Question 1

After a devastating plane crash, in which hundreds of individuals are gravely injured, a nurse separates the wounded into categories: a. minimally injured; b. severely injured; c. near death; and d. dead. This rapid assessment of the severity of illness is known as:

A) Decontamination
B) Distributive justice
C) Triage
D) Disaster planning

Triage

Accepted Answer

Triage is the sorting of patients according the severity of their illnesses or injuries. In emergency rooms in which relatively small numbers of patients appear at one time, the sickest patients are usually treated first. In casualties that involve large masses of people, "reverse triage" is often employed. In "reverse triage," the patients most likely to benefit from the use of available resources are treated first. Decontamination is the cleansing of a patient or a local environment, to remove dangerous chemicals or radioactive materials that may pose a hazard to health. Disaster planning is preparation for a mass casualty event, such as an earthquake, a massive spill, a plane crash, or a nuclear meltdown. It may involve storing inventories of useful medications or supplies, establishing communications systems, training staff or volunteers, staging practice sessions, among other interventions before a disaster occurs. Distributive justice is an ethical concept that suggests that the greatest good is done when the largest number of people benefit from an intervention.

Question 2

Which of the following is the best first action to take with an actively bleeding patient?&#10;A) Assess the patient for bloodborne pathogens, such as chronic hepatitis B or HIV, with a blood test.&#10;B) Apply direct pressure to the bleeding site, after employing standard precautions.&#10;C) Extablish IV access, get send blood for crossmatching, and infuse normal saline until blood products for transfusion are available.

Accepted Answer

Apply direct pressure, but always follow Standard Precautions when handling or exposed to blood or body fluids.

Question 3

In an emergency, the safest blood type to infuse into a patient is:&#10;A) Type AB+&#10;B) Type A+&#10;C) Type B-&#10;D) Type O-

Accepted Answer

Type O- blood has neither A or B antigens, or Rhesus antigen, and is the least likely to trigger a major transfusion reaction.

Question 4

After a nuclear reactor fails, the easiest way to determine if there is an environmental release of radiation is:&#10;A) To look at the reactor, it will appear radioactive to the eye.&#10;B) To inhale the air, radioactivity has a distinct odor.&#10;C) To listen for crackling sounds, as radioactive particles are emitted into the atmosphere.&#10;D) None of the above

Accepted Answer

Radioactivity is colorless, odorless, and inaudible. It cannot be detected visually, by touch, by hearing, or smell.

Question 5

Which of the following are indicators a patient is in shock?&#10;A) Cool, clammy skin&#10;B) Pink, diaphoretic skin&#10;C) Bruises and lacerations on the skin&#10;D) All of the above

Accepted Answer

Shock is a state in which there is inadequate perfusion of blood to meet the metabolic needs of the body. Skin that is not adequately perfused is cooler than normal, may appear blotchy, pale or cyanotic, and is not pink, rosy, or warm.

Question 6

Which of the following are also indicators that a patient is in shock?&#10;A) Elevated blood pressures&#10;B) Hyperthermia&#10;C) Tachycardia&#10;D) Pressured speech

Accepted Answer

A rapid heart rate (tachycardia) is consistent with shock. Some other indicators of shock may include low blood pressure, lack of urinary output, and slowed mentation (lethargy or coma).

Question 7

An open fracture is a fracture in which:&#10;A) Any reasonably observant passerby can see that a bone is broken.&#10;B) The fractured bone protrudes through the skin&#10;C) The fracture is associated with a dislocation&#10;D) The fracture has not yet been splinted.

Accepted Answer

An open or compound fracture is one in which the bone protrudes through the skin. It is more prone to infection than a closed fracture, in which the integrity of the skin overlying the fracture is intact. A common bacterial infection of an open fracture is Staphylococcus Aureus.

Question 8

After a fall from a fourth-story window, a man is found to be in cardiac arrest. You should:&#10;A) Immediately begin cardiopulmonary resuscitation (CPR)&#10;B) Stabilize the spine, then begin CPR&#10;C) Use the head-tilt chin lift to open the airway&#10;D) Check the patient's blood pressure

Accepted Answer

After an injury such as a motor vehicle rollover, or a fall from a great height, patients may have unrecognized ("occult") spinal fractures. Stabilize the patient's spine with cervical collars or backboards, and initiate CPR. Note that the head-tilt chin-lift maneuver may be hazardous to the patient who has an occult cervical spinal fracture, because it moves the neck aggressively. The jaw-thrust maneuver is used to open the airway of a patient who is suspected of having a C-spine injury.

Question 9

Relatively early effects of radiation exposure include:&#10;A) Sunburn, nausea, vomiting and diarrhea&#10;B) Premature aging&#10;C) Birth defects&#10;D) Bone marrow suppression

Accepted Answer

Radiation syndrome is a multiphase illness in which the first adverse reactions are found in rapidly dividing cells, such as those on the skin, or in the epithelial cells that line the gastrointestinal tract. Suppression of bone marrow and premature aging are later consequences.

Question 10

Irrigation of the skin with clean water is mostly likely to benefit victims of:&#10;A) An earthquake&#10;B) A tsunami&#10;C) The release of smallpox&#10;D) A chemical spill

Accepted Answer

Flushing the skin with clean water may remove toxic residues from a chemical spill. It is less likely to impact the course of a smallpox exposure-an agent of biological warfare which primarily injures people as a result of inhalation. Earthquake and tsunami survivors are more likely to have suffered major trauma, internal injuries, dehydration, near-drowning, or hypothermia than the accumulation of toxins on the skin.

Deck 22: Disaster Medicine