# Test question - first step after establishing that an adult pt is unresponsive



## intelli78 (Sep 23, 2012)

Hey everybody. I am a few weeks in to my EMT-B class (at Pima CC in Tucson, AZ). We're using the AAOS book. I recently missed a quiz question that I'd like to get some feedback on.

The question is: "After establishing that an adult patient is unresponsive, you should:
A) Open the airway
B) Assess for breathing
C) Check for a carotid pulse
D) Attach an automated external defibrillator immediately

My problem is this - the NREMT trauama/medical skills sequence seems to provide a different answer than the AHA CPR guidelines. They contradict each other. The skills sheet (2011 version, latest) indicates that airway is the correct answer (which it is, as per the instructor). 

But, AHA says that checking the pulse is the first step after verifying the pt is unresponsive (source: p8 of 2011 BLS for Healthcare Providers manual). This was what I learned first, so it's how I initially answered the question.

My reconciliation is as follows - this is what I'd like your thoughts on, to make sure that I understand the big picture. Basically, I figure that the AHA guidelines would be more applicable if you were acting as a bystander - since CPR is pretty much the only option you have as a bystander, it makes sense to shortcut to it by checking the pulse ASAP. But in the capacity of an EMT, the pt assessment process would be the authoritative source. It's A-B-C rather than straight to pulse (and potentially CPR) because you have other tools at your disposal (e.g., OPAs) that should be inserted before potentially beginning CPR.

Is there anything you guys would add/remove/change to that logic? Do you understand the source of my confusion? Thanks in advance.


----------



## Medic Tim (Sep 23, 2012)

intelli78 said:


> Hey everybody. I am a few weeks in to my EMT-B class (at Pima CC in Tucson, AZ). We're using the AAOS book. I recently missed a quiz question that I'd like to get some feedback on.
> 
> The question is: "After establishing that an adult patient is unresponsive, you should:
> A) Open the airway
> ...



In  a cardiac arrest situation chest compressions come before screwing around with an OPA/NPA/bvm . If you suspect cardiac arrest check for a pulse first. Cab only applies to cardiac arrest/suspected cardiac arrest, all other times it is abc. What you see and hear while approaching the scene will also give you clues. If it doesn't look like they are breathing check for a pulse to see if it is a cardiac arrest or respiratory arrest.


----------



## ffemt8978 (Sep 23, 2012)

Thread closed per this rule:


> Participants are not to post any testing questions or answers from the NREMT or any other licensing or testing agency.


----------

