NCOEMS EXAM PREP DOCUMENT — 2026/2027
NCOEMS EXAM | 2026/2027 Edition | 100 Verified
Questions
NCOEMS Exam 2026/2027 (North Carolina Office of Emergency Medical Services)
100% Verified Solutions | Updated Per Latest NC EMS Guidelines | Graded A+
This comprehensive exam is designed for Emergency Medical Services professionals preparing for the
North Carolina Office of Emergency Medical Services (NCOEMS) certification examinations aligned with
the 2026/2027 NC EMS Protocols and current National Registry of Emergency Medical Technicians
(NREMT) standards. The 100 questions contained herein span five core content areas—Patient
Assessment & Airway Management, Cardiology & Resuscitation, Trauma & Medical Emergencies, EMS
Operations & NC Protocols, and Pharmacology & IV Therapy—and have been meticulously crafted to
reflect current state-specific prehospital care guidelines, NC EMS standing orders, and national
competency standards. Each question includes a detailed rationale, an explanation of why distractors are
incorrect, and a specific reference to the relevant NC EMS protocol section, NREMT test plan competency,
or authoritative prehospital emergency care textbook.
──────────────────────────────────────────────────────────────────
───────────────────
Key Features
✓ Comprehensive trauma and medical patient assessment aligned with NC EMS protocols and
NREMT competency standards
✓ Advanced airway management and ventilation techniques including capnography, supraglottic
devices, and pediatric considerations
✓ NC-specific EMS protocols and standing orders for STEMI routing, stroke assessment, and trauma
center destination
✓ Pharmacology and IV/IO access procedures with weight-based pediatric dosing and medication
calculation scenarios
✓ Prehospital cardiology and resuscitation guidelines per AHA 2025 standards integrated with NC
cardiac routing protocols
Updates for 2026
Revised NC EMS Protocols for Regional Stroke and STEMI Routing: The 2026/2027 NC EMS
Protocols introduce updated regional routing algorithms requiring EMS agencies to transport acute stroke
and STEMI patients to designated Comprehensive Stroke Centers and PCI-capable facilities based on
geographic catchment areas and interfacility transfer agreements. These revisions align with AHA
Mission: Lifeline and AHA/ASA Get With The Guidelines metrics, reducing door-to-needle and door-to-
balloon times across the state.
Updated Pediatric Resuscitation and Weight-Based Dosing Guidelines: Revised pediatric
protocols now incorporate the Broselow-Luten tape system updates, new weight-based medication dosing
charts, and age-appropriate equipment sizing references. The updates reflect the latest AHA Pediatric
Advanced Life Support guidelines and emphasize the importance of precise dose calculation to prevent
medication errors in the pediatric prehospital population.
New NC Opioid Reversal and Naloxone Distribution Operational Protocols: In response to the
ongoing opioid crisis, the 2026 NC EMS Protocols include expanded naloxone administration guidelines
allowing EMT-level providers to administer intranasal naloxone, updated leave-behind naloxone
distribution programs, and revised operational protocols for referral to community substance abuse
treatment resources following opioid overdose reversal.
Page 1
, NCOEMS EXAM PREP DOCUMENT — 2026/2027
Abstract
This document presents a comprehensive 100-question exam prep set designed to assess and reinforce
the clinical competencies required for North Carolina Office of Emergency Medical Services (NCOEMS)
certification per the 2026/2027 NC EMS Protocols and current National Registry of Emergency Medical
Technicians (NREMT) standards. Grounded in state-specific prehospital care guidelines, the AHA 2025
Cardiopulmonary Resuscitation and Emergency Cardiovascular Care guidelines, and NAEMT Prehospital
Trauma Life Support standards, the exam prep set addresses five core domains of prehospital emergency
care: patient assessment and airway management, cardiology and resuscitation, trauma and medical
emergencies, EMS operations and North Carolina-specific protocols, and pharmacology and intravenous
therapy. Each question is accompanied by an evidence-based rationale, an analysis of distractor
incorrectness, and a citation linking the item to the relevant NC EMS protocol section, NREMT test plan
competency, or authoritative prehospital emergency care reference. The exam prep set serves as both a
formative assessment tool for continuing education and a summative review resource for NCOEMS
certification examinations, integrating recent protocol revisions for regional stroke and STEMI routing,
updated pediatric resuscitation guidelines, and new naloxone distribution operational protocols to ensure
alignment with the contemporary prehospital care landscape in North Carolina.
Keywords
NCOEMS, North Carolina EMS, Emergency Medical Services, NC EMS Protocols, EMT, Paramedic,
Prehospital Care, Trauma Assessment, Airway Management
Answer Format
All correct answers are presented in bold. Each question includes a detailed rationale (italicized)
explaining why the correct option is the best answer. A Why Wrong section follows each rationale,
providing concise explanations of why each distractor is incorrect. A specific Reference citation links each
question to its source NC EMS protocol section, NREMT competency, or prehospital emergency care
textbook.
Content Area Overview
Content Area Questions Key Topics Weight
Patient Assessment & 25 Primary/secondary assessment, Scene size-up, Airway 25.0%
Airway Management opening maneuvers, OPA/NPA, Suctioning, Endotracheal
intubation, Supraglottic airways, BVM ventilation,
Capnography/EtCO2, Oxygen delivery systems, Pediatric
airway, Respiratory distress vs. failure
Cardiology & Resuscitation 20 12-lead ECG, STEMI recognition, Cardiac arrest 20.0%
management, Defibrillation, CPR quality, ACLS algorithms,
Antiarrhythmics, Bradycardia/tachycardia, Cardiac pacing,
Post-arrest care, Stroke assessment, NC STEMI/stroke
routing
Trauma & Medical 25 DCAP-BTLS, Mechanism of injury, Hemorrhage control, 25.0%
Emergencies Shock, Head/spinal trauma, Chest trauma, Burns,
Musculoskeletal trauma, Pediatric/geriatric trauma,
Diabetic emergencies, Seizures, Anaphylaxis, Poisoning, NC
trauma routing
EMS Operations & NC 15 Scope of practice, Patient refusal/AMA, Mandatory 15.0%
Protocols reporting, MCI triage (START/SALT), ICS, HEMS criteria,
NC routing protocols, Crime scene preservation,
Documentation, Interfacility transfer, HIPAA, Naloxone
protocols
Pharmacology & IV 15 Medication administration, IV/IO access, IV fluid types, 15.0%
Therapy Dosage calculations, Epinephrine concentrations, Naloxone,
Nitroglycerin, Amiodarone, Atropine, Fentanyl/Morphine,
Pediatric dosing, Vasopressors, Blood products
TOTAL 100 Comprehensive NC EMS Prehospital Competency 100%
Page 2
, NCOEMS EXAM PREP DOCUMENT — 2026/2027
──────────────────────────────────────────────────────────────────
───────────────────
Examination Questions
Domain: Patient Assessment & Airway Management
1. You are assessing a 67-year-old male who was found unresponsive by his family. The
patient has snoring respirations and poor chest rise. What is the most appropriate initial
airway intervention?
A. Insert a nasopharyngeal airway
B. Perform the head-tilt/chin-lift maneuver
C. Insert an oropharyngeal airway
D. Begin positive pressure ventilation with a BVM
Correct Answer: B
Rationale: Snoring respirations in an unresponsive patient indicate partial upper airway
obstruction, most commonly caused by the tongue falling back against the posterior pharynx. The
head-tilt/chin-lift maneuver is the initial intervention to open the airway by displacing the tongue
anteriorly. This basic maneuver should be attempted before inserting airway adjuncts, as it may
immediately resolve the obstruction and is the least invasive approach.
Why Wrong: Option A (NPA) is contraindicated if there is suspicion of basilar skull fracture and is
not the first intervention. Option C (OPA) may cause gagging or vomiting if the patient has a gag
reflex. Option D (BVM) should not be initiated until the airway is opened and the need for ventilation
is confirmed.
Reference: NC EMS Protocols 2026, Section 3: Airway Management; Bledsoe et al., Paramedic Care
(6th ed.), Ch. 8: Airway Management
2. You arrive on scene to find a 34-year-old male who was ejected from a vehicle during a
motor vehicle collision. The patient is unresponsive with labored breathing and visible
blood in his oropharynx. After manually clearing large clots, which airway maneuver is
most appropriate?
A. Head-tilt/chin-lift maneuver
B. Jaw-thrust maneuver without head extension
C. Nasotracheal intubation
D. Insertion of a nasopharyngeal airway
Correct Answer: B
Rationale: In trauma patients with suspected spinal injury, the jaw-thrust maneuver without head
extension is the recommended technique for opening the airway. This patient was ejected from a
vehicle, which carries a high mechanism for cervical spine injury. The jaw-thrust displaces the tongue
anteriorly without flexing or extending the neck, maintaining cervical spine precautions while
establishing a patent airway.
Why Wrong: Option A (head-tilt/chin-lift) involves neck extension and is contraindicated when
cervical spine injury is suspected. Option C (nasotracheal intubation) is a more advanced procedure
and is not the initial airway maneuver. Option D (NPA) may be used as an adjunct but does not
replace the need for proper airway positioning first, and blood in the airway must be suctioned
before adjuncts are effective.
Reference: NC EMS Protocols 2026, Section 3: Airway Management & Section 7: Trauma Protocols;
NREMT Paramedic Competency: Airway Management, Ventilation, and Oxygenation
3. You are treating a 72-year-old female in respiratory distress with a SpO2 of 85% on room
air. She is alert and speaking in two-word sentences with moderate wheezing bilaterally.
Which oxygen delivery device is most appropriate for initial management?
A. Nasal cannula at 2 L/min
Page 3
, NCOEMS EXAM PREP DOCUMENT — 2026/2027
B. Simple face mask at 6 L/min
C. Non-rebreather mask at 15 L/min
D. Venturi mask at 28%
Correct Answer: C
Rationale: A SpO2 of 85% indicates significant hypoxemia requiring high-concentration oxygen
therapy. The non-rebreather mask (NRB) delivers the highest concentration of oxygen (up to 90-95%)
at 10-15 L/min and is the appropriate initial device for a patient in significant respiratory distress
with hypoxia. The patient's ability to speak indicates she is still maintaining her airway, making an
NRB suitable rather than positive pressure ventilation.
Why Wrong: Option A (nasal cannula at 2 L/min) delivers only 24-28% FiO2, which is inadequate for
this degree of hypoxemia. Option B (simple face mask at 6 L/min) delivers approximately 40-60%
FiO2, which may be insufficient for a SpO2 of 85%. Option D (Venturi mask at 28%) is designed for
patients requiring precise low FiO2, typically those at risk of CO2 retention, and is inadequate for
this level of hypoxemia.
Reference: NC EMS Protocols 2026, Section 3: Airway Management – Oxygen Therapy; Bledsoe et
al., Paramedic Care (6th ed.), Ch. 9: Respiratory Management
4. During endotracheal intubation of a 58-year-old cardiac arrest patient, you observe a
waveform capnography reading of 8 mmHg after tube placement. What is the most likely
interpretation of this finding?
A. The endotracheal tube is in the esophagus
B. The endotracheal tube is in the trachea with low pulmonary blood flow
C. The endotracheal tube is in the right mainstem bronchus
D. The capnography sensor is malfunctioning
Correct Answer: B
Rationale: During cardiac arrest, EtCO2 values of less than 10 mmHg typically indicate the
endotracheal tube is correctly placed in the trachea but pulmonary blood flow is extremely low due to
poor cardiac output from inadequate CPR. A waveform present on capnography confirms tracheal
placement, as esophageal placement would show no waveform or only an initial transient reading.
Low EtCO2 during cardiac arrest reflects the direct relationship between cardiac output and CO2
delivery to the lungs.
Why Wrong: Option A (esophageal intubation) would present with absent or flatline waveform on
capnography, not a reading of 8 mmHg with a waveform. Option C (right mainstem bronchus)
would typically show a normal or slightly elevated EtCO2 with diminished breath sounds on the left.
Option D (sensor malfunction) is less likely when a numerical value and waveform are present; the
reading should be interpreted clinically first.
Reference: NC EMS Protocols 2026, Section 3: Airway Management – Capnography; AHA 2020
Guidelines: Capnography During Cardiac Arrest; Bledsoe et al., Paramedic Care (6th ed.), Ch. 8
5. You are performing a scene size-up at a residential house fire. A firefighter brings you a
45-year-old male with singed nasal hairs, soot in his oropharynx, and a hoarse voice. What
is the most critical priority for this patient?
A. Administer high-flow oxygen via NRB
B. Establish intravenous access
C. Perform rapid sequence intubation
D. Assess for burn percentage using the rule of nines
Correct Answer: C
Rationale: Singed nasal hairs, soot in the oropharynx, and hoarse voice are classic signs of upper
airway thermal injury and impending airway obstruction. These findings indicate the patient is at
high risk for rapid airway edema and loss, making early definitive airway management the highest
priority. Rapid sequence intubation (RSI) should be performed proactively before the airway
becomes compromised, as delayed intubation in a swollen airway can be extremely difficult or
impossible.
Page 4
NCOEMS EXAM | 2026/2027 Edition | 100 Verified
Questions
NCOEMS Exam 2026/2027 (North Carolina Office of Emergency Medical Services)
100% Verified Solutions | Updated Per Latest NC EMS Guidelines | Graded A+
This comprehensive exam is designed for Emergency Medical Services professionals preparing for the
North Carolina Office of Emergency Medical Services (NCOEMS) certification examinations aligned with
the 2026/2027 NC EMS Protocols and current National Registry of Emergency Medical Technicians
(NREMT) standards. The 100 questions contained herein span five core content areas—Patient
Assessment & Airway Management, Cardiology & Resuscitation, Trauma & Medical Emergencies, EMS
Operations & NC Protocols, and Pharmacology & IV Therapy—and have been meticulously crafted to
reflect current state-specific prehospital care guidelines, NC EMS standing orders, and national
competency standards. Each question includes a detailed rationale, an explanation of why distractors are
incorrect, and a specific reference to the relevant NC EMS protocol section, NREMT test plan competency,
or authoritative prehospital emergency care textbook.
──────────────────────────────────────────────────────────────────
───────────────────
Key Features
✓ Comprehensive trauma and medical patient assessment aligned with NC EMS protocols and
NREMT competency standards
✓ Advanced airway management and ventilation techniques including capnography, supraglottic
devices, and pediatric considerations
✓ NC-specific EMS protocols and standing orders for STEMI routing, stroke assessment, and trauma
center destination
✓ Pharmacology and IV/IO access procedures with weight-based pediatric dosing and medication
calculation scenarios
✓ Prehospital cardiology and resuscitation guidelines per AHA 2025 standards integrated with NC
cardiac routing protocols
Updates for 2026
Revised NC EMS Protocols for Regional Stroke and STEMI Routing: The 2026/2027 NC EMS
Protocols introduce updated regional routing algorithms requiring EMS agencies to transport acute stroke
and STEMI patients to designated Comprehensive Stroke Centers and PCI-capable facilities based on
geographic catchment areas and interfacility transfer agreements. These revisions align with AHA
Mission: Lifeline and AHA/ASA Get With The Guidelines metrics, reducing door-to-needle and door-to-
balloon times across the state.
Updated Pediatric Resuscitation and Weight-Based Dosing Guidelines: Revised pediatric
protocols now incorporate the Broselow-Luten tape system updates, new weight-based medication dosing
charts, and age-appropriate equipment sizing references. The updates reflect the latest AHA Pediatric
Advanced Life Support guidelines and emphasize the importance of precise dose calculation to prevent
medication errors in the pediatric prehospital population.
New NC Opioid Reversal and Naloxone Distribution Operational Protocols: In response to the
ongoing opioid crisis, the 2026 NC EMS Protocols include expanded naloxone administration guidelines
allowing EMT-level providers to administer intranasal naloxone, updated leave-behind naloxone
distribution programs, and revised operational protocols for referral to community substance abuse
treatment resources following opioid overdose reversal.
Page 1
, NCOEMS EXAM PREP DOCUMENT — 2026/2027
Abstract
This document presents a comprehensive 100-question exam prep set designed to assess and reinforce
the clinical competencies required for North Carolina Office of Emergency Medical Services (NCOEMS)
certification per the 2026/2027 NC EMS Protocols and current National Registry of Emergency Medical
Technicians (NREMT) standards. Grounded in state-specific prehospital care guidelines, the AHA 2025
Cardiopulmonary Resuscitation and Emergency Cardiovascular Care guidelines, and NAEMT Prehospital
Trauma Life Support standards, the exam prep set addresses five core domains of prehospital emergency
care: patient assessment and airway management, cardiology and resuscitation, trauma and medical
emergencies, EMS operations and North Carolina-specific protocols, and pharmacology and intravenous
therapy. Each question is accompanied by an evidence-based rationale, an analysis of distractor
incorrectness, and a citation linking the item to the relevant NC EMS protocol section, NREMT test plan
competency, or authoritative prehospital emergency care reference. The exam prep set serves as both a
formative assessment tool for continuing education and a summative review resource for NCOEMS
certification examinations, integrating recent protocol revisions for regional stroke and STEMI routing,
updated pediatric resuscitation guidelines, and new naloxone distribution operational protocols to ensure
alignment with the contemporary prehospital care landscape in North Carolina.
Keywords
NCOEMS, North Carolina EMS, Emergency Medical Services, NC EMS Protocols, EMT, Paramedic,
Prehospital Care, Trauma Assessment, Airway Management
Answer Format
All correct answers are presented in bold. Each question includes a detailed rationale (italicized)
explaining why the correct option is the best answer. A Why Wrong section follows each rationale,
providing concise explanations of why each distractor is incorrect. A specific Reference citation links each
question to its source NC EMS protocol section, NREMT competency, or prehospital emergency care
textbook.
Content Area Overview
Content Area Questions Key Topics Weight
Patient Assessment & 25 Primary/secondary assessment, Scene size-up, Airway 25.0%
Airway Management opening maneuvers, OPA/NPA, Suctioning, Endotracheal
intubation, Supraglottic airways, BVM ventilation,
Capnography/EtCO2, Oxygen delivery systems, Pediatric
airway, Respiratory distress vs. failure
Cardiology & Resuscitation 20 12-lead ECG, STEMI recognition, Cardiac arrest 20.0%
management, Defibrillation, CPR quality, ACLS algorithms,
Antiarrhythmics, Bradycardia/tachycardia, Cardiac pacing,
Post-arrest care, Stroke assessment, NC STEMI/stroke
routing
Trauma & Medical 25 DCAP-BTLS, Mechanism of injury, Hemorrhage control, 25.0%
Emergencies Shock, Head/spinal trauma, Chest trauma, Burns,
Musculoskeletal trauma, Pediatric/geriatric trauma,
Diabetic emergencies, Seizures, Anaphylaxis, Poisoning, NC
trauma routing
EMS Operations & NC 15 Scope of practice, Patient refusal/AMA, Mandatory 15.0%
Protocols reporting, MCI triage (START/SALT), ICS, HEMS criteria,
NC routing protocols, Crime scene preservation,
Documentation, Interfacility transfer, HIPAA, Naloxone
protocols
Pharmacology & IV 15 Medication administration, IV/IO access, IV fluid types, 15.0%
Therapy Dosage calculations, Epinephrine concentrations, Naloxone,
Nitroglycerin, Amiodarone, Atropine, Fentanyl/Morphine,
Pediatric dosing, Vasopressors, Blood products
TOTAL 100 Comprehensive NC EMS Prehospital Competency 100%
Page 2
, NCOEMS EXAM PREP DOCUMENT — 2026/2027
──────────────────────────────────────────────────────────────────
───────────────────
Examination Questions
Domain: Patient Assessment & Airway Management
1. You are assessing a 67-year-old male who was found unresponsive by his family. The
patient has snoring respirations and poor chest rise. What is the most appropriate initial
airway intervention?
A. Insert a nasopharyngeal airway
B. Perform the head-tilt/chin-lift maneuver
C. Insert an oropharyngeal airway
D. Begin positive pressure ventilation with a BVM
Correct Answer: B
Rationale: Snoring respirations in an unresponsive patient indicate partial upper airway
obstruction, most commonly caused by the tongue falling back against the posterior pharynx. The
head-tilt/chin-lift maneuver is the initial intervention to open the airway by displacing the tongue
anteriorly. This basic maneuver should be attempted before inserting airway adjuncts, as it may
immediately resolve the obstruction and is the least invasive approach.
Why Wrong: Option A (NPA) is contraindicated if there is suspicion of basilar skull fracture and is
not the first intervention. Option C (OPA) may cause gagging or vomiting if the patient has a gag
reflex. Option D (BVM) should not be initiated until the airway is opened and the need for ventilation
is confirmed.
Reference: NC EMS Protocols 2026, Section 3: Airway Management; Bledsoe et al., Paramedic Care
(6th ed.), Ch. 8: Airway Management
2. You arrive on scene to find a 34-year-old male who was ejected from a vehicle during a
motor vehicle collision. The patient is unresponsive with labored breathing and visible
blood in his oropharynx. After manually clearing large clots, which airway maneuver is
most appropriate?
A. Head-tilt/chin-lift maneuver
B. Jaw-thrust maneuver without head extension
C. Nasotracheal intubation
D. Insertion of a nasopharyngeal airway
Correct Answer: B
Rationale: In trauma patients with suspected spinal injury, the jaw-thrust maneuver without head
extension is the recommended technique for opening the airway. This patient was ejected from a
vehicle, which carries a high mechanism for cervical spine injury. The jaw-thrust displaces the tongue
anteriorly without flexing or extending the neck, maintaining cervical spine precautions while
establishing a patent airway.
Why Wrong: Option A (head-tilt/chin-lift) involves neck extension and is contraindicated when
cervical spine injury is suspected. Option C (nasotracheal intubation) is a more advanced procedure
and is not the initial airway maneuver. Option D (NPA) may be used as an adjunct but does not
replace the need for proper airway positioning first, and blood in the airway must be suctioned
before adjuncts are effective.
Reference: NC EMS Protocols 2026, Section 3: Airway Management & Section 7: Trauma Protocols;
NREMT Paramedic Competency: Airway Management, Ventilation, and Oxygenation
3. You are treating a 72-year-old female in respiratory distress with a SpO2 of 85% on room
air. She is alert and speaking in two-word sentences with moderate wheezing bilaterally.
Which oxygen delivery device is most appropriate for initial management?
A. Nasal cannula at 2 L/min
Page 3
, NCOEMS EXAM PREP DOCUMENT — 2026/2027
B. Simple face mask at 6 L/min
C. Non-rebreather mask at 15 L/min
D. Venturi mask at 28%
Correct Answer: C
Rationale: A SpO2 of 85% indicates significant hypoxemia requiring high-concentration oxygen
therapy. The non-rebreather mask (NRB) delivers the highest concentration of oxygen (up to 90-95%)
at 10-15 L/min and is the appropriate initial device for a patient in significant respiratory distress
with hypoxia. The patient's ability to speak indicates she is still maintaining her airway, making an
NRB suitable rather than positive pressure ventilation.
Why Wrong: Option A (nasal cannula at 2 L/min) delivers only 24-28% FiO2, which is inadequate for
this degree of hypoxemia. Option B (simple face mask at 6 L/min) delivers approximately 40-60%
FiO2, which may be insufficient for a SpO2 of 85%. Option D (Venturi mask at 28%) is designed for
patients requiring precise low FiO2, typically those at risk of CO2 retention, and is inadequate for
this level of hypoxemia.
Reference: NC EMS Protocols 2026, Section 3: Airway Management – Oxygen Therapy; Bledsoe et
al., Paramedic Care (6th ed.), Ch. 9: Respiratory Management
4. During endotracheal intubation of a 58-year-old cardiac arrest patient, you observe a
waveform capnography reading of 8 mmHg after tube placement. What is the most likely
interpretation of this finding?
A. The endotracheal tube is in the esophagus
B. The endotracheal tube is in the trachea with low pulmonary blood flow
C. The endotracheal tube is in the right mainstem bronchus
D. The capnography sensor is malfunctioning
Correct Answer: B
Rationale: During cardiac arrest, EtCO2 values of less than 10 mmHg typically indicate the
endotracheal tube is correctly placed in the trachea but pulmonary blood flow is extremely low due to
poor cardiac output from inadequate CPR. A waveform present on capnography confirms tracheal
placement, as esophageal placement would show no waveform or only an initial transient reading.
Low EtCO2 during cardiac arrest reflects the direct relationship between cardiac output and CO2
delivery to the lungs.
Why Wrong: Option A (esophageal intubation) would present with absent or flatline waveform on
capnography, not a reading of 8 mmHg with a waveform. Option C (right mainstem bronchus)
would typically show a normal or slightly elevated EtCO2 with diminished breath sounds on the left.
Option D (sensor malfunction) is less likely when a numerical value and waveform are present; the
reading should be interpreted clinically first.
Reference: NC EMS Protocols 2026, Section 3: Airway Management – Capnography; AHA 2020
Guidelines: Capnography During Cardiac Arrest; Bledsoe et al., Paramedic Care (6th ed.), Ch. 8
5. You are performing a scene size-up at a residential house fire. A firefighter brings you a
45-year-old male with singed nasal hairs, soot in his oropharynx, and a hoarse voice. What
is the most critical priority for this patient?
A. Administer high-flow oxygen via NRB
B. Establish intravenous access
C. Perform rapid sequence intubation
D. Assess for burn percentage using the rule of nines
Correct Answer: C
Rationale: Singed nasal hairs, soot in the oropharynx, and hoarse voice are classic signs of upper
airway thermal injury and impending airway obstruction. These findings indicate the patient is at
high risk for rapid airway edema and loss, making early definitive airway management the highest
priority. Rapid sequence intubation (RSI) should be performed proactively before the airway
becomes compromised, as delayed intubation in a swollen airway can be extremely difficult or
impossible.
Page 4
