke,
vi. pneumothorax,
vii. COPD, and
viii. respiratory infections,

Question 49

In situations involving a patient who has had a syncopal episode, is dizzy, and/or is experiencing
vertigo, the paramedic shall:
1. consider potential life/limb/function threats, such as,

Answer 49

a. hypoglycemia,
b. cardiac dysrhythmias,
c. CVA/Transient Ischemic Attack,
d. hypovolemia,
e. toxicological effects,
f. heat-related illness,
g. anemia,
h. renal failure, and
i. sepsis;

Question 50

Assume carbon monoxide poisoning in setting of exposure to a fuel burning device (e.g.
automobile engine exhaust, heating devices) in an enclosed area where the patient, or
multiple patients, exhibit the following symptoms/signs without other obvious cause:

Answer 50

• Altered mental status
• Cardiac dysrhythmias
• Emesis
• Headache
• Light-headedness
• Nausea
• Seizures
• Syncope
• Weakness
• VSA

Question 51

In situation involving a patient with vaginal bleeding, the paramedic shall:
1. consider life/limb/function threats, such as,

Answer 51

a. in post-menopausal women, tumours,
b. first trimester complications, including,
i. spontaneous abortion,
ii. ectopic pregnancy, and
iii. gestational trophoblastic disease, and
c. second and third trimester complications, including,
i. spontaneous abortion,
ii. placental abruption,
iii. placenta previa, and
iv. ruptured uterus;

Question 52

Vaginal Bleeding Standard perform, at a minimum, a secondary survey to assess,

Answer 52

abdomen, as per Abdominal Pain (Non-Traumatic) Standard, and

b. if the patient is pregnant,
i. note uterine height and palpate for contractions, and
ii. note fetal movements;
3. if the patient is pregnant, attempt to determine,
a. if bleeding is painless or associated with abdominal pain/cramping, and
b. number of prior episodes and causes, if known;

Question 53

tampon can hold
approximately how many ML of blood?
What is normal blood loss during menstruation?

Answer 53

To assist with estimating blood loss, a soaked normal sized pad or tampon can hold
approximately five mL of blood. Normal blood loss during menstruation is 10-35 mL.

Question 54

In situations involving a patient with acute visual disturbances (including generalized eye pain) that
is believed to be of a non-traumatic origin, the paramedic shall:
1. consider threats to life/limb/function, such as,

Answer 54

a. intracranial, intracerebral or retinal hemorrhage/thrombosis, and
b. acute glaucoma;

Question 55

perform, at a minimum, a secondary survey to assess,

a. eyes, for,

Answer 55

i. pupillary size, equality and reactivity,
ii. abnormal movements,
iii. positioning,
iv. redness,
v. swelling,
vi. tearing, and
vii. presence of contact lenses,
b. eye-lids, for ptosis, and
c. vision, for
i. distortion/diplopia,
ii. loss, and
iii. visual acuity; and