EMT Course Answer Key: All 6 BLS Scenario Solutions

This is the answer key for ChartFlow's free EMS simulation course. Each scenario below includes the patient presentation, correct diagnosis, recommended treatment, and documentation guidance for your run report.

Haven't started the course yet? Here’s the link to enroll for free.

We recommend completing each scenario on your own before checking the answers below.

Scenario 1: Opioid Overdose

View the full scenario on our blog

Patient: Unknown caucasian male, middle-aged, found prone in an alleyway. Bystander reports drug use in the area. Unidentified medication patch on upper arm (suspected fentanyl).

Vitals

• BP: 90/60 mmHg
• Pulse: 57 bpm
• SpO2: 89% on room air
• Respiratory Rate: 9 breaths/min (shallow, irregular)
• Skin: Pale, slightly cool
• Pupils: Constricted (pinpoint), no response to light
• LOC: Unresponsive to verbal stimuli and sternal rub

Diagnosis

Opioid Overdose. Key indicators: pinpoint pupils, respiratory depression (9 breaths/min), hypoxia (SpO2 89%), bradycardia, hypotension, complete unresponsiveness, suspected fentanyl patch.

Treatment

• Naloxone (Narcan): Intranasal 1 mg per nare, OR via autoinjector
• Monitor for re-sedation. Naloxone wears off faster than fentanyl; repeat dosing may be required.

What to Document

• Patient Complaint & History: Unknown male, unresponsive in alley, bystander reports drug use, medication patch on upper arm, no known allergies/medications/history
• Procedures & Interventions: Scene safety confirmed, responsiveness assessed, vitals obtained, head-to-toe performed (no trauma), naloxone administered (dose, route, time), post-intervention vitals monitored

Scenario 2: Pediatric Asthma

View the full scenario on our blog

Patient: 8-year-old male at an elementary school. Was playing basketball in gym when breathing difficulty began. Has his own prescribed albuterol inhaler. School nurse on lunch break.

Vitals

• BP: 110/60 mmHg
• Pulse: 115 bpm
• SpO2: 90%
• Respiratory Rate: 20 breaths/min
• Breath Sounds: Audible wheezing, bilateral wheezing on exhale
• LOC: Alert and oriented
• Allergies: None known
• PMH: Asthma (recently diagnosed)

Diagnosis

Asthma Exacerbation. Confirmed by asthma history, bilateral wheezing, SpO2 90%, tripod positioning, labored breathing, triggered by physical activity.

Treatment

• Assist with albuterol MDI (patient's own inhaler): shake, remove cap, attach spacer if available, patient breathes out fully, seal lips around mouthpiece, press canister once while inhaling slowly, hold breath 10 seconds
• Supplemental oxygen via nonrebreather mask
• Contact parents
• Consider hospital transport if symptoms don't improve

Expected Response

Decreased wheezing, improved SpO2 (toward 94% or higher), decreased HR and RR, improved ability to speak in full sentences.

What to Document

• Patient Complaint & History: Difficulty breathing, recently diagnosed asthma, onset during basketball, prescribed albuterol on hand, no known allergies
• Procedures & Interventions: Assisted with albuterol MDI (1 puff, inhaled), oxygen via NRB, parents notified, monitored for improvement

Scenario 3: Anaphylaxis

View the full scenario on our blog

Patient: 55-year-old male at a seafood restaurant. First-time exposure to shellfish (clams). Symptoms started ~45 minutes before EMS arrival with itching, progressing to labored breathing, lip swelling, and near-syncope.

Vitals

• BP: 119/80 mmHg
• Pulse: 125 bpm (tachycardic)
• SpO2: 94%
• Respiratory Rate: 23 breaths/min (shallow, rapid, high-pitched wheezing)
• LOC: Alert and oriented
• Allergies: None previously known (first shellfish exposure)
• PMH: Hypertension (uncontrolled)

Diagnosis

Anaphylaxis. Note: BP appears normal at 119/80, but patient has uncontrolled hypertension, so this reading is likely lower than his actual baseline. Don't dismiss it.

Treatment

• Epinephrine autoinjector (EpiPen): 0.3 mg IM, outer thigh at 90 degree angle, hold 10 seconds. Repeat after 15 minutes if second autoinjector is available and symptoms haven't improved.
• Supplemental oxygen via nonrebreather mask
• Immediate transport to hospital
• Serial vital signs en route

What to Document

• Patient Complaint & History: Difficulty breathing, itching, lip swelling after eating clams for first time, no prior known allergies, PMH hypertension (uncontrolled)
• Procedures & Interventions: Epinephrine 0.3 mg IM (outer thigh, autoinjector), oxygen via NRB, serial vitals, transport to hospital

Scenario 4: Hypoglycemia

View the full scenario on our blog

Patient: 18-year-old female at college housing on move-in day. Type 1 diabetic. Took insulin normally but spent hours carrying boxes with inadequate food intake. Found with altered mental status.

Vitals

• BP: 125/80 mmHg
• Pulse: 128 bpm (tachycardic)
• SpO2: 99%
• Respiratory Rate: 17 breaths/min (clear)
• Skin: Pale, diaphoretic
• LOC: Responds slowly but coherently
• Blood Glucose: 54 mg/dL
• Allergies: Bees
• PMH: Type 1 diabetes, appendectomy age 9

Diagnosis

Hypoglycemia. Normal insulin + heavy exertion + inadequate food intake. Classic signs: diaphoresis, pallor, tachycardia, altered mental status, BGL 54 mg/dL.

Treatment

• Confirm blood glucose: 54 mg/dL
• Oral glucose: squeeze tube directly into mouth, OR spread onto tongue depressor and apply against cheek/tongue
• Prerequisite: Patient MUST be alert and able to protect airway before giving oral glucose
• Repeat every 5-10 minutes if BGL remains low

Key Teaching Points

• Hypoglycemia can occur even without missing an insulin dose if activity increases and food intake doesn't compensate
• Symptoms can mimic behavioral/psychiatric issues (agitation, confusion). Always consider hypoglycemia in diabetic patients.
• Tachycardia (128 bpm) is a compensatory response

What to Document

• Patient Complaint & History: AMS/confusion, Type 1 diabetic, normal insulin today, heavy exertion moving into dorm, inadequate food, allergic to bees
• Procedures & Interventions: BGL obtained (54 mg/dL), oral glucose administered, repeat BGL checks every 5-10 min, LOC and vitals monitored

Scenario 5: Carbon Monoxide Poisoning

View the full scenario on our blog

Patient: 75-year-old female at home. CO detector alarming in kitchen for ~1 hour. Patient moved to dining room to avoid the noise and called EMS to "turn off" the detector. Fire department escorted patient out with PPE.

Vitals

• BP: 139/88 mmHg
• Pulse: 123 bpm (tachycardic)
• SpO2: 99% — FALSELY ELEVATED (unreliable in CO poisoning)
• Respiratory Rate: 19 breaths/min (clear)
• LOC: Alert and oriented
• Skin: Bright red (cherry red), especially around lips, mouth, and nose
• Neuro: Tingling in fingers and toes
• Symptoms: Dizziness, headache, nausea
• Allergies: None
• PMH: Hypertension, Type 2 diabetes, high cholesterol

Diagnosis

Carbon Monoxide Poisoning. Key indicators: active CO detector alarm, classic triad (headache, dizziness, nausea), cherry-red skin (hallmark sign). Critical: SpO2 reads falsely elevated because pulse oximetry cannot distinguish oxyhemoglobin from carboxyhemoglobin.

Treatment

• High-flow oxygen: 10-15 L/min via nonrebreather mask (displaces CO from hemoglobin)
• Immediate transport to hospital
• No medications (BLS-level intervention only)

What to Document

• Note that SpO2 may be falsely elevated due to CO poisoning
• Document cherry-red skin as a clinical indicator
• Record scene info: CO detector activation, ~1 hour exposure, patient remained in home despite alarm
• PMH: HTN, T2DM, hypercholesterolemia, NKDA

Scenario 6: Angina

View the full scenario on our blog

Patient: 50-year-old male at a grocery store, seated beside checkout counter. Known angina. Has his own prescribed nitroglycerin (0.4 mg sublingual tablets). Already took 1 tablet ~10 minutes before EMS arrival.

Vitals

• BP: 130/84 mmHg
• Pulse: 110 bpm
• SpO2: 100%
• Respiratory Rate: 14 breaths/min (clear)
• LOC: Alert and oriented
• Allergies: None
• PMH: Hypertension, high cholesterol, angina

Diagnosis

Angina. Patient has taken 1 nitroglycerin tablet and is NOT hypotensive (BP 130/84), so he is eligible for a second dose.

Treatment

• Administer second nitroglycerin tablet: 0.4 mg sublingual
• Keep patient seated (monitor for BP drop)
• Reassess vital signs 5 minutes after administration
• Offer transport to hospital for further cardiac evaluation
• Detailed head-to-toe and medical history en route to rule out STEMI or unstable angina

What NOT to Do

• Do not administer nitroglycerin if patient is hypotensive
• Do not allow patient to stand immediately after dose (BP drop risk)

What to Document

• Patient Complaint & History: 50 y/o male, known angina, chest pain at grocery store, self-administered 1 NTG 0.4 mg SL ~10 min prior, vitals as listed, A&Ox4, NKDA, PMH HTN/high cholesterol/angina
• Procedures & Interventions: Assisted with second NTG 0.4 mg SL (patient's own prescribed), patient kept seated, vitals reassessed at 5 min, transport offered

Questions or feedback on the EMS course? Reach out to us at hello@chartflow.io.