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EMT / Paramedic Interview & Exam Preparation Guide

For Apollo, CMC Vellore, Kavery & Multi-Speciality Hospitals

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PART 1 - INTERVIEW QUESTIONS & ANSWERS

Section A: Personal / HR Questions

"I am a certified Emergency Medical Technician with [X years] of experience in pre-hospital and in-hospital emergency care. I am trained in BLS, airway management, IV cannulation, patient triage, and transport. I am applying to [Apollo/CMC/Kavery] because of its reputation for high-quality emergency care and my desire to contribute to a professional, high-volume emergency department."

Mention the hospital's reputation - Apollo for tertiary care, CMC Vellore for academic excellence, Kavery for cardiac/neuroscience specialisation. Show you've researched them.

"I remain calm under pressure, communicate clearly with the team, and I have strong hands-on skills in BLS, airway management, and patient stabilisation."

"I follow the START/SALT triage protocol - assess patients systematically, prioritize by acuity, delegate tasks clearly, and communicate with the team throughout without letting emotion override clinical judgment."

"I aim to complete my ACLS and Trauma Nurse/Paramedic certifications, take on a senior paramedic or emergency response coordinator role, and eventually contribute to training junior paramedics."

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Section B: Situational / Scenario-Based Questions

Ensure scene safety -> Check responsiveness (tap shoulders, shout) -> Call for help/activate EMS -> Check pulse (carotid, max 10 seconds) -> No pulse: begin CPR at 30:2 ratio, 100-120 compressions/min, depth 5-6 cm -> Attach AED as soon as available -> Shock if shockable rhythm (VF/pulseless VT) -> Resume CPR immediately after shock -> Continue until ROSC, ALS team arrives, or patient declared.

Follow ABCDE approach:

• A - Airway (patent? obstruction? c-spine control)
• B - Breathing (bilateral chest rise, SpO2, tension pneumothorax signs?)
• C - Circulation (pulse, BP, active hemorrhage control, IV access, fluids)
• D - Disability (GCS, pupils, neuro status)
• E - Exposure (fully expose patient, look for all injuries, prevent hypothermia)

Position patient upright (tripod if needed) -> High-flow O2 via non-rebreather mask (15 L/min) -> Pulse oximetry, vital signs -> Assess for cause: wheeze (asthma/COPD), stridor (upper obstruction), crackles (pulmonary edema) -> Prepare for BVM ventilation if deteriorating -> Notify team for advanced airway if SpO2 <90% despite O2.

• Remove allergen if possible
• Epinephrine (Adrenaline) 0.3-0.5 mg IM (1:1000) into outer thigh - this is the FIRST-LINE drug
• Lay patient flat, elevate legs
• O2 high flow
• IV access, fluid bolus (NS 500 mL-1L)
• Antihistamine (chlorpheniramine) + steroid (hydrocortisone) - secondary drugs
• Monitor for biphasic reaction

15:2 compression-to-ventilation ratio for infants and children with 2 rescuers. For a single rescuer, 30:2 is used. Rate: 100-120 compressions/minute.

GCS ≤8 = intubation threshold. Prepare for rapid sequence intubation (RSI):

• Pre-oxygenate with 100% O2 for 3-5 minutes
• Assemble equipment: laryngoscope, ETT (appropriate size), suction, BVM, ETCO2
• Sedative + paralytic (e.g., ketamine/etomidate + succinylcholine)
• Intubate, confirm with ETCO2 waveform capnography, chest rise, auscultation
• Secure tube, CXR confirmation

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Section C: Technical Questions

• S - Signs & Symptoms
• A - Allergies
• M - Medications
• P - Past medical/surgical history
• L - Last oral intake
• E - Events leading to the emergency

30:2 (30 chest compressions followed by 2 ventilations) for both 1-rescuer and 2-rescuer adult CPR. Once an advanced airway is placed (ETT/supraglottic), ventilate at 10 breaths/minute without interrupting compressions.

• Monophasic defibrillator: 360 joules for VF/pulseless VT
• Biphasic defibrillator: 120-200 joules (as per manufacturer; typically 200J)
• AED: device selects energy automatically
• Internal defibrillation (open chest): 10 joules

1 mg IV/IO every 3-5 minutes (1:10,000 solution for IV use). Epinephrine improves ROSC and short-term survival in cardiac arrest.

• 4 Hs: Hypoxia, Hypovolemia, Hypo/Hyperkalemia (electrolytes), Hypothermia
• 4 Ts: Tension pneumothorax, Tamponade (cardiac), Toxins (drugs/poisons), Thrombosis (PE/MI)

Quick neurological assessment:

• A - Alert
• V - Responds to Voice
• P - Responds to Pain
• U - Unresponsive

• Primary: Waveform end-tidal CO2 (ETCO2) - gold standard
• Secondary: Bilateral chest rise, bilateral breath sounds, absence of gurgling over epigastrium
• Chest X-ray for final confirmation (ETT tip should be 2-3 cm above carina)
• SpO2 improvement

First line: Crystalloids - Normal Saline (0.9% NaCl) or Lactated Ringer's. Bolus: 500 mL-1L in adults (reassess after each bolus). In hemorrhagic shock: blood products (O-negative PRBCs) as early as possible; avoid over-resuscitation with crystalloids.

Component	Score
Eye opening (spontaneous/to voice/pain/none)	4/3/2/1
Verbal response (oriented/confused/words/sounds/none)	5/4/3/2/1
Motor response (obeys/localizes/withdraws/flexion/extension/none)	6/5/4/3/2/1

• Total: 3-15. Normal = 15. Intubation threshold = ≤8. Severe TBI = ≤8.

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PART 2 - WRITTEN EXAM PREPARATION (MCQ Topics)

High-Frequency Topics for Hospital EMT Exams (Apollo/CMC/Kavery)

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PART 3 - HOSPITAL-SPECIFIC TIPS

Apollo Hospitals

• Focus on ACLS protocols, cardiac emergencies (MI, arrhythmias), code blue procedures
• Know Apollo's 5-step patient safety protocol
• They test infection control, hand hygiene (WHO 5 moments)
• Ask about experience with cardiac monitoring, 12-lead ECG interpretation basics

CMC Vellore

• Strong academic institution - expect theory-based written exam
• Know drug mechanisms, not just doses
• They value communication skills and ethical patient handling
• May ask about tropical diseases (dengue, leptospirosis, malaria) management in emergency setting
• Expect questions on academic protocols and evidence-based practice

Kavery Hospital

• Cardiac and neuroscience specialty - know stroke codes, STEMI protocols, post-cardiac surgery monitoring
• Know tPA indications for stroke (onset <4.5 hrs, BP <185/110, no hemorrhage on CT)
• Familiarity with ICU monitoring equipment is valued

General Multi-Speciality Hospital

• Be ready for questions on ALL areas: pediatric emergencies, obstetric emergencies, toxicology
• Know poison management: paracetamol overdose (NAC), organophosphate (atropine + pralidoxime), opioid (naloxone), benzodiazepine (flumazenil)
• Know hospital codes: Code Blue (cardiac arrest), Code Red (fire), Code Pink (infant abduction)

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PART 4 - COMMONLY ASKED BEHAVIOURAL QUESTIONS

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PART 5 - QUICK REVISION FLASHCARDS

• Oxygen delivery: Nasal cannula 1-6 L (24-44%), Simple mask 6-10 L (35-60%), Non-rebreather 15 L (60-90%), BVM with O2 100%
• Normal saline osmolarity: 308 mOsm/L
• Shock BP threshold (adult): Systolic <90 mmHg or MAP <65 mmHg
• Pediatric CPR depth: 1/3 of chest AP diameter (approx. 4 cm infant, 5 cm child)
• ROSC signs: Palpable pulse, BP returns, spontaneous breathing, purposeful movements
• Amiodarone: 300 mg IV for refractory VF/VT (second dose 150 mg)
• Atropine: 0.5 mg IV for symptomatic bradycardia (max 3 mg total)
• Morphine: 2-4 mg IV titrated for acute chest pain (use cautiously)
• Adenosine: 6 mg rapid IV push for SVT (second dose 12 mg)
• Needle decompression: 2nd intercostal space, midclavicular line for tension pneumothorax

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Additional Preparation Resources

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1. Carry your BLS/ACLS/EMT certificates to the interview
2. Dress in formal attire (hospitals value professional appearance)
3. Know the specific hospital's department structure and specialty focus
4. Practice hands-on skills before the interview (CPR demonstration is sometimes asked)
5. Review the latest AHA 2020 CPR Guidelines (still current for most Indian hospital exams)
6. For CMC Vellore: expect a longer written test with case-based reasoning
7. For Apollo: code blue simulation/scenario may be part of the selection process

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EMT / PARAMEDIC - 10-DAY COMPLETE INTERVIEW PREP

Apollo | CMC Vellore | Kavery | Multi-Speciality Hospitals

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DAY 1 - BASIC LIFE SUPPORT (BLS) & CPR

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Q1. What is BLS? What are the steps of BLS for an adult?

1. Ensure scene safety - Look for hazards (fire, electricity, traffic) before approaching
2. Check responsiveness - Tap shoulders firmly, shout "Are you okay?"
3. Call for help - Shout for someone to call emergency services; if alone, call yourself; ask bystander to get AED
4. Check breathing and pulse simultaneously - Look for chest rise; feel carotid pulse for no more than 10 seconds
5. No pulse + no normal breathing - Begin CPR immediately
6. Chest compressions:
   • Place heel of one hand on center of chest (lower half of sternum)
   • Place second hand on top, fingers interlaced
   • Keep arms straight, compress at least 5 cm (2 inches) but not more than 6 cm
   • Rate: 100-120 compressions per minute
   • Allow full chest recoil after each compression - do not lean on chest
7. Ventilations:
   • Give 2 breaths after every 30 compressions (30:2 ratio)
   • Each breath should take 1 second; visible chest rise
   • If unable/unwilling to give breaths: hands-only CPR is acceptable for bystanders
8. Attach AED as soon as it arrives - Turn on, follow voice prompts
9. Continue CPR until: ROSC (return of spontaneous circulation), ALS team takes over, or patient is declared

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Q2. What is the CPR ratio for adults, children, and infants?

• Once advanced airway is placed (ETT): give 1 breath every 6 seconds (10/min) without stopping compressions

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Q3. What is the compression depth for adults, children, and infants?

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Q4. How do you use an AED?

1. Turn on the AED (open lid or press power button)
2. Attach pads: one below right collarbone, one on left side below armpit
3. AED analyzes rhythm - do NOT touch patient during analysis
4. If shockable rhythm (VF or pulseless VT): AED announces "Shock advised" - ensure everyone is clear, press shock button
5. Immediately resume CPR for 2 minutes after shock
6. AED will re-analyze after 2 minutes - repeat if advised

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Q5. What is the "chain of survival"?

• Early recognition and call for help
• Early CPR
• Early defibrillation
• Early advanced care (ALS)
• Post-resuscitation care

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DAY 2 - AIRWAY MANAGEMENT

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Q6. What are the steps to assess and manage an airway?

• Look - Chest rise, use of accessory muscles, cyanosis, foreign body
• Listen - Stridor (upper obstruction), gurgling (secretions), wheeze (lower), silence (complete obstruction)
• Feel - Air movement at mouth and nose

• Head tilt-chin lift - For non-trauma patients
• Jaw thrust - For trauma patients (suspected cervical spine injury) - this is the SAFEST maneuver

• OPA (Oropharyngeal Airway / Guedel Airway): Used in unconscious patients with no gag reflex. Size = distance from corner of mouth to earlobe. Insert inverted then rotate 180 degrees (adults)
• NPA (Nasopharyngeal Airway): Can be used in semiconscious patients. Contraindicated in basal skull fracture. Lubricate before inserting

• Use E-C clamp technique to seal mask
• Give one breath over 1 second; see chest rise
• Two-person technique preferred (one holds mask, one squeezes bag)

• ETT (Endotracheal Tube) - Gold standard for definitive airway
• Supraglottic airways: LMA (Laryngeal Mask Airway), i-gel - used when intubation not possible

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Q7. When do you intubate a patient?

• GCS ≤8 (cannot protect own airway)
• Respiratory failure (SpO2 <90% despite high-flow O2)
• Anticipated airway loss (facial burns, angioedema, epiglottitis)
• Need for deep sedation/paralysis
• Prevention of aspiration in unconscious patient

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Q8. How do you confirm ETT placement?

• Waveform capnography (ETCO2) - GOLD STANDARD - consistent CO2 waveform confirms tracheal placement
• Bilateral equal breath sounds on auscultation
• Absence of sounds over epigastrium (stomach)
• Visible bilateral chest rise

• Chest X-ray (ETT tip should be 2-3 cm above carina, at level of aortic knob)
• Improving SpO2

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Q9. What is RSI (Rapid Sequence Intubation)?

1. Preparation - Equipment ready (laryngoscope, ETT sizes, suction, BVM, drugs drawn up)
2. Preoxygenation - 100% O2 for 3-5 minutes; BVM if inadequate
3. Pretreatment - Atropine (pediatrics, to prevent bradycardia); lidocaine (head injury, to blunt ICP rise)
4. Paralysis with induction - Give sedative + neuromuscular blocker simultaneously
5. Protection - Sellick's maneuver (cricoid pressure) - now controversial
6. Placement - Intubate, confirm with ETCO2
7. Post-intubation management - Secure tube, ventilate, sedation

• Etomidate 0.3 mg/kg IV + Succinylcholine 1.5 mg/kg IV (most common)
• Ketamine 1-2 mg/kg IV + Succinylcholine (hemodynamically unstable patients)
• If succinylcholine contraindicated (hyperkalemia, burns >48h): use Rocuronium 1.2 mg/kg IV

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Q10. What is the difference between stridor and wheeze?

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DAY 3 - CARDIAC EMERGENCIES & ECG BASICS

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Q11. What are the 4 cardiac arrest rhythms? Which are shockable?

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Q12. What are the defibrillation energy settings?

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Q13. What is the ACLS algorithm for cardiac arrest?

1. Start CPR - push hard and fast
2. Defibrillate (shock)
3. Resume CPR immediately x 2 min
4. Epinephrine 1 mg IV/IO every 3-5 min
5. After 3rd shock: Amiodarone 300 mg IV (2nd dose: 150 mg)
6. Reassess rhythm every 2 minutes
7. Treat reversible causes (4H4T)

1. Start CPR - push hard and fast
2. Epinephrine 1 mg IV/IO every 3-5 min
3. Treat reversible causes (4H4T)
4. Reassess rhythm every 2 minutes

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Q14. What are the 4Hs and 4Ts (reversible causes of cardiac arrest)?

• Hypovolemia - give fluids/blood
• Hypoxia - ensure adequate oxygenation
• Hypo/Hyperkalemia (and other electrolytes) - correct electrolytes
• Hypothermia - warm the patient

• Tension pneumothorax - needle decompression
• Tamponade (cardiac) - pericardiocentesis
• Toxins/drugs - specific antidotes
• Thrombosis (PE or MI) - thrombolysis/PCI

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Q15. What are the signs of STEMI on ECG?

• ST elevation > 1mm in 2 or more contiguous limb leads, OR > 2mm in contiguous chest leads
• New LBBB (Left Bundle Branch Block) - treat as STEMI equivalent
• Q waves (pathological) = old infarct

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Q16. What is the MONA protocol for acute MI?

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Q17. What are common arrhythmias and their first-line treatment?

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DAY 4 - TRAUMA MANAGEMENT (ATLS/PHTLS)

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Q18. What is the primary survey in trauma? (CABCDE)

• Apply direct pressure or tourniquet for life-threatening external bleeding FIRST
• Tourniquet: apply 5-7 cm above wound; note time of application

• Open airway using jaw thrust (NOT head tilt in trauma)
• Apply cervical collar if mechanism of injury suggests spinal injury
• Remove foreign bodies, suction blood/secretions
• Intubate if airway compromised

• Expose chest; count respiratory rate; check SpO2
• Check for: tension pneumothorax, open chest wound, flail chest, massive hemothorax
• Give high-flow O2

• Check pulse quality (radial = SP >80; femoral = SP >70; carotid = SP >60)
• Control external bleeding
• Establish 2 large-bore IV lines (14-16G); draw bloods
• Fluid resuscitation (NS or LR bolus 1L); blood if hemorrhagic shock

• GCS; AVPU; pupils (size, reactivity, equality)
• Blood glucose

• Remove ALL clothing to look for ALL injuries
• Log-roll to check back and spine
• Cover with warm blanket to prevent hypothermia

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Q19. What are the classes of hemorrhagic shock?

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Q20. What is tension pneumothorax? How do you treat it?

• Severe respiratory distress
• Absent breath sounds on one side
• Tracheal deviation to OPPOSITE side (late sign)
• Hypotension
• Distended neck veins (JVD)
• Tachycardia

• Needle thoracostomy (decompression): Insert 14-16G cannula into 2nd intercostal space, midclavicular line (or 4th/5th ICS, anterior axillary line). Hiss of air confirms diagnosis.
• Follow with formal chest drain (intercostal tube) insertion: 5th ICS, midaxillary line

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Q21. What is the FAST exam in trauma?

• Pericardial - around heart (cardiac tamponade)
• Right upper quadrant (Morrison's pouch) - liver/kidney
• Left upper quadrant (Splenorenal space) - spleen/kidney
• Pelvic (Pouch of Douglas/Rectovesical) - free pelvic fluid

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DAY 5 - SHOCK MANAGEMENT

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Q22. What is shock? What are the types?

• Cause: Blood loss (hemorrhage), fluid loss (dehydration, burns, vomiting)
• Signs: Tachycardia, hypotension, cool clammy skin, decreased urine output
• Treatment: Stop bleeding; IV fluids (crystalloids then blood products)

• Septic shock: Infection -> vasodilation -> hypotension. BP <90 despite fluids; Norepinephrine is vasopressor of choice. Cultures + antibiotics within 1 hour
• Anaphylactic shock: Allergen -> massive histamine release. IM Epinephrine 0.3-0.5 mg FIRST LINE; fluids; antihistamines; steroids
• Neurogenic shock: Spinal cord injury -> loss of sympathetic tone. Bradycardia + hypotension (no tachycardia). Atropine + vasopressors

• Cause: Pump failure (massive MI, severe heart failure, myocarditis)
• Signs: Hypotension, tachycardia, pulmonary edema (wet and cold)
• Treatment: Identify and treat cause; inotropes (dobutamine); IABP if needed; PPCI for MI

• Cause: Physical obstruction to blood flow
• Tension pneumothorax: needle decompression
• Cardiac tamponade: pericardiocentesis
• Massive PE: thrombolysis (alteplase)

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Q23. How do you differentiate cardiogenic from septic shock?

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DAY 6 - NEUROLOGICAL EMERGENCIES

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Q24. What is GCS and how do you score it?

• Total range: 3 (worst) to 15 (normal)
• Mild TBI: 13-15 | Moderate TBI: 9-12 | Severe TBI: 3-8
• Intubation threshold: GCS ≤8

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Q25. What is the FAST test for stroke?

• Balance (sudden loss of balance)
• Eyes (sudden vision loss or double vision)

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Q26. What is the treatment for ischemic stroke?

1. ABC assessment; O2 if SpO2 <94%
2. IV access; blood glucose (hypoglycemia mimics stroke - check!)
3. Urgent non-contrast CT brain (to exclude hemorrhage)
4. 12-lead ECG

• Ischemic stroke confirmed on CT (no bleed)
• Onset of symptoms within 4.5 hours
• Age >18
• BP <185/110 mmHg (control BP first if needed)
• No contraindications (recent surgery, active bleeding, anticoagulants, prior stroke <3 months)
• Dose: 0.9 mg/kg IV (max 90 mg); 10% as bolus, rest over 60 min

• Large vessel occlusion (MCA, basilar)
• Up to 24 hours from onset (selected patients)

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Q27. What is status epilepticus? How do you manage it?

• 0-5 min: Position patient (lateral), protect from injury, O2, suction, IV access, check BGL
• 5-20 min (1st line): IV/IM Benzodiazepine - Lorazepam 0.1 mg/kg IV (or Diazepam 0.15 mg/kg IV or Midazolam 0.2 mg/kg IM)
• 20-40 min (2nd line): IV Phenytoin 20 mg/kg (or Levetiracetam 60 mg/kg, or Valproate 40 mg/kg)
• 40-60 min (refractory): Intubation + IV Phenobarbital or Propofol/Midazolam infusion
• Treat underlying cause: hypoglycemia (D50), hyponatremia, infection, toxins

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DAY 7 - TOXICOLOGY & ANTIDOTES

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Q28. What are the key antidotes every EMT must know?

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Q29. What are the signs of organophosphate poisoning? (DUMBBELS)

• D - Diarrhea
• U - Urination (incontinence)
• M - Miosis (pinpoint pupils)
• B - Bradycardia
• B - Bronchospasm/Bronchorrhea (wheezing, wet secretions)
• E - Emesis (vomiting)
• L - Lacrimation (excessive tearing)
• S - Salivation (excessive drooling)

1. Remove from exposure; decontaminate (remove clothes, wash skin)
2. Airway management (suction secretions heavily)
3. Atropine 2-4 mg IV every 5-10 min until secretions dry (endpoint = dry secretions, NOT pupils)
4. Pralidoxime (2-PAM) 1-2g IV over 15-30 min (within 24-48 hours of exposure)

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Q30. What are the signs of opioid overdose? How do you treat it?

• Pinpoint pupils (miosis)
• Respiratory depression (slow, shallow breathing)
• Decreased consciousness (sedation/coma)

1. Airway - open, suction; BVM if not breathing
2. O2 high flow
3. Naloxone (Narcan) 0.4-2 mg IV/IM/intranasal - repeat every 2-3 minutes
4. Watch for re-sedation (naloxone has shorter half-life than most opioids) - may need infusion or repeat doses
5. Transport to hospital

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DAY 8 - PEDIATRIC & OBSTETRIC EMERGENCIES

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Q31. What are normal vital signs for different age groups?

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Q32. How do you manage febrile seizures in a child?

1. Safety - protect child, lateral position
2. Airway management - suction, O2
3. Time the seizure
4. If seizure >5 min: Diazepam 0.5 mg/kg rectal / 0.1-0.2 mg/kg IV or Midazolam 0.1 mg/kg IM/buccal
5. Treat fever: paracetamol/ibuprofen, tepid sponging
6. Investigate cause of fever; LP if first seizure in infant <12 months

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Q33. What are obstetric emergencies an EMT must know?

• Seizures in a pregnant woman (>20 weeks) with pre-eclampsia (hypertension + proteinuria)
• Treatment: MgSO4 4g IV loading dose over 15 min, then 1-2g/hr infusion; control BP (labetalol/hydralazine); deliver the baby

• Blood loss >500 mL after vaginal delivery or >1000 mL after C-section
• 4 Ts of causes: Tone (atony), Tissue (retained placenta), Trauma (lacerations), Thrombin (coagulopathy)
• Treatment: Uterine massage, Oxytocin 10 IU IM immediately after delivery, bimanual compression, fluids

• Head delivered but shoulders are stuck (anterior shoulder behind pubic symphysis)
• HELPERR mnemonic: Help, Episiotomy, Legs (McRoberts maneuver - flex hips), Pressure (suprapubic pressure), Enter (rotational maneuvers), Remove posterior arm, Roll to all-fours

• Umbilical cord comes out before baby - emergency!
• Do NOT push cord back; elevate presenting part; knee-chest position; immediate C-section

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DAY 9 - MEDICAL EMERGENCIES (QUICK MCQ FACTS)

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Q34. What are the signs and treatment of pulmonary embolism (PE)?

• Sudden onset dyspnea (most common symptom)
• Pleuritic chest pain
• Hemoptysis
• Tachycardia, hypotension (massive PE)
• Raised JVP
• ECG: Sinus tachycardia (most common); S1Q3T3 pattern; new RBBB

• O2, IV access, monitor
• Anticoagulation: Heparin (LMWH or unfractionated heparin) immediately
• Massive PE with cardiac arrest/hemodynamic instability: Thrombolysis (Alteplase 100 mg IV over 2 hours)
• Surgical embolectomy if thrombolysis fails

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Q35. How do you manage a diabetic emergency?

• Conscious patient: 15g fast-acting carbohydrates orally (sugar water, glucose tablets)
• Unconscious/cannot swallow: 50 mL of 50% Dextrose IV (D50W) OR Glucagon 1mg IM
• Recheck BGL after 15 min; give complex carbs after recovery

• Signs: Hyperglycemia (>250 mg/dL), Kussmaul breathing, fruity breath, nausea, dehydration, BGL >250 + ketones + acidosis (pH <7.3)
• Treatment: IV fluids (NS 1L/hr first); insulin infusion; potassium replacement; monitor electrolytes

• BGL >600 mg/dL, no significant ketosis; severe dehydration
• Treatment: Aggressive IV fluids; slow correction

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Q36. What is the management of acute severe asthma?

• Cannot speak full sentences
• SpO2 <92%
• Silent chest (no air entry)
• Cyanosis
• Exhaustion, altered consciousness

1. Sit patient upright
2. High-flow O2 (target SpO2 94-98%)
3. Salbutamol (Albuterol) MDI with spacer OR nebulizer 2.5-5 mg - repeat every 20 min
4. Ipratropium bromide 0.5 mg nebulized with salbutamol
5. Oral/IV Prednisolone 40-50 mg (or hydrocortisone 200 mg IV)
6. MgSO4 2g IV over 20 min (for severe/life-threatening)
7. Prepare for intubation if deteriorating (most dangerous - will crash after intubation)

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Q37. What is the difference between cardiac tamponade and tension pneumothorax?

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DAY 10 - HOSPITAL CODES, INFECTION CONTROL & FINAL REVISION

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Q38. What are hospital emergency codes?

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Q39. What are the WHO 5 Moments of Hand Hygiene?

1. Before touching a patient
2. Before a clean/aseptic procedure
3. After body fluid exposure risk
4. After touching a patient
5. After touching patient surroundings

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Q40. What are universal precautions in emergency care?

• Wear gloves for any contact with blood, body fluids, or mucous membranes
• Wear mask + eye protection for risk of splashing
• Wear gown for heavy contamination risk
• Never recap needles by hand (needle-stick prevention)
• Dispose sharps in puncture-proof containers
• Report all needle-stick injuries immediately

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Q41. What is the SBAR communication tool?

• S - Situation: "This is [name], I am calling about patient [name] in Bed [X]"
• B - Background: Age, diagnosis, relevant history
• A - Assessment: "I think the problem is..." with vital signs
• R - Recommendation: "I need you to come urgently / order X medication / check the patient"

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Q42. What is documentation in emergency care and why is it important?

• Document in real time or as soon as possible
• Include: time of events, vital signs, interventions, drugs given (dose, route, time), patient response
• Use objective language ("Patient GCS 8" not "Patient was unresponsive")
• Medicolegal document - never erase; strike through errors with single line and initial
• MIST handover: Mechanism, Injuries, Signs/vitals, Treatment given

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FINAL 10-DAY STUDY SCHEDULE

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TOP 20 MCQ REVISION FACTS (Read daily)

1. CPR rate: 100-120/min | Depth (adult): 5-6 cm
2. Adult CPR ratio: 30:2 | Child 2-rescuer: 15:2
3. Defibrillation (monophasic): 360 J | Biphasic: 200 J
4. Epinephrine in cardiac arrest: 1 mg IV every 3-5 min
5. Amiodarone for refractory VF/VT: 300 mg IV (2nd dose: 150 mg)
6. Adenosine for SVT: 6 mg IV rapid push (2nd dose: 12 mg)
7. Atropine for bradycardia: 0.5 mg IV (max 3 mg)
8. GCS intubation threshold: ≤8
9. Stroke tPA window: 4.5 hours from symptom onset
10. Anaphylaxis first-line drug: Epinephrine IM 0.3-0.5 mg (1:1000)
11. Organophosphate antidote: Atropine + Pralidoxime
12. Paracetamol antidote: N-Acetylcysteine
13. Opioid antidote: Naloxone 0.4-2 mg
14. Tension PTX: needle at 2nd ICS, MCL
15. MONA = Morphine, Oxygen, Nitrates, Aspirin (for MI)
16. Normal SpO2: 95-100% | Give O2 if <94%
17. Normal adult HR: 60-100 | RR: 12-20 | BP: 90-120/60-80
18. Status epilepticus: first drug = Lorazepam or Diazepam IV
19. PPH treatment: Oxytocin 10 IU IM
20. Eclampsia treatment: MgSO4 4g IV loading dose

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SAMPLE ANSWER TEMPLATE FOR SCENARIO QUESTIONS

1. Scene safety - Is it safe to approach?
2. Call for help - Activate team/emergency response
3. Primary assessment - ABCDE or CABCDE
4. Identify the problem - Name the condition
5. Immediate interventions - In order of priority
6. Monitoring - Vital signs, SpO2, ECG, ETCO2
7. Drugs - Drug name, dose, route, timing
8. Reassessment - Did patient respond? What next?
9. Handover/documentation - SBAR or MIST

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Sources: Tintinalli's Emergency Medicine | Rosen's Emergency Medicine | Miller's Anesthesia | Goodman & Gilman's Pharmacology | The Washington Manual of Medical Therapeutics | Current Surgical Therapy | Lippincott's Pharmacology | AHA 2020 CPR Guidelines