Chapter 27 | Behavioral Emergencies

Question 1

Define:

behavior

Answer 1

manner in which a person acts or performs

Question 2

Define:

behavioral emergency

Answer 2

abnormal behavior in a given situation that is unacceptable or intolerable to patient/family/community

Question 3

Define:

acute psychosis

Answer 3

severe break in patient’s abilities to process information and interact with their environments

Question 4

List:

symptoms of acute psychosis

3 points

Answer 4

• hallucinations
• delusions
• catatonia (rigid and immobile)

Question 5

Define:

neurotransmitters

Answer 5

chemicals within the body that transmit a message to the brain

Question 6

Define:

schizophrenia

Answer 6

chronic mental disorder that affects how a person thinks/feels/behaves

Question 7

Define:

positional asphyxia

Answer 7

inadequate breathing or respiratory arrest caused by a body position that restricts breathing

Question 8

Fill in the blank:

Be sure to [BLANK] before entering a scene or caring for a violent or potentially violent patient.

Answer 8

Be sure to ensure your own safety before entering a scene or caring for a violent or potentially violent patient.

Question 9

Fill in the blank:

Patients who may pose a danger to you are, in most cases, dealt with by [BLANK].

Answer 9

Patients who may pose a danger to you are, in most cases, dealt with by the police.

Question 10

Explain:

how to care for hostile patient

5 points

Answer 10

request backup (if necessary)

seek advice from medical command (if necessary)

watch for sudden behavior changes

reassess frequently

consider restraint

Question 11

Define:

reasonable force

Answer 11

force necessary to keep patient from injuring self or others

Question 12

List:

factors determining reasonable-ness of force

4 points

Answer 12

• patient’s size/strength
• patient’s behavior
• mental status
• available methods of restraint

Question 13

Define:

excited delirium

Answer 13

extremely agitated or psychotic behavior during struggle

usually fatal

Question 14

Define:

catatonia

Answer 14

abnormality of movement and behavior arising from a disturbed mental state

usually being super rigid or immobile (like a wax statue)

Question 15

Fill in the blanks:

Excited delirium is followed by [BLANK], [BLANK], and then [BLANK].

Answer 15

Excited delirium is followed by cessation of struggling, respiratory arrest, and then death.

Question 16

Choose:

Which of the following is most indicative of a behavioral emergency?

A. A terminally ill cancer patient begins giving away her prized possessions.

B. A patient at the scene of a terrorist attack wails with grief at the loss of a spouse.

C. A patient with no apparent awareness of his surroundings speaks in gibberish.

D. A patient in severe respiratory distress begins grunting and collapses to her knees.

Answer 16

C

patient with no apparent awareness of his surrounding and who is speaking in gibberish most likely has AMS (because behavior is at odds with circumstances)

all other patients are responding in normal ways to difficult or life-threatening situations

Question 17

Choose:

Which of the following is a common medical cause for behavioral changes in a patient?

A. Rapid capillary refill

B. High blood sugar

C. Low blood sugar

D. Slow heart rate

Answer 17

C

when diabetic patient’s blood sugar level gets too low (hypoglycemia), patient starts to have mental and physical changes that may be confused with psychological problems

err on the side of caution and look for physiological causes first

Question 18

Choose:

A 38-year-old female patient presents with restlessness, confusion, and an altered mental status. Which finding below indicates a physiological cause of her bizarre behavior?

A. Hypertension

B. Stroke

C. Hypercholesterolemia (high blood cholesterol)

D. Hypoxia

Answer 18

D

Question 19

Choose:

You respond with the police to a domestic violence call where the wife has sustained superficial injuries. The police inform you that the husband is in custody and may be having a reaction to a drug such as PCP (phencyclidine). He is speaking rapidly and appears nervous. The police ask you to check him out before they take him away.

What should be your greatest safety concern regarding this patient?

A. Use of some drugs can lead to unpredictable behavior and may result in sudden violence.

B. His condition may involve a chemical contamination that poses a safety threat to all near him.

C. His excited state may result in a heart attack or similar medical problem.

D. He will likely attempt to evade arrest by running​ away, posing a threat to others.

Answer 19

A

greatest concern is unpredictability of patient in this condition

Question 20

Choose:

Which patient is showing the least likely sign of aggressive or hostile behavior?

A. A patient keeps getting too close to you.

B. A patient keeps slapping away your attempts at a physical examination.

C. A patient is moving and speaking suddenly and unpredictably.

D. A patient expresses remorse for his unhealthy habits.

Answer 20

D

remorse doesn’t demonstrate a potential for aggressive or hostile behavior nearly as much as panicky or threatening behavior

slapping away attempts at physical examination actually is hostile behavior

Question 21

Choose:

When a patient is acting irrationally and uncooperatively, which of the following is the most effective approach toward gaining the patient’s trust and cooperation?

A. Making sure other people are around as you interact with the patient

B. Being general and nondescript in your expectations of the patient

C. Displaying a calm, confident demeanor

D. Telling the patient what the patient wants to hear, even though it may not be the truth

Answer 21

C

showing the patient that you are relaxed and confident helps to reassure patient that problems are not unmanageable and that you are the person to help

Question 22

Choose:

Rushing the assessment of a patient who is in an agitated state from a situational stress reaction:

A. encourages the patient to give you pertinent information more quickly.

B. makes the situation seem more out of control to the patient.

C. contributes to the patient’s perception of your authority.

D. puts the current emergency into better perspective for the patient.

Answer 22

B

rushing assessment will likely magnify the patient’s feeling that events are out of control

instead show a firm control over your actions and the situation

Question 23

Choose:

You have arrived at the scene of a patient with a psychiatric condition that has led to a behavioral emergency. The scene has been declared safe, and you have explained to the patient why you are there.

What should be your next step?

A. Obtain a history from the patient.

B. Obtain the patient’s vital signs.

C. Conduct a primary assessment of the patient.

D. Prepare for transport, with the plan of completing your assessment en route to the hospital.

Answer 23

C

next priority is to conduct a primary assessment

A and B are wrong because obtaining a history and obtaining vital signs from the patient are parts of secondary assessment

D is wrong because primary assessments must be accomplished on all patients before transporting

Question 24

Choose:

In your assessment of a 50-year-old female with confusion, irrational behavior, and agitation, you discover that the patient has a history of high blood pressure, diabetes, previous heart attacks, arthritis, and gallstones.

Which of the following should be a part of your continued assessment for this patient?

A. summoning paramedics, as this patient is most likely having a heart attack.

B. trending the patient’s blood pressure by obtaining at least three readings.

C. a thorough examination of the abdomen, to reveal the presence of gallstones.

D. obtaining the patient’s blood glucose level.

Answer 24

D

hypoglycemia is likely cause of AMS

Question 25

Choose:

When transporting a patient who you believe to be having a behavioral emergency as the result of a medical emergency, what is your first concern?

A. Performing a detailed secondary examination

B. Assessment of the airway, breathing, and circulation

C. Transporting the patient to the nearest ED

D. Collecting a thorough history

Answer 25

B

all other concerns are secondary

Question 26

Choose:

When you are responding to a call involving a behavioral emergency, you should ensure throughout the call that you:

A. develop a definitive diagnosis of the patient’s condition.

B. remain alert for personal and scene safety problems.

C. carefully avoid touching or coming too near the patient.

D. gather evidence ruling out a psychiatric cause.

Answer 26

B

Question 27

Choose:

When you are called to care for a patient who may be about to attempt suicide, your first concern should be:

A. for your own safety.

B. to restrain the patient.

C. to establish your authority over the patient.

D. to call law enforcement.

Answer 27

A

Question 28

Answer:

Once you decide to restrain a patient, how quickly should the intervention be carried out?

Answer 28

as quickly as possible

should take the patient by surprise (working to your advantage) as well as eventually result in the de-escalation of the scene so that you can begin treating the patient.

Question 29

Choose:

Why is it dangerous to restrain a patient in the prone position?

A. It takes more rescuers to restrain a patient that way.

B. It can be the cause of positional asphyxia and lead to cardiac arrest.

C. Patients are harder to place on the stretcher that way.

D. The police will not allow that to be done.

Answer 29

B

patient may seem to calm down but may actually be going into respiratory or cardiac arrest as a result of positional asphyxia

Question 30

Choose:

You are transporting a stable patient with a behavioral problem. What should you do?

A. put a same-sex provider in the back with the patient, if possible.

B. restrain the patient for transport.

C. request that law enforcement ride in with you.

D. leave the patient unattended in the back.

Answer 30

A

emotionally disturbed patients sometimes accuse EMS personnel of sexual misconduct

Question 31

Choose:

Which of the following is true of excited delirium?

A. The patient is usually hypersensitive to pain.

B. The patient often has a history of dementia.

C. It is often associated with alcohol withdrawal.

D. It is often associated with cocaine or amphetamine use.

Answer 31

D

excited delirium entails bizarre and/or aggressive behavior, shouting, paranoia, panic, violence toward others, insensitivity to pain, unexpected physical strength, and/or hyperthermia

Question 32

Describe:

inadequate breathing or respiratory arrest caused by a body position that restricts breathing

Answer 32

positional asphyxia

Question 33

Choose:

You are at the scene of a middle-aged man who attempted to take his own life by cutting both of his wrists deeply. He is distraught over the death last week of his wife of 30 years. He is conscious and refuses any care or transport, and he warns you and your partner to stay away from him. He is unarmed but bleeding freely.

Which of the following is the best course of action?

A. Wait until the patient bleeds sufficiently to cause unconsciousness, and then treat him.

B. Request law enforcement assistance and contact medical direction for advice.

C. Immediately restrain the patient against his will and treat him accordingly.

D. Follow the patient’s commands and leave the scene immediately.

Answer 33

B

it will always be beneficial to have the police present if the patient must be restrained as a matter of safety

you may also be required to contact medical direction about the psychiatric patient who refuses care

Question 34

Choose:

If a patient’s erratic and confused behavior suddenly subsides into calm and rationality, the least likely cause of the abnormal behavior was:

A. hypoxia.

B. hypoglycemia.

C. head trauma.

D. mind-altering substances.

Answer 34

C

Question 35

Choose:

You are restraining a patient who continues to spit at you. What should you do?

A. Restrain the patient in the prone position

B. Put a surgical mask on the patient

C. Consider tightening the restraints so that they are painful

D. Refuse to transport the patient

Answer 35

B

Question 36

Choose:

A patient who threatens to harm himself or his wife because he is sure she is plotting against him with her sister (although both she and her sister deny it) is:

A. in a behavioral emergency if he is lying.

B. certainly lying but not in a behavioral emergency.

C. in a behavioral emergency.

D. possibly telling the truth, and behaving normally, if so.

Answer 36

C

whether or not statements are true, patient is still threatening harm to self/others

Question 37

Choose:

Which example best demonstrates providing reassurance to a patient who appears to be suicidal?

A. You listen carefully to the patient’s concerns and indicate that hospital treatment is best.

B. You relate your own struggles with dark thoughts.

C. You ask the patient if he feels his emotional pain is somehow unique.

D. You validate the patient’s emotions by agreeing that life is often overwhelming.

Answer 37

A

Question 38

Choose:

Which of the following should you do when interacting with a behavioral patient?

A. Avoid discussing what is troubling the patient

B. Lie to the patient if it assists with your assessment

C. Limit the interaction to no more than 15 minutes

D. Encourage the patient to discuss what is troubling them

Answer 38

D

do this, but DO NOT dwell on stressors or situations that escalate the current behavior

Question 39

Choose:

You are caring for a​ 27-year-old male who is screaming and throwing dishes in the kitchen. The family called EMS because they are concerned about his behavior. They inform you that his father just died that day.

What can you reasonably conclude?

A. That the patient’s behavior is normal in the circumstances and deserves support and monitoring

B. That the patient’s behavior should simply be accepted and ignored until it stops

C. That the patient’s behavior is unacceptable and​ intolerable, even if the reason is understandable

D. That the patient is in a behavioral emergency brought on by grief

Answer 39

A

behavioral Emergencies are looked at in the context of “within a given situation”

in this situation, patient found out about his father dying that day

part of a situation such as this include screaming, crying, throwing things, or other outbursts — so, in this context, the patient’s behavior would not be unusual (but would deserve support and monitoring of the patient)

Question 40

Choose:

As you physically examine a patient who might be in a behavioral emergency, you should:

A. be alert for any relevant medical and traumatic conditions.

B. make the examination as rapid and abbreviated as possible.

C. stop at the first sign that appears to point to a psychiatric cause for the patient’s behavior.

D. expect to find clear evidence of mental illness.

Answer 40

A

Question 41

Choose:

You are caring for a 19-year-old male patient who has multiple superficial lacerations over each wrist, in different stages of healing. When you ask him what the marks are from, he states that he sustained them when he was trying to climb over a chain link fence. You suspect multiple attempts at suicide.

What should you do?

A. Report your suspicions to the staff at the receiving hospital

B. Inform the patient that he needs to be honest about any suicide attempts

C. State that transport must be delayed until an exact cause for injuries may be determined

D. Accept the​ patient’s explanation, and simply remind him to be more careful

Answer 41

A

Question 42

Choose:

A patient who told his friend that he planned to commit suicide is refusing ambulance transportation but is agreeable to going to the hospital via a friend’s private vehicle.

What action should you take at this point?

A. Allow the friend to transport the patient via private vehicle.

B. Have your partner accompany the patient in the friend’s car.

C. Have the patient sign a refusal of care and transportation form.

D. Contact medical direction for assistance.

Answer 42

D

situation kinda sus? call med command

Question 43

Choose:

Your patient is a 15-year-old female who has been 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?

A. Refuse to transport the patient without a police escort.

B. Have a female EMT attend to the patient.

C. Transport the patient, but do not speak to her or perform an assessment.

D. Ask that the patient be given a tranquilizer injection prior to transport.

Answer 43

B

Question 44

Choose:

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 she tells you to get away from her.

Which of the following should not be done?

A. Use Standard Precautions.

B. Call law enforcement for assistance.

C. Keep bystanders away from the patient.

D. Take the razor blade away from her by force.

Answer 44

D

Question 45

Choose:

You respond to the scene of a private residence for a patient who is known to have insulin-dependent diabetes. The patient is combative and cursing as you approach.

Should this patient be restrained?

A. Yes, he likely has a medical condition that requires treatment.

B. No, this patient is not likely experiencing a behavioral emergency.

C. There is not enough information to answer this question.

D. Yes, he is combative and all combative patients can be restrained.

Answer 45

C

Question 46

Choose:

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 not be appropriate in treating this patient?

A. Contact the receiving hospital and report on current mental status and other essential information.

B. Take charge of the situation; let the patient know that what he has done is wrong and tell him he is coming with you whether he likes it or not.

C. Watch for sudden changes in the patient’s behavior and physical condition.

D. As soon as possible, perform a history and physical exam and provide emergency care on the wrist, if necessary.

Answer 46

B

Question 47

Choose:

Which of the following is not an acceptable method or adjunct in restraining a patient?

A. Placing a surgical mask over the patient’s face to prevent spitting

B. Restraining the patient face-up

C. Hog-tying the patient

D. Securing all four limbs with leather restraints

Answer 47

C

Question 48

Choose:

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?

A. Positional asphyxia is the position the person is seated in when you approach him.

B. Positional asphyxia is inadequate breathing or respiratory arrest caused by a body position that restricts breathing.

C. Positional asphyxia is a birth defect that causes psychiatric issues and is initiated because of the way the fetus was positioned in the uterus.

D. Positional asphyxia is the name for the position someone assumes after she has been hit with a taser.

Answer 48

B

Question 49

Choose:

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?

A. Contact the patient’s family to find out what their wishes are.

B. Leave the scene and allow law enforcement to handle the situation.

C. Respect the patient’s wishes; he is alert, oriented, and capable of giving consent.

D. Transport the patient against his will with the assistance of law enforcement.

Answer 49

D

Question 50

True or false:

There is always an indication that a suicide attempt is imminent.

Answer 50

false

suicide can’t be predicted in many cases (no outward signs preceding it)

Question 51

True or false:

All suicide attempts must be taken seriously.

Answer 51

true

Question 52

True or false:

Attempted suicide is a matter for law enforcement, not EMS.

Answer 52

false

it often involves both

Question 53

True or false:

Truly suicidal patients nearly always leave a note.

Answer 53

false

Question 54

Choose:

When providing emergency care to an aggressive or hostile patient, what is the highest priority?

A. Performing a scene size-up

B. Calming the patient down

C. Finding out if the patient is oriented to person, time, and place

D. Checking the patient for possible physical causes of the behavior

Answer 54

A

Question 55

True or false:

Patients experiencing a behavioral emergency are not always dangerous to themselves or others.

Answer 55

true

Question 56

True or false:

It is unusual to find a person with schizophrenia outside a mental health facility.

Answer 56

false

Question 57

True or false:

Apparent behavioral emergencies may be due to an underlying medical cause.

Answer 57

true

Question 58

True or false:

Cultural differences may cause a patient’s behavior to initially appear abnormal to the EMT.

Answer 58

true

Question 59

Choose:

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 threatened to go out, get a gun, and shoot himself. His 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?

A. Do not take any action that may be considered threatening by the patient; doing so may bring about hostile behavior directed against you or others.

B. Always be on the watch for weapons.

C. Make certain the patient gets between you and the door. The patient should always feel he has an escape route.

D. Do not isolate yourself from your partner or other sources of help.

Answer 59

C

Question 60

Choose:

Why is it important to gather a detailed medical history when dealing with a psychiatric emergency?

A. It will help you to determine whether you need to restrain the patient.

B. It will help you to determine whether the police are needed.

C. It is not. You want to get the call resolved as quickly as possible and this will just delay it.

D. It will alert you to past issues as well as medication.

Answer 60

D

Question 61

True or false:

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.

This is the mechanism by which the impulse is moved along the nervous system.

Answer 61

true

Question 62

True or false:

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.

Neurotransmitters are released from a neuron, then travel across the synapse to the next neuron.

Answer 62

true

Question 63

True or false:

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.

After the impulse is transmitted, the neurotransmitter goes through a process called reuptake, in which the neurotransmitter is returned to the postsynaptic neuron.

Answer 63

false

Neurotransmitters are released from a neuron, then travel across the synapse to the next neuron.

Question 64

True or false:

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.

The receptors on the postsynaptic neuron receive the neurotransmitter.

Answer 64

true

Question 65

Choose:

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?

A. Contact medical direction for further advice.

B. Stay with the patient until he has stopped vomiting.

C. Find a relative or neighbor to come over and stay with the patient.

D. Obtain a witnessed refusal.

Answer 65

A

Question 66

Choose:

There are general rules for dealing with psychiatric emergencies. Which of the following is not one of those rules and would not be considered appropriate?

A. Identify yourself and your role.

B. Never make eye contact with the patient, as it will just increase his nervousness.

C. Speak slowly and clearly, using a calm and reassuring tone.

D. Listen to the patient. You can show you are listening by repeating part of what the patient says back to him.

Answer 66

B

Question 67

Choose:

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?

A. Have your partner join you in approaching the patient and explain to him that he has to stop singing or you will have him arrested.

B. Quietly and carefully evaluate the situation and keep your emotions under control. Be as unhurried as you can.

C. Quickly approach the patient and take charge. Tell him he has to come with you to be evaluated.

D. Have the police take charge, restrain the patient, and have him brought into your ambulance.

Answer 67

B

Question 68

Choose:

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?

A. There is no need to assess for medical conditions if the patient does not have a history of past medical problems.

B. Attempt to determine whether there is a possible physical cause for the patient’s behavior.

C. Begin intense individual counseling with the patient.

D. Establish the best way to restrain the patient before he has the opportunity to become violent.

Answer 68

B

Question 69

Fill in the blank:

Refusals and restraints [DO/DON’T] cause significant medical/legal risk.

Answer 69

Refusals and restraints do cause significant medical/legal risk.

Question 70

Fill in the blank:

Laws typically [DO/DON’T] allow providers to treat and transport patients against their will if posing a danger to selves or others.

Answer 70

Laws typically do allow providers to treat and transport patients against their will if posing a danger to selves or others.

Question 71

Choose:

You are on the scene of a possible overdose. You find a 30-year-old man pacing around 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?

A: Sit close to him with your arm around his shoulders to show that you are truly concerned.

B: Speak quickly to give the patient all of the important information without delay.

C: Repeat part of what the patient is saying to show that you are listening to him.

D: Stand still with your arms crossed to instill a sense of control and authority.

Answer 71

C

Question 72

Choose:

All of the following are general rules for dealing with a psychiatric patient except:

A: speak slowly and clearly, and use a calm and reassuring tone.

B: do not be judgmental; instead, show pity, because he needs to know that you understand him.

C: make eye contact with the patient.

D: listen to the patient, showing you are listening by repeating part of what the patient says back to him.

Answer 72

B

Question 73

True or false:

It can sometimes be difficult to determine whether someone who is showing unusual behavior is having a psychological emergency or is showing an altered mental status due to a physical issue.

Consider patients who are exhibiting crisis or unusual behavior to be having an altered mental status from a nonpsychiatric cause until proven otherwise.

Answer 73

true

Question 74

True or false:

It can sometimes be difficult to determine whether someone who is showing unusual behavior is having a psychological emergency or is showing an altered mental status due to a physical issue.

Many medical and traumatic conditions are likely to alter a patient’s behavior.

Answer 74

true

Question 75

True or false:

It can sometimes be difficult to determine whether someone who is showing unusual behavior is having a psychological emergency or is showing an altered mental status due to a physical issue.

Lack of oxygen may cause restlessness and confusion, cyanosis (blue or gray skin), and altered mental status.

Answer 75

true

Question 76

True or false:

It can sometimes be difficult to determine whether someone who is showing unusual behavior is having a psychological emergency or is showing an altered mental status due to a physical issue.

Stroke or inadequate blood to the brain may cause confusion or dizziness and what appears to be erratic behavior.

Answer 76

true

Question 77

Choose:

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?

A: Sudden onset of schizophrenia

B: Alcohol withdrawal

C: An underlying physical illness

D: Alcoholic intoxication

Answer 77

C

Question 78

Choose:

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?

A: Find a relative or neighbor to come over and stay with the patient.

B: Contact medical direction for further advice.

C: Obtain a witnessed refusal.

D: Stay with the patient until he has stopped vomiting.

Answer 78

B

Question 79

Choose:

You arrive on the scene of a motor vehicle accident to find an adult male in his early twenties with a large gash on his forearm that is spurting blood. You immediately apply pressure with your gloved hand as you reach for a trauma dressing. The patient is alert and responsive but appears pale with a weak rapid pulse and respirations of 30 breaths per minute. As you finish your initial assessment and bandage the wound, the patient becomes agitated and demands that you stop treating him.

What should be done at this point?

A. Call for law enforcement assistance to restrain the agitated patient.

B. Discontinue treatment if he refuses, while ensuring the wound is adequately stabilized.

C. Explain the importance of completing the bandaging procedure and insist on restraining the patient to the stretcher.

D. Tell the patient you cannot leave him until the wound is bandaged

Answer 79

B

It is best to try to keep the situation calm and finish the current treatment. An adult patient that is conscious and alert has the right to refuse care or transport any point in the intervention. It is best to quickly finish and let the patient go. We never have a right to force treatment on this type patient.

Question 80

Choose:

Your unit is alerted to a “man down” unconscious and unresponsive. Upon arrival on scene, you observe a man lying face down in his garage in a pool of blood. As you roll the patient over, you see an entry wound to the temporal area of the patient’s head, and see a handgun laying under the body of the patient. The patient has fast, shallow respirations, and there appears to be no exit wound.

What should you do next?

A. Request law enforcement assistance for a potential suicide, retreat to a safe location and wait for their arrival.

B. Request law enforcement assistance for a potential suicide, move the patient if the handgun hinders your ability to perform aide, and begin life saving measures.

C. Request law enforcement assistance for a potential suicide, move the handgun to clear the area around the patient, and begin life saving measures.

D. Begin life saving measures, load the patient as quickly as possible, and transport immediately.

Answer 80

B

You should immediately request law enforcement assistance for a potential suicide. Understand that you are now working within a potential crime scene. Move the patient away from the handgun to perform life saving measures. This will ensure that the handgun is left undisturbed and in its original position.