BSI/Scene Safety
EMTs should wear high-efficiency particulate air (HEPA) respirators when they are in contact with patients who have which of the following?
a. HIV (human immunodeficiency virus) or AIDS (acquired immune deficiency syndrome)
b. tuberculosis (TB)
c. open wounds
d. hepatitis B
b. HEPA respirators are worn when in contact with patients who have airborne infections such as TB. HIV/AIDS and hepatitis B are both blood-borne pathogens. Contaminants from open wounds would also be blood borne.
The air sacs in the lungs where oxygen–carbon dioxide exchange occurs are the
a. bronchioles.
b. bronchi.
c. epiglottis.
d. alveoli.
d. The alveoli are the numerous minute air sacs that make up the lungs; bronchioles are small branches of the bronchi, which are the two main tubes branching from the trachea; the epiglottis is the structure that closes off the trachea during swallowing.
The most common electrical rhythm disturbance that results in sudden cardiac arrest is called
a. pulse less electrical activity (PEA)
b. ventricular fibrillation (VFib)
c. ventricular tachycardia (VTach)
d. asystole
b. Because ventricular fibrillation is the most common cause of sudden cardiac arrest, it is critical to apply an AED on an unconscious apneic and pulseless patient as quickly as possible. The other rhythms can also cause a patient to be in cardiac arrest, but they do not occur as frequently as “V-fib.”
4. Which of the following is the highest priority patient?
a. 57-year-old male with chest pain and systolic blood pressure of 80
b. 40-year-old female with moderate pain from a leg injury
c. 75-year-old male who appears confused but responds to commands
d. 25-year-old female in labor with contractions six minutes apart
a. The patient with chest pain and systolic blood pressure less than 100 is the highest priority patient of the four. A leg injury may be life threatening if the femoral artery is injured, but most often, a single extremity injury is not a threat to life. The elderly gentleman may be exhibiting his normal mental status, or he may be having problems due to an ongoing health problem. You need more information before you can make that determination, but he is not in any imminent danger right now. Labor with contractions six minutes apart is not considered imminent delivery. If you have any questions, however, you should continue assessing this patient as well by asking pertinent questions and checking for crowning.
Which patient can safely receive only a focused physical examination rather than a rapid trauma assessment?
a. 10-year-old male with a deformed right lower leg who is responsive after falling off his bicycle
b. 20-year-old female who complains of severe pain in her ankle after stepping off a curb
c. 70-year-old male who complains of neck pain after a medium-speed car collision
d. 30-year-old male who is unresponsive but has only minor cuts on the extremities
b. Patient b is the only one both responsive and who has no significant mechanism of injury.
You are called to assist a 60-year-old female who complains of a severe headache. Upon entering the home, you smell a strong odor of natural gas. What is your first action?
a. Check the patient’s airway, breathing, and circulation.
b. Insert a nasopharyngeal airway and assess vital signs.
c. Remove the patient from the house to your ambulance.
d. Open all windows and determine the source of the gas leak.
c. Your first action should be to remove your crew and the patient from the possible noxious gas and to notify the gas company of the leak. You may also be required to alert the hazardous-materials response team. You should not attempt to locate the gas leak yourself. Treatment for the patient will begin with an ABC assessment and management of any problems you might encounter
24. Pink or bloody sputum is often seen in patients with
a. pulmonary edema.
b. anaphylaxis.
c. allergic reaction.
d. flu.
a. Other symptoms of pulmonary edema may include difficulty breathing, excessive sweating, anxiety, and pale skin.
What is the best method to assess circulation in an infant?
a. Palpate the carotid pulse.
b. Palpate the brachial pulse.
c. Palpate the radial pulse.
d. Observe capillary refill time.
b. Assess circulation in an infant by palpating the brachial pulse in the upper arm. The carotid and radial pulses are difficult to locate in infants. Capillary refill time shows that the patient has impaired circulation, but it is not the first tool to use in assessing circulation because it is affected by external factors (like the environment) as well as internal factors like poor perfusion.
Your patient is an 11-month-old female. How can you determine if she has a decreased mental status and is responsive to verbal stimuli?
a. She will be upset when you take her from her mother’s arms.
b. She will be unable to tell you how old she is if you ask her.
c. She will attempt to locate her parents’ voices when they speak.
d. She will try to pull away from a painful stimulus on her toe.
c. An infant who is alert to verbal stimuli will still try to locate the parents’ voices; choice a describes an alert infant; choice d describes an infant who is responsive to painful stimuli; choice b is incorrect because infants of this age are not developed enough to tell you their age regardless of their mental status.
Which patient should receive a rapid trauma survey to determine hidden injuries?
a. alert 2-year-old child in a car seat who was in a medium-speed crash
b. alert 20-year-old male who fell ten feet and is complaining of leg pain
c. alert 65-year-old female who fell in the bathtub and is complaining of wrist pain
d. alert 11-year-old female who tripped while roller-skating and fell down three steps
a. The rapid trauma survey is used when you are unsure of the presence of hidden injuries or if the mechanism of injury (MOI) is unclear or severe enough to suggest the need for a rapid assessment. A 2-year-old child could be severely injured by a medium-speed collision, even if he or she appears alert and was properly restrained. The other choices do not represent MOIs considered to be high risk for hidden injury.
Of the following, which body fluid has the most potential to transmit blood-borne diseases?
a. nasal discharge
b. vomitus
c. amniotic fluid
d. feces
c. Fluids containing blood have the highest potential for disease transmission.
. A gurgling sound heard with artificial ventilation is a sign that
a. the patient must be suctioned immediately.
b. supplemental oxygen should be added to the gas-valve mask.
c. the airway is most likely open, patent, and clear.
d. the patient is trying to communicate with you.
a. A gurgling sound means that the patient needs to be suctioned immediately; ventilation cannot be adequate when the airway is blocked from mucous, blood, or other secretions.
. A 45-year-old male is experiencing chest discomfort. After placing him in his position of comfort, your next action should be to
a. ventilate the patient with a nonrebreather mask at 15 L/min.
b. ventilate the patient with the bag-valve mask at 15 L/min.
c. administer oxygen by nonrebreather mask at 15 L/min.
d. administer oxygen by the nasal cannula at 6 L/min.
c. There is no information to indicate that the patient requires ventilatory support. Any patient experiencing chest discomfort should receive the highest possible concentration of oxygen.
You are using the OPQRST acronym to assess a responsive medical patient. What question would you ask to assess the P component?
a. What were you doing when the pain started?
b. Can you describe the character of the pain for me?
c. What makes the pain feel worse or better?
d. On a scale of 1 to 10, how would you rank the pain?
c. The P component of the OPQRST acronym refers to provocation or palliation, or what makes the pain feel worse or better.
Your patient is a 29-year-old male who has fallen off a ladder. He is bleeding profusely from a wound on his right forearm and has severe pain in his left thigh. Which of the following is an appropriate initial treatment for this patient?
a. Perform a quick initial assessment to assess his ABCs.
b. Stop the bleeding by applying a tourniquet near the elbow.
c. Maintain an open airway and ventilate the patient with a gas-valve mask.
d. Elevate the patient’s legs 20–30 cm to treat him for shock.
a. Although you note several injuries, you still need to perform a rapid initial assessment to determine if any problems with the ABCs that you have not noted may be more life threatening than what you can obviously see. Stop the bleeding (but do not use a tourniquet) and treat the patient for shock, but do not elevate the patient’s legs if there is an injury to the legs, pelvis, head, neck, chest, abdomen, or spine. There is no indication that this patient needs ventilation at this time.
In which of the following situations should you call for immediate assistance?
a. You must care for two critical patients with gunshot wounds.
b. Your patient is a 26-year-old female in active labor.
c. Your patient is a child with fever who has had a brief seizure.
d. Your partner is needed to stabilize the cervical spine.
a. You could make the argument that you need additional help in the management of each of these situations; however, the one with the most critical need is when you must care for more than one critical patient. Both patients with gunshot wounds need immediate attention, so you should call for backup. In the other three situations, you should not require assistance unless some complicating factor presents itself. Patient b may or may not require ALS assistance, but most (over 80%) deliveries are simple and uncomplicated and can be easily managed by basic life support (BLS) providers. Patient c is having a febrile seizure, which is managed by stabilizing the ABCs and transporting. In patient d, even if your partner is required to stabilize the cervical spine, you should be able to manage the patient for the time being until other assistance arrives to assist with packaging and moving the patient.
When suctioning a patient, how far should you insert a soft suction catheter?
a. as far as you can see
b. as far as the base of the tongue
c. until resistance is encountered
d. past the vocal cords
b. Choice b is the correct procedure. Choice a is correct for a rigid catheter, choice c is the correct method for inserting an oropharyngeal airway, and choice d is applicable only to endotracheal intubation.
Which of the following is a sign of increased pressure in the circulatory system?
a. flat neck veins
b. palpable carotid pulse
c. distended jugular veins
d. decreased radial pulse
c. A supine patient may or may not have jugular veins that are prominent enough to palpate. However, even if the neck veins are normally present when an individual is supine, they will not be engorged in blood and overly firm to the touch. This is what is meant by the phrase distended neck veins. Distended neck veins (in any position) are a sign of increased circulatory pressure. The carotid pulse should always be palpable. A decreased radial pulse may indicate hypovolemic shock or an injured extremity
A patient complaining of facial paralysis on one side of his face with tearing, localized pain, and sensitivity may be suffering from the most common form of facial paralysis called
a. dystonia.
b. muscular dystrophy.
c. amyotrophic lateral sclerosis (ALS).
d. Bell’s palsy.
d. Bell’s palsy is the most common form of facial paralysis. Muscular dystrophy is a degenerative disease characterized by the weakening of skeletal muscle fibers. ALS, also known as Lou Gehrig’s disease, affects the nerve cells that control voluntary movement. Dystonia describes repetitive motions or abnormal posturing.
You are called to a store where a holdup has been committed. Police are already on the scene searching for the gunman. Through the store window, you see the store manager, who has been shot. You should
a. enter the store immediately to care for the manager.
b. leave immediately and seek cover a distance away.
c. wait until the police tell you it is safe to enter the scene.
d. request medical direction to determine if you can enter
c. EMTs should not enter a crime scene until it has been secured by police. As you travel to the scene, you should determine where it is most appropriate to park your vehicle. Generally, you want cover (protection from attack) and concealment (out of direct visual range) in your staging area.
. When arriving at the scene of a possible hazardous materials incident, you would identify hazards by
a. thoroughly investigating the scene yourself.
b. interviewing victims and bystanders.
c. scanning with binoculars from a safe distance.
d. assisting law enforcement officers in the search.
c. Never enter a scene where hazardous materials are present until you have verified that the scene is safe. Use binoculars to survey the scene from a distance in order to identify hazardous materials placards. Consider victims and bystanders contaminated and take appropriate precautions.
What is the correct procedure for a patient who has secretions or emesis that suctioning cannot easily remove?
a. Insert an oropharyngeal or nasopharyngeal airway immediately.
b. Suction for 15 seconds, ventilate for two minutes, and then repeat.
c. Logroll the patient and clear the oropharynx and nasopharynx.
d. Hyperventilate the patient with a bag-valvemask unit.
c. Choice c is the correct procedure for clearing the airway when simple suctioning is not working. Choice b is appropriate for a patient with copious frothy secretions like the kind produced with pulmonary edema. Choices a and d are inappropriate without first clearing the airway
Your patient is a 62-year-old male with a history of heart disease. He is experiencing chest pain. Your first action should be to
a. place the pads for the AED on his chest.
b. begin CPR while preparing the AED.
c. ask him if he has taken his nitroglycerin, and if not, offer to assist him.
d. place him in a comfortable position and administer high-flow oxygen.
d. Your first action would be to administer oxygen and place the patient in a comfortable position; next, if not contraindicated, you would request permission to administer nitroglycerin. You should first obtain a set of vital signs to ensure he is not in cardiogenic shock. Never put defibrillator pads onto a conscious patient with a pulse; this procedure is contraindicated. AED pads are not serving the same function as the electrodes used by ALS providers to monitor the heart rhythm.
Your patient is awake, confused, and disoriented. How would you grade her using the AVPU scale?
a. A
b. V
c. P
d. U
a. A means alert. The other letters in the acronym stand for verbal, pain, and unresponsive.
In a multiple-casualty situation, which patient should be assigned the highest priority?
a. adequate breathing, responsive, venous bleeding
b. adequate breathing, responsive, suspected spine injury
c. inadequate breathing, responsive, suspected broken tibia
d. inadequate breathing, unresponsive, suspected internal bleeding
d. Patients with breathing difficulties and serious bleeding receive the highest priority in a multiple-casualty situation.