West Coast EMT Chapter 21 -- Toxicology, West Coast EMT Chapter 22 -- Psychiatric Emergencies

A 49-year-old male presents with confusion, sweating, and visual hallucinations. The patient's wife tells you that he is a heavy drinker and she thinks he had a seizure shortly before your arrival. This patient is MOST likely experiencing:

Select one:

A. acute schizophrenia.

B. delirium tremens.

C. alcohol intoxication.

D. acute hypovolemia.

B. delirium tremens.

A person who routinely misuses a substance and requires increasing amounts to achieve the same effect is experiencing:

Select one:

A. tolerance.

B. withdrawal.

C. dependence.

D. addiction.

A. tolerance.

Activated charcoal is given to patients who have ingested certain substances because it:

Select one:

A. decreases absorption of poisons into the lungs.

B. binds to the substance and prevents absorption.

C. is a direct antidote for many toxic substances.

D. induces vomiting and empties the stomach.

B. binds to the substance and prevents absorption.

An overdose of acetaminophen, the active ingredient in Tylenol, will MOST likely cause:

Select one:

A. liver failure.

B. kidney failure.

C. gastric ulcers.

D. CNS depression.

A. liver failure.

As you enter the residence of a patient who has possibly overdosed, you should:

Select one:

A. quickly gain access to the patient.

B. be alert for personal hazards.

C. look for drug paraphernalia.

D. observe the scene for drug bottles.

B. be alert for personal hazards.

Heroin is an example of a(n):

Select one:

A. hypnotic.

B. sympathomimetic.

C. cholinergic.

D. opioid.

D. opioid.

How do poisons typically act to harm the body?

Select one:

A. By causing a slowing of nearly all bodily functions

B. By changing the normal metabolism of cells or by destroying them

C. By interfering with normal neurologic function

D. By causing burns and damage to either external or internal organs

B. By changing the normal metabolism of cells or by destroying them

Hypotension, hypoventilation, and pinpoint pupils would be expected following an overdose of:

Select one:

A. oxycodone (Percocet).

B. ecstasy.

C. amphetamine sulfate (Benzedrine).

D. crack cocaine.

A. oxycodone (Percocet).

If the victim of a toxicologic emergency vomits, an EMT should _________.

Select one:

A. have the patient enclose the vomitus in a container and take it to the emergency department.

B. not approach the vomitus.

C. safely dispose of the vomitus as soon as possible and decontaminate the vehicle as necessary.

D. use appropriate personal protective equipment and examine the vomitus for pill fragments or other clues for patient care.

D. use appropriate personal protective equipment and examine the vomitus for pill fragments or other clues for patient care.

In an apparent suicide attempt, a 19-year-old female ingested a full bottle of amitriptyline (Elavil). At present, she is conscious and alert and states that she swallowed the pills approximately 30 minutes earlier. Her blood pressure is 90/50 mm Hg, her pulse is 140 beats/min and irregular, and her respirations are 22 breaths/min with adequate depth. When transporting this patient, you should be MOST alert for:

Select one:

A. acute respiratory depression.

B. seizures and cardiac arrhythmias.

C. an increase in her blood pressure.

D. a sudden outburst of violence.

B. seizures and cardiac arrhythmias.

Most poisonings occur via the __________ route.

Select one:

A. injection

B. absorption

C. inhalation

D. ingestion

D. ingestion

Of the four avenues of poisoning, generally ___________ is the most worrisome in terms of treatment to the EMS provider.

Select one:

A. injection

B. absorption

C. ingestion

D. inhalation

A. injection

The recommended treatment for absorbed or contact poisons includes _________.

Select one:

A. neutralizing the poisonous substance with a chemical

B. transporting the patient to the emergency department with the poisonous substance in place

C. safely removing or diluting the poisonous substance

D. collecting and transporting the poisonous substance to the emergency department for identification

C. safely removing or diluting the poisonous substance

Victims of inhaled poisoning will require which of the following?

Select one:

A. Suctioning to clear the airway

B. Transport to an emergency department for evaluation

C. Ventilation with a bag-valve mask

D. An oropharyngeal or nasopharyngeal device to maintain an airway

B. Transport to an emergency department for evaluation

When caring for a known alcoholic patient with severe trauma to the chest and abdomen, you should be concerned that:

Select one:

A. internal bleeding may be profuse because prolonged alcohol use may impair the blood's ability to clot.

B. delirium tremens (DTs) are commonly induced by physical trauma and can lead to life-threatening seizures.

C. long bone fractures are likely because chronic alcohol consumption weakens the structure of the bones.

D. signs and symptoms of shock may be masked by the stimulant effects produced by alcohol.

A. internal bleeding may be profuse because prolonged alcohol use may impair the blood's ability to clot.

Which of the following questions would be LEAST pertinent during the initial questioning of a patient who ingested a substance?

Select one:

A. How long ago was the substance taken?

B. Why was the substance ingested?

C. What type of substance was taken?

D. How much of the substance was taken?

B. Why was the substance ingested?

Which of the following sets of vital signs would the EMT MOST likely encounter in a patient with acute cocaine overdose?

Select one:

A. BP, 180/100 mm Hg; pulse, 50 beats/min

B. BP, 200/100 mm Hg; pulse, 150 beats/min

C. BP, 190/90 mm Hg; pulse, 40 beats/min

D. BP, 60/40 mm Hg; pulse, 140 beats/min

B. BP, 200/100 mm Hg; pulse, 150 beats/min

Which of the following statements regarding the Salmonella bacterium is correct?

Select one:

A. The Salmonella bacterium produces toxins that cause food poisoning.

B. The Salmonella bacterium itself causes food poisoning.

C. Symptoms of salmonellosis appear within 12 hours.

D. Refrigeration of food will prevent salmonellosis.

B. The Salmonella bacterium itself causes food poisoning.

You and your paramedic partner are caring for a patient who ingested codeine, acetaminophen (Tylenol), and hydrocodone (Vicodin). The patient is unresponsive, his breathing is slow and shallow, and his pulse is slow and weak. Treatment for this patient should include:

Select one:

A. assisted ventilation and naloxone (Narcan).

B. assisted ventilation and flumazenil (Romazicon).

C. oxygen via a nasal cannula and atropine sulfate.

D. high-flow oxygen via a nonrebreathing mask.

A. assisted ventilation and naloxone (Narcan).

You receive a call to a residence where a man found his wife unresponsive on the couch. The patient's respiratory rate is 8 breaths/min, her breathing is shallow, her heart rate is 40 beats/min, and her pulse is weak. The husband hands you an empty bottle of hydrocodone (Vicodin), which was refilled the day before. You should:

Select one:

A. perform a rapid head-to-toe exam.

B. apply oxygen via a nonrebreathing mask.

C. ventilate her with a BVM.

D. contact the poison control center.

C. ventilate her with a BVM.

A 38-year-old male with a history of schizophrenia is reported by neighbors to be screaming and throwing things in his house. You are familiar with the patient and have cared for him in the past for unrelated problems. Law enforcement officers escort you into the residence when you arrive. The patient tells you that he sees vampires and is attempting to ward them off by screaming and throwing things at them. He has several large lacerations to his forearms that are actively bleeding. The MOST appropriate way to manage this situation is to:

Select one:

A. try to gain the patient's trust by telling him that you see the vampires too.

B. approach the patient and calm him by placing your hand on his shoulder.

C. request that the police officers arrest him and take him to the hospital.

D. restrain the patient with appropriate force in order to treat his injuries.

D. restrain the patient with appropriate force in order to treat his injuries.

A 40-year-old male intentionally cut his wrist out of anger after losing his job. Law enforcement has secured the scene prior to your arrival. As you enter the residence and visualize the patient, you can see that he has a towel around his wrist and a moderate amount of blood has soaked through it. You should:

Select one:

A. tell the patient that you want to help.

B. calmly identify yourself to the patient.

C. approach the patient with caution.

D. quickly tend to the bleeding wound.

B. calmly identify yourself to the patient.

A behavioral crisis interferes with which of the following?

Select one:

A. Activities of daily living

B. Behavior that is acceptable to the community

C. Dressing, eating, or bathing

D. All of these answers are correct.

D. All of these answers are correct.

A general impression of the patient is formed by an EMT:

Select one:

A. speaking privately with the patient.

B. at a distance when the patient is first seen.

C. when the patient is in the ambulance.

D. speaking with family members or bystanders first.

B. at a distance when the patient is first seen.

Everyone exhibits some signs and symptoms of mental illness at some point in life ____________.

Select one:

A. and needs medication administered to control them

B. but that does not mean a person is mentally ill

C. because mental illness affects everyone

D. and should be physically restrained for their own safety and the safety of the EMT

B. but that does not mean a person is mentally ill

From a mental health standpoint, an abnormal or disturbing pattern of behavior is a matter of concern if it lasts for at least:

Select one:

A. 3 weeks.

B. 1 week.

C. 1 month.

D. 2 weeks.

C. 1 month.

Signs of excited delirium include:

Select one:

A. subdued behavior, crying, and suicidal thoughts.

B. slurred speech, bradycardia, and a high fever.

C. diaphoresis, tachycardia, and hallucinations.

D. pallor, hypotension, and constricted pupils.

C. diaphoresis, tachycardia, and hallucinations.

The two basic categories of diagnosis that a physician will use for behavioral crises or psychiatric emergencies are ____________.

Select one:

A. organic brain syndrome and altered mental status

B. functional and nonfunctional

C. physical and psychological

D. All of these answers are correct.

C. physical and psychological

What is the most common misconception surrounding mental illness?

Select one:

A. Many mental illnesses stem from drug or alcohol abuse.

B. Everyone has some form of mental illness.

C. All persons with mental disorders are physically violent and dangerous.

D. Feeling "bad" or "depressed" means that you must be "sick."

D. Feeling "bad" or "depressed" means that you must be "sick."

When a psychiatric emergency arises, a patient is most likely to exhibit which of the following behaviors?

Select one:

A. Any behaviors that are a violent threat to the patient, EMTs, or others

B. Disruptions to activities of daily living

C. Visual or auditory hallucinations

D. Any behaviors unacceptable to the patient, family, or community

A. Any behaviors that are a violent threat to the patient, EMTs, or others

When caring for a patient experiencing excited delirium, the EMT should remember that:

Select one:

A. most patients will have low blood pressure and hyperglycemia.

B. lights and siren are effective in redirecting the patient's behavior.

C. excited delirium is worsened by nervous system depressant drugs.

D. sudden death can occur if the patient's violence is not controlled.

D. sudden death can occur if the patient's violence is not controlled.

Which of the following is a good guideline for physical examination of any patient?

Select one:

A. Always work toe-to-head.

B. Complete the physical exam first, then check the ABCs.

C. Examine extremities first.

D. Avoid touching without permission.

D. Avoid touching without permission.

Which of the following is an example of a psychiatric emergency?

Select one:

A. A person who is depressed and no longer caring for himself

B. A person going on a week-long "bender" after losing a job

C. A person violently attacking family members

D. A person who is experiencing a panic attack

C. A person violently attacking family members

Which of the following is considered an organic brain syndrome?

Select one:

A. Alzheimer dementia

B. Schizophrenia

C. Depression

D. Anxiety conditions

A. Alzheimer dementia

Which of the following terms applies to a state of delusion in which the patient is out of touch with reality?

Select one:

A. Agitated delirium

B. Psychosis

C. Schizophrenia

D. Suicidal

B. Psychosis

Why might EMTs encounter a larger proportion of violent patients than the population at large?

Select one:

A. EMTs respond to patients who, by definition, are having an emergency.

B. EMTs respond with law enforcement.

C. It is a common misperception; EMTs do NOT encounter a larger proportion of violent patients than the population at large.

D. EMTs have to restrain patients.

A. EMTs respond to patients who, by definition, are having an emergency.

You are assessing a 45-year-old female who is severely depressed. She states that it seems as though her entire world is crashing down around her. She further states that she has had frequent thoughts of suicide, but is not sure if she can actually go through with it. How should you manage this situation?

Select one:

A. Ask the patient if she has developed a suicidal plan.

B. Have law enforcement place her in protective custody.

C. Encourage the patient to remain quiet during transport.

D. Leave the scene and have a neighbor check in on her.

A. Ask the patient if she has developed a suicidal plan.

You are attending to a 27-year-old patient with a history of depression. The patient's family tells you that she has been openly talking about harming herself and suicide, and they got scared when she tried to overdose on some medications. The patient did not take the pills and is alert and oriented. Despite all of your best efforts to convince her, the patient refuses to go to hospital for treatment. Based on this information, you should:

Select one:

A. call for the police to attend the scene and, once they arrive, release responsibility for patient transport to them

B. ensure that the patient is competent and completes the required documentation, and leave her in the care of her family.

C. stay with the patient while you arrange for other transport options as a potentially life-threatening emergency exists.

D. restrain the patient and transport her to the hospital as she represents a threat to her safety.

C. stay with the patient while you arrange for other transport options as a potentially life-threatening emergency exists.

You are attending to a 32-year-old male patient. The patient's wife tells you that he returned from Afghanistan last year. While he initially seemed fine, lately he has become withdrawn and distanced himself from his family and friends. He does not talk about it, but she knows that he has been having terrible nightmares that wake him up. The most appropriate question to ask regarding his experience in Afghanistan is:

Select one:

A. Can you tell me about your experience?

B. Have you ever been diagnosed with PTSD?

C. Were you shot at or under fire?

D. Were you in combat?

C. Were you shot at or under fire?

You receive a call for a domestic dispute. When you arrive at the scene, you find a young male standing on the front porch of his house. You notice that an adjacent window is broken. The patient has a large body, is clenching his fists, and is yelling obscenities at you. Which of the following findings is LEAST predictive of this patient's potential for violence?

Select one:

A. The broken window

B. His large body size

C. His clenched fists

D. His shouting of obscenities

B. His large body size