Stridor
upper airway problem
wheezing
lower airway problem
Rhonchi
inflamed bronchiole and excessive mucus causes snoring/rattling sounds (lower airway prob)
Rales
gas exchange blocked by fluid
Chronic obstructive pulmonary disease
COPD
inflammation and mucus build up limit ventilation of lungs
causes chronic bronchitis and emphysema
“blue bloater”: cyanotic and overweight
*rhonchi
asthma
inflammation in lower airway
beta agonist
pulmonary embolism
air bubbles, blood clot, foreign particles
- stabbing chest pain and bloody cough (maybe)
pulmonary edema
cardiogenic: fluid collects in spaces due to high pressure
noncardiogenic: destruction of capillary bed that allow fluid to leak (pneumonia, toxic gas, drowning, aspiration
*recent surgery
epiglottitis
inflammation of upper airway
caused by bacteria, viruses, fungi, chemical/trauma
symptoms: stridor at inhale, drooling
cystic fibrosis
hereditary
mucus secretes in glands of lungs
causes pulmonary failure
acute respiratroy distress
caused from a different pulmonary insult
fluid leaks from high pressure into interstitial space and alveoli leading to alveolar collapse and dec compliance
myocardial infarction
blockage causes tissue death
myocardial ischemia
impaired oxygen transport causes heart muscle to become hypoxic
unstable angina
chest pain that occurs while a person is at rest and not exerting himself
angina pectoris
chest pain symptom from acute coronary syndrome
nitro helps relief
acute myocardial infarction
narrowing or complete block of coronary artery cause myocardial tissue death aka heart attack
aortic aneurysm
ballooning of aortic wall until rupture occurs
hard to detect before rupture
aortic dissection
false aneurysm resulting from tear in intima layer of aorta that creates a blood-filled cavity
*diff bp in left and right arm
Left ventricle failure
LV cant pump blood so bp inc in left atrium backing up pulmonary veins and capillaries =pulmonary edema
right heart failure
most common
ventricle cant pump blood lead to LVF, COPD
signs: peripheral edema, JVD, liver enlargement
congestive heart failure
build up of fluid in body from pump failure
acute: MI
*edema in feet, ankles, legs, hands
Hypertensive emergencies
systolic: greater than 160
and or diastolic greater than 94 with signs of organ damage
Ischemic stroke
blood clot reducing blood flow to brain
more treatable
Thrombolytic: plaque on inner arterial walls narrow vessels
Embolytic: originate from clot in carotid artery in heart or neck
Hemorrhagic stroke
rupture of artery causing intracerebral or subarachnoid bleeding (very fatal)
*high BP= risk factor
LOC common
7 D’s of stroke care
vascular headache
migraine
dilation or distention of vessels, vision changes
cluster headache
pain excrutiating to one side
tension headache
muscle contraction
organic headache
from withdrawal
dysphasia
difficulty speaking
aphasia
cant speak at all
cincinnati stroke scale
facial droop
arm drift
abnormal speech: “cant teach an old dog new tricks”
LA stroke evaluation
Consider…
Age>45
No seizure history
duration <24hrs
Pt not wheelchair/bed bound
BGL 60-400 mg/dL
Physical exam:
*facial droop
*grip strength
*arm drift
status eplepticus
generalized motor seizure
grand mal
tonic clonic
starts low and spreads upwards leading to LOC and convulsions
aura
warning of a seizure
sound, twitch, smell, anxiety
Phases of seizure
tonic: stiffness
Clonic: muscle spasms alternating with relaxation
Postical: AMS , confusion, exhaustion, paralysis (1-30min)
simple partial seizure
absence or petit mal seizure
common in kids
begin and end fast
blank stare
complex partial seizure
gets larger
temporal lobe seizure
febrile seizure
results from sudden temperature spike
common in babies
High priority seizures:
longer than 5 min
consecutive with out period of responsiveness
ABC inadequate
seizure in water
insulin
secreted by pancreas when BGL is elevated
helps transport glucose out of blood stream
glucagon
secreted by pancreas when BGL gets low
stored in liver
epinephrine
stops insulin secretion
released by adrenal glands
promotes release of stored glucose from liver
Glucose levels
normal : 80-120
hypo: less than 50
hyper: more than 200
causes of diabetes mellitus
lack of insulin secretion by pancreas due to destruction of insulin producing cells
inability of cell to recognize insulin and allow glucose to enter cell
Type 1- insulin dependent
pancreas can’t make insulin
early onset
must inject insulin
Type 2- non insulin dependent
not enough insulin or cant be stored effectively
adult onset
must regulate diet and exercise
Hypoglycemia
type 1 diabetes
BGL< 60
Hyperglycemia
either diabetic ketoacidosis
HHNS hyperglycemic hyperosmolar nonketotic syndrome
HHNS
600 mg/dL
usually type 2 elderly
less fat burning
more likely to have seizures
wont see kussmauls
no fruity breath
DKA
350mg/dL
type 1 usually
cells burn fat for energy
sugar excreted in urine
fat burning increases ketones=acidic blood
electrolyte imbalance = cardiac disturbance
****Krussmauls: rapid deep respirations
**fruity breath
The 5 patients rights in pharmacology
Right Patient
Right med
Right route
Right dose
Right date (time/expiration)
downtime
time starts when pat goes into cardiac arrest until CPR is effectively performed
total downtime
total time from when pt goes into cardiac arrest until pt is taken to ED or return of spontaneous circulation
Ventricular Fibrillation
disorganized cardiac rhythm with no pulse or cardiac output
-majority of cardiac arrests
-AED used
Ventricular tachycardia
very fast heart rhythm generated in ventricle instead of sinoatrial node in rhythm
-pumps so fast, heart is not refilled= dec CO
-AED responds when HR>180
-Only apply AED if pulseless and apneic (or with agonal resp)
Asystole
Absence of contractions of the heart
Pulseless electrical activity
heart has organized rhythm but heart muscle is os weak it can’t pump, respond to electrical activity, or circulatory sys lost so much blood there is nothing to pump
*CANT USE AED
hypersensitivity
occurs during first exposure to specific antigen. This means that when person is exposed again, antibodies are present and anaphylaxis will occur
Sensitization
Process of developing hypersensitivity on first exposure to an antigen
Left upper quadrant of abdomen
most of stomach
spleen
pancreas
part of large intestine
left kidney
Right upper quadrant of abdomen
most of liver
gallbladder
part of large intestine
right kidney
Right lower quadrant of abdomen
appendix
part of large intestine
female reproductive organs
Left Lower quadrant
part of large intestine
female reproductive organs
visceral pain
pain when abdominal organ is involved
*poorly localized, less severe bc organs don’t have many nerve fibers
*dull, achy
parietal pain
aka somatic
irritation of peritoneal lining
*severe and localized
referred pain
visceral pain that is not felt in organ itself
peritonitis
blood, pus, bacteria, or chemicals leak into the peritoneal cavity
symptoms:
-pain/tenderness
-N/V and diarrhea
-fever and chills
- lack of appetite
-positive markle test
markle test
examines rebound tenderness
-patient stands on feet with knees straight.
_when raising himself onto toes, drop suddenly to heels
-Positive if this causes more pain
appendicitis
inflammation of appendix from blockage in intestines
Symptoms:
-RLQ pain
-low fever
-N/V
-abdominal guarding
- lack of appetite
- Postive Markle
pancreatitis
severe pain in middle of upper quads that radiates to the mid/lower back
-triggered by alcohol, gallstones, infection
*can cause jaundice, rapid pulse, abdominal distention
cholecystitis
gallbladder inflammation due to gallstones
Symptoms:
sudden onset pain in middle of upper quads to the RUQ
-belching/ heart burn
- greenish vomit
Hematemesis
GI bleed symptom of vomiting blood (red or like coffee grounds)
hematochezia
GI bleed symptom of bright red blood in stool
melena
GI bleed symptom of dark tarry stools with decomposed blood from upper GI tract
esophageal varices
bulging or weakened blood vessels in lining of lower esophagus
*common in alcoholics/ liver disease
Symptoms:
-lots of hematemesis
-absence of pain
-rapid pulse
-pale cool clammy
-jaundice
gastroenteritis
inflammation of stomach and small intestines
Symtoms:
fever, dehydration
N/V
abdominal pain/cramps
Ulcers
open wounds in digestive tract
Symptoms:
gradual onset
pain in LUQ region
pain is burning sensation
N/V
hematemesis, hematochezia, melena
peritonitis
hernia
protrusion or thrusting forward of a portion of the intestine through an opening or weak spot of wall.
Symptoms:
sudden onset (after heavy lifting)
fever
rapid pulse
tender mass
abdominal aortic aneurysm
aortic dissection where blood leaks into abdominal cavity
Symptoms
-gradual onset of lower lumbar groin pain
-testicular pain
-mottled abdominal skin
- pale cool clammy
-absent/ dec femoral pulse
12 lead EKG placement
A 2-year-old child who has no recent history of illness suddenly appears cyanotic and cannot speak after playing with a small toy. You should:
A. visualize the child’s airway
B. give oxygen and transport at once
C. perform a blind finger sweep
D. perform abdominal thrusts
D. perform abdominal thrusts
Compared to adults, infants and children are at higher risk for hypothermia for all of the following reasons, EXCEPT:
A. a smaller amount of body fat
B. a smaller overall muscle mass
C. a relatively small surface area
D. a decreased ability to shiver
C. a relatively small surface area
A 45-year-old male is working on the roof when he fell approximately 12 feet, landing on his feet. He is conscious and alert and complains of an ache in his lower back. He is breathing adequately and has stable vital signs. You should:
A. obtain a Glasgow Coma Score value and give him oxygen
B. immobilize his spine and perform a focused secondary exam
C. perform a rapid head-to-toe examination and immobilize his spine
D. allow him to refuse transport if his vital signs remain stable
B. immobilize his spine and perform a focused secondary exam
Airway management can be challenging in patients with Down syndrome because their:
A. mandible is large, which inhibits a mask-to-face seal
B. teeth are misaligned and they have a large tongue
C. occiput is round, which causes flexion of the neck
D. tongue is relatively small and falls back in the throat
B. teeth are misaligned and they have a large tongue
Which of the following statements regarding blast injuries is correct?
A. solid organs are relatively protected from shock wave injury but may be injured during the secondary or tertiary blast phase
B. the gastrointestinal tract is the organ system most sensitive to blast injuries and is the leading cause of death following an explosion
C. solid organs such as the middle ear, lungs, and gastrointestinal tract are most susceptible to pressure changes
D. tertiary blast injuries are penetrating or non-penetrating injuries that result from flying debris, such as ordnance projectiles
A. solid organs are relatively protected from shock wave injury but may be injured during the secondary or tertiary blast phase
A 38-year-old male was electrocuted while attempting to wire a house. Your assessment reveals that he is unresponsive, pulseless, and apneic. A coworker has shut off power to the house. You should:
A. begin CPR and transport at once
B. begin CPR and apply the AED
C. fully immobilize his spinal column
D. assess for entry and exit wounds
B. begin CPR and apply the AED
An elderly patient may understate or minimize the symptoms of his or her illness because:
A. the nervous system has deteriorated
B. of decreased perception of pain
C. he or she fears hospitalization
D. of conditions such as dementia
C. he or she fears hospitalization
A “silent” heart attach occurs when:
A. sweating is the only presentation
B. the usual chest pain is not present
C. a sudden dysrhythmia causes death
D. the patient minimizes the chest pain
B. the usual chest pain is not present
An epidural hematoma is MOST accurately defined as:
A. an injury caused by a damaged cerebral artery
B. bleeding between the skull and dura mater
C. bleeding between the dura mater and the brain
D. venous lacerations that occur within the brain
B. bleed between the skull and dura mater
A person’s ability to shiver is lost when his or her body temperature falls below:
A. 93 F (33 C)
B. 90 F (32 C)
C. 95 F (35 C)
D. 94 F (34 C)
B. 90 F (32 C)
Which of the follow statements regarding the rapid extrication technique is correct?
A. it involves rapidly removing a patient from a vehicle after immobilizing them with a short backboard
B. the rapid extrication technique is indicated is the scene is unsafe and the patient is not entrapped in a vehicle
C. rapid extrication involves the use of heavy equipment to disentangle a patient from a crashed vehicle
D. the only indication for performing a rapid extrication is if the patient is not entrapped and in cardiac arrest
B. The rapid extrication technique is indicated is the scene is unsafe and the patient is not entrapped in a vehicle
If you do not have the appropriate size cervical collar, you should:
A. use rolled towels to immobilize the patient’s head
B. place sandbags on either side of the patient’s head
C. ask the patient to keep his or her head in a neutral position
D. defer cervical immobilization and apply lateral head blocks
A. use rolled towels to immobilize the patient’s head
A child may begin to show signs of separation anxiety as early as:
A. 2 months
B. 6 months
C. 12 months
D. 18 months
B. 6 months
A 69-year-old female was involved in a motor vehicle crash. She is semiconscious with a blood pressure of 80/55 mm Hg and a heart rate of 74 beats/min. Her daughter, who was uninjured in the crash, tells you that her mother has a history of hypertension and takes beta-blockers. Considering the fact that this patient is in shock, what is the MOST likely explanation for the absence of tachycardia?
A. intrathoracic bleeding and cardiac compression
B. deterioration of the cardiac conduction system
C. failure of the parasympathetic nervous system
D. the effects of her antihypertensive medication
D. the effects of her antihypertensive medication
A disease vector is defined as:
A. the spectrum of signs that define a disease
B. any agent that acts as a carrier or transporter
C. the period of time between exposure and illness
D. the ability or a virus or a bacterium to be spread
B. any agent that acts as a carrier or transporter
When caring for a woman who is experiencing a gynecologic emergency, the EMT’s main focus should be to:
A. determine the underlying cause of her problem
B. keep assessment and treatment to a minimum
C. maintain her ABCs and transport without delay
D. ask questions related to her gynecologic history
C. maintain her ABCs and transport without delay
When caring for patients with cerebral palsy, it is important to remember that:
A. their limbs are often underdeveloped and are prone to injury
B. hearing aids are usually ineffective for patients with hearing loss
C. they are unable to walk and totally dependent upon you
D. most patients have the ability to walk, but have an unsteady gait
A. their limbs are often underdeveloped and are prone to injury
A patient is bleeding severely from a severed femoral artery high in the groin region. Which of the following would MOST likely control the bleeding?
A. apply a topical hemostatic agent with direct pressure
B. apply chemical ice packs to the wound and transport
C. position the patient with his injured side down
D. apply a pelvic binder device to stabilize the pelvis
A. apply a topical hemostatic agent with direct pressure
If a woman with vaginal bleeding reports syncope, the EMT should assume she:
A. is pregnant
B. is in shock
C. has an ectopic pregnancy
D. has an infection
B. is in shock
A 20-year-old male collided with another player during a hockey game and complains of severe pain to the left shoulder. Assessment reveals that the clavicle is bulging anteriorly at the shoulder. The EMT should suspect:
A. dislocation of the glenohumeral joint
B. separation of the acromioclavicular joint
C. multiple fractures of the proximal humerus
D. posterior dislocation of the shoulder
B. separation of the acromioclavicular joint
Which of the following statements regarding the use of the warning lights and siren on the ambulance is correct?
A. warning lights and siren should be avoided, even if the patient is unstable
B. it is generally unacceptable to increase your speed if lights and siren are in use
C. if it is necessary to use the siren, you should tell the patient beforehand
D. if the patient is stable, you may used the warning lights without the siren
C. if it is necessary to use the siren, you should tell the patient beforehand
Equipment and supplies that are carried on an ambulance should be stored:
A. as directed by the EMS system’s medical director
B. according to the urgency and frequency of their use
C. in locked or secured cabinets to prevent theft
D. based on recommendations of the health department
B. according to the urgency and frequency of their use
A 70-year-old man complains of a sudden onset of difficulty breathing. He has dried blood on his lips and is very anxious. His left leg is red, swollen, and painful. The EMT should:
A. administer high-flow oxygen
B. apply a cold pack to his leg
C. suspect severe pneumonia
D. position the patient supine
A. administer high-flow oxygen
At present, the likelihood of a nuclear attack against the United States is very low because:
A. the United States has an effective early warning system to detect an incoming nuclear missile
B. other than the United States, no other countries are currently in possession of nuclear weapons
C. all nuclear devices or weapons that different countries are in possession of are currently accounted for
D. terrorist nations do not have the ability to deliver a nuclear weapon via missile or bomb
D. terrorist nations do not have the ability to deliver a nuclear weapon via missile or bomb
All of the following biologic agents or diseases can be transmitted from person to person, EXCEPT:
A. smallpox
B. pneumonic plague
C. ricin
D. viral hemorrhagic fever
C. ricin
Portable and mounted suction units must be powerful enough to generate a vacuum of at least __ mm Hg when the tubing is clamped.
A. 100
B. 300
C. 200
D. 400
B. 300
A high-pitched inspiratory sound that indicates a partial upper airway obstruction is called:
A. rhonchi
B. stridor
C. wheezing
D. grunting
B. stridor
A 70-year-old man complains of shortness of breath. During your assessment, you note that he has bilateral hearing aids. When you ask him questions related to his chief complaint, he does not answer you. You can hear a whistling sound coming from his hearing aids. You should:
A. remove both of his hearing aids and use a pencil and paper to communicate
B. try repositioning the hearing aid or remove it and turn down the volume
C. remove his hearing aids, turn up the volume, and replace them in his ears
D. recognize that the batteries in his hearing aids are probably depleted
B. try repositioning the hearing aid or remove it and turn down the volume
Upon arriving on the scene of a major motor vehicle crash at night, you find that the safest place to park your ambulance is in a direction that is facing oncoming traffic. You should:
A. turn your headlights off
B. place a flare near the crash
C. turn all warning lights off
D. quickly access the patient
A. turn your headlights off
The primary clinical feature associated with exposure to phosgene oxide is:
A. skin blistering
B. a red rash
C. bradycardia
D. miosis
A. skin blistering
Which of the following is a severe burn in a 2-year-old child?
A. any burn that involves the arms, legs, or posterior part of the body
B. any full-thickness burn, regardless of its location on the body
C. partial-thickness burn that covers 10% of the BSA
D. superficial burn that covers 25% of the BSA
B. any full-thickness burn, regardless of its location on the body
General care for a patient with a tracheostomy tube includes all of the following, EXCEPT:
A. removing the tube if the area around it appears to be infected
B. suctioning the tube as needed to clear a thick mucous plug
C. maintaining the patient in a position of comfort when possible
D. ensuring adequate oxygenation and ventilation at all times
A. removing the tube if the area around it appears to be infected
Which of the following statements regarding anthrax is correct?
A. anthrax is a deadly virus that replicates
B. cutaneous anthrax has a 90% mortality rate
C. pulmonary anthrax is the most deadly form
D. there is presently no vaccine against anthrax
C. pulmonary anthrax is the most deadly form
Braxton-Hicks contractions are characterized by:
A. pink or red bloody show in conjunction with the contractions
B. a rupture of the amniotic sac just before the contractions begin
C. alleviation of pain with movement or changing positions
D. regular contractions of progressively increasing intensity
C. alleviation of pain with movement or changing positions
An infant is considered to be premature if it:
A. weighs less than 5 lbs or is born before 36 weeks’ gestation
B. is born before 40 weeks’ gestation or weighs less than 7 lbs
C. is born before 36 weeks’ gestation or weighs less than 6 lbs
D. weighs less than 5.5 lbs or is born before 37 week’s gestation
A. weighs less than 5 lbs or is born before 36 weeks’ gestation
Aggressive ambulance driving may have a negative effect on other motorists because:
A. they often freeze when they see lights in the rearview mirror
B. they move to the right or drive as close to the curb as possible
C. they may become enraged and attempt to run you off the road
D. it may not allow for their reaction time to respond to your vehicle
D. it may not allow for their reaction time to respond to your vehicle
A type __ ambulance features a conventional, truck cab-chassis with a modular ambulance body that can be transferred to a newer chassis as needed.
A. I
B. IV
C. II
D. III
A. I
Common causes of syncope in older patients include all of the following, EXCEPT:
A. blood volume loss
B. venous pooling
C. acute hypertension
D. vasoconstriction
D. vasoconstriction
Hypothermia can worsen internal bleeding secondary to:
A. blood-clotting abnormalities
B. cardiac arrhythmias
C. a decreased heart rate
D. severe muscular rigidity
A. blood-clotting abnormalities
Initial signs and symptoms associated with viral hemorrhagic fevers include:
A. joint pain and unequal pupils
B. headache and sore throat
C. severe abdominal muscle spasms
D. acute onset of double vision
B. headache and sore throat
A 77-year-old woman slipped and fell on a throw rug and landed on her left hip. She denies striking her head or losing consciousness. Assessment of her left leg reveals that it is shortened and externally rotated. Distal pulses, sensory, and motor functions are intact. You should:
A. bind both of her legs together with triangular bandages and carefully secure her onto the ambulance stretcher
B. place her onto a scoop stretched, pad around her left hip with pillows, and secure her to the scoop with straps
C. carefully slide a long backboard underneath her, keep her in supine position, and apply a splint to her leg
D. manually stabilize her left leg, apply a traction splint, and then secure her to a long backboard or scoop
B. place her onto a scoop stretched, pad around her left hip with pillows, and secure her to the scoop with straps
The main objective of traffic control at the scene of a motor vehicle crash is to:
A. get oncoming traffic past the scene as soon as possible
B. prevent curious onlookers from observing the scene
C. facilitate a route for the media to access the scene
D. warn oncoming traffic and prevent another crash
D. warn oncoming traffic and prevent another crash
According to the “E” in the DOPE mnemonic, which of the following actions should you person to troubleshoot inadequate ventilation in a patient with a tracheostomy tube?
A. look for blood or other secretions in the tube
B. check the mechanical ventilator for malfunction
C. attempt to pass a suction catheter in the tube
D. listen to breath sounds to assess for a pneumothorax
B. check the mechanical ventilator for malfunction
Bruising to the right upper quadrant of the abdomen following blunt trauma is MOST suggestive of injury to the:
A. stomach
B. spleen
C. liver
D. kidney
C. liver
A precipitous labor and delivery is MOST common in women who:
A. are pregnant for the first time
B. have delivered a baby before
C. are younger than 30 years of age
D. have gestational diabetes
B. have delivered a baby before
Accumulation of blood in the abdominal cavity will MOST likely cause:
A. nausea or vomiting
B. diffuse breathing
C. referred pain
D. distention
D. distention
A 75-year-old woman complains of shortness of breath. Which of the following finding should alert the EMT to the possibility of a pulmonary embolism?
A. the patient’s abdomen is swollen
B. the patient is prescribed an inhaler
C. history of deep vein thrombosis
D. frequent urinary tract infections
C. history of deep vein thrombosis
A patient in respiratory arrest at the scene of a multiple-casualty incident would typically be classified as a fourth priority (black tag; expectant) patient, unless:
A. her or she has external signs of severe thoracic trauma
B. there are at least three other patients in respiratory arrest
C. there are enough resources to provide care for him or her
D. he or she has signs of an injury to the cervical spine
C. there are enough resources to provide care for him or her
An air embolism associated with diving occurs when:
A. high water pressure forces air into the mediastinum
B. the alveoli completely collapse due to high pressure
C. the diver holds his or her breath during rapid ascent
D. the diver hyperventilates prior to entering the water
C. the diver holds his or her breath during rapid ascent
When enlisting the help of an interpreter who signs, it is important for you to ask the interpreter to:
A. avoid any kind of lip movement while he or she is signing with the patient
B. report exactly was the patient signs and not to add any commentary
C. document the answers to the questions that the patient has responded to
D. voice what he or she is signing while communicating with the patient
B. report exactly was the patient signs and not to add any commentary
Which of the following situations would require the use of a specialized rescue team?
A. a patient trapped in a cave or a confined space
B. an obese patient who must be moved to the ambulance
C. a patient in a badly damaged car, not entrapped
D. a patient found floating face down in a swimming pool
A. a patient trapped in a cave or a confined space
Continual reassessment of the scene a suspected terrorist or weapon of mass destruction incident is MOST important because:
A. weather conditions may change quickly
B. bystanders may destroy the evidence
C. a secondary explosive device may detonate
D. terrorists are often at the scene after an attack
C. a secondary explosive device may detonate
After the fetus has descended into the pelvis at the end of the third trimester, many mothers experience:
A. an urge to push
B. easier breathing
C. mid-back pain
D. a bloated feeling
B. easier breathing
Assuming that no obvious signs of intra-abdominal injury are present, which of the following injuries would MOST likely cause an injury to the liver or spleen to be overlooked?
A. shoulder fracture
B. lumbar spine fracture
C. femur fracture
D. pelvic fracture
A. shoulder fracture
A 6-month-old male presents with 2 days of vomiting and diarrhea. He is conscious, but his level of activity is decreased. The infant’s mother tells you that he has not soiled a diaper in over 12 hours. The infant’s heart rate is 140 beats/min and his anterior fontanelle appears to be slightly sunken. You should suspect:
A. severe dehydration
B. moderate dehydration
C. mild dehydration
D. hypovolemic shock
B. moderate dehydration
A common cause of shock in an infant is:
A. dehydration from vomiting and diarrhea
B. excessive tachycardia
C. cardiovascular disease
D. a cardiac dysrhythmia
A. dehydration from vomiting and diarrhea
When performing CPR on a child, you should compress the chest:
A. with one or two hands
B. until a radio pulse is felt
C. to a depth of 1-2 inches
D. 80-100 minutes
A. with one or two hands
A 33-year-old woman who is 36 weeks pregnant is experiencing vaginal bleeding. During transport, you note that she suddenly becomes your diaphoretic, tachycardic, and hypotensive. You should:
A. place her in a left lateral recumbent position
B. carefully place sterile gauze into her vagina
C. ventilate her with a bag-valve mask
D. position her legs supine and elevate her legs 12 inches
A. place her in a left lateral recumbent position
The onset of menstruation usually occurs in women who are
A. between 11 and 16 years of age
B. between 25 and 28 years of age
C. between 18 and 23 years of age
D. between 8 and 10 years of age
A. between 11 and 16 years of age
A tube from the brain to the abdomen that drains excessive cerebrospinal fluid is called a:
A. cerebral bypass
B. CS tube
C. shunt
D. G-tube
C. shunt
Because hearing-impaired patients typically have more difficulty hearing high-frequency sounds, it is important for you to:
A. increase the pitch of your voice
B. lower the pitch of your voice
C. speak in a monotone voice
D. try basic sign language first
B. lower the pitch of your voice
A surgical procedure that creates and opening between the intestine and the surface of the body that allows for elimination of waste products is called a(n):
A. colostomy
B. intestinal shunt
C. gastric stoma
D. gastrostomy
A. colostomy
A 2-month-old infant was found unresponsive in his crib by his mother. When you arrive, you determine that the infant is apneic and pulseless. His skin is pale and cold and his arms are stiff. You should:
A. begin high-quality CPR and request an ALS ambulance
B. request the medical examiner to perform and autopsy
C. inform the child’s mother that her son is deceased
D. begin high-quality CPR and transport immediately
C. inform the child’s mother that her son is deceased
A partial-thickness burn involves the outer layer of skin and a portion of the:
A. epidermis
B. muscle fascia
C. fatty layer
D. dermal layer
D. dermal layer
A 37-year-old male was pinned between a flatbed truck and a loading dock. On exam, you find bruising to the beck, distended neck veins, bilaterally diminished breath sounds, and bilateral scleral hemorrhaging. You should:
A. perform a secondary assessment
B. request a paramedic ambulance
C. suspect a severe hemopneumothorax
D. aggressively manage his airway
D. aggressively manage his airway
Cerebral palsy is a condition that results from damage or injury to the:
A. voluntary muscles
B. spinal cord
C. brain
D. peripheral nervous system
C. brain
A 13-year-old child is on a home ventilator. The parents called because the mechanical ventilator is malfunctioning and the child has increasing respiratory distress. You should:
A. attempt to troubleshoot the mechanical ventilator problem
B. reset the ventilator by unplugging it for 30 to 60 seconds
C. disconnect the ventilator and apply a tracheostomy collar
D. place a call to the home health agency treating this patient
C. disconnect the ventilator and apply a tracheostomy collar
Most cases of external bleeding from an extremity can be controlled by:
A. applying local direct pressure
B. packing the wound with gauze
C. compressing a pressure point
D. elevating the injured extremity
A. applying local direct pressure
In order to evaluate hazards present at the scene and determine the number of patients, you should:
A. use the information provided by dispatch
B. perform a 360-degree walk around of the scene
C. request the fire department at all scenes
D. interview bystanders present at the scene
B. perform a 360-degree walk around of the scene
An older woman with osteoporosis presents with pain and deformity to her left hip after she shifted her weight onto her other foot. She MOST likely experienced a(n):
A. pathologic fracture
B. idiopathic fracture
C. comminuted fracture
D. compression fracture
A. pathologic fracture
The purpose of a jump kit is to:
A. contain anything you might need during the first 5 minutes of patient care
B. carry advanced life support equipment approved by the EMS medical director
C. facilitate defibrillation within 5 to 10 minutes of making patient contact
D. manage a critically injured patient until her or she is loaded into the ambulance
A. contain anything you might need during the first 5 minutes of patient care
A 45-year-old female was the unrestrained passenger of a small car that rear-ended another vehicle at a moderate rate of speed. She is conscious and alert, but complains of pain to both of her knees. There is visible damage to the dashboard on the passenger’s side of the vehicle. In addition to fractures or dislocations of the knees, you should be MOST suspicious for:
A. fracture of the tibia or fibula
B. posterior hip dislocation
C. a thoracic spine fracture
D. anterior hip dislocation
B. posterior hip dislocation
When a woman presents with abdominal pain or other vague symptoms, the EMT is often unable to determine the nature of the problem until he or she:
A. has formed a general impression of the patient
B. has gathered patient history information
C. has obtained a complete set of vital signs
D. ascertains if the patient was ever pregnant
B. has gathered patient history information
Whenever possible, a female sexual assault victim should be:
A. encouraged to shower and change her clothes
B. given the option of being treated by a female EMT
C. thoroughly assessed, even if no signs of injury exist
D. asked to provide a brief description of the perpetrator
B. given the option of being treated by a female EMT
A portable oxygen cylinder should have a minimum capacity of __ of oxygen.
A. 250 L
B. 750 L
C. 500 L
D. 1,000 L
C. 500 L
Causes of delirium in the older patient includes all of the following, EXCEPT:
A. decreased cerebral perfusion
B. acute hypovolemia
C. low blood sugar level
D. Alzheimer disease
D. Alzheimer disease
Which of the following statements regarding the persistency and volatility of a chemical agent is correct?
A. sulfur mustard, a vesicant agent, is generally considered to have a low level of persistence
B. sarin, a powerful nerve agent, is nonvolatile and can remain on a surface for long periods of time
C. lewisite, a vesicant agent, is nonvolatile and evaporates quickly in an optimum temperature
D. VX, a highly persistent nerve agent, can remain in the environment for weeks to months
D. VX, a highly persistent nerve agent, can remain in the environment for weeks to months
Which of the following statements regarding gonorrhea is correct?
A. most men who are infected with gonorrhea do not experience symptoms
B. painful urination is a common symptom of gonorrhea in both men and women
C. mild infections with gonorrhea cause abdominal pain, vomiting, and fever
D. symptoms or gonorrhea usually appear within 3 months of being infected
B. painful urination is a common symptom of gonorrhea in both men and women
In nontrauma patients, an early indicator of internal bleeding is:
A. dizziness upon standing
B. rapid, shallow breathing
C. decreasing blood pressure
D. a rapid, thready pulse
A. dizziness upon standing
Abruptio placenta occurs when:
A. a tear in the placenta causes severe internal hemorrhage
B. the placenta develops over and covers the cervical opening
C. the placenta affixes itself to the outer layer of the uterus
D. the placenta prematurely separates from the uterine wall
D. the placenta prematurely separates from the uterine wall
You are en route to an emergency call when you approach a slow-moving vehicle on a two-way road. You can see oncoming traffic in the other lane. The driver has his windows up and does not realize you are behind him. You should:
A. use your public address system to alert the driver
B. pass the driver on the right-hand shoulder
C. remain at a safe distance until it is safe to pass
D. quickly pass the vehicle on the left side
C. remain at a safe distance until it is safe to pass
A person is said to be obese when he or she is __ over his or her ideal weight.
A. 10% or more
B. 40% or more
C. 20% or more
D. 30% or more
D. 30% or more
When arriving at the scene of an overturned tractor-trailer rig, you note that a green cloud is being emitted from the crashed vehicle. The driver is still in the truck; he is conscious but bleeding profusely from the head. After notifying the hazardous materials team, you should:
A. quickly gain access to the patient
B. park downhill from the scene
C. position the ambulance upwind
D. ask the driver to exit the vehicle
C. position the ambulance upwind
A 17-year-old male was shot in the right anterior chest during an altercation. As your partner is applying oxygen, you perform a rapid assessment and find an open chest wound with a small amount of blood bubbling from it. You should:
A. place a sterile dressing over the wound and apply direct pressure
B. direct your partner to assist the patient’s ventilations with a BVM
C. control the bleeding from the wound and prepare to transport
D. apply an occlusive dressing to the wound and continue your assessment
D. apply an occlusive dressing to the wound and continue your assessment
Multiple people in a small town began experiencing abdominal cramps, excessive salivation and urination, and muscle twitching shortly after a small crop duster plane made several passes over the community. As you are assessing the patients, you further determine that most of them are bradycardic and have miosis. In addition to 100% oxygen, the MOST important treatment for these patients includes:
A. amyl nitrate and naloxone
B. atropine and pralidoxime chloride
C. epinephrine and hyperbaric oxygen
D. activated charcoal and glucose
B. atropine and pralidoxime chloride
A 6-year-old male presents with acute respiratory distress. His mother states that she saw him put a small toy in his mouth shortly before the episode began. The child is conscious, obviously frightened, and coughing forcefully. You should:
A. place the child in a supine position and perform abdominal thrusts
B. deliver a series of five back blows and then reassess his condition
C. encourage him to cough, give oxygen as tolerated, and transport
D. carefully look into his mouth and remove the object if you see it
C. encourage him to cough, give oxygen as tolerated, and transport
A female with a suspected head injury has slow, shallow breathing. The MOST appropriate treatment for her includes:
A. ventilation assistance to maintain an oxygen saturation of 90%
B. hyperventilating her at 30 breaths/min
C. administering oxygen via a nonrebreathing mask
D. ventilation assistance to maintain an ETCO2 of 30 to 35 mm Hg
D. ventilation assistance to maintain an ETCO2 of 30 to 35 mm Hg
A 52-year-old male presents with a fever of 102.5 F and a severe headache. As you assess him, you note the presence of multiple blisters on his face and chest, which are all identical in shape and size. This patient’s clinical presentation is MOST consistent with:
A. cutaneous anthrax
B. yellow fever virus
C. smallpox
D. sarin toxicity
C. smallpox
During a HazMat incident, you are working in the treatment area. As patients are removed from the danger zone, you should:
A. perform a rapid assessment and then have them decontaminated
B. quickly decontaminate the patients and begin assessing them
C. remain where you are and have the patients brought to you
D. retrieve patients from the decontamination area and begin treatment
C. remain where you are and have the patients brought to you
A 70-year-old man presents with a severe nosebleed. His medical history includes COPD, depression, and a hemorrhagic stroke 3 years ago. His BP is 190/110 mm Hg, his pulse is 100 beats/min, and his respirations are 24 breaths/min. His medications include albuterol, sertraline (Zoloft), and multivitamins. Which of the following is MOST likely causing his nosebleed today?
A. diabetic complications
B. hemorrhagic stroke
C. high blood pressure
D. his prescribed albuterol
C. high blood pressure
You are assessing a 10-year-old boy who fell out of a tree. Evaluation of the MOI would concentrate on which of the following?
- the surface onto which the child fell
- the part of the body that struck the ground first
- the height from which the child fell
Rearrange the steps of the decision scheme for field triage of injured patients into the correct order.
- Measure vital signs and LOC
- Assess anatomy of injury
- Assess MOI and evidence of high-energy impact
- Transport
Which of the following has the greatest impact on producing injury?
speed (the energy that is available to cause injury doubles when an object’s weight doubles, but it quadruples when speed doubles)
How many collisions are there in a typical vehicle impact?
3
There are three collisions in a typical impact: the collision of the car against another object, the collision of the passenger against the interior of the car, and the collisions of the internal organs against the solid structures of the body.
In which type of vehicle crash are you most likely to find a patient with whiplash injuries?
rear-end
The phenomenon that results from the rapid changes in tissue and fluid pressure that occur with the passage of a projectile, resulting in serious injury to internal organs distant to the actual path of the bullet, is known as what?
cavitation
What type of blast injury occurs when objects are propelled by the force of the blast wave and strike the victim, causing injury?
secondary
What level of trauma center provides prompt assessment, resuscitation, and stabilization of injured patients and emergency operations, but not definitive care for all patients?
level 3
You are assessing a patient who opens her eyes when you speak to her, who can respond to you but seems confused as to time and place, and localizes pain. What is her Glasgow Coma Scale score?
12
3 for eye opening, 4 for confused conversation, and 5 for localizing pain
You are assessing a patient who was in a front-end car crash. His GCS is 12, systolic blood pressure is 81 mm Hg, and respiratory rate is 22 breaths/min. What is this patient’s Revised Trauma Score?
10
The patient’s RTS is 10: GCS of 12 = 3, SBP of 81 mm Hg = 3, and RR of 22 breaths/min = 4.
You would use the Revised Trauma Score scoring system for a patient if there is potential for what type of trauma?
head
The RTS is most commonly used for patients with head trauma because it is weighted to compensate for major head injury without multisystem injury or major physiologic changes.
At what step in the ACS-COT/CDC updated field triage decision scheme would you assess mechanism of injury and evidence of high-energy impact?
step 3
The index of suspicion is MOST accurately defined as:
your awareness and concern for potentially serious underlying injuries
When assessing an elderly patient who fell, it is important to remember that:
osteoporosis can cause a fracture as a result of a fall from a standing position
Force acting over a distance is the definition of:
work
While en route to a major motor vehicle crash, an on-scene police officer advises you that a 6-year-old male who was riding in the front seat is involved. He further states that the child was only wearing a lap belt and that the air bag deployed. On the basis of this information, you should be MOST suspicious that the child has experienced:
neck and facial injuries
Approximately 25% of severe injuries to the aorta occur during:
lateral collisions
A 15-year-old female was struck by a small car while riding her bicycle. She was wearing a helmet and was thrown to the ground, striking her head. In addition to managing problems associated with airway, breathing, and circulation, it is MOST important for you to:
stabilize her entire spine
Which of the following injuries would MOST likely occur as a direct result of the third collision in a motor vehicle crash?
aortic rupture
Which of the following statements regarding gunshot wounds is correct?
The speed of a bullet has the greatest impact on the injury produced
Which of the following destinations is most appropriate for a 41-year-old male patient who was involved in a rollover motor vehicle collision and is unconscious and unresponsive, assuming that travel times to each is equal?
level 1 or level 2 trauma center
Your patient has a Glasgow Coma Scale (GCS) score of 13, a systolic blood pressure of 80 mm Hg, and a respiratory rate of 8 breaths/min. His Revised Trauma Score (RTS) is:
9
you determine that your patient is experiencing internal bleeding. what should you do next?
administer oxygen
__ occurs when blood volume is significantly diminished and the circulatory system fails to provide sufficient circulation to the body.
Hypoperfusion
You are treating a patient with significant external bleeding. Rearrange the steps into the correct order in which they should be addressed.
- control bleeding
- adress ABCs
- treat for shock
- assess for DCAP-BLTS
Which of the following should you do when applying a tourniquet?
Place the tourniquet proximal to the injury (in the axillary region for upper extremity injuries and at the groin for lower extremity injuries).
make sure the tourniquet is tightened securely
Which of the following are the key to the formation of blood clots?
Platelets
How soon do cells in the brain and spinal cord start to die without constant perfusion?
Within 4-6 minutes
In general, what is the maximum amount of acute blood loss the adult body can tolerate?
20% of total blood volume
(or more than 2 pints/1 liter)
The condition in which low blood volume results in inadequate perfusion is called what?
Hypovolemic shock
Which type of bleeding is characterized by a bright red color and spurting?
Arterial
Which of the following would be the first sign of hypovolemic shock?
anxiety
first sign of hypovolemic shock is a change in mental status, such as anxiety, restlessness, or combativeness.
You determine that your patient is experiencing internal bleeding. What should you do first?
administer oxygen
Which condition is likely when signs of hypotension; tachycardia; and cool, clammy skin are found?
shock
What should you do first to control external bleeding in an extremity?
Apply direct pressure.
You are assessing a patient who is bleeding from the ear, which gives you a high index of suspicion that he has a skull fracture. How should you address this?
loosely cover the site
Whether you are using a commercial device or a stick and triangular bandage as a tourniquet, it is important to remember that:
the tourniquet should only be removed at the hospital because bleeding may return if the tourniquet is released
Which section of the heart receives deoxygenated blood?
right
Hypovolemic shock occurs when:
the body cannot compensate for rapid blood loss
A 67-year-old male presents with weakness, dizziness, and melena that began approximately 2 days ago. He denies a history of trauma. His blood pressure is 90/50 mm Hg and his pulse is 120 beats/min and thready. You should be MOST suspicious that this patient is experiencing:
gastrointestinal bleeding
A young male was shot in the abdomen by an unknown type of gun. He is semiconscious, has shallow breathing, and is bleeding externally from the wound. As you control the external bleeding, your partner should:
assist the patient’s ventilations
In older patients, the first indicator of nontraumatic internal bleeding may be:
weakness or dizziness
Which of the following splinting devices would be MOST appropriate to use for a patient who has an open fracture of the forearm with external bleeding?
air splint
Circulation of blood within an organ or tissue in adequate amounts to meet the cells’ oxygen, nutritional, and waste-removal needs is termed _.
perfusion
Which organ or organ system has the greatest tolerance for lack of perfusion (shock)?
gastrointestinal system
Significant vital sign changes will occur if the typical adult acutely loses more than __ of his or her total blood volume.
20%
TRUE or FALSE. A hematoma is an open injury that occurs whenever a large blood vessel is damaged and bleeds rapidly.
false – A hematoma does occur whenever a large blood vessel is damaged and bleeds rapidly, but it is a closed injury.
TRUE or FALSE. You should never remove an avulsion skin flap, regardless of its size.
true
TRUE or FALSE. When possible, ALS providers should administer IV fluid within 3 minutes after the crushing object is lifted off the body.
false – When possible, ALS providers should administer IV fluid before the crushing object is lifted off the body.
TRUE or FALSE. The goal of the inflammation phase of wound healing is the removal of foreign material, damaged cellular parts, and invading microorganisms from the wound site.
true
For which injury would you use an occlusive dressing directly on the wound?
Open neck injury
Which of the following factors will help you to determine the severity of a burn?
- Involvement of any critical body areas (face, upper airway, hands, feet, genitalia)
- extent of the burn
- depth of the burn
- preexisting medical conditions
Which of the following patients is likely to have injuries with entrance and exit wounds?
- a do-it-yourselfer who touched a live wire while repairing a light fixture
- a 19-year old who has been hit by high-caliber gunfire
(electrical burns and high-caliber gunshots leave entrance and exit wounds)
Which of the following is the final stage of wound healing?
Collagen production
(collagen provides stability to damaged tissue and joins wound borders, closing the open tissue)
You are assessing a 28-year-old with a rigid cast extending the length of his left leg. The patient is complaining of pain on passive movement and he is showing signs of impaired circulation. What do you suspect?
Compartment syndrome
(commonly develops in the extremities and may occur in conjunction with open or closed injuries or when swelling occurs under restrictive immobilization devices such as a cast)
You are assessing a patient who has been in a high-impact T-bone collision. She is bleeding from the abdomen and you can see part of her large intestine outside her body. What is this injury called?
Evisceration
You are treating an 8-year-old who fell while riding his bike on a gravel road. The wound on his arm is seeping blood, is about 7 inches long, and there is a lot of dirt and gravel in it. How should you treat this injury?
Apply sterile dressing.
The severity of a thermal injury directly correlates with temperature, concentration, and what other factor?
Duration of exposure
You are responding to a fight at a restaurant and find a man, conscious and alert. His face is mottled with blisters and abrasions, and he has blood on his shirt. He tells you he was trying to stop the fight when he was hit in the face with scalding hot coffee and fell backwards over a chair. According to the rule of nines, what percentage of the patient’s skin surface is burned?
9%
What is your first responsibility when treating a burn patient?
Stopping the burning
Which of the following is true about electrical burns?
They are always more severe than the external signs indicate.
(A major danger associated with electrical burns is the amount of deep tissue damage done)
Which type of soft-tissue injury is LEAST likely to result in infection?
Contusions on the left lateral chest
When using the rule of nines, which of the following do you need to include in your calculations?
Full- and partial-thickness burns
The __ is a prominent bony mass at the base of the skull 1 inch posterior to the external opening of the ear.
Mastoid process
You are treating a patient with a facial injury that has displaced the eyeball from the socket. Which of the following actions are appropriate to take?
- cover the eye with a moist, sterile dressing
- cover both eyes to decrease sympathetic eye movement
Which of the following is true about posterior epistaxis?
- more severe than anterior epistaxis
- causes nausea and vomiting
What is a hematoma?
A collection of blood within the tissues
Which of the following fractures is associated with bruising around the ears and blood coming from the nose?
basilar skull fracture
What is hyphema?
Bleeding into the anterior chamber of the eye
You are assessing a patient who was hit in the face by a baseball bat. There are multiple contusions on his face, and he reports double vision. His left eye does not track with his right eye. What should you suspect?
Blow-out fracture
Which of the following is or are found in the middle ear?
Anvil, hammer, and stirrup
In which instance would you consider removing an impaled object?
When the object is impaled in the cheek and compromises the airway
What is an air embolism?
A clinical situation in which a vein is punctured and air is sucked into the heart
Unequal pupils most likely indicate what type of injury?
Brain
You are treating a patient with significant bruising to her face and a broken nose. She is conscious, but her LOC is significantly altered and her breathing is labored. What should you do to manage this patient’s airway?
Insert an oropharyngeal airway.
Which area of the body are you palpating if you feel subcutaneous emphysema?
…..
lecture for chapt 27
Burns to pediatric patients are generally considered more serious than burns to adults because:
pediatric patients have more surface area relative to total body mass
You have applied a dressing and roller-gauze bandage to a laceration on the arm of a young female. During transport, she begins to complain of numbness and tingling in her hand. You should:
assess distal circulation and readjust the bandage as needed
Which of the following areas of the body has the thinnest skin?
ears
Which of the following processes occurs during the inflammation phase of the healing process?
The immune system releases histamines, which cause vasodilation and increased capillary permeability, resulting in local redness and swelling
In addition to severe bleeding, the MOST life-threatening complication associated with an open neck injury is:
an air embolism
A 33-year-old male sustained an abdominal evisceration to the left lower quadrant of his abdomen after he was cut with a large knife. After appropriately managing his ABCs and assessing him for other life-threatening injuries, how you should care for his wound?
Cover it with moist, sterile gauze and secure with an occlusive dressing
The sebaceous glands produce sebum, a material that:
waterproofs the skin and keeps it supple
A 56-year-old male has an incomplete avulsion to his right forearm. After controlling any bleeding from the wound, you should:
replace the avulsed flap to its original position and cover it with a sterile dressing
An 8-year-old male was bitten by a stray dog. He has a large laceration to the back of his left hand, which your partner covered with a sterile dressing and bandage. In addition to transporting the child to the hospital, you should:
report the incident to the appropriate authorities
A closed soft-tissue injury characterized by swelling and ecchymosis is called a(n):
contusion
A 6-year-old female was riding her bicycle and struck a clothesline with her throat. She is breathing, but with obvious difficulty. Your assessment reveals a crackling sensation in the soft tissues of her neck and facial cyanosis. In addition to the appropriate airway management, the intervention that will MOST likely improve her chance of survival is:
rapidly transporting her to the hospital
A 4-year-old female has a peanut lodged in the external auditory canal of her right ear. You should:
transport her to the emergency department
The MOST significant complication associated with facial injuries is:
airway compromise
Bleeding from soft-tissue injuries to the face is MOST effectively controlled with:
direct pressure using dry, sterile dressings
The superficial temporal artery can be palpated:
just anterior to the tragus
Which of the following statements regarding the vitreous humor is correct?
It is a clear, jellylike fluid near the back of the eye that cannot be replaced if it is lost
When a light is shone into the pupil:
it should become smaller in size
When transporting a patient with a facial injury, it is MOST important to be as descriptive as possible with the hospital regarding the patient’s injuries because:
they may need to call a specialist to see the patient
When performing a full body scan, you should assess for __.
DCAP-BTLS
Significant trauma to the face should increase the EMT’s index of suspicion for a(n):
spinal column injury
TRUE or FALSE. The most prominent and most easily palpable spinous process is at the seventh cervical vertebra at the base of the neck.
true
TRUE or FALSE. Central nervous system structures are very strong even though they are not well protected.
false – Central nervous system structures, whose bony enclosures protect them quite well, are also very fragile.
TRUE or FALSE. The structure of the skull and the presence of the meninges in effect reduce the likelihood of problems in closed head injuries.
false – The closed bony structure of the skull (which is similar to a vault) and the meninges may lead to serious problems in closed head injuries. Severe injury may cause bleeding within the skull. Such bleeding causes increased pressure inside the skull and compresses softer brain tissue. In many cases, only prompt surgery can prevent permanent brain damage.
In a(n) __, CSF flows freely from the patient’s ear; this type of injury can be difficult to diagnose with a radiograph.
Basilar skull fracture
When assessing a patient with a suspected head or spine injury, which of the following should you do?
- Assess the patient in the position found
- Administer high-flow oxygen
Which of the following are signs of Cushing triad?
- Bradycardia
- Hypertension
- Irregular Respirations
Which of the following acts as a shock absorber for the CNS?
Cerebrospinal fluid
Accounting for approximately 80% of all skull fractures, which of the following often present with no physical signs?
Linear skull fractures
You are treating a patient who might have a skull fracture. What should you do if a dressing you have applied to a head wound becomes soaked?
Place a clean dressing over the bloody one.
Cushing triad in a patient is a sign of which of the following?
Intracranial pressure
While performing a secondary assessment of a patient who was hit with a tire iron on the side of the head, you find a depressed area above the patient’s left ear. This indicates that the patient could have which of the following?
An epidural hematoma
When securing a patient to a backboard, what area of the body should you secure last?
Head
The time between an initial period of unconsciousness and a subsequent loss of consciousness is referred to as what?
Lucid interval
You are reassessing a patient and you find that her left pupil is dilated and fixed. What does this indicate?
Increased intracranial pressure
Battle sign is an indication of which of the following?
skull fracture
You are treating a patient who went face-first through a windshield. She has extensive head injuries and is displaying hypertension, bradycardia, and Cheyne-Stokes respirations. Which of the following should you suspect?
Cushing triad
__ in a patient with a chest injury is a sign that the blood is not being oxygenated sufficiently.
cyanosis
What is ventilation?
The body’s ability to move air in and out of the chest and lung tissue
When a patient sustains a spinal cord injury above the C3 region, which of the following is likely to happen?
Loss of the ability to breathe due to loss of ability of phrenic nerves to function
You are assessing a patient who sustained a blunt force chest injury during a motorcycle accident. There are no obvious signs of external bleeding, but the patient is hypovolemic and there are decreased breath sounds on the left side. Which of the following should you suspect?
Hemothorax
Which of the following are you likely to see in flail chest?
Paradoxical motion
(The detached portion of the chest wall moves opposite of normal: It moves in instead of out during inhalation and out instead of in during exhalation.)
What are the two most common injuries caused by penetrating chest trauma?
Open pneumothorax and cardiac tamponade
What is the best position in which to place a patient when you want to assess for jugular vein distention?
Sitting at a 45-degree angle
You are assessing a patient and notice he has a collapsed jugular vein. What does this indicate?
Hemothorax
You are treating a patient who fell hard on her right side when she fell off a bike. Exposure of the patient’s chest reveals a large bruise on the lateral aspect of the right side of the chest. When you palpate the area, the patient yells out in extreme pain and states that she cannot take a deep breath. What condition should you suspect?
Rib fractures
Which of the following blood vessels can be lacerated by a fractured rib?
aorta
In blunt trauma, a blow to the chest may fracture the ribs, the sternum, or whole areas of the chest wall; bruise the lungs and the heart; and even damage the aorta. Almost one-third of people who are killed immediately in car crashes die as a result of traumatic rupture of the aorta.
In which condition is it recommended you use positive-pressure ventilation?
flail chest
which of the following describes the initial signs of a head injury?
decreased level of consciousness, confusion, nausea
an epidural hematoma is nearly always the result of a blow to the head that produces a linear fracture in what region of the cranium?
temporal
During your primary assessment of a 19-year-old unconscious male who experienced severe head trauma, you note that his respirations are rapid, irregular, and shallow. He has bloody secretions draining from his mouth and nose. You should:
suction his oropharynx for up to 15 seconds
Common signs and symptoms of a serious head injury include all of the following, EXCEPT:
a rapid, thready pulse
In contrast to a cerebral concussion, a cerebral contusion:
involves physical injury to the brain tissue
Which of the following breathing patterns is MOST indicative of increased intracranial pressure?
Irregular rate, pattern, and volume of breathing with intermittent periods of apnea
A man jumped from the roof of his house and landed on his feet. He complains of pain to his heels, knees, and lower back. This mechanism of injury is an example of:
axial loading
When assessing a patient with a head injury, you note the presence of thin, bloody fluid draining from his right ear. This indicates:
rupture of the tympanic membrane following diffuse impact to the head
A patient with a head injury presents with abnormal flexion of his extremities. What numeric value should you assign to him for motor response?
3
What part of the nervous system controls the body’s voluntary activities?
somatic
The five sections of the spinal column, in descending order, are the:
cervical, thoracic, lumbar, sacral, and coccygeal.
The Glasgow Coma Scale (GCS) is used to assess:
eye opening, verbal response, and motor response
The thoracic cavity is separated from the abdominal cavity by the:
diaphragm
If a patient with a chest injury is only able to inhale small amounts of air per breath, he or she:
must increase his or her respiratory rate to maintain adequate minute volume
In order to avoid exacerbating a patient’s injury, it is especially important to use extreme caution when providing positive-pressure ventilation to patients with a:
pneumothroax
A man called EMS 12 hours after injuring his chest. Your assessment reveals a flail segment to the right side of the chest. The patient is experiencing respiratory distress and his oxygen saturation is 78%. His breath sounds are equal bilaterally and his jugular veins are normal. You should suspect:
pulmonary contusion
You respond to a residence for a 40-year-old female who was assaulted by her husband; the scene has been secured by law enforcement. Upon your arrival, you find the patient lying supine on the floor in the kitchen. She is semiconscious with severely labored breathing. Further assessment reveals a large bruise to the left anterior chest, jugular venous distention, and unilaterally absent breath sounds. As your partner is supporting her ventilations, you should:
immediately request ALS support
You arrive at the scene of a major motor vehicle crash. The patient, a 50-year-old female, was removed from her vehicle prior to your arrival. Bystanders who removed her state that she was not wearing a seatbelt. The patient is unresponsive, tachycardic, and diaphoretic. Your assessment reveals bilaterally clear and equal breath sounds, a midline trachea, and collapsed jugular veins. You should be MOST suspicious that this patient has experienced a:
laceration of the aorta
Which of the following is most likely to cause immediate death?
aortic rupture
A spinal cord injury at the level of C7 would MOST likely result in:
paralysis of the intercostal muscles
Children are often “belly breathers” because _.
their intercostal muscles are not developed
A flail chest occurs when:
a segment of the chest wall is detached from the thoracic cage
TRUE or FALSE. A patient who has sustained a blunt abdominal injury should be log rolled to a supine position onto a backboard.
true
TRUE or FALSE. Free air in the peritoneal cavity is abnormal and indicates that a hollow organ or loop of bowel has perforated.
true
TRUE or FALSE. A very common early sign of a significant abdominal injury is tachycardia.
true
because the heart is increasing its pumping action to compensate for blood loss.
TRUE or FALSE. You should allow patients with peritonitis to lie still with their legs drawn up.
true
Patients with peritonitis generally prefer to lie very still with their legs drawn up to guard from pain in the abdomen. Allow a patient with a patent airway to remain in a position of comfort.
Which of the following is true about injuries to the kidneys?
- A penetrating wound that reaches the kidneys almost always involves other organs.
- a sign of kidney damage is hematuria
Bruising over the right upper quadrant could indicate injury to which of the following?
Liver
You should have an index of suspicion that a patient with pain referred to the right shoulder has an injury to which organ?
liver
Injury to the liver (or spleen) may present with referred pain to the shoulders. Unlike radiating pain, which is characterized by pain that “moves” from one area of the body to another, referred pain is characterized by pain in two separate locations.
Which of the following are considered solid organs?
Pancreas and spleen
Which of the following signs would indicate that an injury to the kidney has occurred?
Hematuria
You are assessing a patient who reports pain that is tearing and describes it as going from the abdomen posteriorly. What should you suspect?
Dissecting abdominal aneurysm
What is the major cause of death following injury to a hollow organ in the abdomen?
Sepsis
(typically occurs later in the hospital)
What is the purpose of wrapping a sexual assault victim in a burn sheet?
To preserve potential evidence
Which of the following is an indication of a spleen injury?
Referred left shoulder pain
Which of the following statements is true?
The higher the velocity of a projectile, the larger the cavity it produces.
Where is abdominal injury most likely to occur in young children?
Liver
In pediatric patients, the liver and spleen are very large in proportion to the size of the abdominal cavity and are more easily injured. The soft, flexible ribs of infants and young children do not protect these two organs very well and may allow injury to underlying organs, even without fracturing the ribs.
Difficulty breathing and a sunken appearance of the anterior abdominal wall is MOST indicative of a ruptured:
diaphragm
A 54-year-old male experienced an avulsion to his penis when his foreskin got caught in the zipper of his pants. He was able to unzip his pants and remove the foreskin prior to your arrival. Your assessment reveals that he is in severe pain and that the avulsion is bleeding moderately. The MOST appropriate treatment for this patient includes:
applying direct pressure with a dry, sterile dressing
Compression injury is most likely due to which of the following?
Improperly placed lab belt
Which of the following is true regarding injury to the kidneys?
Injury to the kidneys usually indicates injury to other organs
When a patient stiffens the muscles of the abdomen, it is known as _.
guarding
All of the following are hollow abdominal organs, EXCEPT the:
spleen
Abdominal pain, vomiting, and fever are most likely due to _.
infection
You should suspect a kidney injury anytime the patient presents with _.
a hematoma in the flank region
You are transporting a 42-year-old male who experienced blunt abdominal trauma. He is receiving oxygen at 12 L/min via a nonrebreathing mask and full spinal precautions have been applied. During your reassessment, you note his level of consciousness has decreased and his respirations have become shallow. You should:
insert an airway adjunct if he will tolerate it and begin assisting his ventilations with a BVM
Injuries to the external male genitalia _.
are rarely life-threatening
Rearrange the injuries from least to most severe based on the musculoskeletal injury grading system.
- Dislocated fingers
- Nondisplaced long bone fracture
- Displaced pelvic fracture
- Bilateral femur fracture
- Pelvic fracture with hemodynamic instability
In which situations should you splint the limb in the position of deformity?
- When you encounter resistance or extreme pain when applying traction
- when the deformity is the result of a dislocation and is severe
Which of the following are goals of in-line traction?
- Stabilize the fragments to prevent movement
- Align the limb for splinting
- Avoid neurovascular compromise
TRUE or FALSE. If you are unable to restore the distal pulse on scene, you should splint the limb in a straight position and provide prompt transport to the hospital.
false – If you are unable to restore the distal pulse, splint the limb in the position that is most comfortable for the patient and provide prompt transport to the hospital.
TRUE or FALSE. Lateral and medial dislocations to the knee are less common than posterior dislocations and are less likely to injure the popliteal artery.
true
TRUE or FALSE. A fracture of the femoral shaft is best stabilized with a traction splint, such as a Sager splint.
true
TRUE or FALSE. Fractures of the proximal femur usually involve the hip joint.
false – Fractures of the proximal femur are usually called hip fractures, but they rarely involve the hip joint.
When assessing distal circulation in a patient’s lower extremities, which pulse should you palpate?
popliteal
Which MOI causes a fracture or dislocation at a distant point?
Indirect force
What is the most reliable indicator of an underlying fracture?
Point tenderness
A disruption of a joint in which the bone ends are no longer in contact is known as what?
Dislocation
In the musculoskeletal injury grading system, under which category would you place a laceration of a major nerve or blood vessel?
serious
Which of the following would you use to stabilize an AC separation?
Sling and swathe
You are attending to a patient with a nondisplaced elbow fracture. She has a strong pulse and good capillary refill. How should you address this type of injury?
Splint from the shoulder joint to the wrist joint to stabilize the entire arm.
What is the primary goal of in-line traction?
Avoid further neurovascular compromise
Which sign/symptom would give you a high index of suspicion that a patient may have compartment syndrome?
Disproportionate pain
Which of the following is a drawback of an air splint?
Temperature changes affect air pressure in the splint.
In which of the following situations should the EMT splint an injured limb in the position of deformity?
If resistance is encountered or the patient experiences severe pain
Which of the following musculoskeletal injuries would pose the greatest threat to a patient’s life?
pelvic fracture with hypotension
A “hip” fracture is actually a fracture of the:
proximal femur
A fracture is MOST accurately defined as a(n):
break in the continuity of the bone
With regard to musculoskeletal injuries, the zone of injury is defined as the:
area of soft-tissue damage surrounding the injury
An open fracture is MOST accurately defined as a fracture in which:
the overlying skin is no longer intact
The MOST significant hazard associated with splinting is:
delaying transport of a critically injured patient
During your secondary assessment of a 30-year-old male who fell 25 feet, you note crepitus when palpating his pelvis. Your partner advises you that the patient’s blood pressure is 80/50 mm Hg and his heart rate is 120 beats/min and weak. After completing your assessment, you should:
stabilize the pelvis with a pelvic binder and protect the spine
When caring for a patient with a possible fracture of the scapula, the EMT should:
carefully assess the patient for breathing problems
A 22-year-old female was ejected from her car after striking a tree head-on. As you approach her, you note obvious closed deformities to both of her femurs. She is not moving and does not appear to be conscious. You should:
stabilize her head and perform a primary assessment
Cardiorespiratory response when core body temperature falls into the range of 89ºF to 92ºF (31.7ºC to 33.3ºC) involves __ .
Slowing respirations and a slow pulse
You arrive at the scene and find the patient sitting under a tree in his garden; he is conscious, but confused. His wife tells you that he has been working outside all day. She further states that he refused to take a break and drink some water. Your assessment finds a flushed appearance; weak and rapid radial pulses; and hot, moist skin. Based on this, you suspect that your patient is suffering from __ .
heat stroke
There are several clinical findings that indicate your patient is experiencing the most serious heat illness, heat stroke. Unlike other, less-severe forms of heat illness, patients with heat stroke have an altered LOC and flushed, hot skin. Your patient has both of these.
TRUE or FALSE. It is difficult to find a pulse in a drowning victim because of constriction of the peripheral blood vessels and low cardiac output, resulting in cyanosis.
true
TRUE or FALSE. In an air embolism, the air pressure in the lungs remains constant while the external pressure on the chest increases.
false – In an air embolism, the air pressure in the lungs remains at a high level while the external pressure on the chest decreases.
TRUE or FALSE. Symptoms of air embolism may not occur for several hours.
false – Air embolism occurs immediately on returning to the surface, but symptoms of decompression sickness may not occur for several hours
TRUE or FALSE. The diving reflex may cause immediate bradycardia.
true
Hypothermia is diagnosed when the core body temperature falls below what temperature?
95°F (35°C)
Shivering stops and muscle activity ceases once the body’s core temperature reaches what?
90°F (32.2°C)
Rough handling of a patient with severe hypothermia may cause which of the following dysrhythmias?
Ventricular fibrillation
In the context of an environment that is 90°F with 85% humidity, what does moist, pale, cool skin indicate?
There has been excessive fluid and salt loss.
What is often the first sign of heat stroke?
Change in behavior
In which of the following environmental emergencies are you most likely to encounter laryngospasm?
drowning
What is the most dangerous, and most common, emergency in scuba diving?
Air embolism
You are treating a patient who was climbing a 10,000-foot mountain when he began to experience a severe, constant, throbbing headache; ataxia; and extreme fatigue. He is nauseated and, as you assess him, he loses consciousness. Which of the following should you suspect?
HACE
(high altitude cerebral edema)
You suspect that the patient you are treating was bitten by a rattlesnake. What should you do first?
Place the patient is a supine position.
(keeps the venom from spreading)
A person who stands outside in windy, wintry weather and wears only lightweight clothing is experiencing heat loss mainly by what method?
Convection
The MOST prominent symptom of decompression sickness is:
abdominal or joint pain
Burns associated with lightning strikes are typically:
superficial
You respond to a local lake where a diver complains of difficulty breathing that occurred immediately after rapidly ascending from a depth of approximately 30 feet. On assessment, you note that he has cyanosis around his lips and has pink froth coming from his nose and mouth. You should:
suction his mouth and nose, apply high-flow oxygen, monitor the patient’s breath sounds for a pneumothorax, and contact medical control regarding transport to a recompression facility
Hypothermia occurs when the core body temperature falls below:
95°F (35°C)
You are transporting a 28-year-old man with a frostbitten foot. The patient’s vital signs are stable and he denies any other injuries or symptoms. The weather is treacherous and your transport time to the hospital is approximately 45 minutes. During transport, you should:
protect the affected part from further injury
A 31-year-old male was bitten on the leg by an unidentified snake. The patient is conscious and alert and in no apparent distress. Your assessment of his leg reveals two small puncture marks with minimal pain and swelling. In addition to administering oxygen and providing reassurance, further care for this patient should include:
supine positioning, splinting the leg, and transporting
The EMT must assume that any unwitnessed water-related incident is accompanied by:
possible spinal injury
Drowning is MOST accurately defined as:
death from suffocation after submersion in water
A 30-year-old male was rescued after being lost in the woods for approximately 18 hours. The outside temperature is 30°F (-1°C). He is immediately placed in the warmed ambulance, where you perform a primary assessment. He is unresponsive, pale, and apneic. You should:
assess for a carotid pulse for up to 60 seconds
Which of the following MOST accurately describes hyperthermia?
The body is exposed to more heat than it can lose
When a person acts in a manner that is unacceptable to himself or those around him, this would be considered which of the following?
Behavioral emergency CORRECT. A behavioral emergency exists when a person exhibits abnormal behavior-that is, behavior within a given situation that is unacceptable or intolerable to the patient, the family, or the community. Frequently behavioral emergencies involve behavior that is potentially harmful to the patient or to the people that interact with the patient. Behavioral emergency is a blanket term for what is considered mental illness, psychotic episodes, and psychosomatic reactions, which are narrow focus terms and not all encompassing as behavioral emergencies.
The opiate triad includes all of the following except:
hypertension. CORRECT. The opiate triad is characterized by three signs: coma (or depressed level of consciousness), pinpoint pupils, and respiratory depression (slow, shallow respirations). Hypertension is not part of the opiate triad.
Cleaning fluid, glue, and model cement are common examples of which of the following?
Volatile chemicals CORRECT. Volatile chemicals produce vapors that can be inhaled. They can give an initial “rush” and then act as a depressant on the central nervous system. Cleaning fluid, glue, model cement, and solutions used to correct typing mistakes are commonly abused volatile chemicals.
Why would an EMT give activated charcoal to a patient who overdosed on the medication Soma?
Activated charcoal binds to the Soma, preventing absorption by the body. CORRECT. Activated charcoal is designed to chemically bind to the poison in order to prevent and minimize the absorption of the poison by the body.
Which of the following is one of the MOST common inhaled poisons associated with fire suppression?
Carbon monoxide CORRECT. Carbon monoxide (CO) is one of the most commonly inhaled poisons. It is usually associated with motor-vehicle exhaust and fire suppression.
The term poison is BEST described as any substance that can do which of the following?
Harm the body CORRECT. Once on or in the body, poisons can do damage and harm the body in a variety of ways. A poison may act as a corrosive or irritant, destroying skin and other body tissues. A poisonous gas can act as a suffocating agent, displacing oxygen in the air. Some poisons are systemic poisons, causing harm to the entire body or to an entire body system.
Carbon monoxide poisoning occurs by which of the following routes?
Inhalation CORRECT. Inhaled poisons (poisons that are breathed in) take the form of gases, vapors, and sprays. Such poisons include carbon monoxide (from car exhaust, wood-burning stoves, and furnaces), ammonia, chlorine, insect sprays, and the gases produced from volatile liquid chemicals.
OxyContin is an example of which of the following types of drugs?
Narcotic CORRECT. Narcotics are drugs capable of producing stupor or sleep. They are often used to relieve pain. Many drugs legitimately used for these purposes (such as codeine) are also abused, affecting the nervous system and changing many of the normal activities of the body, often producing an intense state of relaxation or feeling of well-being. One narcotic, in particular, OxyContin (oxycodone), has become a common drug of abuse.
Your patient is an 18-year-old male who fell into a neighbor’s swimming pool but was pulled out by bystanders. The neighbors report that the patient wandered into their yard and that he said he had a “funny numb feeling” in his head and his chest hurt before stumbling into the pool. As you are performing CPR, you notice that the mucous membranes in his mouth and nose are swollen. Which of the following would account for the patient’s behavior and current condition?
Volatile chemicals CORRECT. Volatile chemicals produce vapors that can be inhaled. They can give an initial “rush” and then act as a depressant on the central nervous system. Cleaning fluid, glue, model cement, and solutions used to correct typing mistakes are commonly abused volatile chemicals. These chemicals will make the patient experience a numb feeling. Inhalation of a volatile chemical will also produce headache and possible chest pain. GHB, methamphetamines, and CO poisonings would not cause swollen mucous membranes and numbness like a volatile chemical would.
Your patient is a conscious 4-year-old female who has ingested a medication prescribed for her grandfather. To determine appropriate treatment, which of the following information is NOT necessary to provide to medical control?
Grandfather’s name and the name of the physician who prescribed the medication CORRECT. Which physician prescribed the medication and the grandfather’s name is of no consequence in this scenario to deliver adequate patient care at the EMT level.
Your patient is a 7-year-old male who ate an unknown type of mushroom on a dare by his friends. You should ask all of the following questions except:
Why did you eat the mushroom? CORRECT. The fact that the patient took the drug on a dare or for any other reason for that matter is irrelevant for the EMT to deliver good patient care. The presence of “peer pressure” as well if the patient knows the mushrooms are poisonous or not does not play into the EMT being able to deliver good patient care.
Gamma-hydroxybutyrate (GHB) is an example of which of the following types of drugs?
Depressant CORRECT. A downer (depressant) you may see is GHB (gamma-hydroxybutyrate), also known as Georgia Home Boy or goop. In addition to depressing the central nervous system, it produces a sense of euphoria and sometimes hallucinations. It has caused respiratory depression so severe that patients have required assisted ventilations even though some of them were still breathing.
What clinical finding is MOST suggestive of an inhaled poison?
Black-colored sputum CORRECT. Altered mental status and tachypnea can occur with any poisoning. A swollen tongue can be from an inhaled poison but is more likely the result of anaphylaxis. Black-colored sputum is a clear indication that the patient has inhaled toxic smoke, which is an inhaled poison.
You are called to a farm for a possible organophosphate poisoning of one of the workers. Your first action is to:
call for specialized hazardous materials units. CORRECT. The patient is potentially covered with a hazardous and poisonous material. Calling for a specialized hazardous materials unit that has the training and resources to properly decontaminate the patient is the best first action.
Which of the following is a common sign and symptom in poisonings of all types?
Nausea and vomiting CORRECT. Nausea and vomiting are two of the most common results of all kinds of poisoning. When a poison is ingested you may also find altered mental status, abdominal pain, diarrhea, chemical burns around the mouth, and unusual breath odors. With inhaled poisons, find out if the patient is having difficulty breathing, chest pain, coughing, hoarseness, dizziness, headache, confusion, seizures, or altered mental status.
Which of the following is a substance that will neutralize a poison or its effects?
Antidote CORRECT. An antidote is a substance that will neutralize the poison or its effects.
Your patient is a 2-year-old conscious male who has swallowed a small quantity of bleach. Which of the following findings should you evaluate the patient for?
Irritation in and around the mouth CORRECT. Mild exposure to bleach can result in coughing, eye irritation, and sore throat. Common signs and symptoms include a liquid or powder (bleach) on the patient’s skin, burns, itching, irritation, and redness. A small quantity of bleach being ingested will not cause dilated pupils, irregular pulse, and respiratory depression.
Volatile chemicals are agents that are able to change easily from a form to a form.
liquid; gas CORRECT. The gases produced from volatile liquid chemicals are noxious meaning they can easily change from a liquid into a gas. These substances go from a liquid to a gas at a wide range of temperatures, especially at room temperature and normal atmospheric pressure.
Which of the following is NOT true concerning a patient’s reaction to toxic gas exposure?
. If the patient is treated immediately, there will be no long-term effects. CORRECT. These patients need immediate medical evaluation because they have serious long-term effects and consequences, including neurological deficits, from their exposure, despite the most definitive care. The patients may experience long-term effects from exposure.
Which of the following conditions can mimic the signs of alcohol intoxication?
. All of the above CORRECT. Diabetes, epilepsy, head injuries, high fevers, hypoxia, and other medical problems may make the patient appear to be intoxicated when he is not.
You are called to the scene of a 17-year-old female patient who is unresponsive. Her mother suspects that she tried to commit suicide by taking her pain pills. The patient is unresponsive to painful stimuli, has agonal respirations, and has vomited. She has a weak carotid pulse. After securing the airway and providing oxygen by bag-valve mask, what is your next action?
. Perform a rapid physical examination of the patient. CORRECT. The patient is unresponsive. Although an overdose is suspected, you must not get tunnel vision that this is the only possibility. You must take the time to rule out any other possibilities. You must perform a rapid physical exam after correcting issues with the airway, breathing, and circulation, then look for any other life-threatening injuries whenever the patient is unresponsive.
When a substance enters the body through unbroken skin, it has entered the body by which of the following routes?
Absorption CORRECT. Absorbed poisons (poisons taken into the body through unbroken skin) may or may not damage the skin. Many are corrosives or irritants that will injure the skin and then be slowly absorbed into body tissues and the bloodstream, possibly causing widespread damage. Others are absorbed into the bloodstream without injuring the skin.
Which of the following is LEAST often seen in carbon monoxide poisoning?
Cherry red lips CORRECT. There is a commonly accepted idea that a patient exposed to carbon monoxide will have cherry red lips. In fact, cherry red skin is NOT typically seen in patients with carbon monoxide poisoning.
Which of the following is the immediate toxic effect of alcohol?
Central nervous system depression CORRECT. Many persons consume alcohol without having any problems. However, others occasionally or chronically abuse alcohol. Even though adults can legally drink alcohol, it is still a drug that can have a potent depressive effect on a person’s central nervous system. Emergencies arising from the use of alcohol may be due to the effect of alcohol that has just been consumed, or it may be the result of the cumulative effects of years of alcohol abuse.
Your patient is a 3-year-old male with a stoma who has swallowed a household cleaner. Medical direction gives you an order for milk to dilute the stomach contents. Which of the following is the correct way of carrying out this order?
Have the patient drink one glass of milk. CORRECT. Occasionally, medical direction will give an order for dilution of a poisonous substance. This means an adult patient should drink one to two glasses of water or milk, whichever is ordered. A child should typically be given one-half to one full glass.
When a chemical substance is taken for reasons other than therapeutic use, this action is called:
substance abuse. CORRECT. Substance abuse is a term that indicates a chemical substance is being taken for other than therapeutic (medical) reasons.
Which of the following effects may occur due to chronic abuse of alcohol?
All of the above CORRECT. Chronic drinkers (alcoholics) often have derangements in blood sugar levels, poor nutrition, the potential for considerable gastrointestinal bleeding, and other problems. A person can be both intoxicated and having a heart attack or hypoglycemia. If the patient has ingested alcohol and other drugs, this can produce a serious medical emergency.
Why should an EMT utilize a local poison control center in managing a poisoning patient?
They can assist in finding out important information about the poison. CORRECT. A poison control center does not remove the need for an EMT to train for poisonings nor does it remove any liability from the EMT. Poison control centers do not have specialty teams that can be activated to treat patients. Poison control centers have immediate access to huge databases that contain detailed information on thousands of poisons. They can provide important information on poison-specific antidotes or treatment guidelines.
Your patient is a 48-year-old male who has n exposed to a toxic powder that can be absorbed through the skin. Which of the following measures should be taken by the EMT?
Brush off the powder and flush the patient’s skin with copious amounts of water. CORRECT. Emergency care of a patient with absorbed poisons includes the following steps:
- Detect and treat immediately life-threatening problems in the primary assessment. Evaluate the need for prompt transport of critical patients.
- Perform a secondary assessment; obtain vital signs. This includes removing contaminated clothing while protecting oneself from contamination.
- Remove the poison by doing one of the following:
∙ Powders. Brush powder off the patient and then continue as for other absorbed poisons.
∙ Liquids. Irrigate with clean water for at least 20 minutes and continue en route if possible.
∙ Eyes. Irrigate with clean water for at least 20 minutes and continue en route if possible. A copious amount of water implies massive amounts of water after the powder is brushed off first. The water is applied to the skin where the powder made contact with it.
Which patient would most likely benefit from the administration of activated charcoal?
14-year-old female who overdoses on her grandfather’s cardiac medication CORRECT. The use of activated charcoal is limited to ingestions of solid substances where adsorption may be beneficial.
By definition, a systemic poison causes harm to which of the following?
Entire body CORRECT. Systemic causes harm to the entire body.
Which of the following is an injury that commonly occurs in alcoholic patients with even minor falls and blows to the head?
Subdural hematoma CORRECT. A chronic alcoholic is prone to subdural hematomas, which is bleeding between the dura mater and brain due to balance issues associated with drinking and the frailty of the blood vessels in the head due to alcoholism. Be especially careful of patients with even minor head injuries, since subdural hematoma is common in alcoholics.
You are called to the scene of a 21-year-old female patient who is unresponsive. Her boyfriend suspects that she tried to commit suicide by overdosing on her depression medications. The patient is unresponsive to painful stimuli, with agonal respirations, and has vomited. She has a weak carotid pulse. After securing the airway and providing oxygen by bag-valve mask, what is the MOST important question the EMT can ask regarding the medication?
What medication did she take? CORRECT. Knowing exactly what medication the patient ingested is critical so medical control will know how to best treat the effects of the overdose.
Regarding activated charcoal, which of the following is NOT true?
It is an antidote to many poisons. CORRECT. Activated charcoal is not an antidote for any specific poison.
How does carbon monoxide cause toxic effects?
Prevents red blood cells from carrying oxygen CORRECT. When inhaled, carbon monoxide prevents the normal carrying of oxygen by the red blood cells. Long exposure, even to low levels of the gas, can cause dramatic effects. Death may occur as hypoxia becomes more severe. Carbon monoxide has a 200 times greater affinity for hemoglobin than oxygen does so that when it binds to hemoglobin it displaces the available oxygen that may bind.
Smoke inhalation can result in all of the following except:
lung contusion. CORRECT. Smoke inhalation is a serious problem associated with fire scenes. Smoke inhalation is often associated with thermal burns as well as with the effects of chemical poisons within the smoke. The smoke from any fire source contains many poisonous substances. Modern building materials and furnishings often contain plastics and other synthetics that release toxic fumes when they burn or are overheated. It is possible for the substances found in smoke to burn the skin, irritate the eyes, injure the airway, cause respiratory arrest, and, in some cases, cause cardiac arrest. Lung contusion is bruising of the lung tissues caused by blunt force trauma to the chest cavity.
Your patient has come in contact with a strong acid substance. Using an alkaline solution to treat the patient may result in which of the following?
All of the above CORRECT. “Neutralizing” acids or alkalis with solutions such as dilute vinegar or baking soda in water should not be done. When incidents like these occur, such substances are almost never readily available. Even if they were, they would not be appropriate. They have never been shown to help, and there is good reason to believe they would make matters worse. When an acid is mixed with an alkali, it is true that the two may be neutralized. It is also true, though, that this reaction produces heat. Skin that has been injured already by an acid or alkali may be further damaged by attempts to neutralize the chemical. All of the above CORRECT. “Neutralizing” acids or alkalis with solutions such as dilute vinegar or baking soda in water should not be done. When incidents like these occur, such substances are almost never readily available. Even if they were, they would not be appropriate. They have never been shown to help, and there is good reason to believe they would make matters worse. When an acid is mixed with an alkali, it is true that the two may be neutralized. It is also true, though, that this reaction produces heat. Skin that has been injured already by an acid or alkali may be further damaged by attempts to neutralize the chemical.
Which of the following is the MOST important means of managing a patient who has inhaled a poison, after the airway has been established?
High concentrations of oxygen CORRECT. The principal prehospital treatment of inhaled poisoning consists of maintaining the airway and supporting respiration. In the case of inhaled poisoning, oxygen is a very important drug. Some inhaled poisons prevent the blood from transporting oxygen in the normal manner. Some prevent oxygen from getting into the bloodstream in the first place. In either case, your ability to keep the airway open, ventilate as needed, and give high-concentration oxygen may make the difference in the patient’s survival and quality of life.
You respond to the county jail for a 48-year-old inmate arrested two days ago for public intoxication. Guards state the patient is a known alcoholic and “frequent flier.” The guards state that for several hours the patient was “acting crazy” and seeing “bugs on the walls.” The patient then began seizing and they called for an ambulance. You notice the patient is no longer seizing, diaphoretic, or confused. What condition do you suspect?
Delirium tremens CORRECT. The patient is a known alcoholic who has been incarcerated for 48 hours and thus is unable to obtain any alcohol. This history-along with his signs and symptoms of altered mental status, hallucinations, unusual behavior, and seizure-is the classic presentation of delirium tremens.
A patient who has abused “uppers” will display which of the following signs and symptoms?
Excessive talkativeness, dilated pupils, and dry mouth CORRECT. Uppers are stimulants that affect the nervous system and excite the user. Many abusers use these drugs in an attempt to relieve fatigue or to create feelings of well-being. Examples are caffeine, amphetamines, and cocaine. Cocaine may be “snorted,” smoked, or injected. Other stimulants are frequently taken in pill form. Also included in this category are so-called “bath salts.” These are synthetic drugs that have very potent stimulant effects and sometimes hallucinogenic effects as well.
You are called to the scene of a 14-year-old female patient who is unresponsive. Her mother states she has n teased and bullied at school and she suspects that she tried to commit suicide by taking her pain pills. The patient is unresponsive to painful stimuli, with agonal respirations, and has vomited. She has a weak carotid pulse. Your first action is to:
suction the patient’s airway. CORRECT. The patient is unresponsive with emesis. Before any airway or oxygen will be effective, the patient’s airway must first be cleared of any obstruction. The emesis must be suctioned.
By what route does nitroglycerin spray enter the body?
Absorption CORRECT. Even though the medication is in spray form, it is not inhaled but absorbed under the tongue in the oral mucosa, so it is referred to as sublingual, which means under the tongue. Nitroglycerin is also a medication that is absorbed through the skin in spray, tablet, or paste form so caution must be used by the EMT assisting a patient in taking a prescribed dosage of medical control approved nitroglycerine.
Which of the following is a sign or symptom of withdrawal from alcohol?
All of the above CORRECT. Signs of alcohol withdrawal include: confusion and restlessness; unusual behavior, to the point of demonstrating “insane” behavior; hallucinations; gross tremor (obvious shaking) of the hands; profuse sweating; seizures (common and often very serious); hypertension; and tachycardia.
Your patient is a conscious 16-year-old female who has ingested an unknown number of sleeping pills. Which of the following questions is LEAST pertinent to the care of this patient?
Who do these sleeping pills belong to? CORRECT. It is important in the case of ingestion of pills to ascertain how many pills the patient has taken along with the time duration over which the pills were taken in minutes or hours. It is also important for the EMT to figure out if anyone else has previously tried any treatments for the patient prior to EMS arrival. Where the patient got the sleeping pills from and who the pills belong to are irrelevant facts for the EMT delivering patient care.
Which of the following would LEAST likely indicate that an emergency is due to drugs or alcohol?
Unresponsive patient with unequal pupils CORRECT. It is important to determine whether the patient is suffering from a medical condition or the effects of drugs and/or alcohol. Many medical conditions can mimic the effect of drugs and alcohol. Search the area immediately around the patient for evidence of drug or alcohol use. An unresponsive patient who has unequal pupils is likely suffering from a structural problem (head injury, stroke, tumor) within the cranium, not a drug- or alcohol-related problem.
Which of the following statements regarding syrup of ipecac is NOT true?
It has an immediate action. CORRECT. Ipecac is an orally administered drug that causes vomiting in most people with just one dose, but it sometimes takes an additional dosage. When vomiting occurs, it results, on the average, in removal of less than one-third of the stomach contents. Because ipecac is slow, is relatively ineffective, and has the potential to make a patient aspirate vomitus, it is rarely used today.
Which of the following is the BEST initial intervention for a patient who has inhaled a poison?
Provide a patent airway, ventilation, and high-concentration oxygen. CORRECT. The principal prehospital treatment of inhaled poisoning consists of maintaining the airway and supporting respiration. In the case of inhaled poisoning, oxygen is a very important drug. Some inhaled poisons prevent the blood from transporting oxygen in the normal manner. Some prevent oxygen from getting into the bloodstream in the first place. In either case, your ability to keep the airway open, ventilate as needed, and give high-concentration oxygen may make the difference in the patient’s survival and quality of life.
Which of the following groups is the most susceptible to the effects of a poison?
Elderly CORRECT. For most poisonous substances, the reaction is far more serious in the ill, the very young, and the elderly.
Which of the following describes any substance produced by a living organism that is poisonous to human beings?
. Toxin CORRECT. A toxin, a substance that is poisonous to humans. For example, some mushrooms and other common plants can be poisonous if eaten. These include some varieties of house plants, including the rubber plant and certain parts of holiday plants such as mistletoe and holly berries. In addition, bacterial contaminants in food may produce toxins, some of which can cause deadly diseases (such as botulism).
You are treating a 61-year-old who is a chronic alcohol abuser. He is complaining of “snakes slithering around his ankles,” and he tells you that he had only two drinks tonight. You notice that he is sweating, trembling, and anxious. Before you can complete your assessment, he begins to have a seizure. Which of the following is the most likely cause of this situation?
The patient is suffering from alcohol withdrawal. CORRECT. Signs of alcohol withdrawal include: confusion and restlessness; unusual behavior, to the point of demonstrating “insane” behavior; hallucinations; gross tremor (obvious shaking) of the hands; profuse sweating; seizures (common and often very serious); hypertension; and tachycardia. This patient is suffering from a chronic condition and not an acute issue like alcohol poisoning from overdrinking, or the drinking of antifreeze, mouthwash or other substance to maintain an inebriated state.
You respond to assist law enforcement with a 35-year-old male patient who, according to them, is “high as a kite.” The patient is anxious, tachycardic, and angry. What condition do you suspect?
Cocaine overdose CORRECT. The patient is tachycardic. GHB, marijuana, and alcohol are all downers. They would not cause tachycardia. Cocaine is the only choice that causes tachycardia.
Your patient is a 3-year-old female who has taken an unknown quantity of aspirin. She is conscious and alert. Which of the following orders is likely to be given by medical control?
Administer activated charcoal. CORRECT. Activated charcoal works through adsorption, the process of one substance becoming attached to the surface of another. In contrast to ordinary charcoal, which adsorbs some substances, activated charcoal has been manufactured to have many cracks and crevices. As a result, activated charcoal has an increased amount of surface available for poisons to bind to.
Your patient is a 38-year-old male who has taken an overdose of several different medications and has consumed some household cleaning agents as well. On your arrival, the patient only responds to painful stimuli, and has a heart rate of 90 beats per minute with a respiratory rate of 12 breaths per minute. Medical control orders you to give the patient two to three glasses of milk to drink to dilute the contents of the stomach. Which of the following actions should you do?
Refuse the order and explain why. CORRECT. Occasionally, medical direction will give an order for dilution of a poisonous substance. This means an adult patient should drink one to two glasses of water or milk, whichever is ordered. A child should typically be given one-half to one full glass. However, because the patient has an altered mental status, the patient should receive nothing by mouth because he may aspirate. In this instance you should question the order from medical direction.
Which of the following substances may be ordered by medical control to dilute a poison?
Milk or water CORRECT. Occasionally, medical direction will give an order for dilution of a poisonous substance. This means an adult patient should drink one to two glasses of water or milk, whichever is ordered. A child should typically be given one-half to one full glass. Dilution with water may slow absorption slightly, whereas milk may soothe stomach upset.
Carbon monoxide poisoning should be suspected when a patient has n in an enclosed area and has which of the following signs and/or symptoms?
All of the above CORRECT. The signs and symptoms of carbon monoxide poisoning are deceptive, because they can resemble those of the flu. Specifically, you may see: headache, especially “a band around the head;” dizziness; breathing difficulty; nausea and vomiting (emesis); cyanosis; and altered mental status. In severe cases, unconsciousness may result. You should suspect carbon monoxide poisoning whenever you are treating a patient with vague, flu-like symptoms who has been in an enclosed area.
Which of the following is NOT a way in which poisons can access the body?
Radiation CORRECT. Poisons can be classified into four types, according to how they enter the body: ingested, inhaled, absorbed, and injected. Radiation is not one of the ways in which poisons enter the body.
You are called to the residence of a 78-year-old widow who lives alone with no children. She was found by neighbors on the floor of the living room. She has fallen and fractured her left humerus. She is disoriented and responds to verbal stimuli only. She has a blood pressure of 78/40 and a pulse of 48. She has a history of high blood pressure and takes medication for it. She also takes medication for high cholesterol and a medication to slow down a fast heart rate. Emergency Medical Responders find the medication bottles in the medicine cabinet and they are empty. Your partner suspects that she accidentally overdosed on her medications. Do you agree or disagree?
Agree. The vital signs agree with this hypothesis. CORRECT. The patient is normally hypertensive and tachycardic and must take medicines to regulate these conditions. If her vital signs were from a broken humerus, we would expect her pulse to be normotensive or tachycardic, not bradycardic. It is more likely that the patient fell and broke her arm from a syncopal episode secondary to the bradycardia. There is no evidence in the question that she is suicidal or depressed. Living alone does not automatically mean one is lonely. If the patient had not taken her medications, she would be tachycardic and hypertensive. In fact, she is profoundly hypotensive and bradycardic. The most logical answer is that she accidentally overdosed on her medications, resulting in the heart rate and blood pressure dropping to unhealthy levels.
It is a chilly fall morning and you are called to an RV campground for three patients who are complaining of headache, dizziness, and nausea. Your primary assessment reveals that they are cyanotic and have an altered mental status. You suspect:
carbon monoxide poisoning. CORRECT. Given the cold weather and multiple patients, it is most likely that the campers are overcome by carbon monoxide poisoning. Carbon monoxide poisoning occurs in camping when campers leave on gas heaters in enclosed spaces such as campers and tents that do not get adequate ventilation.
Your patient is a 50-year-old female with a history of alcoholism. She is found unresponsive in bed by her son. Which of the following possibilities should you keep in mind during your assessment?
All of the above CORRECT. Chronic drinkers (alcoholics) often have derangements in blood sugar levels, poor nutrition, the potential for considerable gastrointestinal bleeding, and other problems. A person can be both intoxicated and having a heart attack or hypoglycemia. The chronic alcoholic is prone to experiencing subdural hematomas from falls and blows to the head associated with the alcohol abuse. If the patient has ingested alcohol and other drugs, this can produce a serious medical emergency.
The drug ecstasy is classified as what type of drug?
Hallucinogen CORRECT. Hallucinogens such as LSD, PCP, and certain types of mushrooms are mind-affecting drugs that act on the nervous system to produce an intense state of excitement or a distortion of the user’s perceptions. This class of drugs has few legal uses. They are often eaten or dissolved in the mouth and absorbed through the mucous membranes. A newer hallucinogen is ecstasy, also known as XTC, X, or MDMA (because it is methylenedioxymethamphetamine). Often taken at “rave” parties with other drugs, this hallucinogen also has the stimulant properties of uppers.
Signs and symptoms of alcohol abuse include all of the following except:
an acetone or ketone odor to the breath. CORRECT. An acetone or ketone odor on the breath is a sign of diabetes. The following list contains signs and symptoms of alcohol abuse: odor of alcohol on the patient’s breath or clothing (be certain that the odor is not “acetone breath,” as with some diabetic emergencies); swaying and unsteadiness of movement; slurred speech, rambling thought patterns, incoherent words or phrases; a flushed appearance to the face, often with the patient sweating and complaining of being warm; nausea or vomiting; poor coordination; slowed reaction time; blurred vision; confusion; hallucinations, visual or auditory (“seeing things” or “hearing things”); lack of memory (blackout); and altered mental status.
Most cases of accidental poisoning involve which of the following?
Young children CORRECT. Most accidental poisonings involve young children. Toddlers are at the curious age of getting into unlocked cabinets if left unattended.
Which of the following is the cause of the black residue found in a patient’s mouth and nose following smoke inhalation?
Carbon CORRECT. The following signs indicate an airway injured by smoke inhalation: difficulty breathing; coughing; breath that has a “smoky” smell or the odor of chemicals involved at the scene; black (carbon) residue in the patient’s mouth and nose; black residue in any sputum coughed up by the patient; and nose hairs singed from superheated air.
You have just arrived on the scene of an agricultural business and see three men coming out of a building, choking and holding their heads. One of the men tells you there are two workers still inside. What should you do next?
Call for properly trained assistance and stay a safe distance away from the scene. CORRECT. Poisons such as insecticides and agricultural chemicals may be absorbed through the skin of anyone coming in contact with them. Many of these chemicals are considered organophosphates, which causes overstimulation of the parasympathetic nervous system. Since EMT safety is a critical part of all calls, do not hesitate to ask for assistance with any patient who appears exposed to an absorbed agricultural chemical and maintain a safe distance from the substance and any patients until properly trained responders mitigate the incident.
Your patient is a 23-year-old male who is unresponsive in the restroom of a bar. His respirations are slow and shallow, he has a heart rate of 50 beats per minute, he is sweating profusely, and he has constricted pupils. Which of the following substances is MOST likely responsible for the patient’s condition?
Heroin CORRECT. Illegal narcotics such as heroin are also commonly abused. Heroin is often injected into a vein. Other narcotics are typically in pill form. Narcotic overdoses are generally characterized by three signs: coma (or depressed level of consciousness), pinpoint pupils, and respiratory depression (slow, shallow respirations). Together, these are sometimes referred to as the opiate triad.
Your patient is a 17-year-old male who is spitting and coughing after swallowing some gasoline while siphoning from a gas tank. Which of the following should you do first?
Contact medical control. CORRECT. The top priority in this patient after maintaining an adequate airway is to consult with medical control for further definitive steps to take in the patient care treatment of this patient.
What is the most important treatment for a patient who has inhaled a poison?
Administer high-concentration oxygen. CORRECT. The single most important treatment for inhaled poisons is high-concentration oxygen.
A patient has a dry powder poison covering both upper extremities and chest. You should:
brush the powder off and irrigate the contaminated area with large amounts of water. CORRECT. Dry powders should be brushed off before the area is irrigated. Many chemicals are inactive in the powder form but are active, or become more activated, when they come in contact with water, creating a reaction that increases the heat and extends the burn. Once the powder has been brushed off, irrigate the area with large (copious) amounts of water.
Which patient would MOST likely benefit from the administration of activated charcoal?
Alert 16-year-old female who overdosed on Tylenol® CORRECT. The alert 16-year-old female who overdosed on Tylenol will most likely benefit from administration of activated charcoal.
Barbiturates may be referred to as which of the following?
Downers CORRECT. Downers, such as barbiturates, have a depressant effect on the central nervous system. This type of drug may be used as a relaxing agent, sleeping pill, or tranquilizer.
Which of the following is a trade name for activated charcoal?
Actidose CORRECT. The trade names for activated charcoal are: SuperChar, InstaChar, Actidose, Liqui-Char, and others.
Which of the following types of drugs may induce sleep or stupor?
Both A and B
When a poison attaches to the chemical structure of activated charcoal, which of the following BEST describes this mechanism of action?
Adsorption CORRECT. Activated charcoal works through adsorption, the process of one substance becoming attached to the surface of another. In contrast to ordinary charcoal, which adsorbs some substances, activated charcoal has been manufactured to have many cracks and crevices. As a result, activated charcoal has an increased amount of surface available for poisons to bind to.
You are called to the scene of a local night club for a 21-year-old female patient who is bradycardic and in respiratory arrest. The patient’s airway is patent and the chest easily rises with bag-valve-mask ventilation. The patient’s friends state the patient had only one or two drinks when she suddenly complained of dizziness and “seeing things.” Her friends state that she then passed out, started twitching like she was seizing, and then stopped. Her friends adamantly state that she does not do drugs. What situation do you suspect?
GHB overdose CORRECT. The patient most likely had consumed an alcoholic beverage that someone slipped a date rape drug into such as GHB. Patients who consume GHB will have hallucinations and will have central nervous system depression to the point of respiratory arrest. Seizure-like twitches are possible with severe hypoxia.
Which of the following is NOT part of the treatment for a 15-year-old female who has swallowed drain cleaner?
Administer activated charcoal. CORRECT. Patients who have ingested acids or alkalis should not take activated charcoal because the caustic material may have severely damaged the mouth, throat, and esophagus. Activated charcoal cannot help the damage that has already been done, and swallowing it may cause further damage. Examples of such caustic substances are oven cleaners, drain cleaners, toilet bowl cleaners, and lye.
Which of the following MOST affects the extent of damage a poison does to the body?
Patient’s age, weight, and general health CORRECT. The actual effect and extent of damage is dependent on the nature of the poison, on its concentration, and sometimes on how it enters the body. These factors vary in importance depending on the patient’s age, weight, and general health.
When treating a patient with acute abdominal pain, you should do which of the following?
Have the patient lie still and assume a position of comfort CORRECT. Allow the patient to assume a position of comfort and remain still.
Your patient is a 17-year-old with a history of asthma. She is complaining of pain in her lower abdomen. Assessment reveals that her breath sounds are clear and equal, she has a respiratory rate of 28 breaths per minute, a heart rate of 96 beats per minute, and a blood pressure of 112/74 mmHg. Which of the following is the MOST appropriate next step?
Provide high-concentration oxygen. CORRECT. Emergency care will consist of protecting the patient’s airway, oxygen as needed, placing the responsive patient in a position of comfort, placing the unresponsive patient or patient with difficulty maintaining an airway in the left lateral recumbent position, and transporting the patient to the hospital.
Pain felt in the epigastric region of the abdomen is of concern because of the possibility of which of the following?
Myocardial infarction CORRECT. Pain from a heart attack (myocardial infarction) may be felt as abdominal discomfort. This pain, often described as indigestion or digestive discomfort, is commonly felt in the epigastric region (the area below the xiphoid, in the upper center of the abdomen). All epigastric abdominal pain should be considered cardiac in nature until proven otherwise.
Pain that the patient feels in a body part or area of the body that has nothing to do with a diseased organ is termed:
referred pain. CORRECT. Referred pain is felt in a body part other than its point of origin. Pain associated with abdominal and other conditions can be referred or felt in other areas of the body. This phenomenon is associated with the proximity of separate nerve tracks as they enter the spinal cord.
You are called to a nursing home for an 85-year-old patient complaining of abdominal pain. The patient has a history of dementia and cannot describe the pain to you. The nurse states the patient has n vomiting dark coffee ground emesis for about an hour. His blood pressure is 90/40, pulse 100, and respiratory rate of 24. Aside from the airway, what is your greatest concern?
The patient will go into hypovolemic shock. CORRECT. Coffee ground emesis is the result of partially digested blood. The patient is suffering from internal GI bleeding. The greatest complication from internal bleeding is hypovolemic shock.
You are called to a residential neighborhood at 12:30 A.M. Your patient has just finished eating a super-sized meal of deep fried fish. He is now complaining of a “crampy” pain in the right upper quadrant and has had two episodes of nausea and vomiting with a green emesis. What condition do you suspect that your patient is experiencing?
Cholecystitis CORRECT. Cholecystitis or inflammation of the gallbladder is commonly precipitated by ingesting food high in saturated fat and will occur many times after eating. The green vomitus is likely due to the obstruction of the bile duct.
You are examining a 24-year-old female patient with lower quadrant abdominal pain. What is the MOST lethal possibility?
Ectopic pregnancy CORRECT. Ectopic pregnancy is a potentially fatal condition that presents with lower quadrant abdominal pain.
Your patient is a 35-year-old female with abdominal pain. Which of the following findings CANNOT be attributed to the patient experiencing pain?
Decreased level of consciousness
Which of the following questions is inappropriate when taking the history of a female patient with abdominal pain?
what is your sexual orientation? CORRECT. Knowing a patient’s sexual orientation is not appropriate as the patient’s answer would not change your approach in assessing and treating the patient.
Your patient is a 60-year-old male who is complaining of severe epigastric abdominal pain and difficulty breathing. He is pale, sweaty, and pleads with you, “Don’t let me die, I think I’m going to die.” Which of the following measures is NOT part of your initial treatment of this patient?
Applying the defibrillator pads to his chest CORRECT. The patient that is conscious should not have the defibrillator pads placed on their chest.
Organs of the right upper quadrant include:
most of the liver, gallbladder, and part of the large intestine. CORRECT. The organs of the right upper quadrant include most of the liver, gallbladder, and part of the large intestine.
Which of the following is of greatest concern for the EMT in the prehospital care of a woman with vaginal bleeding?
Monitoring for hypovolemic shock CORRECT. The most important concern for the EMT is to monitor the patient for hypovolemic shock.
Pain that originates in an organ, such as the intestines, is called __ pain.
visceral CORRECT. Visceral pain originates from the organs (the viscera) within the abdomen. The organs themselves do not have a large number of nerve endings to detect pain. Therefore, visceral pain is often described as dull, achy, or intermittent and may be diffuse, or difficult to locate. The patient may say he has abdominal pain but cannot point to a specific location.
You are called to a 25-year-old male complaining of right lower quadrant (RLQ) pain. His other symptoms are nausea and vomiting, fever, and decreasing pain in the umbilicus area. As an EMT, you feel this patient might have:
appendicitis. CORRECT. A person who has an appendicitis, will have signs and symptoms that include nausea and sometimes vomiting, pain in the area of the umbilicus (initially), followed by persistent pain in the right lower quadrant (RLQ).
You respond to a 75-year-old female who is complaining of epigastric pain that feels like heartburn and radiates to the right shoulder. Her vital signs are stable and she has a previous history of myocardial infarction. She has prescription nitroglycerine tablets. An ALS unit is en route. After performing a physical examination and applying oxygen by nasal cannula, you should:
contact medical control regarding the administration of the patient’s nitroglycerin. CORRECT. Cholecystitis and myocardial infarction both can have epigastric abdominal pain and are difficult to distinguish in the field. The correct diagnosis requires blood tests, 12-lead EKG interpretation, and possibly ultrasound. Medical control should be contacted regarding the administration of nitroglycerin for a possible myocardial infarction.
Your patient was diagnosed with cholecystitis (gallbladder inflammation) three days ago. The patient now presents with nausea, vomiting, and pain in the right shoulder. The pain in the shoulder can be classified as:
referred pain. CORRECT. Irritation under the diaphragm can cause referred pain that can present as shoulder pain.
Which of the following is NOT true concerning abdominal pain in geriatric patients?
The elderly person may not be able to give a specific description of the pain.
Most organs of the abdomen are enclosed within the:
peritoneum. CORRECT. Most of the organs of the abdomen are enclosed within the peritoneum. These organs include the stomach, liver, spleen, appendix, small and large colon, and in women the uterus, fallopian tubes, and ovaries. There are two layers of the peritoneum: the visceral peritoneum, which covers the organs, and the parietal peritoneum, which is attached to the abdominal wall.
Which of the following is a cause of gynecological emergencies?
All of the above CORRECT. Soft-tissue trauma, sexual assault, and disorders of the female reproductive organs are all causes of gynecological emergencies.
You respond to a 65-year-old patient complaining of abdominal pain. Your physical exam reveals a nonpulsating mass in the lower left quadrant. You suspect:
hernia. CORRECT. A nonpulsating mass in the lower left quadrant is most likely a hernia.
You are called to the scene of a 16-year-old female patient complaining of severe lower quadrant abdominal pain. The patient states she is sexually active. Upon palpation, you observe rebound tenderness in the right lower quadrant. You suspect:
appendicitis. CORRECT. Although both appendicitis and ectopic pregnancy have lower right quadrant pain, rebound tenderness is the hallmark of appendicitis.
Which of the following is NOT a cause of abdominal pain?
Stroke CORRECT. You may be called to evaluate patients who have complaints that appear nonspecific but involve the digestive system. Nausea, vomiting, and diarrhea are examples. Some of these complaints will result from digestive system disorders, whereas other causes could be cardiac issues, diabetic issues, food poisoning, or the flu. Stroke will cause headaches and problems with speech, coordination, and senses like eyesight, but will not cause abdominal pain.
You respond, along with fire department Emergency Medical Responders, to a 48-year-old female having a syncope episode in the bathroom. You find the patient sitting on the commode vomiting into the trash can. The vomitus appears to look like coffee grounds and has a foul smell. The patient is pale and has n weak for the past few days. She has:
GI bleeding. CORRECT. Bleeding can occur from within the GI system anywhere from the esophagus to the rectum. Depending on the size of the source blood vessel, GI bleeding may be gradual or sudden and massive. Because this type of bleeding occurs inside the lumen of the esophagus, stomach, or intestines, blood eventually has to pass out through the rectum and/or through the mouth. Patients may report the passage of abnormal stools that are dark black or maroon in color and tarry in appearance, or they may simply pass frank blood without stool from the rectum. If the patient is bleeding from an upper GI source (the esophagus, stomach, or first portion of the small bowel), he also may exhibit vomiting of frank blood or “coffee-ground” vomit.
The detection of a bulging mass through the belly button that is not pulsating should make the EMT suspicious that the patient may be suffering from which of the following?
Hernia
You are called to a nursing home for an 85-year-old patient complaining of abdominal pain. The patient has a history of dementia and cannot describe the pain to you. The nurse states the patient has n vomiting dark coffee ground emesis for about an hour. His blood pressure is 90/40, pulse 100, and respiratory rate of 24. Why should the EMT use an oxygen mask with caution?
The patient cannot clear any additional emesis. CORRECT. The patient has dementia and is vomiting. Therefore, the patient may not have the mental capability to remove the mask while vomiting. The mask will hold the emesis in and increase the chances of the patient aspirating the emesis.
Which of the following is true concerning parietal pain?
It is generally localized to a particular area. CORRECT. Parietal pain is a localized, intense pain that arises from the parietal peritoneum, the lining of the abdominal cavity.
You are called to a nursing home for an 85-year-old patient complaining of abdominal pain. The patient has a history of dementia and cannot describe the pain to you. The nurse states the patient has n vomiting dark coffee ground emesis for about an hour. His blood pressure is 90/40, pulse 100, and respiratory rate of 24. In what position should you transport the patient?
. Semi-Fowler’s CORRECT. Although the patient is in compensated shock, the possibility of aspiration is the more pressing concern. The semi-Fowler’s position will minimize any aspiration from continued vomiting.
You are called to a residence for a 48-year-old male patient. He is lying in bed and is incoherent. He is unable to follow commands. His blood pressure is 80/40, pulse 136, and respiratory rate of 36. His wife states that he had lower right abdominal pain for about two days and it progressively worsened. He said about an hour ago he had a sudden increase in pain and then became incoherent. The wife states the husband refused to see a doctor before, but she finally called 911. You suspect:
peritonitis. CORRECT. Since the patient’s pain has suddenly worsened followed by a decrease in level of consciousness, the symptoms indicates that the appendix has ruptured and peritonitis has set in. Peritonitis is a bacterial infection within the peritoneal cavity and is a serious threat to life.
Which of the following is NOT a cause of parietal pain?
Muscle spasm CORRECT. Parietal pain may be sharp or constant and localized to a particular area. When obtaining the history, you may find the patient will describe this type of pain as worsening when he moves and getting better when he remains still or lies with the knees drawn up. Muscle spasm pain would present as a sharp stabbing pain over the skeletal muscle involved, which does not happen with parietal pain.
Your patient is a 34-year-old male complaining of pain “in his right side.” He is pale and diaphoretic with a heart rate of 90 beats per minute, a respiratory rate of 28 breaths per minute, and a blood pressure of 132/80 mmHg. The patient is very agitated and anxious. Which approach is most appropriate?
Reassure him that you will make him as comfortable as possible and get him to the hospital for additional care. CORRECT. The focus of your assessment process will be to accurately perform a secondary assessment to describe the condition and identify potentially serious conditions such as shock. Since patients with abdominal pain may have an increased pulse simply as a result of the pain, serial vitals taken over time will help identify potentially dangerous trends. Calming, placing the patient in a position of comfort, and administering oxygen may actually reduce the pulse, which is a good sign.
When the gallbladder is diseased, the pain is not only felt in the right upper quadrant (RUQ) but also in the right shoulder. This is known as:
referred pain. CORRECT. Referred pain is pain felt in a place other than where the pain originates.
You are responding to a 52-year-old male patient complaining of heartburn with epigastric pain. The patient’s vital signs are stable and he does not have any pain upon palpation. He has a history of reflux disease and is on several medications for heartburn and acid reflux. What is your greatest concern with this patient?
He is suffering from a myocardial infarction. CORRECT. Signs and symptoms of a myocardial infarction often mimic the signs and symptoms of reflux disease. A myocardial infarction has a high fatality rate and should be the greatest concern for the EMT with a patient experiencing epigastric pain.
Which of the following organs is located in the retroperitoneal space?
. Kidneys CORRECT. The organs in the retroperitoneal area include the kidneys, the pancreas, and the aorta.
Your patient is a 40-year-old female who has n experiencing abdominal pain and vomiting for 2 days. She is now responsive to verbal stimulus; has cool, dry skin; a heart rate of 116; respirations of 24; and a blood pressure of 100/70. Which of the following is the BEST position for transporting this patient?
Left lateral recumbent with the legs bent CORRECT. Since she has altered mental status (AMS) the best choice is left lateral recumbent, especially if she vomits, rather than supine, Fowlers, or semi-Fowlers positions which may lead to aspiration if vomiting occurs.
You respond to an abdominal pain call. Your partner suspects that the patient is having an abdominal aortic aneurysm (AAA). What type of pain is the patient most likely experiencing?
Tearing CORRECT. In cases of abdominal aortic aneurysm, you may palpate a pulsating mass (abnormal bulge or lump). This mass may be found in conjunction with tearing or sharp pain in the back. Tearing pain is the hallmark of an abdominal aortic aneurysm (AAA). Patients experiencing parietal, visceral, and referred pain do not have a feeling of tearing. The aorta is the only structure capable of feeling the tearing sensation associated with dissection of the layers of the artery.
You are called to the scene of a patient with abdominal pain. Upon arrival, you find a 38-year-old Asian man on the floor next to his desk writhing in pain. He is complaining of severe right-sided flank pain. His blood pressure is 140/90, pulse 100, and his skin is ashen and diaphoretic. You suspect:
renal colic. CORRECT. Severe, writhing flank pain is the hallmark of renal colic (kidney stones).
You are treating a 38-year-old female patient with abdominal distress. The patient’s vital signs are stable and you are getting ready to transport. What is the BEST position to transport the patient?
On side with knees bent CORRECT. Having the patient bend her knees will relax the abdominal muscles and help to improve her level of comfort while still allowing for adequate use of the stretcher’s seat belts. Many patients in abdominal pain will instinctively curl up in the fetal position for this reason.
Which of the following is a characteristic of referred pain?
It is felt in a location other than the organ causing it. CORRECT. Referred pain is pain felt in a place other than where the pain originates. For example, when a gallbladder is diseased, pain is often felt not in the area of the gallbladder but, instead, in the area of the right shoulder blade. This is because nerve pathways from the gallbladder return to the spinal cord by way of shared pathways with nerves that sense pain in the shoulder area. Referred pain into the shoulder is also a common complaint associated with ectopic pregnancies.
You arrive on the scene to find an approximately 60-year-old male patient writhing on the floor. He is complaining of a tearing pain radiating to his lower back. He has absent femoral pulses and has a pulsatile mass just superior to his umbilicus. You suspect which of the following conditions?
Abdominal aortic aneurysm CORRECT. The pulsatile mass, tearing pain radiating to the lower back, and the absent femoral pulses are signs indicative of an abdominal aortic aneurysm that is currently rupturing.
Which abdominal quadrant contains the appendix?
Right lower CORRECT. The appendix is in the right lower quadrant.
Which of the following is a concern when caring for the patient with abdominal pain?
All of the above CORRECT. The focus of your assessment process will be to accurately perform a secondary assessment to describe the condition and identify potentially serious conditions such as shock. Since patients with abdominal pain may have an increased pulse simply as a result of the pain, serial vitals taken over time will help identify potentially dangerous trends. Calming, placing the patient in a position of comfort, and administering oxygen may actually reduce the pulse, which is a good sign.
The patient complaining of parietal abdominal pain would concern you the MOST is the one who:
. is lying on the floor very still and quiet with his knees drawn up to his chest. CORRECT. Patients suffering from acute parietal abdominal pain try to stay completely still and quiet to decrease the pain. Drawing the knees to the chest releases some of the tension on the abdominal muscles and can slightly reduce the pain.
In what position should the patient complaining of severe abdominal pain be placed if there are no signs or symptoms of shock?
One of comfort CORRECT. When treating a patient with acute abdominal pain without signs of hypoperfusion (shock), you should place the patient in the position of most comfort. Typically, patients with acute abdominal pain position themselves bent over at the waist with their knees bent and drawn up toward their chest. Often this position reduces the tension on the abdominal muscles, thus reducing pain.
Which of the following questions may help the EMT assess a patient with abdominal pain?
All of the above
You respond to the scene of a 50-year-old male complaining of severe abdominal pain. He has a history of alcohol and drug abuse. His vital signs are stable and he presents with epigastric pain that radiates to the back. He has guarding and point tenderness in the upper quadrants. You suspect:
pancreatitis. CORRECT. The patient’s alcoholic history, along with epigastric pain that radiates to the back, most likely indicates pancreatitis. It is important to remember that only a physician in a hospital setting can make the final diagnosis.
Which of the following is the main focus of the EMT’s assessment and history taking of the patient with abdominal pain?
Determining the presence of shock CORRECT. There are many potential causes of abdominal pain that the EMT should not be concerned with field diagnosing a particular cause. The focus of your assessment process will be to accurately perform a secondary assessment to describe the condition and identify potentially serious conditions such as shock.
You respond to a 75-year-old female who is complaining of epigastric pain that feels like heartburn. The pain radiates to the right shoulder. Her vital signs are stable and she has a previous history of a myocardial infarction. She has prescription nitroglycerin tablets. She is most likely suffering from:
cholecystitis. CORRECT. The referred right shoulder pain makes cholecystitis the most likely answer.
With the exception of the __, most abdominal organs are not able to sense tearing sensations.
aorta CORRECT. Most abdominal structures or organs (like the liver, ovaries, or colon) do not have the ability to detect tearing sensations. The exception is the aorta and the stomach. In cases of an expanding abdominal aortic aneurysm (AAA), the inner layer of the aorta is damaged and blood leaks from the inner portions of the vessel to the outer layers. This causes a tearing of the vessel lining and pockets of blood resting in a weak area of the vessel. Much like a balloon, the area of collected blood creates an expanding pouch in the blood vessel wall. This is often sensed as a “tearing” pain in the back.
Which of the following structures is (are) NOT located in the abdominal cavity?
Kidneys CORRECT. The area outside the peritoneum is called extraperitoneal space, which includes the retroperitoneal space, the area between the abdomen and the back. The organs in the retroperitoneal area, which is technically not part of the abdomen, include the kidneys, the pancreas, and the aorta.
Which patient is experiencing visceral pain?
45-year-old female complaining of abdominal pain “all over” CORRECT. Visceral pain is often diffuse in nature, making it difficult for the patient to identify the exact location. A patient who is experiencing abdominal pain “all over” would have visceral pain.
Your patient is a 22-year-old male who has ingested a large amount of alcohol and is vomiting. He is conscious but uncooperative. He allows you to examine him but refuses transport to the hospital. You have sought assistance from law enforcement on scene. Which of the following is the BEST action?
Contact medical control for further advice. CORRECT. In this case the best course of action is to contact medical direction for further advice, including the possibility of soft restraints and transport. The patient is a threat to himself or herself so transport is warranted. Do not delay transport after contacting medical direction for further insight as to patient treatment.
Neurotransmitters are chemicals within the body that transmit the message from the distal end of one neuron (presynaptic neuron) to the proximal end of the next neuron (postsynaptic neuron). While it sounds like a complicated process, it takes only milliseconds. Which one of the following sentences is false?
After the impulse is transmitted, the neurotransmitter goes through a process called reuptake, in which the neurotransmitter is returned to the postsynaptic neuron. CORRECT. After the impulse is transmitted, the neurotransmitter goes through a process called reuptake, in which the neurotransmitter is returned to the presynaptic neuron, not the postsynaptic neuron.
Which of the following may cause a patient to exhibit abnormal behavior?
Hypoxia CORRECT. Lack of oxygen to the brain (hypoxia) is a major cause of abnormal behavior in patients.
Which of the following does NOT indicate that a patient may be about to become violent?
Crying CORRECT. Crying by itself is not an emotion that may lead to violent behavior or outbursts.
Which of the following communication strategies should be used in dealing with a patient with a behavioral emergency?
Acknowledge the patient’s feelings
Which of the following factors suggest that a patient is at risk for suicide?
All of the above CORRECT. Those patients that are at an increased risk for suicide include those with: recent emotional trauma, sudden improvement or worsening in depression, and alcohol/drug abuse.
When responding to an attempted suicide, which of the following is the EMT’s primary concern?
Personal safety CORRECT. The most important consideration for an attempted suicide is for the EMT to be concerned with personal safety.
It can sometimes be difficult to determine whether someone who is showing unusual behavior is having a psychological emergency or is showing an altered level of consciousness due to a physical issue. Which of the following statements are true?
- Consider patients who are exhibiting crisis or unusual behavior to be having an altered mental status from a nonpsychiatric cause until proven otherwise.
- Many medical and traumatic conditions are likely to alter a patient’s behavior.
- Lack of oxygen may cause restlessness and confusion, cyanosis (blue or gray skin), and altered mental status.
- Stroke or inadequate blood to the brain may cause confusion or dizziness and what appears to be erratic behavior.
1, 2, 3, 4 CORRECT. All of the answers can cause an altered level of consciousness. An altered level of consciousness, regardless of its cause, can mimic a psychological emergency. A patient with altered mental status should be assessed for medical and traumatic conditions first rather than deeming a psychiatric cause is to blame. Patients should be assessed for signs and symptoms of stroke and hypoxia.
It is often difficult to distinguish a true medical emergency from a psychiatric emergency. You are confronted with a patient experiencing personality changes ranging from irritability to irrational behavior, altered mental status, amnesia or confusion, irregular respirations, elevated blood pressure, and decreasing pulse. It appears to be a psychiatric emergency. What else could also likely cause this behavior?
Head injury CORRECT. Head trauma can cause personality changes ranging from irritability to irrational behavior, altered mental status, amnesia or confusion, irregular respirations, elevated blood pressure, and decreasing pulse. Decreasing pulse, irregular respirations, and hypertension are signs of a closed head injury with ICP, displaying Cushing’s Triad.
You are dispatched to a local fast-food restaurant for a “nature unknown” call. You arrive on-scene and find a 47-year-old male in front of the counter repeatedly singing “Happy Birthday” to himself. Police are on-scene and the scene is safe. Which of the following would be considered appropriate care?
Quietly and carefully evaluate the situation and keep your emotions under control. Be as unhurried as you can. CORRECT. Be as unhurried as you can. Let the patient know that you are there to help. Speak slowly and clearly. Use a calm and reassuring tone. Listen to the patient. You can show you are listening by repeating part of what the patient says back to him. Threatening the patient with the police or possible restraining of the patient will only cause the situation to escalate. Remaining calm is the most important action by the EMT.
Which of the following traumatic conditions may account for signs and symptoms of a behavioral emergency?
Internal hemorrhage CORRECT. Internal hemorrhage with a substantial blood loss associated with it could account for a behavioral emergency.
When restraining a patient, which of the following is NOT a consideration?
Patient’s informed consent CORRECT. Informed consent in the case of restraining is not required as a consideration for the EMT.
Which of the following is NOT an acceptable method or adjunct in restraining a patient?
Hog-tying the patient CORRECT. Patients should never be restrained in a prone position or in any position that threatens movement of the chest wall. Monitor the patient’s airway. Never “hog tie” the patient or restrain the patient in any manner that will impair breathing. Patients who have been improperly restrained have died as a result of a condition often referred to as positional asphyxia.
EMTs may come across a situation where a patient begins to act extremely agitated or psychotic. Elevated temperature and sometimes alcohol or drug intoxication may be present. The patient will soon cease struggling, and often within minutes the patient develops inadequate or absent respirations and subsequently dies. It is important for the EMT to be alert for this sequence of events in a patient who exhibits this behavior and monitor the patient constantly throughout the call. This condition is called:
excited or agitated delirium. CORRECT. The medical literature refers to a condition called excited delirium (also called agitated delirium). In this condition, a patient begins to act extremely agitated or psychotic.
You respond to the scene of a private residence for a patient who is a known insulin-dependant diabetic patient. The patient is combative and cursing as you approach. Should this patient be restrained?
There is not enough information to answer this question. CORRECT. In the scenario above there is not enough information. We would need to know as the patient’s vital signs, including the patient’s blood glucose level.
According to coworkers, your 25-year-old female patient suddenly began acting aggressively and being verbally abusive. She tells you she is “starving” and you notice that she is pale and diaphoretic. Which of the following would be an appropriate general impression?
An underlying physical illness CORRECT. A patient that complains of starving and is pale and diaphoretic may be experiencing a hypoglycemic/hyperglycemic episode or some other physical illness. Medical conditions should always be investigated first rather than ruling a situation as alcohol intoxication or as schizophrenia or another behavioral disease.
Which of the following must be treated by the EMT if present in a patient with an apparent behavioral emergency?
Hypoglycemia CORRECT. It is important for the EMT to treat a hypoglycemic episode in a behavioral situation.
You are on the scene of a possible overdose. You find a 30-year-old man pacing about his living room. There is evidence of illicit drug use and the apartment is in disarray. The patient seems agitated and nervous. Attempts at calming the patient should include which of the following?
Repeat part of what the patient is saying to show that you are listening to him. CORRECT. You should listen to the patient, and show you are listening by repeating part of what the patient says back to him. This would be the most effective technique at calming down the patient.
When a patient or bystander at the scene of an emergency displays fear, anger, or grief, this is best described as which of the following?
Stress reaction CORRECT. When faced with severe, unexpected stress, most patients will display emotions such as fear, grief, and anger. These are typical stress reactions at an accident scene and common reactions to serious illness and death.
Which of the following statements concerning forcible restraint of patients is true?
This is normally considered to be within the jurisdiction of law enforcement. CORRECT. Forcible restraining is considered under the auspice of the law enforcement and should always involve them if practical.
Which of the following statements concerning behavioral emergencies is true?
. It may be difficult to determine what behavior is abnormal for a given person in a given situation. CORRECT. It may be difficult to determine what behavior is abnormal for a given person in a given situation.
All of the following are general rules in dealing with a psychiatric patient except
do not be judgmental; instead, show pity, as he needs to know that you understand him. CORRECT. Pity is inappropriate and can tend to aggravate the situation. What you need to do is show compassion.
It is important that, as an EMS provider, you avoid creating a situation where positional asphyxia could occur. Which of the following is positional asphyxia?
Positional asphyxia is inadequate breathing or respiratory arrest caused by a body position that restricts breathing. CORRECT. Positional asphyxia is inadequate breathing or respiratory arrest caused by a body position that restricts breathing. Typically, it can occur when a person is “hog-tied” or placed in a prone position with his hands secured behind him.
Which one of the following statements is NOT true?
It is very unusual for an EMT to be called for a psychiatric emergency. CORRECT. It is actually a very common occurrence for an EMT to be called for a psychiatric emergency.
Your patient is a 37-year-old male sitting on the kitchen floor. His wife is attempting to talk with him, but he does not look at her or answer. He is fidgeting and has apparently thrown some dishes against the wall. What should be your first consideration?
. Stay a safe distance away. CORRECT. The first consideration on the scene of the behavioral emergency is personal safety by the EMT.
Which of the following statements concerning people who have made prior suicide attempts is true?
They are at an increased risk for a subsequent successful suicide. CORRECT. Patients with prior suicide attempts are at an increased risk for a subsequent successful suicide.
When dealing with a psychiatric emergency, which one of the following would generally be inappropriate behavior on your part?
Be as hurried as you can. It is extremely important to resolve the call and get the patient to the hospital as soon as possible. CORRECT. The assessment of the behavioral emergency patient must be slow and methodical, devoid of sudden movements and hurriedness which may provoke the patient. A thorough assessment is important for these patients. If you rush your patient assessment and interview, the patient may feel as if the situation is out of control. The patient also may believe that you are concerned about the problem but not about him. Let the patient know that you are there to help him.
Your patient is a 24-year-old male who is severely depressed. He tells you that he can’t “handle the pressure” anymore and that he wants to die. He is refusing transport. Which of the following is the most appropriate decision regarding this patient’s care?
Transport the patient against his will with the assistance of law enforcement. CORRECT. A patient that is threatening to harm themselves is a menace to society and must be transported, even if it is against their will with the completed documents from law enforcement. The patient must be transported to an appropriate facility for further evaluation and treatment.
You are dispatched to a suicide attempt. You arrive to find a 16-year-old, who is extremely agitated and pacing up and down in the living room of his house. Apparently, he had threatened to go out, get a gun, and shoot himself. The parents called it in as an attempted suicide. The scene is safe and there are apparently no weapons accessible to the patient. Which of the following would NOT be appropriate in caring for this patient?
Make certain the patient gets between you and the door. The patient should always feel he has an escape route. CORRECT. The escape route is for you, not for the patient. Make sure the patient does not get between you and the door. If the scene becomes unsafe it is imperative that you have a way out.
When providing emergency care to an aggressive or hostile patient, what is the highest priority?
Performing a scene size-up CORRECT. The highest priority when providing emergency care to an aggressive or hostile patient is to perform a scene size-up. If there are indications at the time of dispatch that the call may involve a potentially violent or agitated patient, then police should be requested to respond to the scene, arriving ahead of EMS units to ensure the scene is safe (“secure”) for EMS to enter. You should not enter the scene until it is safe to do so.
You are called to the scene of an attempted suicide. You arrive to find a 25-year-old man sitting on the sofa who apparently cut his wrists. Family members have bandaged them, and there does not appear to be any bleeding risk at this time. The scene is secure. Which action would you NOT take in treating this patient?
Make sure you take charge of the situation. Let the patient know that what he has done is wrong. Tell him he is coming with you whether he likes it or not. Do not worry about gaining the patient’s confidence. Take charge. The patient must know that you are the boss. CORRECT. You should not try to take charge of the situation, as this may anger the patient even more. You should speak slowly and await the patient to answer your questions. Try to gain the patient’s confidence by explaining what questions must be answered and what must be done as part of the physical exam and taking vital signs. Let the patient know that you think it would be best if he goes to the hospital and that you need his cooperation and help. Back off if necessary. If the patient’s fear or aggression increases, do not push the issues of the examination or transport. Instead, try to reestablish the conversation and give the patient more time before you again suggest that going to the hospital is a good idea.
Which of the following is appropriate when assessing an emotionally disturbed patient?
Both A and B CORRECT. The best answer choice is the combination of maintaining eye and verbal contact along with avoiding arguing.
You are dispatched to a psychiatric emergency for a 68-year-old male. Dispatch provides no other information and, when questioned by you, they do not have any more information. Although all steps are important in dealing with this situation, which step is the MOST important?
Scene size-up CORRECT. Scene size-up and scene safety is the most important step in dealing with any psychiatric emergency. Is the scene safe for you and the other providers is the primary question for the EMT to answer.
which of the following should NOT be included in documentation of an incident involving a patient with a behavioral or psychiatric emergency?
Whether or not you think the patient is mentally ill CORRECT. Personal opinions by the EMT of whether the patient is mentally ill or not should not be included on the patient care report.
Which of the following actions is the MOST appropriate for the EMT to take when managing a patient with a behavioral emergency?
Remain calm and reassure the patient. CORRECT. The most appropriate initial action for the EMT to take is to remain calm and reassure the patient.
Concerning attempted suicide, which of the following statements is true?
all suicide attempts must be taken seriously, even if the method seems insincere. CORRECT. All suicide attempts must be taken seriously, even if the method seems insincere.
When a person acts in a manner that is unacceptable to himself or those around him, this would be considered which of the following?
Behavioral emergency CORRECT. A behavioral emergency exists when a person exhibits abnormal behavior-that is, behavior within a given situation that is unacceptable or intolerable to the patient, the family, or the community. Frequently behavioral emergencies involve behavior that is potentially harmful to the patient or to the people that interact with the patient. Behavioral emergency is a blanket term for what is considered mental illness, psychotic episodes, and psychosomatic reactions, which are narrow focus terms and not all encompassing as behavioral emergencies.
Which of the following medical conditions may be the underlying cause of an apparent behavioral emergency?
All of the above CORRECT. Medical conditions (such as stroke and hypoglycemia) can coexist with underlying psychiatric or behavioral issues (mental illness), sometimes making chronic behavioral symptoms worse.
Which of the following situations generally allows the EMT to transport a patient with a behavioral emergency against his or her wishes?
The patient is a threat to himself or others. CORRECT. The behavioral patient that is a threat to themselves or others may be transported against their will. The patient in this case would not have the right of refusal of care due to being considered a potential threat to societal norms of behavior.
Once you have established with reasonable certainty that your patient is suffering from a behavioral emergency, which of the following is the best course of action?
Attempt to determine if there is a possible physical cause for the patient’s behavior. CORRECT. The best course of action is to determine if there is a physical cause for the patient’s behavior.
Your patient is a 15-year-old female who has n diagnosed with a personality disorder. She has no history of violent behavior. The staff at her residential care facility wants her to be transported for evaluation of a possible urinary tract infection. Which of the following is the BEST way to handle this situation?
Have a female EMT attend to the patient. CORRECT. It is important to always try to get a female EMT to attend to a female patient with a behavioral emergency, if possible.
Concerning behavioral emergencies, which of the following statements is true?
A patient who does not respond to crisis management techniques may be restrained for transport to a psychiatric facility.
Which of the following is acceptable when managing the patient with a behavioral or psychiatric emergency?
Make supportive statements such as, “That must have been very hard for you.” CORRECT. Empathetic statements will go a long way in building a rapport with the patient.
You are on the scene where a 23-year-old female has attempted suicide by cutting her forearms with a razor. She is sitting in the front yard and has lost a large amount of blood. She is conscious and holding a small razor blade, and tells you to get away from her. Which of the following should NOT be done?
Take the razor blade away from her by force. CORRECT. On the scene of an attempted suicide an EMT should never take the razor blade away from a patient by force.
There are general rules when dealing with psychiatric emergencies. Which of the following is NOT one of those rules and would be considered inappropriate?
Never make eye contact with the patient, as it will just increase his nervousness. CORRECT. You should make eye contact; it will show him that you are concerned for him and will try to help him out of the situation.
Your patient is exhibiting bizarre and aggressive behavior; he starts shouting and becomes violent. He has extra strength and appears insensitive to pain. Drug paraphernalia is visible on-scene. This behavior is known as:
excited delirium. CORRECT. A patient experiencing an excited delirium (also called agitated delirium) will begin to act extremely agitated or psychotic. It is believed that a patient with this condition has an elevated temperature and sometimes alcohol or drug intoxication. The patient will cease struggling, and often within minutes the patient is found to have inadequate or absent respirations and subsequently dies.
As an EMT, it is important that you be able to do all of the following except:
provide counseling and advice to patients with personal problems. CORRECT. The EMT however is not a licensed counselor and should not be in the habit of giving advice for personal problems.
Which of the following findings would be helpful in differentiating between a closed head injury and a behavioral emergency?
Unequal pupils CORRECT. A patient with unequal pupils would more likely have a closed head injury and not a behavioral emergency as unequal pupils demonstrates an underlying structural condition.
Which of the following patients would be considered to be at the greatest risk for suicide?
22-year-old man who has lost his job and is getting divorced CORRECT. A person that has recently lost a job and is going through a divorce is a greater risk for suicide.
Which of the following statements regarding behavioral emergencies is NOT true?
It would be unusual to find a person with schizophrenia outside a mental health facility. CORRECT. It is actually very common to find a person with schizophrenia outside a mental health facility.
When managing a patient who may hurt himself or others, you should do all of the following except:
make sure only you and the patient are in the room. CORRECT. You never want to be the only other person in the room with a patient threatening to harm themselves or others. Always have another person as back-up and as a witness.
Which of the following is the BEST defense for an EMT when facing allegations of misconduct from a mentally ill patient?
Providing accurate and complete documentation, supported by a third-party witness CORRECT. Documentation of complete and accurate patient treatment, witnessed by a third party is one of the best defenses in a civil tort case.
You have responded to a call about a “psychiatric patient” to find a 24-year-old woman talking to herself in her home. She is rocking back and forth and you can see from a distance that she is perspiring profusely. You also see an empty medication bottle on the floor. She does not acknowledge your presence. When you attempt to speak to her, she continues to talk to herself as if you were not there. Which of the following should be included in your actions at the scene?
Ensure that law enforcement is responding and wait for their arrival. CORRECT. The top priority for this patient is to notify law enforcement and wait for their arrival so as to ensure personal safety. Involve law enforcement early for assistance with the behavioral patient.
Why is it important to gather a detailed medical history when dealing with a psychiatric emergency?
It will alert you to past issues as well as medication. CORRECT. The detailed medical history will alert you to past psychiatric problems, or psychiatric medications the patient may be taking (or not taking-causing the outburst).
Management of the suicidal patient includes all of the following except:
psychoanalysis of the patient by the EMT. CORRECT. A patient that is suicidal is a threat to themselves or others and should never be psychoanalyzed by the EMT. They must be transported for further evaluation and treatment by a physician.
What is the purpose of the red blood cells?
They are responsible for the delivery of oxygen to the cells. CORRECT. Red blood cells make up the majority of the cells in the circulation and give blood its characteristic red color. These cells contain specialized molecules called hemoglobin that bind to oxygen and are responsible for oxygen delivery to the cells.
Which of the following pathologies make patients at high risk for acute renal failure?
Shock CORRECT. Acute renal failure can occur as a result of shock, toxic ingestions, and other causes. Some patients who experience acute renal failure can recover normal kidney function if the underlying cause of the insult to the kidneys is rapidly identified and corrected.
You are dispatched to a private residence for a sick person. When you arrive you are told by the patient that due to the snow storm yesterday he missed his scheduled appointment at the dialysis center and is not feeling well. Your assessment does not reveal anything remarkable outside of the fact that he has missed his dialysis. Which of the steps below would NOT be part of your care?
Place the patient in a supine position. CORRECT. The patient should be placed in a position of comfort, which is usually upright. A patient that is placed supine will have difficulty in breathing.
One of the more serious diseases of the body is called renal failure. Renal failure occurs when the:
kidneys fail to function as required. CORRECT. Renal failure occurs when the kidneys lose their ability to adequately filter the blood and remove toxins and excess fluid from the body.
The medications that transplant patients need to take for the rest of their lives to prevent organ rejection also often lead to high susceptibility of:
infection. CORRECT. Patients with kidney transplants spend the rest of their lives on a special class of drugs that prevent organ rejection by suppressing the body’s immune system. However, these same drugs that help protect the transplanted kidney also make these patients more susceptible to serious infections.
The correct terminology used for patients whose kidneys are damaged to the point where they require dialysis to survive is:
end-stage renal disease. CORRECT. Patients who go on to develop irreversible renal failure-to the extent that their kidneys can no longer provide adequate filtration and fluid balance to sustain life-are defined as patients with end-stage renal disease (ESRD). Patients with ESRD usually require dialysis to survive.
Prehospital management of all the urinary system problems of the kidney transplant patient by the EMT can be characterized by:
supportive care. CORRECT. The treatment by the EMT of a kidney transplant patient involves supportive care and transport to the hospital for further assessment and treatment.
A patient with a medical history of sickle cell anemia is complaining of chest pain and shortness of breath. The patient is breathing 26 times a minute in short, shallow respirations. However, the patient’s oxygen saturation via pulse oximetry is 100% on room air. The best approach regarding supplemental oxygen is to:
place the patient on a nonrebreather mask. CORRECT. The patient is breathing with shallow respirations at a rate of 26 per minute. A nonrebreather mask would be the device to deliver enough of a volume of oxygen for this patient. It is important to treat the patient and not the monitor (pulse oximetry), thus O2 high flow via a nonrebreather mask is the best treatment option for this patient.
You are dispatched to a private residence for a sick person. You arrive and find a 47-year-old male patient who recently completed his peritoneal dialysis and complains of severe abdominal pain that is worsened by movement. One of the more serious complications of this type of dialysis is a bacterial infection within the peritoneal cavity. What would be the tell-tale sign that this is what is happening in this case?
The patient’s dialysis fluid appears cloudy when it is drained from the peritoneal cavity rather than its normal clear appearance. CORRECT. Patients on peritoneal dialysis who develop peritonitis may develop abdominal pain, fever, and the tell-tale sign that their dialysis fluid appears cloudy when it is drained from the peritoneal cavity rather than its normal clear appearance. Infected peritoneal dialysis fluid is much like chicken broth in color and turbidity.
Approximately how many Americans are currently on some type of dialysis?
400,000 CORRECT. Almost a million Americans have end-stage renal disease, and more than 400,000 of these patients are on chronic dialysis.
You are dispatched to an unconscious hemodialysis patient. On arrival to the dialysis clinic, the patient is unresponsive, apneic, and pulseless. You secure the ABCs, begin ventilation, and initiate chest compressions. However, the patient’s cardiac arrest rhythm is continuously unresponsive to defibrillations with your AED. The best approach is to:
begin transporting and contact an ALS intercept. The patient’s dysrhythmia may be related to kidney failure. CORRECT. End-stage renal disease patients who suffer cardiac arrest may not respond to defibrillation from an AED. Paramedics carry certain drugs that can be administered in the field to help stabilize ESRD-induced dysrhythmias. Consider ALS backup, but do not delay transport to the hospital.
Once you encounter uncontrolled bleeding from an AV fistula, which of the following methods would you consider using to control bleeding in addition to direct pressure and elevation?
Hemostatic dressings CORRECT. Immediately control any serious bleeding from the site of the A-V fistula. Use direct pressure, elevation, and hemostatic dressings as needed, if protocol allows.
Which of the following organs may seriously be damaged in sickle cell anemia, and often subsequently leads to severe infections?
Spleen CORRECT. The spleen may be seriously damaged in sickle cell anemia as it filters the blood and can become blocked by the abnormal red blood cells. Because the spleen is important in fighting infections, its loss places patients with sickle cell anemia at higher risk for severe, life-threatening infections.
A patient with renal disease who is currently on dialysis and missed an appointment may present with dangerously high levels of the electrolyte:
potassium. CORRECT. Because these patients lack the ability to rid the body of excess fluid, patients who have missed dialysis will often present with signs and symptoms similar to those seen in congestive heart failure. In addition, because patients with ESRD can no longer balance and clear excess electrolytes as well as other toxins, patients who have missed dialysis may suffer from electrical disturbances of the heart (dysrhythmias). This is because the proper functioning of the heart’s electrical system requires that the balance of electrolytes in the bloodstream be kept within a certain tight range. Elevated levels of the electrolyte potassium are particularly dangerous, and can result in patient death from dysrhythmias.
Two chronic medical conditions that dialysis patients frequently have in addition to kidney failure are and .
hypertension; diabetes CORRECT. Never forget that the vast majority of dialysis patients have other underlying diseases such as diabetes and high blood pressure, so these patients are at risk for medical emergencies related to those diseases as well, independent of their renal failure. Other medical conditions such as chronic obstructive pulmonary disease (COPD), blood clots, stroke (aneurysms), high cholesterol, and heart failure are not as prevalent in end-stage renal disease (ESRD) as what hypertension (HTN) and diabetes are.
How frequently does the majority of peritoneal dialysis require treatment?
Multiple treatments a day
Hemodialysis is used to help the kidneys filter and remove excess .
toxins; fluids CORRECT. In hemodialysis a patient is connected to a dialysis machine that pumps his blood through specialized filters to remove toxins and excess fluid.
You encounter a patient who has been having diffuse abdominal pain for one week. The patient has a pulse rate of 86, a blood pressure of 140/90, and a respiratory rate of 20. However, the patient appears pale, and complains of generalized weakness and shortness of breath during everyday activities. You suspect the patient is experiencing:
chronic anemia. CORRECT. The patient has been weak for about a week, which leads the answer to be chronic anemia versus an acute onset of anemia.
What is one of the most common diseases to affect the renal and urinary system?
Urinary tract infections CORRECT. Urinary tract infections (UTIs) are perhaps the most common disease process that afflicts the renal and urinary system. UTIs are caused by bacteria, and most UTIs are limited to the bladder, causing symptoms of painful urination and frequent urination.
Which of the following medications does NOT interfere with the blood-clotting process?
Acetaminophen CORRECT. Acetaminophen (Tylenol) is a pain reliever and anti-inflammatory and does not interfere with the blood-clotting process.
What is a cycle of filling and draining of the abdominal cavity during peritoneal dialysis called?
Exchange CORRECT. Each cycle of filling and draining the peritoneal cavity is called an exchange. A set, rotation, and trade are not the correct terms for an exchange of the abdominal cavity during peritoneal dialysis.
Approximately what percentage of United States dialysis patients treat themselves at home?
8% CORRECT. Only 8% of U.S. dialysis patients treat themselves at home with home hemodialysis or peritoneal dialysis.
The kidney’s major function(s) include(s):
All of the above CORRECT. Some of the functions of the kidneys include maintaining blood volume, balancing electrolytes, and excreting urea.
Dialysis patients who have missed an appointment may present with signs of , which is a similar presentation to .
pulmonary edema; congestive heart failure CORRECT. Because dialysis patients lack the ability to rid the body of excess fluid, patients who have missed dialysis will often present with signs and symptoms similar to those seen in congestive heart failure. These include shortness of breath, because of fluid buildup in the lungs, and the accumulation of fluids elsewhere, such as the ankles, hands, and face.
How many times a week do the majority of American hemodialysis patients receive treatment?
Three CORRECT. Dialysis at dialysis centers is generally performed three times per week.
What is continuous ambulatory peritoneal dialysis?
A gravity exchange process for peritoneal dialysis in which a bag of dialysis fluid is raised above the level of an abdominal catheter to fill the abdominal cavity and lowered below the level of the abdominal catheter to drain the fluid out
You are dispatched to a private residence for a 52-year-old African American male sitting in his living room complaining of chest pain. During your assessment, he discloses that he has the sickle cell trait. Because of this you should:
treat the patient as any other 52-year-old with chest pain. CORRECT. Patients with sickle cell trait do not suffer the complications of sickle cell anemia, have normal life spans, and require no special consideration in our treatment.
Which of the following abbreviations is NOT correct?
CAPD for continuous acute peripheral disease CORRECT. CAPD is an abbreviation for continuous ambulatory peritoneal dialysis.
Platelets are actually fragments of larger cells that are crucial to the formation of clots. Clumping (called aggregation) of platelets is the body’s most rapid response to stop bleeding from an injured site. However, in some situations the clumping of platelets is not desirable, such as when a plaque in a coronary artery ruptures. In this situation, the rapid clumping of platelets can cause a clot that then completely blocks the coronary artery and results in a heart attack (myocardial infarction). One of the most effective and widely available drugs to prevent the aggregation of platelets is:
aspirin. CORRECT. Aspirin is a medication that keeps platelets from clumping together.
Patients who dialyze at home are at high risk for what type of infection?
Peritonitis CORRECT. The most common serious complication of patients who dialyze at home is acute peritonitis, a bacterial infection within the peritoneal cavity.
There are two main types of dialysis, hemodialysis and peritoneal dialysis. The main difference between them is hemodialysis:
is usually done at a special facility and peritoneal dialysis is usually done at home. CORRECT. Hemodialysis is usually done at dialysis centers and requires about three treatments a week. Peritoneal dialysis is usually done at home but requires more frequent treatments.
__ patients are at high risk for acquiring the inherited disorder called sickle cell anemia.
African American CORRECT. Sickle cell anemia can occur in patients of African, Middle Eastern, or Indian descent but is most common in patients of African descent.
You are attending to an end-stage renal disease (ESRD) patient who has missed dialysis. Which of the following statements is most accurate?
Patients who have missed dialysis and who become unresponsive and pulseless do not respond very well to the use of an AED. CORRECT. ESRD patients who suffer cardiac arrest may not respond to defibrillation from an AED.
Why might you consider contacting medical direction before applying a tourniquet in the case of uncontrollable bleeding from an AV fistula?
Damage to the fistula may occur. CORRECT. Immediately control any serious bleeding from the site of the A-V fistula. Use direct pressure, elevation, and hemostatic dressings as needed. Generally, a tourniquet should be avoided in this situation as it may damage the A-V fistula. Contact medical direction if bleeding remains uncontrolled and you are considering tourniquet use as damage to the fistula may occur. Tourniquets are routinely used on other external bleeding after direct pressure in any other patient besides an A-V shunt bleed.
The sensation felt when palpating an arterial-venous fistula or shunt is known as a:
thrill. CORRECT. A thrill is a vibration felt on gentle palpation, such as that which typically occurs within arterial-venous fistula.
Peritoneal dialysis allows patients to dialyze at home through:
the abdomen. CORRECT. Peritoneal dialysis works by utilizing the large surface area inside the peritoneal cavity that surrounds the abdominal organs as a means of removing toxins and excess fluid from the body.
How would you define anemia?
A lack of a normal number of red blood cells in the circulation CORRECT. Anemia is a lack of a normal number of red blood cells in the circulation.
How long does a typical hemodialysis treatment last?
3 to 4 hours CORRECT. The vast majority of patients on dialysis who are treated in dialysis centers undergo three treatments a week, each lasting 3 or 4 hours.
Because of abnormally shaped hemoglobin, sickle cell anemia (SCA) patients may occasionally experience __, causing a blockage of small blood vessels.
. sludging CORRECT. The complications of SCA are generally attributed to the sludging of the abnormally shaped red blood cells, which causes blockages within the body’s small blood vessels.
Patients with a history of chronic sickle cell anemia (SCA) may present with which of the following signs and symptoms?
Pale appearance and dyspnea on exertion
You suspect a patient who has been having a difficult time controlling the bleeding following a small laceration to the foot may have a history of:
taking blood thinners. CORRECT. Patients on blood thinners are more prone to have life-threatening bleeding when they are injured than patients who are not on these medications. These patients have a difficult time controlling bleeding from even a small laceration.
Certain drugs are commonly referred as “blood thinners” or drugs that inhibit clotting. Which of the following would NOT be considered such a drug?
Prilosec CORRECT. Prilosec is used to treat ulcers or sores in the stomach and intestines.
The blood has many functions critical to a patient’s health. Which one of the listed items below is NOT a function of the blood?
Removal of carbon monoxide from the cells CORRECT. Carbon monoxide is not a typical waste product of the cells like carbon dioxide is.
You are dispatched to a sick call. The patient was just extricated from a bathtub where he was trapped under the shower door for 2 weeks. This 72-year-old male had limited access to water from the bathtub faucet. The patient is complaining of disorientation, nausea, and vomiting. What do you think is the underlying cause for the illness?
Acute renal failure CORRECT. The acute renal failure in this scenario is caused from the body being in a state of shock as compared to a chronic condition of renal failure like ESRD.
The most frequently transplanted organ is the:
kidney. CORRECT. Kidneys are the most commonly transplanted organs.
Which of the following is NOT the purpose of making airway management the highest priority of patient care when managing the patient in shock?
It allows the bronchoconstriction of the smaller airways to be reversed
Which of the following is a characteristic of venous bleeding?
It can be profuse, but is generally easily controlled. CORRECT. Venous bleeding is generally easily controlled by direct pressure.
Which of the following is a classification of the severity of shock?
Compensated CORRECT. There are two categories of severity: compensated shock and decompensated shock.
In the average adult, the sudden loss of __ cc of blood is considered serious.
. 1,000 CORRECT. A blood loss of 1,000 cc (mL) of blood is considered serious.
Which of the following will worsen the condition of the patient in shock?
Conducting oneself in a manner that increases the patient’s fear and anxiety CORRECT. Conducting oneself in a manner that increases the patient’s fear and anxiety will worsen the condition of the patient in shock.
Which of the following circumstances may result in hypoperfusion?
All of the above CORRECT. In the cases of external bleeding (hemorrhagic shock), blood vessel dilation (as in neurogenic shock), or the heart is damaged (cardiogenic shock), ensuing hypoperfusion (shock) may occur.
Which of the following vessels contain blood under the highest amount of pressure?
Arteries CORRECT. The arteries carry blood away from the heart and experience the highest pressure in them.
External bleeding may be classified according to types. Which one of the following is one of those types?
Capillary bleeding CORRECT. External bleeding may be classified according to which of the three types of blood vessels are injured and losing blood. They are arterial, venous, and capillary bleeding.
Which of the following BEST describes the delivery of oxygen and nutrients at the body’s cellular level?
Perfusion CORRECT. The adequate circulation of blood throughout the body, which fills the capillaries and supplies the cells and tissues with oxygen and nutrients, is called perfusion.
Your patient is a 6-year-old child who has fallen down while running on a sidewalk. She has abrasions on both knees and the palms of both hands, which are oozing blood. This is an example of bleeding from which of the following types of vessels?
Capillaries CORRECT. Capillary bleeding is characterized by oozing from the wound.
Which of the following is the major cause of shock that the EMT will encounter?
Hemorrhage CORRECT. Hemorrhagic shock caused by excessive blood loss is a major cause of shock that the EMT will encounter.
Which of the following is NOT indicated in the management of a patient in shock?
High-speed ambulance transportation CORRECT. High-speed ambulance transportation is never warranted for a patient in shock due to the danger of reckless driving associated with higher speeds of emergency response vehicles.
Limiting time spent at a scene can be especially important if the mechanism of injury suggests that the patient could go into shock. In order to keep the time at the scene to a minimum, which of the following assessments or treatments should NOT be performed on the scene?
Splinting swollen extremities CORRECT. In order to keep scene time as short as possible, keep procedures done at the scene to a minimum. The on-scene assessment and care should consist of the ABCs with spinal precautions, a rapid trauma exam, immobilization, and moving the patient to the ambulance. Some elements of patient assessment, such as detailed exams and treatments, are best done in the ambulance en route to the hospital (like splinting extremities).
Which of the following is NOT recommended when controlling epistaxis
Having the patient tilt the head backward to elevate the nose CORRECT. One treatment that is not warranted when controlling epistaxis is to have the patient tilt the head backward to elevate the nose.
Which of the following distinguishes decompensated shock from compensated stage of shock?
Cell damage and death in the vital organs
Which of the following blood vessels CANNOT stop bleeding by constricting?
Capillaries CORRECT. Capillaries do not possess the muscular layer that reflexively constricts the vessel in response to local injury. For this reason, capillaries continue to bleed until the clotting process is successful.
Which of the following must be kept in mind when considering the severity of external bleeding?
Signs of shock do not appear until a large amount of blood has been lost. CORRECT. When considering the severity of external bleeding it is important to remember signs of shock do not appear until a large amount of blood has been lost.
Which of the following signifies a failure in the patient’s compensatory response to blood loss?
Hypotension CORRECT. The early signs of hypoperfusion would be tachycardia, tachypnea, and pale, cool, and clammy skin. As the compensatory response mechanisms like these start to fade, hypotension would take over as an ominous sign of elevated blood loss levels, leading to decompensated shock.
Which of the following is the MOST sensitive indicator of hypoperfusion?
Altered mental status CORRECT. The most sensitive indicator of hypoperfusion is altered mental status of the patient. Altered mental status occurs because the brain is not receiving enough oxygen. When the brain is deprived of oxygen, even slightly, behavioral changes may be noted.
When deciding where to transport a patient who is in hypovolemic shock or who has the potential for developing hypovolemic shock, which of the following is the MOST important service to be provided by the receiving hospital?
Immediate surgical capabilities CORRECT. The most important consideration for a patient in hypovolemic shock is the immediate surgical capabilities of the receiving hospital.
Which of the following is the LEAST effective method of controlling bleeding?
Elevation CORRECT. Elevation of an injured extremity has never been proven to decrease bleeding.
Which one of the following is incorrect in the application of a tourniquet?
If possible, the tourniquet should be placed on a joint. CORRECT. Tourniquets should not apply the tourniquet over a joint. If the wound is on a joint, or just distal to the joint, apply the tourniquet above the joint.
Your patient is a 33-year-old man who has a gunshot wound to his right leg and has active, steady, dark red bleeding. He is awake, pale, and diaphoretic. He has a strong radial pulse of 112 per minute, a respiratory rate of 24 breaths per minute, and a blood pressure of 122/82 mmHg. He has no other injuries or complaints. Which of the following is the BEST sequence of steps in the management of this patient?
Direct pressure, high-concentration oxygen, and splinting the leg CORRECT. The best course of action in this scenario is to apply direct pressure, high-flow oxygen, and splint the leg to prevent unnecessary movement.
Which of the following is part of the body’s compensatory response to blood loss?
Blood vessels constrict and the heart rate increases. CORRECT. The body’s compensatory response to blood loss is to cause the blood vessels to constrict and the heart rate to increase so as to maintain adequate cardiac output.
As an EMT, your BEST clue indicating the possibility of internal bleeding may be the presence of:
mechanism of injury. CORRECT. Although all of the answers are signs of potential internal bleeding (such as a rigid abdomen, pain, bruising, and swelling), your best clue indicating the possibility of internal bleeding may be the presence of a mechanism of injury (MOI) that could have caused internal bleeding.
Which of the following types of vessels have valves to maintain one-way blood flow?
Veins CORRECT. Veins have valves in them to maintain the one-way blood flow back towards the heart.
Your patient has attempted suicide by slitting his wrists. You notice that he has run the knife across his wrist, perpendicular to the arm, and that the wound is rather deep. Which of the following statements is true regarding the likelihood for serious blood loss?
Blood loss is probably not life-threatening. CORRECT. A clean, lateral cut of a blood vessel allows the vessel to retract and thicken its wall. This reduces the lumen, reduces blood flow, and assists in the clotting mechanism. In this type of case, blood loss usually will not be life-threatening. A longitudinal cut is an entirely different matter.
Which of the following is recommended in situations in which a tourniquet must be used?
Use a material that is wide and thick. CORRECT. Place the tourniquet approximately 2 inches above the bleeding wound and make sure it is at least 2 to 4 inches wide and thick.
Which of the following statements is true when talking about neurogenic shock
Neurogenic shock is sometimes caused by spinal injuries. CORRECT. Neurogenic shock is hypoperfusion due to nerve paralysis (sometimes caused by spinal cord injuries) resulting in the dilation of blood vessels that increases the volume of the circulatory system beyond the point where it can be filled.
The most common form of a hemostatic agent is hemostatic:
dressings. CORRECT. Most hemostatic agents seen in the field today are either hemostatic dressings or specially formulated hemostatic gauze wraps (bandages). The advantage of hemostatic gauze is that a length of the leading edge of the gauze can be wadded up and inserted into the wound as a dressing, then secured in position, using the remaining wrap as a bandage.
Your patient is a 12-year-old boy who ran his arm through a glass window and has an 8-inch laceration on his anterior forearm. You have applied a pressure dressing and bandage, but these have become saturated due to continued bleeding. Which of the following should you do now?
Elevate that arm and prepare to apply a tourniquet or consider administering a hemostatic agent. CORRECT. After direct pressure is tried in conjunction with elevation, the correct next step would be to apply a tourniquet or a hemostatic agent if local protocol allows.
Which of the following is a characteristic of arterial bleeding?
spurting under pressure CORRECT. Arterial bleeding would be spurting with each heartbeat.
Which of the following is the MOST effective way of controlling external bleeding
Using direct pressure with a dressing CORRECT. The most effective method of controlling external bleeding is to apply direct pressure.
Which of the following may occur when there is bleeding from a large vein?
All of the above CORRECT. When there is bleeding from a large vein the patient is at risk for air embolism and hypoperfusion. The EMT is at risk for the transmission of bloodborne illnesses from the exposure to blood products.
You will frequently be called upon to deal with internal bleeding. Blunt trauma is the leading cause of internal injuries and bleeding. Which of the following are mechanisms of blunt trauma that may cause internal bleeding?
- Falls
- Motor vehicle or motorcycle crashes
- Auto-pedestrian collisions
- Blast injuries
. 1, 2, 3, 4 CORRECT. Blunt trauma is the leading cause of internal injuries and bleeding. Mechanisms of blunt trauma that may cause internal bleeding are falls, motor vehicle or motorcycle crashes, auto-pedestrian collisions, and blast injuries.
Which of the following vessels has the thickest muscular walls that allow constriction and dilation?
Arteries CORRECT. Arteries have the thickest muscular walls to allow for vasoconstriction and vasodilation.
Although many of the signs and symptoms of shock are the same no matter what the cause, the symptoms follow a logical progression as shock develops and worsens. Arrange the following signs and symptoms in the likely order that they will appear.
- Altered mental status
- Dropping blood pressure
- Nausea and vomiting
- Pale, cool, and clammy skin
- Increased pulse
- Increased respirations
1, 4, 3, 6, 5, 2 CORRECT. The brain is very sensitive to any decrease in oxygen supply. When the brain is deprived of oxygen, even slightly, mental and behavioral changes may be seen. When the brain senses inadequate tissue perfusion, it attempts to correct the problem by diverting blood from nonvital areas to the vital organs. Blood is quickly diverted from the skin. In the body’s efforts to direct blood to the vital organs, blood is diverted from the digestive system, resulting in nausea and sometimes vomiting. Respirations increase in an attempt to raise the oxygen saturation of the blood. As shock progresses, respiration becomes more rapid, labored, shallow, and sometimes irregular. The pulse will increase in an attempt to pump more blood, becoming weak and thready. Blood pressure drops because the body’s compensating mechanism can no longer keep up with the decrease in perfusion or blood loss. This is a late sign.
Which of the following is another name for describing the condition of shock?
Hypoperfusion CORRECT. Another term for describing shock is hypoperfusion.
Which of the following is NOT a consequence of hypoperfusion?
Aerobic metabolism will continue in the cell. CORRECT. As a result of hypoperfusion, oxygen and nutrients are not delivered to the cell. The result would be the body shifting from normal aerobic metabolism to anaerobic metabolism.
Which of the following statements is NOT true when you are on-scene and treating a patient that appears to be in shock?
It is important to spend on-scene time to be sure you have corrected and dealt with any of the causes of the shock so that it does not get worse. This is more important than rapid transport. CORRECT. You must attempt to stop what is causing the shock, such as external bleeding, and attempt to maintain perfusion that can be done while you are preparing for transport. Your most significant treatment for the shock patient may be early recognition of the problem and prompt transportation to a hospital. Every minute saved between the time of injury and the patient getting to an operation suite adds to his chances of survival.
Which of the following is the most important reason for controlling external bleeding?
To prevent hypoperfusion CORRECT. The main reason for controlling external bleeding is to prevent hypoperfusion (shock).
Which of the following BEST explains the reason for minimizing scene-time for the trauma patient with significant hemorrhage or the potential for significant hemorrhage?
Studies have indicated that trauma patients who receive surgery within 1 hour of injury have better chances of survival. CORRECT. Studies have indicated that trauma patients who receive surgery within 1 hour of injury have better chances of survival.
Which of the following is responsible for most of the signs and symptoms of early shock?
The body’s attempts at compensation for blood loss CORRECT. The majority of the responsibility for early signs and symptoms of shock lies with the body and its attempts to compensate for blood loss. Regardless of internal or external bleeding, the body will compensate for any blood loss in the early stages of shock.
If you do not have a commercial tourniquet available, what common device found on the ambulance can be used as a substitute?
Blood pressure cuff CORRECT. A blood pressure cuff may be used in an emergency as a substitute for a commercial tourniquet.
Shock is the circulatory system’s failure to provide sufficient blood and oxygen to all the body’s tissues. Which of the answers is NOT a major type of shock?
Hypervolemic CORRECT. Hypervolemic shock is not one of the three major types of shock.
Which of the following should increase the EMT’s suspicion of internal bleeding?
All of the above CORRECT. All of the following should increase the EMT’s suspicion of internal bleeding: penetrating trauma to the chest or abdomen, high-speed motor vehicle collision, and fall from a height two or more times the patient’s height.
Which of the following BEST describes the function of blood?
It transports gases along with nutrients, aids in excretion, and provides protection and regulation. CORRECT. Blood transports gases like oxygen along with nutrients, aids in excretion of waste products (like CO2), and provides protection and regulation.
In which of the following vessels does the vital exchange take place and also has the thinnest walls through which oxygen, nutrients, and wastes can pass?
. Capillaries CORRECT. The smallest vessels where gas exchange can occur are in the capillaries.
Which of the following is NOT part of the circulatory system?
Brain CORRECT. The brain is part of the nervous system and not a part of the circulatory system.
Your patient is a 28-year-old male who cut his thigh with a chain saw. It appears that he has lost about 600 cc of blood. Which of the following is NOT part of the proper management of this patient?
Replacement of fluid level by giving the patient adequate amounts of water CORRECT. Any patient that has severe bleeding, especially one that may require surgery, should not be given anything by mouth.
Cold is sometimes used to help control bleeding. When using cold, the following guidelines and statements are true except:
. it should be applied directly to the skin; it will not be effective if anything is between the cold agent and the wound. CORRECT. You should never apply ice or cold packs directly to the skin. Instead wrap ice or a cold pack in a cloth or towel before applying it to the skin.
Which of the following is the MOST effective way of controlling external bleeding?
Using direct pressure with a dressing CORRECT. The most effective method of controlling external bleeding is to apply direct pressure.
An injury caused by heavy pressure to the tissues, such as when an extremity is trapped under a fallen tree, that results in damage to muscle cells and the accumulation of waste products in the tissue is called a(n):
crush injury. CORRECT. Force can be transmitted from the body’s exterior to its internal structures, even when the skin remains intact and the only indication of injury is a simple bruise. This force can cause the internal organs to be crushed or ruptured, causing internal bleeding. This is called a crush injury.
When using the rule of palm to estimate the approximate body surface area burned, the patient’s palm equals about what percentage of the body’s surface area (BSA)?
1% CORRECT. The patient’s palm equals approximately 1% of the BSA
Which of the following is NOT considered soft tissue?
Cartilage CORRECT. The soft tissues of the body include the skin, fatty tissues, muscles, blood vessels, fibrous tissues, membranes, glands, and nerves. Teeth, bones, and cartilage are considered hard tissues.
Which of the following is a description of the rule of nines for an adult?
The rule of nines assigns 9% to the head and neck, each upper extremity, the chest, the abdomen, the upper back, the lower back and buttocks, the front of each lower extremity, and the back of each lower extremity, then 1% to the genital region. CORRECT. The rule of nines assigns 9% to the head and neck, each upper extremity, the chest, the abdomen, the upper back, the lower back and buttocks, the front of each lower extremity, and the back of each lower extremity, with the remaining 1% assigned to the genital region.
Which of the following layers of the skin is the MOST important in insulating the body against heat loss?
Subcutaneous layer CORRECT. Shock absorption and insulation are major functions of the subcutaneous layer.
Which of the following statements is incorrect regarding an electrical injury?
Injury is usually limited to the area around the source and ground burns. CORRECT. An electrical burn can be quite extensive and involve many internal organs such as the heart, spleen, and lungs. If the source burn is on the left hand and the ground burn is on the feet, right hand, hip, knee, and so on, the path crosses the heart and other vital organs.
Which of the following injuries requires the use of an occlusive dressing?
All of the above CORRECT. Open neck wounds, abdominal eviscerations, and chest wound require the use of occlusive dressing so that air from the atmosphere is not entrained into the body through the open wound.
You are treating a 5-year-old for extensive burns. You know that burns pose a greater risk to infants and children. The reason for this is:
their body surface area is greater in relation to their total body size. CORRECT. A child’s body surface area is greater in relation to the total body size. This results in greater fluid and heat loss than would occur in an adult patient. Infants and children have a higher risk of shock, airway problems, and hypothermia from burns.
A burn extending into the subcutaneous fat would be classified as which type of burn?
Full thickness CORRECT. Full thickness burns involve the entire epidermis and dermis layers and extend down to the subcutaneous layer of the skin.
You are treating the amputation of three fingers on a 40-year-old male. The fingers were torn off while he was cleaning his snow blower. You have stopped the bleeding. What should you do with the amputated fingers?
Wrap them in a sterile dressing, put them in a plastic bag, and keep them cool. CORRECT. You cannot make a decision regarding the ability to reattach any amputated parts. Therefore, you should make every effort to bring them with you. Direct contact with ice could cause them to freeze, which would not allow them to be reattached. You should keep the fingers clean and cool.
Your patient is a 35-year-old female who spilled a cup of hot coffee on herself. She has an area about twice the size of the palm of her hand on her right thigh that is red and painful, but without blisters. When caring for this injury in the prehospital setting, which of the following is appropriate?
Apply a dry sterile dressing. CORRECT. Dry sterile dressing application is appropriate care in the prehospital environment.
Which of the following is NOT a major function of the skin?
Regulates the pH balance of the body CORRECT. The kidneys function to regulate the pH of the body.
Which type of wound has a small opening into the skin, but may be quite deep, and is often caused by instruments such as nails, ice picks, or pencils?
Puncture CORRECT. A puncture wound has a small opening in the skin and may be deep, caused by nails, ice picks, or pencils.
Which of the following is required in the management of all open soft-tissue injuries?
Use of Standard Precautions by the EMT CORRECT. All open soft-tissue injuries should alert the EMT to use Standard Precautions such as gloves.
According to the rule of nines for infants and young children, the patient’s head and neck account for what percentage of the total body surface area?
18% CORRECT. 18% is assigned to the infant and child’s head and neck as compared to 9% for the adult’s head and neck.
You are dispatched to an industrial plant for a burn. You arrive and find a 60-year-old male who came in contact with a broken steam line and appears to have partial thickness burns on both hands and arms. He is lying on the ground and coworkers are gently spraying him with water from a nearby hose. What should you do?
Care for the burn and do a complete patient assessment, including cervical spine precautions. CORRECT. Patient assessment should not be neglected in order to give complete burn care. When caring for a burn patient, it is important to think beyond the burn. Did this person fall? Do you have to be concerned with his medical history (e.g., does he have a history of heart problems that might be exacerbated by the burns)?
For which of the following patients should the EMT carefully continue to monitor the patient’s ventilatory status throughout treatment and transport due to the greatest risk of respiratory failure?
16-year-old male whose shirt caught on fire, resulting in circumferential burns of his chest CORRECT. A patient with circumferential burns to the chest is at great risk for respiratory failure due to possible ineffectiveness of chest expansion during breathing secondary to edema of the tissues.
Which of the following statements is NOT true concerning the proper transport of an avulsed ear?
It should be in a dry sterile dressing. CORRECT. An avulsed part should be wrapped in a sterile dressing and kept moist with sterile saline. It should be labeled with the patient’s name and date and time bagged. It should be kept cool, but care should be taken that it is not frozen. It should not be immersed in cooled water or saline.
You assess a 35-year-old female patient with a chemical burn to her right forearm and hand. As you assess the burn, you notice a white powder on the burn. What should be your next step?
Brush the powder off the patient’s arm and hand, and then flush with copious amounts of water. CORRECT. After brushing the powder off the burned area is washed with copious amounts of water.
You are dispatched to a local industrial plant for an “electrical injury.” You arrive on-scene and find a 46-year-old male lying supine in front of an electrical panel. You are told he was attempting to make a repair and somehow received an electrical shock and was thrown to the ground. The scene is safe and the electricity is off. Your initial exam reveals a conscious person, breathing adequately. Vital signs are normal and there are no obvious signs of burns. Coworkers state that he was unconscious until your arrival. What is the next step?
While on the scene, rapidly do a complete assessment, provide oxygen, provide care for potential spine injuries, and transport as soon as possible after the exam. CORRECT. The major problem caused by electrical shock is usually not the burn. Respiratory and cardiac arrest are real possibilities. Some problems have a slow onset. All serious electrical shock patients should be fully immobilized because electrical current can cause severe muscular contractions.
Which of the following is recommended when caring for an amputated part?
Seal the part in a plastic bag and place it in a pan of water cooled by an ice pack. CORRECT. Treatments for the amputated part involve sealing the part in a plastic bag and place it in a pan of water cooled by an ice pack. Never put ice directly on the amputated part.
Bleeding from soft-tissue injuries should initially be controlled with which one of the following techniques?
Direct pressure CORRECT. Direct pressure is the initial way to control bleeding from a wound.
While assessing a 78-year-old male patient who escaped an apartment fire with partial thickness burns to both arms, the EMT must be aware of which of the following?
Medical conditions may be aggravated by the burn. CORRECT. In an elderly burn patient there may be underlying medical conditions that may be aggravated by the burn.
A 37-year-old male was hit by a trolley and his foot was almost severed. It is only connected by some skin and crushed bone. What should you do?
Apply a pressure dressing to control bleeding, stabilize the foot by splinting, apply oxygen, and transport as a priority patient. CORRECT. To control bleeding apply direct pressure, manually stabilize the foot, splint in a position of function, apply O2, and transport. EMTs should never complete an amputation. Control bleeding and splint to minimize further damage.
The meatus is
an orifice of the urethra. CORRECT. The meatus is an orifice of the urethra. The area between the scrotum and the anus is the perineum. The tube that carries urine from the kidney to the bladder is the ureter. The canal through which urine is discharged from the bladder to the exterior of the body is the urethra.
Which of the following BEST describes a partial thickness burn?
The skin is red and moist with blister formation. CORRECT. In a partial thickness burn the skin is red and moist with blister formation.
Which of the following BEST describes an avulsion?
Flap of skin that is partially or completely torn away from the underlying tissue CORRECT. An avulsion is a flap of skin that is partially or completely torn away from the underlying tissue.
Which of the following is NOT appropriate in caring for a patient with closed soft-tissue injuries and a significant mechanism of injury?
Allow the patient to have small sips of water. CORRECT. With a significant MOI, the patient should receive nothing by mouth (NPO) as surgery may be warranted.
Your patient is a 40-year-old man who was burned when he spilled gasoline on his pants as he was standing near the pilot light of his hot water heater. He has partial thickness burns from his feet to just above his knees, and circumferentially around both legs. Using the rule of nines, which of the following most accurately represents the extent of body surface area burned?
18% CORRECT. The front of one leg is 9% and the back is 9%. Taking half of the leg (from the knee down to the foot) would yield 4.5% on each front and 4.5% on each back leg (since the burns are circumferential). 9% on each leg would equate to 18% for both legs.
You are dispatched to the local high school for a “person struck with a baseball.” You arrive on the scene and find a 16-year-old male sitting on the bench. Apparently he was the pitcher and was struck in the abdominal area by a line drive ball that was hit very hard. He states that nothing is hurting except he has some mild pain in the area where he was struck. He is upset that the ambulance was called and wants to go back into the game and continue pitching. Your exam reveals nothing remarkable except mild pain when you palpate the injured area. Vital signs are normal. What is the next step?
Take appropriate Standard Precautions, apply high-concentration oxygen by nonrebreather mask, and transport the patient ASAP, carefully monitoring the patient during transport. CORRECT. Always consider the mechanism of injury (MOI) when you examine a patient with a closed injury. In this case, the MOI was significant. You have to be careful and consider internal bleeding and shock until ruled out in the ED.
You are assessing a 30-year-old male patient that had his arm caught in a piece of machinery. By the time you arrive he has been freed. The patient tells you that he does not understand why you were called, but as you inspect the injured limb you notice a small puncture wound. You should have a high index of suspicion of which of the following injuries?
High-pressure injection CORRECT. The EMT should maintain a high index of suspicion for a high-pressure injection of substances like hydraulic fluid from the machinery.
Burns pose a greater risk to infants and children for which of the following reasons?
Pediatric patients have a greater risk of shock from the burn.
A wound in which the epidermis is scraped away with minimal bleeding, such as commonly occurs when a child falls on his knees on a sidewalk, is called a(n):
. abrasion. CORRECT. An abrasion is a wound where the epidermis is scraped away with minimal bleeding.
Which of the following is NOT an open tissue injury?
Contusion CORRECT. A contusion is a bruise which is a closed tissue injury.
Which of the following is of concern in a patient who received burns to his hand when he grabbed a live electrical wire?
The extent of tissue damage may be much greater than it appears on the surface. CORRECT. The extent of tissue damage may be much greater than it appears on the surface (where contact with the live wire was made).
You are caring for a 23-year-old female who fell off of a bicycle and sustained a severe laceration on the inside of her upper thigh. Her slacks are torn, and you can see most of the wound. What is the next step?
You need to expose the wound completely, control bleeding, clean the surface by simply removing large pieces of foreign matter if any, and dress and bandage the wound. CORRECT. General guidelines for caring for open wounds are expose, control bleeding, and clean the surface area; then use a sterile dressing and bandage. You should not attempt to clean the wound itself. Bleeding control is the priority.
Which of the following is a desirable characteristic of dressings used in the prehospital management of most open wounds?
. Sterile CORRECT. Most open wounds are treated with dry, sterile dressings.
When managing an electrical burn, the EMT should:
check for a source and ground burn injury. CORRECT. Never attempt to remove a patient from an electrical source unless you have been trained and are equipped to do so. Check for source and ground burn injury. Never touch a patient who is in contact with an electrical source. CPR should always been attempted unless there is obvious signs of death, regardless of the down times in minutes.
Which of the following is of concern with a puncture wound?
All of the above CORRECT. A puncture wound has a strong possibility of contamination. In a puncture wound there may be hidden internal bleeding with minimal external bleeding. Another concern with a puncture wound is the object that remains impaled in the body.
Your patient is a 55-year-old male who was found in the parking lot behind a tavern. He states that he was assaulted and robbed by three individuals. He is complaining of being “hit in the face and kicked and punched in his ribs and stomach.” Your examination reveals contusions and swelling around both eyes, bleeding from the nose, a laceration of his upper lip, and multiple contusions of the chest, abdomen, and flanks. Which of the following should cause the greatest concern regarding the prehospital care of this patient?
Potential internal injuries CORRECT. Due to the mechanism of injury (MOI), the potential of internal injuries is the greatest concern.
Which of the following is a consideration in determining a burn’s severity?
All of the above CORRECT. Other illnesses or injuries, BSA involved, and the agent type are all considerations in determining a burn’s severity.
Your patient is a 14-year-old male who crashed his bicycle, landing prone and sliding along a gravel trail. He has deep abrasions to his hands, arms, chest, and knees. The patient has small pieces of gravel, twigs, and dirt embedded in the abrasions. Which of the following is the best way to manage this situation after taking cervical spine immobilization?
Assess for additional injuries, flush away large pieces of debris with a sterile dressing, place dressings on the abrasions, bandage them in place, and transport. CORRECT. The correct method after assessing for additional injuries is to flush away large pieces of debris with a sterile dressing, place dressings on the abrasions, bandage, and then transport.
Your patient is a 25-year-old man who picked up an iron skillet with a very hot handle. He has a reddened area with blisters across the palm of his hand. Which of the following must be avoided in the prehospital management of this wound?
Application of antibiotic ointment CORRECT. Application of an antibiotic ointment is not part of burn management in the prehospital environment, but may be later done at the ED.
You are dispatched to the local elementary school for an injured student. Upon arrival you find that two 7-year-olds got into a fight and one of them jabbed a pencil in the other’s cheek. The pencil is still sticking out of the child’s cheek. When you examine the patient, you cannot see the end of the pencil that went through the cheek, as it appears to be stuck in the palate. There is not significant bleeding, and the child is not having any difficulty breathing. The child is very upset and wants you to pull the pencil out. What should you do?
Stabilize the object, but do not try to remove it. CORRECT. The object does not appear to be interfering with the airway, breathing, or circulation. Because you cannot see the end of the object that is in the mouth, and it is not interfering with airway, breathing, or circulation, it should be treated like other impaled objects, that is, stabilized and left in place.
In caring for a 27-year-old male who has a large laceration on his anterior forearm, you have noticed that your pressure dressing has become saturated with blood. Which of the following should you do next?
Apply additional dressing material over the top of the original dressing and bandage it in place. CORRECT. The correct sequence is to apply additional dressings over the blood soaked dressings and apply more direct pressure to control bleeding, then bandaging in place.
While assessing a patient with partial thickness burns to his chest and neck, what should be your highest priority (even if there are no symptoms presently)?
Airway CORRECT. Airway issues are the highest priority in a burn patient.
You are examining a 48-year-old patient who has been burned. You decide to use the rule of palm to measure the extent of the burn. What does this mean?
The palm of the patient’s hand equals about 1% of the body’s surface area. CORRECT. Because the burns on the patient are being measured, you should use his palm and not yours in the calculation. Either the rule of nines or the rule of palm works regardless of the age of the patient, although the areas are different on children for the rule of nines.
Your patient is a 40-year-old male who has been exposed to a dry chemical powder and is complaining of severe pain on both of his hands, the site of the contact. He is working in an illegal chemical manufacturing plant and there is no decontamination shower on site. Which of the following would be the BEST way to manage this situation?
Brush away as much of the powder as possible and then have the patient hold his hands under running water from a faucet or regular garden hose. CORRECT. After brushing away the substance the patient’s skin should be washed with copious amounts of water.
You are dispatched to an auto repair shop for an “accident.” You arrive and are told by the owner that one of the workers apparently got his hand in the way while using a high-pressure grease gun and injected the grease into his hand. You find the patient seated in a chair with a coworker applying ice to the injured hand. Your examination reveals a minor round laceration in the hand. The patient is complaining of pain in the area but wants to let the wound take care of itself and go back to work. What should you do?
Remove the ice from the wound, then elevate and splint the limb. Transport the patient high priority. CORRECT. EMT treatment for high-pressure injection wounds includes elevating and splinting the limb. Cold can cause vasoconstriction and lead to further tissue damage. This is an extremely significant injury and can lead to loss of limb if treatment is delayed or improper.
Which of the following is the outermost layer of the skin?
Epidermis CORRECT. The outermost layer of the skin is the epidermis.
Your patient is a 32-year-old man with a fish hook that has perforated his hand between the thumb and index finger. Which of the following is the best way to manage the situation in the prehospital setting?
Leave the hook in place and try not to disturb it. CORRECT. With an impaled object it is best to leave the object in place, stabilize it if necessary, and transport to the ED for removal.
Which of the following patients has the greatest likelihood of being cared for in a burn center?
30-year-old woman who has deep partial thickness burns on her hand and arm as a result of spilling hot cooking oil on herself CORRECT. A partial thickness burn of the arm and hand caused by a chemical (hot oil) will require treatment at a burn center due to the hand involvement as well as the hot liquid contacting the skin.
Which of the following is NOT a type of avulsion?
A finger is cut off with a butcher’s saw. CORRECT. A finger being completely cut off with a butcher’s saw would be an amputation.
A 36-year-old man has accidentally shot a nail into his thigh while using a nail gun. Under which of the following circumstances should the EMT remove the nail from the injury site?
None of the above CORRECT. An impaled object should not be removed from the thigh.
Which of the following is NOT true concerning lacerations?
. They may be degloving injuries to the skin or tissue. CORRECT. Degloving injuries are a type of avulsion where the tissue or skin is completely or partially pulled off.
An injury in which the epidermis remains intact, but blood vessels and cells in the dermis are injured, is called a(n):
contusion. CORRECT. In a contusion, the epidermis remains intact, but blood vessels and cells in the dermis are injured.
Severe internal bleeding can result in a rapid progression of hemorrhagic __ and death in a matter of minutes.
shock
The second step in bleeding control of an extremity bleed when direct pressure has failed is the use of a(n)
tourniquet
A(n) _ temperature may make the clotting process slower and less effective.
low body
A blood loss of _ % will affect the patient’s vital signs
15
List four of the factors that may increase bleeding.
Any of the following: improper dressing application initially, movement, low body temperature, medications, intravenous fluids, removing bandages and dressings prematurely.
List the emergency care treatments for open neck wounds.
- Apply pressure to the wound
- Apply an occlusive dressing
- Put a regular bandage over the occlusive dressing
- Once the bleeding is controlled, put on a pressure dressing
- Immobilize the spine if needed
List the four types of bandages.
Self-adhering bandage, gauze roll, triangular bandage, or splint.
You have arrived at a scene where a young girl tripped while running, and pushed her arms through a plate glass window while falling. She is responsive to painful stimuli and has blood spurting from a large laceration on her right upper arm. Your partner yells for you to immediately apply direct pressure to the laceration to prevent further blood loss, while he works to control the airway. You have yet to apply gloves, but your uniform shirt has long sleeves, and you normally wear prescription glasses. What would you do next?
Apply gloves prior to applying direct pressure over the injury site
You believe that a patient who has been shot in the lower abdomen is bleeding internally and is in an early stage of shock. The patient’s mental status is decreasing. What would be appropriate prehospital care of this patient?
Oxygen therapy and rapid transport to the hospital
Which patient requires the EMT to remove an impaled object in the field?
A young female with a broken pencil through her cheek and into the oropharynx; blood from the injury is flowing into her throat
what is a contusion?
blood vessels in the dermal layer have ruptured
You have just applied a pressure dressing to the leg of a woman who suffered a deep laceration to her calf from a piece of broken glass. What should you do next?
assess for a pedal pulse
Prior to your arrival on the scene of a motorcycle crash, an Emergency Medical Responder contacts you via radio and reports that there is one patient who has an avulsion to her left arm. As a knowledgeable EMT, which kind of injury should you anticipate?
loose flap of skin torn on the patient’s left arm
A patient suffered abrasions to the legs after falling on a moving treadmill. In relation to the function of the skin, the EMT should be most concerned about:
risk for infection
A 62-year-old male was the restrained driver of a car that was hit on the driver’s side. Emergency Medical Responders have extricated the patient and provided spinal motion restriction precautions, including a cervical collar, long board, and straps. When asked, the patient complains of dizziness as well as left leg and left arm pain. Assessment reveals multiple contusions and deformity to his left forearm and a laceration with minor bleeding to the left side of his face. The patient’s airway is open and his breathing is labored. A rapid radial pulse is felt. Skin is cool and dry. Which assessment finding would the EMT address first?
labored breathing
A pregnant 31-year-old female has been shot in the neck. Currently, she is responsive to verbal stimuli, with an open airway and rapid, but adequate respirations. Her radial pulse is weak and fast. Vital signs are as follows: pulse 152 beats/min, respirations 22 breaths/min, blood pressure 92/76 mmHg, and SpO2 100% on high-concentration oxygen as initiated by the fire department EMRs. Which other intervention by the EMT will most benefit this patient?
place an occlusive dressing on the neck and keep the patient warm during transport
Which instruction is appropriate when helping a new EMT care for a male patient with a laceration to his left arm?
“Don’t worry about removing embedded dirt from the wound, just the dirt around the laceration.”
You are called for an 8-year-old boy who has fallen. At the scene, the boy’s mother states that her son was running while flying a kite and tripped, striking his face on a rock. Assessment reveals a large reddish-blue lump with intact skin under his left eye. When alerting the hospital emergency department of your arrival, you should inform them that the patient has which type of injury?
hematoma
Epistaxis is another way of saying the patient has
nosebleed
Open wounds in which flaps of skin and tissue are torn loose with only a small part of the tissue still attached to the body are termed
avulsion
An average adult weighing 154 pounds will have approximately how many liters of total blood volume?
4-5
An open injury exposing the blood vessels and nerve tissue contained within the dermal layer of the skin is called a(n)
abrasion
Burns are classified according to the __ of the injury.
depth
A hypoperfusion syndrome that can occur with moderate to major burns that cover sufficient body surface area (BSA) is called _
burn shock
The tough and leathery dead soft tissue formed in a full-thickness burn injury is called __
eschar
A partial-thickness burn is also called a(n) __ burn.
2nd
When calculating BSA, the EMT should remember that the genital region represents __ percent of the total BSA.
1
Burn injuries need to be __ within approximately the first 10 minutes of injury.
cooled
A(n) __ burn, or third-degree burn, is a burn in which all layers of the skin are damaged.
full-thickness
An alternative to the rule of nines for estimating the BSA of a burn involving a small or irregular portion of the body involves using a comparison of the burned area to the patient’
palm
All burns normally classified as moderate should be reclassified as
__ in a person younger than 5 or older than 55 years of age.
major
If dry lime is the burn agent, do not irrigate the burn with _ until it has been off the patient.
water, brushed
List 5 signs and symptoms of partial-thickness burns.
Blisters, intense pain, white to cherry-red skin, moist and mottled skin, pain on peripheral edges of burn.
List 2 signs and symptoms of superficial full-thickness burns.
- Dry, hard, leathery skin that can look white and waxy to dark brown or black and charred
- Little to no pain
List at least 2 of the most important factors in determining burn severity.
Percentage of BSA involved; location of burn; patient’s age; preexisting medical conditions.
List three considerations when treating burns of the eye.
- Don’t open the eyelids if they’re burned
- If it’s a thermal burn apply a dry, sterile dressing to both of the eyes to stop them from moving
- Chemical burns should be flushed with water for at least 20 minutes
A patient was burned when he accidentally ignited gasoline while working on his car. When performing your assessment of the injury, which finding would indicate that the patient has suffered a partial-thickness burn?
Painful skin on the abdomen that is moist and contains blisters
A partial thickness burn covering 8 percent of the body would be considered moderate for which patient?
A 25-year-old patient with sickle cell disease
A 44-year-old electrician has been shocked. He now responds to verbal stimuli with garbled speech. His airway is open and he is breathing poorly at a rate of 8 times per minute. His pulse is slow and irregular. Which action would the EMT perform next?
Ventilate with a bag-valve mask at 10 breaths/min
Why would an EMT be concerned about a partial-thickness burn circumferentially to the chest?
Restriction of breathing
An industrial worker sustained partial- and full-thickness burns to his right hand after accidentally touching an electric furnace used to incinerate medical waste. Assessment reveals no threats to the airway, breathing, or circulation. Which action would the EMT perform next?
Pour cool saline water on the hand
An intoxicated patient has suffered a burn to his left lateral thigh after passing out with his leg touching the side of a kerosene heater. Close examination of the burn reveals tough leathery tissue in the center of the burn, with red skin with blisters surrounding it. Regarding the burn, what would the EMT agree to be true?
The central portion of the burn is a full-thickness burn and the surrounding portion is a partial-thickness burn
A patient was trapped in a burning apartment before being rescued by firefighters. As you approach him, you note that his legs and arms are burned. The patient is screaming in pain and coughing, but no longer actively burning. Given this information, which intervention would you perform first?
Decide whether to administer oxygen with a nasal cannula or nonrebreather mask
A patient has experienced partial- and full-thickness thermal burns to the anterior chest, abdomen, and arms in an industrial accident. Which action would be appropriate in the care of this patient?
Cool the burns with water and cover the burns with a sterile, dry burn sheet
Of the actions described, which indicates proper care of a patient who has experienced a partial-thickness burn to the hand?
Carefully remove rings prior to applying a dry sterile dressing
You are transporting a patient who was shocked by an electrical current while repairing a residential electrical service panel. He has partial-thickness burns to the hand and foot where the electricity entered and exited his body, respectively. When reassessing this patient, which finding would be of most concern?
palpation of an irregular heartbeat
A 20-year-old waitress spilled hot coffee and burned her right forearm. When assessing the burn, you note a full-thickness burn surrounded by partial-thickness burns. The patient complains of pain in the surrounding partial-thickness burn, but not in the center where the full-thickness burn is located. As an EMT, you recognize that the patient does not localize pain to the center of the burn because of:
destruction of pain receptors located in the dermis
A patient has a burn that completely encircles his right forearm and hand. After performing the primary assessment, the EMT should:
Check for motor status, sensory status, and a pulse in the right upper extremity
Which statement made by an EMT shows that he understands the major cause of death in the prehospital setting for a burn patient?
“Most burn patients who die before getting to the hospital die of airway or bleeding problems, not the burn itself.”
The most serious problem usually associated with electrical shocks is
respiratory and/or cardiac arrest
A partial-thickness (second-degree) burn will appear
red-white
One method that the EMT can use to estimate the body surface area damaged by a burn is the
rule of nines
In managing a burn correctly, an EMT may take all of the following steps (3)
apply dry, sterile dressings; keep the warm; keep burn site clean
The most important treatment for a patient who has sustained a chemical burn to the eyes is
copious irrigation with water
In estimating the BSA affected by a burn, each upper extremity in an adult represents what percentage of the total body area?
9%
A burn that encircles a body area such as the chest, an arm, or a leg is called
circumferential
In a child younger than age 5, any partial-thickness burn involving between 10 and 20 percent of BSA should be considered
critical
When dealing with chemical burns, the EMT should remember that dry chemicals should be
brushed away before irrigating
_ are the places where bones meet and are a critical element in the body’s ability to move.
joints
With _ force, the force impacts one end of the limb, causing injury some distance away from the point of impact.
indirect
_ are bands of connective tissue that bind the muscles to the bones.
tendons
Three types of mechanisms that cause musculoskeletal injuries include:
direct, indirect, twisting
The __ splint applies constant pull along the length of the femur to stabilize fractures and reduce muscle spasms.
traction
The EMT should splint suspected dislocations in position unless _ are absent
distal pulses
Proper _ and prehospital care of musculoskeletal injuries can help prevent closed injuries from becoming __ injuries.
splinting; open
For any splint to be effective, it must immobilize the extremity or joint _ and _ the injury
above; below
The point of realignment of deformed extremities is to assist in restoring effective , motor function, and
pulse; sensation
a _ is an injury to a joint with possible damage to or tearing of ligaments.
sprain
List the six basic components of the skeletal system.
Skull, spinal column, thorax, pelvis, upper extremities, lower extremities.
List four types of musculoskeletal injuries.
fracture, dislocation, sprain, strain
List at least 4 signs and symptoms of musculoskeletal injuries.
Pain and tenderness; deformity or angulation; crepitus; swelling; bruising; exposed bone ends; joints locked into position; severe weakness and loss of function; disfigurement.
TF: Some types of rigid splints are pliable enough to be molded to fit any appendage.
true
A patient complaining of a headache states that he fell and struck the back of his head. Which statement by the patient should be of most concern to the EMT?
“I take a blood thinner for my heart”
The cerebellum is described as the area of the brain that:
Controls reflexes and assists in maintaining body posture
As brain herniation occurs, the body responds by:
Increasing systolic blood pressure in an attempt to maintain perfusion to the brain
A 40-year-old male fell 20 feet from a ledge while hiking. The park ranger is now maintaining manual spine motion restriction for the patient. The patient is combative and confused, but his airway is open and his breathing is adequate. The patient has a radial pulse of 112 beats/min, blood pressure of 96/76 mmHg, and SpO2 of 91% on room air. What should the EMT do first?
begin administering supplemental oxygen
A woman fell from a second-story window onto the concrete sidewalk below. She is unresponsive and has a large depression to the back and top of her skull. Additional findings include abdominal bruising and an angulated left ankle. Your partner reports that the patient’s vital signs are pulse, 68 beats/min; respirations, 14 breaths/min and irregular; blood pressure, 198/112 mmHg; and SpO2, 91% on room air. Based on these assessment findings, what should the EMT suspect is occurring?
Severe head injury with increasing pressure within the skull
A 52-year-old male is unresponsive and has bruises and lacerations to the head, chest, and abdomen. Bystanders state that the patient was intoxicated and got into a fight with several patrons of a bar. They state that he was beaten with his opponents’ fists, but not other objects or weapons. The patient has snoring respirations, shallow breathing, and a strong radial pulse. His skin is warm and dry. After providing manual spine motion restriction, what should be your next action?
perform the jaw-thrust maneuver
A young adult male is in police custody after he crashed his car into a utility pole. There is minor front-end damage to the vehicle, and the air bags deployed. The patient was not wearing a seat belt and has an abrasion to his forehead. He is awake and oriented to person, time, and place. His speech is slurred and he has an odor resembling that of beer on his breath. The arresting officer states that he just wants you to check the patient before he transports him to jail. Given this scenario, which action seems most appropriate for the EMT to take?
Contact medical direction with assessment findings
A young adult male has a gunshot wound to the left side of his head. He is unresponsive with snoring respirations. He is breathing 6 times per minute with a pulse rate of 52 beats/min and a blood pressure of 192/104 mmHg. His radial pulse is strong and his skin is cool, but not diaphoretic. In addition to spine motion restriction precautions, the first intervention for this patient would be:
performing a jaw-thrust maneuver
A 41-year-old male patient was struck in the head with a metal pipe during a fight with an angry neighbor. The scene is safe, and as you approach the patient, you note that he is combative and has blood on the left side of his head and face, and on his shirt. His breathing appears to be labored and he is incontinent of urine. Which care should you perform immediately?
take manual cervical spine motion restriction
You are assessing a patient who had a previous brain injury in which a portion of the cerebellum was destroyed. In relation to this specific injury, which finding would the EMT expect?
Poor muscle coordination when signing his name to the prehospital care report
A collection of blood within the skull or brain tissue is called a
hematoma
All of the following are highly vascular membranes separating the cranium and the brain except the
subarachnoid space
The bruising and swelling of brain tissue that may accompany concussion is called a(n)
contusion
Signs of cushing’s reflex
increased heart rate, change in respirations, contusion
The weakest portion of the skull, which is made up of many separate bones, is called the
basilar skull
The helmet-like structure that protects the brain is called the
cranial skull
The extreme emergency following a skull fracture in which arterial bleeding pools between the skull and the outermost protective covering of the brain is called a(n)
epidural hematoma
The serous substance called _
protects the brain and spinal cord against impact.
cerebrospinal fluid
Inside the skull, the brain is protected from injury by three layers of _
meninges
Bruising and swelling of the brain tissue, also known as a(n) __, occurs when the force of a blow is great enough to rupture blood vessels.
contusion
In addition to AVPU, some EMS systems use the _ _
for determining a patient’s level of responsiveness.
glasgow coma scale
A late finding in a patient with a significant brain injury is that blood pressure _ and heart rate ___ .
increases; decreases
Two nonpurposeful responses that a patient with a head injury might make are _ and __
flexion; extension
The lowest level of responsiveness on the AVPU scale is __
unresponsive
A purplish discoloration of the soft tissues around one or both eyes is called _ and may be an indication of intracranial injury.
raccoon sign
List, in order from outer to inner, the 3 meningeal layers.
Dura mater, arachnoid, pia mater
List the three anatomic components of the brain, and give one function or characteristic of each.
- Cerebrum – the biggest part of the brain. Controls most conscious and sensory functions, emotions, personality
- Cerebellum – controls reflexes, equilibrium, and muscle movement, coordination, and activity
- Brain stem – most primitive and best protected part of the brain, controls most automatic functions
List four mechanisms of injury that commonly produce head injuries.
- Motor vehicle crashes
- assaults/violence
- falls
- sports injuries
List the structural divisions and functional divisions of the nervous system.
Structural: central and peripheral
Functional: autonomic and voluntary
List the five divisions of the spinal or vertebral column and the number of vertebrae in each.
- Cervical: 7
- Thoracic: 12
- Lumbar: 5
- Sacral: 5
- Coccyx: 4
Compression is one mechanism of spinal injury. List six others.
- Flexion
- Extension
- Rotation
- Lateral bending
- Distraction
- Penetration
TF A patient may display paralyzed arms, but the legs may still function from a partial spinal cord injury.
false
A young intoxicated male patient cannot move his left arm and leg after diving into the shallow end of a pool and hitting the bottom head first. The EMT would recognize which mechanism as most likely responsible for this injury?
compression
A patient who was injured in a motor vehicle collision has a separation of the rib and its associated spinal vertebrae. Based on the anatomy of the spine, where has this injury occurred?
thoracic spine
Which statement is most accurate regarding the processes needed for a patient to clench the hand into a fist?
The central nervous system must send a message through the spinal cord and then to the peripheral nerves
A 25-year-old male jail inmate was pushed over the railing of a walkway 20 feet above the ground. He is unresponsive and has an open fracture of the left upper arm. How would you determine if the patient has sensation in his legs?
Pinch his foot and look for movement on the leg
A patient is being extricated from a car using a short vest-type device. After the patient has been extricated, the EMT should:
Secure the patient with the vest-type device to a long backboard
An injury to a hemisection of the spinal cord that disrupts the spinal tracts on only one side of the cord is:
Brown-Séquard syndrome
A window washer fell 20 feet from scaffolding while washing the windows on an office building. He is alert and oriented, but states that he cannot move or feel his legs. Additionally, because his blood pressure is 72/48 mmHg, you suspect spinal shock. Which other assessment finding reinforces your suspicion of spinal shock?
warm and dry skin
Which of the following findings in a patient with a traumatic mechanism of injury is sufficient to prevent the EMT from “clearing the spine” and necessitate the implementation of spine motion restriction precautions?
GCS score of 12
A male patient fell 20 feet from a cliff to a trail below while hiking with his girlfriend. The primary assessment shows him to be confused, with an open airway and shallow breathing. His pulse is 72 beats/min and his blood pressure is 78/50 mmHg. The skin is warm and flushed. The patient has no motor ability or sensation in his legs. What is the most likely cause of this patient’s presentation?
spinal shock
Which one of the following is not an indication for removing a helmet in a case of suspected head or spine injury?
helmet fits snugly
The mechanism of injury in which the vertebrae and spinal cord are stretched and pulled apart is called
distraction
Probably the most common and reliable sign of spinal cord injury in conscious patients is
paralysis of the extremity
All of the following are signs and symptoms in patients with spinal injuries
incontinence, paralysis, priapism
The face has _ bones
14
The bony structures of the skull that surround the eyes are called the __
orbits
TF When treating bleeding wounds to the neck, the EMT should use circumferential bandages.
F
TF When treating an injury to the nose, the EMT should not probe for a foreign body.
T
TF When dressing an injured ear, the EMT would place part of the dressing between the ear and the side of the head.
T
TF If a patient has lost a tooth, the EMT should wrap the tooth in dry gauze to preserve it for possible reimplantation.
F
TF The EMT should only attempt removal of objects in the conjunctiva; the EMT should not attempt removal of objects on or lodged in the cornea.
T
TF Generally, you should not remove contact lenses if there has been a chemical burn to the eye.
F
TF If a fracture of the orbits is suspected, you should establish and maintain spine motion restriction.
T
A young male golfer has been struck in the right eye with a golf club. The upper and lower lids are swollen shut and ecchymotic. There are also blood clots between the two eyelids. What would be an indication that the EMT is providing proper care to this patient?
He wipes any remaining blood from the face but not the eye
During an altercation, an intoxicated male was cut with a sharp knife. Assessment reveals a laceration, oozing dark red blood, across the right eyelid down to the right cheek. It also appears that the patient’s eye was cut with the knife, a suspicion reinforced by the patient’s complaint of eye pain and collection of blood in the sclera. The EMT would:
Cover the eye with a sterile dressing soaked in saline
The best way to detect contact lenses for removal is to:
Shine a penlight into each eye at a slight angle and look for a shadow
A man grinding metal took his safety goggles off and was struck in the face with a shower of tiny metal fragments. He now complains of pain and visual disturbance in his right eye. When assessing the eye, you note that the globe is red, with several pieces of metal embedded in the tissue. Proper care of this patient would include:
covering both eyes with a bandage
A female patient with a maxillary fracture has sustained injury to her:
upper jaw
A construction worker complains of pain to both eyes after an extended period spent welding on a gas well. The light is bothering him, and he rates the pain as a 10/10. He states that this problem occurred once before and was caused by the intense light of his welding tool. The primary assessment reveals no deficits. The patient’s vital signs are pulse, 80 beats/min; respirations, 14 breaths/min; blood pressure, 132/68 mmHg; and SpO2, 98%. Although the injury is very painful, his vision is not compromised. Which set of instructions indicates proper care of this patient?
“I do not think that we will need to provide supplemental oxygen.”
A baseball player was struck in the side of the face by a baseball. Assessment findings include swelling and numbness to the left side of the face and left eyelid, as well as crepitus in the same area. Assessment of the eye reveals no obvious injury. The patient denies any problem with his eyesight, but is having difficulty visually tracking your finger upward. What would be appropriate care for this injury?
cold packs to the face and eyelid
A patient complains of pain and discomfort to the left eye after being hit in the face with a cloud of dust while working at a manufacturing complex. As you specifically assess the eye, you note some redness to the globe but do not see any obvious foreign object. The most appropriate care you can provide to this patient would be:
covering both eyes with a bandage
You have arrived on the scene of an industrial plant where a female worker had a chemical splashed into her eye. She now complains of severe pain in the eye and is flushing it with tap water over a sink. Which question is it most important that the EMT ask first?
are you wearing contacts
A 19-year-old female was assaulted by her intoxicated boyfriend. After punching her in the chest, he slashed her face with a knife. Assessment reveals the patient to be stable with a large laceration from beneath her right eye to her right ear. She is very upset and crying and repeatedly asks you if this injury will leave a permanent scar on her face. Your best response would be:
“When we get to the hospital, you can discuss this more thoroughly with the doctor.”
In a patient with conjunctivitis, the EMT would expect to observe a/an:
reddened membrane over the sclera
A patient complaining of eye pain informs you that he was diagnosed with a corneal abrasion three days ago. He called 911 today because the discomfort has not yet resolved and he desires medical attention. Based on this information, which statement is most accurate?
The clear structure that covers the pupil has been damaged
If a nose fracture is suspected, the EMT should
apply cold compress
The portion of the eye that focuses light to the retina is the
lens
An eye injury that involves an eye being pulled out of its socket is called a(n)
extrusion
The correct emergency treatment for profuse bleeding with facial injuries includes
application of direct pressure
The part of the eye that contains the aqueous humor is the
anterior chamber
The thin covering of the inner eyelids is called the
conjunctiva
An appropriate irrigant for an EMT to use for a chemical burn is
saline
If a patient has sustained a chemical burn to the eye, the EMT should irrigate the eye for at least 20 minutes or, if the injury involves an alkali, for at least
1 hour