Special Arrest Circumstances: Pregnancy, Drowning, Opioids, Hypothermia, Trauma, and Children Practice Questions

25 multiple-choice questions on Special arrest circumstances: pregnancy, drowning, opioids, hypothermia, trauma, and children for paramedic and EMT students, from Chapter 40 (Responding to the Field Code). Read each question, pick your answer, then tap Show answer to check it and read the explanation.

25 practice questions

1. During CPR on a woman who is 34 weeks pregnant, your partner wants to stop and check fetal heart tones. You should tell him that:

   1. A. Check tones briefly at each rhythm check
   2. B. CPR must pause for fetal assessment
   3. C. Fetal checks are not done during CPR
   4. D. Fetal tones help decide on hysterotomy
   Show answer

   Answer: C. Fetal checks are not done during CPR

   Fetal assessment is not performed during maternal cardiac arrest because it distracts from and interrupts maternal resuscitation, which is the best treatment for the fetus. Even a brief fetal check at a rhythm check lengthens the pause, and the decision for resuscitative hysterotomy rests on maternal criteria, such as no ROSC with the fundus at or above the umbilicus, not on fetal heart tones. Focus on high-quality CPR, uterine displacement, airway, and early preparation for resuscitative delivery.

2. If a pregnant patient in cardiac arrest with the fundus at or above the umbilicus does not have ROSC, AHA guidance aims for resuscitative hysterotomy (perimortem cesarean delivery) to be done by about:

   1. A. 15 to 20 minutes after arrest
   2. B. 4 to 5 minutes after arrest
   3. C. 30 to 40 minutes after arrest
   4. D. 50 to 60 minutes after arrest
   Show answer

   Answer: B. 4 to 5 minutes after arrest

   AHA guidance aims to begin a resuscitative hysterotomy at about 4 minutes and deliver by about 5 minutes after arrest when there is no ROSC and the uterus is large enough to compress the vena cava, because emptying the uterus relieves aortocaval compression and improves the chance of ROSC for the mother and survival for the infant. The time is a planning target rather than a cutoff: ILCOR 2025 found no evidence for a precise start time, and later deliveries have sometimes succeeded, which is why early hospital notification and transport matter. Fifteen to 20 minutes or longer is well past the window in which delivery most helps both patients, and survival falls steadily with each minute. (2025 AHA Part 10, cardiac arrest in pregnancy; AHA 2015 maternal arrest statement.)

3. When defibrillating a pregnant woman in VF, you should use:

   1. A. One-half of the usual adult energy
   2. B. Energy reduced by 25% in late pregnancy
   3. C. Higher energy to cross the larger chest
   4. D. Standard adult energy levels
   Show answer

   Answer: D. Standard adult energy levels

   Defibrillation is safe for the fetus and should use the same energy as for any adult, because the mother's survival is the best way to save the fetus. Lowering the energy, by half or by a quarter, only reduces the chance of converting VF, and the changes of pregnancy do not call for higher settings either.

4. Vascular access in a pregnant patient in cardiac arrest should ideally be placed:

   1. A. In a vein of the foot
   2. B. In the femoral vein
   3. C. Above the diaphragm
   4. D. In the tibia by IO
   Show answer

   Answer: C. Above the diaphragm

   Drugs given below the diaphragm may not reach the heart quickly because the gravid uterus compresses the inferior vena cava, so a humeral IO or an arm or neck vein is preferred. A foot vein, the femoral vein, and a tibial IO all drain through the compressed inferior vena cava. (AHA 2015 maternal arrest statement; 2025 AHA special circumstances.)

5. A 7-year-old boy is pulled from a lake, apneic and pulseless, after a few minutes underwater. Your first priority is to:

   1. A. Do abdominal thrusts to drain the water
   2. B. Immobilize the spine before any CPR
   3. C. Start compression-only CPR right away
   4. D. Open the airway and give rescue breaths
   Show answer

   Answer: D. Open the airway and give rescue breaths

   Drowning arrest is asphyxial, so restoring oxygenation comes first; AHA emphasizes breaths early, and some guidelines advise 5 initial rescue breaths. Abdominal thrusts delay ventilation and increase the risk of vomiting and aspiration.

6. Under 2025 AHA guidance, a lone rescuer who cannot encircle an infant's chest with both hands should compress with:

   1. A. The heel of one hand
   2. B. Two fingers on the sternum
   3. C. The heels of both hands
   4. D. Fingertips at the xiphoid
   Show answer

   Answer: A. The heel of one hand

   The 2025 AHA/AAP pediatric guidelines recommend the two-thumb encircling-hands technique or the heel of one hand for infant compressions and no longer recommend the two-finger technique, because two fingers often fail to reach the needed depth of about one-third of the chest (about 4 cm). Both hands would compress an infant far too deeply. Fingertips at the xiphoid compress the wrong spot and can injure the liver. (2025 AHA/AAP pediatric BLS.)

7. A bystander finds an unresponsive man with a syringe nearby. He is not breathing normally, and she cannot tell whether he has a pulse. Per AHA opioid guidance, she should:

   1. A. Give naloxone, then wait to see if he wakes
   2. B. Call 9-1-1, start CPR, and give naloxone
   3. C. Roll him into the recovery position
   4. D. Give only rescue breaths for 5 minutes
   Show answer

   Answer: B. Call 9-1-1, start CPR, and give naloxone

   Lay rescuers are not expected to judge a pulse, so an unresponsive person who is not breathing normally is treated as being in cardiac arrest: call for help, begin CPR, and give naloxone if available without delaying compressions. The 2025 AHA guidelines added an opioid emergency algorithm with public-access naloxone. Waiting to see whether naloxone works leaves a possibly pulseless patient without CPR. The recovery position is for someone who is breathing normally. Breaths alone are for a patient with a confirmed pulse, which this bystander cannot confirm. (AHA 2023 toxicology focused update; 2025 AHA guidelines opioid algorithm.)

8. A 30-year-old woman found after an opioid overdose is unresponsive and not breathing, but she has a strong carotid pulse. You should:

   1. A. Begin chest compressions at once
   2. B. Ventilate by BVM and give naloxone
   3. C. Defibrillate if an AED is available
   4. D. Give oxygen by nonrebreather only
   Show answer

   Answer: B. Ventilate by BVM and give naloxone

   With a pulse, this is respiratory arrest, so ventilation and naloxone are the priorities, and compressions are not needed. A nonrebreather cannot oxygenate an apneic patient.

9. When placing anterolateral pads on a woman in late pregnancy with large breasts, the lateral pad should go:

   1. A. Directly on top of the left breast
   2. B. Above the left breast, below the clavicle
   3. C. Under the breast tissue at the apex
   4. D. Midline over the lower sternum
   Show answer

   Answer: C. Under the breast tissue at the apex

   Breast tissue raises impedance and moves current away from the heart, so the lateral pad is placed under or beside the breast at the cardiac apex, in the left midaxillary line; standard adult energy is used. A pad on top of the breast delivers less current to the heart. A pad above the breast or over the lower sternum sits too far from the apex and too close to the other pad, so much of the current bypasses the ventricles. (AHA 2015 maternal arrest statement; ERC 2021 ALS.)

10. A marathon runner with exertional heat stroke goes into cardiac arrest in the medical tent. Along with standard CPR and defibrillation, you should:

    1. A. Stop all cooling until ROSC returns, then resume
    2. B. Warm him to keep him out of VF
    3. C. Give dantrolene before any shocks
    4. D. Keep cooling him during the resuscitation
    Show answer

    Answer: D. Keep cooling him during the resuscitation

    Heat stroke injures cells for as long as the core stays above about 40°C, so cooling, such as ice-water towels, ice packs, or immersion if CPR can still be done, continues during the arrest along with standard ACLS. Stopping cooling lets the core temperature and organ damage keep rising. Warming makes no sense in a hyperthermic patient; it is cold, not heat, that predisposes to VF. Dantrolene has not been shown to help in exertional heat stroke and must never delay defibrillation. (ACSM 2023 exertional heat illness consensus; ERC 2021 special circumstances.)

11. A 24-year-old man is in cardiac arrest after a gunshot wound to the thigh with ongoing bleeding. The highest priority is:

    1. A. Hemorrhage control with a tourniquet
    2. B. Epinephrine 1 mg IV every 3 to 5 minutes
    3. C. Amiodarone 300 mg for any VF
    4. D. Rapid sequence intubation
    Show answer

    Answer: A. Hemorrhage control with a tourniquet

    Traumatic arrest from hemorrhage is a volume problem, so controlling bleeding, restoring volume, and relieving obstruction come before medical arrest drugs. Epinephrine does little when the vascular space is empty.

12. After ROSC, a woman at 30 weeks of pregnancy should be transported:

    1. A. Supine and flat with the legs raised
    2. B. In steep Trendelenburg, head down
    3. C. Turned onto her right side
    4. D. On her left side or with LUD kept up
    Show answer

    Answer: D. On her left side or with LUD kept up

    After ROSC the gravid uterus can still compress the vena cava and drop venous return, so she should be placed in left lateral tilt or have manual left uterine displacement maintained, while airway, oxygen, and blood pressure are supported. Lying flat on her back, even with the legs raised, leaves the uterus on the vena cava. Trendelenburg does not relieve aortocaval compression and pushes the uterus against the diaphragm. Turning her to the right side compresses the vena cava, which lies to the right of the spine. (AHA 2015 maternal arrest statement.)

13. The most common cause of cardiac arrest in children is:

    1. A. Primary ventricular fibrillation
    2. B. Respiratory failure or shock
    3. C. Coronary artery disease
    4. D. Congenital heart block
    Show answer

    Answer: B. Respiratory failure or shock

    Most pediatric arrests are asphyxial, the end result of progressive hypoxia from respiratory failure or shock, which is why early ventilation matters. Primary VF is much less common in children than in adults.

14. The recommended compression depth for a child (age 1 year to puberty) is:

    1. A. About 2 in (5 cm)
    2. B. About 1 in (2.5 cm)
    3. C. About 3 in (7.5 cm)
    4. D. About 1.25 in (3 cm)
    Show answer

    Answer: A. About 2 in (5 cm)

    Child compressions should be at least one-third of the chest depth, about 5 cm. Compressing only 2.5 cm is far too shallow to generate meaningful blood flow.

15. The recommended compression depth for an infant is:

    1. A. About 0.5 in (1 cm)
    2. B. About 2.5 in (6 cm)
    3. C. About 1.5 in (4 cm)
    4. D. About 2 in (5 cm)
    Show answer

    Answer: C. About 1.5 in (4 cm)

    Infant compressions should be at least one-third of the anterior-posterior chest depth, about 4 cm. About 5 cm is the target for children, not infants.

16. Two paramedics are performing CPR on a 4-month-old whose chest they can encircle. Under 2025 AHA guidance, an appropriate compression technique is:

    1. A. Two-thumb encircling hands
    2. B. Two-finger technique
    3. C. Heel of both hands
    4. D. Fingertips over the xiphoid
    Show answer

    Answer: A. Two-thumb encircling hands

    The 2025 AHA/AAP pediatric guidelines recommend either the two-thumb encircling-hands technique or the heel of one hand on the sternum for infant compressions, without ranking one above the other; the heel of one hand is used when the rescuer cannot encircle the chest. The two-finger technique was eliminated because it often fails to reach the needed depth of about one-third of the chest (about 4 cm). The heels of both hands are used for adults and larger children and would compress an infant far too deeply. Fingertips over the xiphoid compress the wrong spot and risk liver injury. (2025 AHA/AAP Pediatric Basic Life Support.)

17. Two rescuers performing CPR on a 6-year-old without an advanced airway should use a compression-to-ventilation ratio of:

    1. A. 30:2
    2. B. 5:1
    3. C. 3:1
    4. D. 15:2
    Show answer

    Answer: D. 15:2

    Two-rescuer CPR for infants and children uses 15:2 to provide more ventilation for asphyxial arrests. A lone rescuer uses 30:2 for all ages; 3:1 is the newborn ratio.

18. A 20-kg child is in VF. The initial defibrillation energy should be:

    1. A. 20 J (1 J/kg)
    2. B. 40 J (2 J/kg)
    3. C. 100 J (5 J/kg)
    4. D. 200 J (adult dose)
    Show answer

    Answer: B. 40 J (2 J/kg)

    The first pediatric shock is 2 J/kg, with later shocks at 4 J/kg or more, up to 10 J/kg or the adult dose. One joule per kilogram is below the recommended starting dose.

19. A dispatcher is coaching a parent trained in CPR whose 4-year-old is in cardiac arrest after choking. Compared with compression-only CPR, giving breaths with compressions:

    1. A. Is harmful, since breaths delay all compressions
    2. B. Makes no difference in children of any age at all
    3. C. Is preferred; most child arrests are asphyxial
    4. D. Is useful only once an AED has been applied first
    Show answer

    Answer: C. Is preferred; most child arrests are asphyxial

    Most pediatric arrests result from respiratory failure, so the child is already hypoxic and needs ventilation as well as compressions. Rescuers who are willing and trained should give breaths; compression-only CPR is still better than no CPR.

20. You are using an AED on a 5-year-old in cardiac arrest, but no pediatric pads or attenuator are available. You should:

    1. A. Withhold the AED because the child is under 8
    2. B. Use adult pads placed so they don't touch
    3. C. Cut the adult pads in half to fit the chest
    4. D. Wait for ALS to arrive with a manual monitor
    Show answer

    Answer: B. Use adult pads placed so they don't touch

    If attenuated pads are not available, a standard adult AED should still be used, often in an anterior-posterior position so the pads do not overlap. A high-energy shock is far better than no shock for a child in VF.

21. For a child in cardiac arrest with an advanced airway, ventilations should be given at about:

    1. A. 1 breath every 2 to 3 seconds
    2. B. 1 breath every 6 seconds
    3. C. 1 breath every 8 to 10 seconds
    4. D. 1 breath every second
    Show answer

    Answer: A. 1 breath every 2 to 3 seconds

    Since 2020, AHA recommends 20 to 30 breaths per minute for children with an advanced airway, a faster rate than for adults, which reflects the asphyxial nature of most pediatric arrests. One breath every 6 seconds is the adult rate.

22. A 6-year-old with a tracheostomy is in cardiac arrest, and you cannot ventilate through the tube even after suctioning it. You should next:

    1. A. Ventilate harder through it
    2. B. Give compressions only
    3. C. Wait for the hospital team
    4. D. Replace the trach tube
    Show answer

    Answer: D. Replace the trach tube

    A blocked or dislodged tracheostomy tube is a common cause of arrest in these children. If suctioning does not clear it, change the tube (or insert a smaller one or an ET tube into the stoma); if that fails, ventilate by mask over the mouth and nose while covering the stoma. Forcing breaths through a blocked tube does not work.

23. For a child in nonshockable cardiac arrest, AHA advises giving the first dose of epinephrine:

    1. A. Only after 10 full minutes of CPR have passed
    2. B. After the third rhythm check has passed
    3. C. Within 5 minutes of starting compressions
    4. D. Only after an advanced airway is placed
    Show answer

    Answer: C. Within 5 minutes of starting compressions

    Pediatric registry data show that each minute of delay in the first epinephrine dose in nonshockable arrest is linked to worse survival, so AHA says it is reasonable to give the first dose within 5 minutes of starting compressions (0.01 mg/kg IV or IO). Waiting 10 minutes or until the third rhythm check (about 6 minutes in) is later than recommended. Epinephrine does not require an advanced airway, and IV or IO access is the route. (2020 AHA PALS, carried into 2025 AHA/AAP pediatric guidance.)

24. A 14-year-old suddenly collapses while playing basketball and is not breathing normally. Compared with most child arrests, his initial rhythm is more likely to be:

    1. A. Shockable, so get an AED now
    2. B. Asystole from respiratory failure
    3. C. Bradycardia, so start rescue breaths
    4. D. PEA from commotio cordis
    Show answer

    Answer: A. Shockable, so get an AED now

    Sudden witnessed collapse in a young athlete is usually a primary cardiac event, often with VF, so early CPR and immediate AED use are critical. Most pediatric arrests are asphyxial, but sudden collapse during exertion points to a cardiac cause. A slow rhythm treated with rescue breathing fits the asphyxial pattern of younger children, and commotio cordis, when it occurs, produces VF rather than PEA.

25. A 3-month-old has a heart rate of 50 per minute with poor perfusion despite effective ventilation with oxygen. You should:

    1. A. Give atropine 0.02 mg/kg first
    2. B. Start chest compressions
    3. C. Continue to ventilate only
    4. D. Wait for the rate to fall below 40
    Show answer

    Answer: B. Start chest compressions

    In infants and children, a heart rate below 60 with poor perfusion despite adequate oxygenation and ventilation is treated with CPR, because cardiac output in this age group depends on rate. Atropine is a second-line drug in pediatric bradycardia.