Medical Emergencies

5 free sample questions of the 72 in this topic. The full set is in the app.

1. Question 1

   Classic symptoms of acute coronary syndrome (ACS) in an adult include:

   • A.Sharp left-sided chest pain only when laying down
   • B.Pressure-like or 'crushing' substernal chest pain, often with radiation to the jaw/arm, diaphoresis, dyspnea, nausea — particularly in middle-aged or older adults
   • C.Tearing chest pain to the back
   • D.Sudden pleuritic chest pain after a long flight
   Show answer & explanation

   Answer: B. Pressure-like or 'crushing' substernal chest pain, often with radiation to the jaw/arm, diaphoresis, dyspnea, nausea — particularly in middle-aged or older adults

   Classic ACS: pressure/crushing substernal chest pain ± radiation to jaw/left arm/back, diaphoresis, nausea, dyspnea. Aortic dissection is tearing pain to the back; PE is pleuritic after immobility; pneumothorax is sudden pleuritic.

   Source: National EMS Education Standards 2021 — Medicine > Cardiology (EMT: F,F)

2. Question 2

   Atypical presentations of ACS are more common in:

   • A.Young men
   • B.Older adults, women, and patients with diabetes — who may present with weakness, dyspnea, nausea, or syncope without prominent chest pain
   • C.Athletes
   • D.Children
   Show answer & explanation

   Answer: B. Older adults, women, and patients with diabetes — who may present with weakness, dyspnea, nausea, or syncope without prominent chest pain

   Atypical ACS presentations (weakness, fatigue, dyspnea, nausea, syncope, epigastric pain) are more common in women, older adults, and diabetics. Maintain a low threshold for ACS workup in these groups.

   Source: National EMS Education Standards 2021 — Medicine > Cardiology (EMT: F,F)

3. Question 3

   For a conscious adult with suspected ACS, EMT-level care typically includes:

   • A.Aspirin 162–325 mg chewable (if not allergic and no GI bleed), assisted nitroglycerin if prescribed and SBP adequate, oxygen if hypoxic, position of comfort, rapid transport to a PCI-capable hospital
   • B.IV nitroglycerin infusion
   • C.Thrombolytic administration
   • D.Coronary angioplasty in the field
   Show answer & explanation

   Answer: A. Aspirin 162–325 mg chewable (if not allergic and no GI bleed), assisted nitroglycerin if prescribed and SBP adequate, oxygen if hypoxic, position of comfort, rapid transport to a PCI-capable hospital

   EMT-scope ACS care: chewable aspirin (162–325 mg), assist with patient's prescribed nitroglycerin per protocol, oxygen if hypoxic (target SpO2 94–98%; routine O2 not needed if SpO2 ≥94%), comfortable position, expedited transport to PCI center.

   Source: National EMS Education Standards 2021 — Medicine > Cardiology (EMT: F,F)

4. Question 4

   Routine supplemental oxygen for ACS patients with SpO2 ≥94% is:

   • A.Required for every chest pain patient
   • B.NOT recommended — evidence shows no benefit (and possible harm) for routine oxygen in normoxic ACS patients; oxygenate only if hypoxic
   • C.Required only if the patient is over age 75
   • D.Indicated only with a NRB at 15 L/min
   Show answer & explanation

   Answer: B. NOT recommended — evidence shows no benefit (and possible harm) for routine oxygen in normoxic ACS patients; oxygenate only if hypoxic

   Modern guidelines: do NOT routinely apply supplemental oxygen to ACS patients who are not hypoxic. Indications are SpO2 <94% or evidence of respiratory distress. Hyperoxia may worsen outcomes.

   Source: Highlights of the 2025 AHA Guidelines for CPR and ECC — Adult ALS — Oxygen in ACS

5. Question 5

   Congestive heart failure (CHF) exacerbation in the field typically presents with:

   • A.Bilateral basilar crackles, pink frothy sputum, dyspnea (especially when supine — orthopnea), JVD, peripheral edema, tachycardia
   • B.Wheezing only
   • C.Sharp pleuritic pain
   • D.Hyperthermia and rash
   Show answer & explanation

   Answer: A. Bilateral basilar crackles, pink frothy sputum, dyspnea (especially when supine — orthopnea), JVD, peripheral edema, tachycardia

   Acute CHF: pulmonary edema → crackles, pink frothy sputum, dyspnea/orthopnea, JVD, peripheral edema, tachycardia. Sit the patient upright (legs dangling helps), give oxygen, consider CPAP per protocol, expedite transport.

   Source: National EMS Education Standards 2021 — Medicine > Cardiology (EMT: F,F)

67 more Medical Emergencies questions are in the app, along with explanations and flashcards for every one.

OnScene is an independent study aid based on the NREMT EMT Examination Specifications (2023 Practice Analysis), the National EMS Education Standards 2021, the National EMS Scope of Practice Model 2019, and the 2025 AHA Guidelines for CPR and ECC. It is not affiliated with, endorsed by, or sponsored by the NREMT, NHTSA, the American Heart Association, or any other organization.