Write  the letter of the best answer in the space provided.


                  1.    Insulin can best be described as a(n)

A.  amino acid.                                                    C.  blood sugar.

B.  hormone.                                                        D.  platelet.


                  2.    The organ(s)  responsible for the production of insulin is (are) the

A.  liver.                                                             C.  pancreas.

B.  kidneys.                                                         D.  spleen.


                  3.    All of the following are signs or symptoms commonly associated with a diabetic emergency except

A.  an elevated heart rate.                                      C.  seizure activity.

B.  combativeness.                                               D.  hot, dry skin.


                  4.    The simple form of sugar that is the body’s main source of energy is

A.  insulin.                                                         C.  adrenalin.

B.  glucose.                                                         D.  diabanese.


                  5.    Glucose is administered  in the form of a

A.  tablet.                                                           C.  suspension.

B.  liquid for injection.                                        D.  gel.


                  6.   Which memory aid should be used to gather a history from a patient with an altered mental status?

A.  SAMPLE                                                       C.  START

B.  AVPU                                                           D.  DCAP-BTLS


                  7.    The type of diabetes that requires a patient to inject insulin daily is

A.  Type 1.                                                         C.  “maturity-onset diabetes.”

B.  Type 2.                                                         D.  diabetic ketoacidosis.


                  8.    If a patient has excessive thirst, breath with a fruity odor,  and warm, dry skin, you would suspect

A.  hypoglycemia.                                                C.  hyperglycemia.

B.  epilepsy.                                                        D.  cerebral edema.


                  9.    All of the following are medications  often taken by diabetics except

A.  Glynase®.                                                            C.  nitroglycerin.

B.  Humalog®.                                                     D.  Orinase®.


                10.    For the EMT to administer oral glucose, the patient must meet all of the following criteria except

A.  an altered mental status.

B.  a baseline blood pressure that is greater than 90 mmHg systolic.

C.  a history of diabetes controlled  by medication.

D.  the ability to swallow.

                11.    Proper administration of oral glucose usually produces

A.  headache.                                                       C.  diaphoresis.

B.  bradycardia.                                                    D.  no side effects.


                12.    What action does oral glucose take in the bloodstream?

A.  decreases blood sugar                                      C.  decreases insulin level

B.  increases blood sugar                                       D.  increases insulin level


                13.    If you are in doubt  as to whether  the patient is suffering from an emergency related to hypoglycemia or hyperglycemia, err to benefit the patient and

A.  allow the patient to drink.                              C.  administer oral glucose.

B.  withhold  liquids from the patient.                    D.  withhold  oral glucose.


                14.    Which of the following is a contraindication to the administration of oral glucose?

A.  history of diabetes                                          C.  trauma

B.  altered mental status                                       D.  unresponsiveness


                15.    Patients with an altered mental status and without  suspected spinal injury should be transported in what position?

A.  shock                                                            C.  prone

B.  lateral recumbent                                             D.  supine






Review the following real-life  situation. Then answer the questions that follow.


You and your partner are dispatched  at 1015  to the Riverside Apartments  on Montgomery Drive, Apartment 323, for an unconscious male. Upon  your arrival, the patient’s excited wife meets you at the door. As she leads you to the kitchen, she explains that her husband,  who is diabetic, has not been feeling well and stayed home from work today due to nausea and vomiting. While they were sitting at the kitchen table, he suddenly passed out and she immediately called 911.  As you enter the kitchen,  you see a male patient  in his late 50s slumped  in a kitchen  chair. Your  primary assessment reveals that  the  patient  is unresponsive and bradypneic (10 breaths per minute), with a weak and rapid radial pulse and pale, cool, and clammy skin.


1.  What condition do these signs and symptoms suggest?





2.  In addition  to a SAMPLE history, what additional  questions  would you ask the patient’s wife?




3.  Is oral glucose indicated for this patient? Why or why not?






4.  What additional  emergency medical care would you provide to this patient?




Write  the word or words that best complete each sentence in the space provided.


1.   The body’s main source of energy is                                                  .


2.   The hormone secreted by the pancreas that is needed  to promote the movement  of glucose from the blood into the cells is known as          .

3.   When there is a(n)                                                   of insulin, glucose cannot enter the cells; instead, it remains in the bloodstream, causing a high level of glucose in the blood,  a condition known as     .

4.   When a diabetic’s insulin level is too high, too much sugar enters the cells and not enough  sugar remains in the blood,  a condition called             .

5.                                                                     is the medication  of choice in the emergency medical care of the diabetic patient with an altered mental status.

6.   Assess and document the mental status of a diabetic patient using the                                         scale.


7.   As an alternative to squeezing  small portions  of the tube of oral glucose into the patient’s mouth, the EMT could use a(n)                     .

8.   Type                                                   diabetes typically develops in adulthood and is controlled  by diet, exercise, oral medications,  and, in severe cases, with insulin.

9.                                                       is a disease characterized  by an altered relationship between glucose and insulin.

10.    If no mechanism of injury is apparent,  you would suspect that a patient’s altered mental status is a result of a(n)             .

11.    Never administer oral glucose to a patient who cannot swallow or who is                             .


12.    For a patient with an altered mental status, repeat the ongoing  assessment every




13.    The most common sign of hypoglycemia is a(n)




14.    An altered mental status from hypoglycemia will typically have a(n)



15.    A patient may take as long as                                                   minutes before showing improvement from receiving oral glucose.







1.  List five medications  often taken by diabetics.








2.  List nine signs and symptoms associated with a diabetic emergency.







3.  List the three indications for administering  glucose to a diabetic patient.







4.  List the four steps in the administration of glucose.







Write  in  the missing  information on the medication flash card below and  save the completed card for future reference.


Medication  Names:


1.  Generic:


2.  Trade:
















Medication  Form:                                                                                                                                                 Dosage:                                                                                                                                                                   Actions:





Side Effects:                                                                                                                                       


Write  the letter of the best answer in the space provided.


                 1.    A sudden  and temporary  alteration  in brain function  caused by massive electrical discharge in a group of nerve cells in the brain is called

A.  a convulsion.                                                  C.  postictal activity.

B.  a seizure.                                                       D.  dysrhythmias.


                 2.    The chronic brain disorder that is characterized  by recurrent  seizures is called

A.  the aura.                                                        C.  epilepsy.

B.  CVA.                                                            D.  postictal activity.


                 3.    All of the following are common  causes of seizures except

A.  shock.                                                           C.  infection.

B.  hypoxia.                                                        D.  hypoglycemia.


                 4.    The period following a seizure in which the patient may be unresponsive,  extremely sleepy, weak, and disoriented  is called the

A.  grand mal state.                                             C.  tonic phase.

B.  postictal state.                                                D.  clonic phase.


                 5.    Many patients will tell the EMT that they knew they were going to seize because of the

A.  tonic phase.                                                   C.  clonic phase.

B.  postictal state.                                                D.  aura.


                 6.    The period of a seizure when the patient’s muscles become contracted and tense with arching of the back is called the

A.  tonic phase.                                                   C.  clonic phase.

B.  postictal state.                                                D.  aura.


                 7.    The period of a seizure when muscles spasm and then relax, producing violent and jerky activity, is called the

A.  clonic phase.                                                  C.  aura.

B.  tonic phase.                                                   D.  postictal state.


                 8.    A life-threatening condition characterized  by a patient’s seizing for more than 5 minutes or consecutive seizures without  an intermittent period of consciousness is called

A.  a grand mal seizure.                                        C.  status epilepticus.

B.  a convulsion.                                                  D.  epilepsy.


                 9.    A sudden  and temporary  loss of consciousness is called

A.  epilepsy.                                                        C.  syncope.

B.  a convulsion.                                                  D.  seizure.


                10.   The type of seizure most common  in children between 6 months  and 6 years old that is caused by high fever is called a(n)     seizure.

A.  absence (petit mal)                                          C.  grand mal

B.  febrile                                                            D.  complex partial

                11.   A type of seizure most common  in children, which is characterized  by a blank stare, lasting only a few seconds, and beginning  and ending abruptly, is called a(n)  ______ seizure.

A.  complex partial                                               C.  Jacksonian

B.  focal sensory                                                   D.  absence (petit mal)


                12.   If a patient’s seizures last longer than 10 minutes,  the EMT should begin

A.  endotracheal intubation.                                    C.  positive-pressure ventilations.

B.  CPR.                                                            D.  AED use.


                13.   All of the following are common  medications  used in the treatment of epilepsy except

A.  Dilantin®.                                                      C.  insulin.

B.  Mysoline®.                                                    D.  phenobarbital.


                14.   The term for weakness on one side of the body is

A.  aphasia.                                                         C.  hemiparalysis.

B.  dysphasia.                                                      D.  hemiparesis.


                15.   Usually, a postictal patient should be placed in the           position.

A.  Trendelenburg                                                 C.  lateral recumbent

B.  Fowler’s                                                        D.  prone




Review the following real-life  situation. Then answer the questions that follow.


You and your partner  are dispatched  to the local mall for a man having a seizure. Upon  your arrival, you are greeted  by a mall security guard who reports  that  your patient  was noted  walking alone through the mall when he suddenly fell to the ground and began having a “convulsion.” The guard tells you that the episode must have lasted about  6 or 7 minutes.  Your patient  is a male, approximately 30 years old, who is in a semi-sitting position next to a water fountain. He appears to be breathing  adequately and is conscious, although a bit dazed.


1.  What type of seizure did the security guard describe to you?





2.  In what stage of the seizure is the patient upon your arrival? How long should this stage last?





3.  What emergency care measures should you take with this patient?





4.  What should you do if the patient states that this is normal for him and he doesn’t want to go to the hospital?





Write  the word or words that best complete each sentence in the space provided.


1.   A(n)                                                   is a sudden  and temporary  alteration  in brain function  caused by massive electrical discharge in a group of nerve cells in the brain.

2.   A common  cause of seizures is                                                   , a chronic brain disorder characterized  by recurrent  seizures.

3.   The                                                  state follows the seizure and is the recovery period for the patient.

4.   Seizure activity that is related to an injury or a medical condition may be an ominous  sign of


or even permanent brain damage.


5.   You cannot force a patient to accept transport  or treatment, but you do need to


the call.


6.   If the patient is talking normally, it indicates a(n)                                                     airway and




7.   A patient who suffers seizures that last more than 5 minutes or seizures that occur consecutively without  a period of responsiveness between them is considered  to be in                                               .


8.   Perform a(n)                                                                                                               if the patient is postictal and still has an altered mental status or if she does not have a past medical history of epilepsy or seizures.

9.   The                                                  serves as a warning that a seizure is going to begin and involves some type of sensory perception  by the patient.

10.                                                    is a sudden  and temporary  loss of consciousness.


11.    The EMT should place the syncopal patient in the  position to allow for improved blood flow to the brain.

12.                                                    seizures, caused by high fever, are most common  in young children.


13.    The EMT needs to be aware that medical conditions such as  __________________

and                                                  may be confused with a seizure or may produce  a seizure.

14.    A seizing patient’s movements should be  __________________ rather than


to prevent further injury.


15.    The EMT should gather a(n)  __________________ history from the responsive seizure patient, relatives, and/or  bystanders.






1.  List five common  causes of seizures.




2.  List seven steps in the emergency medical care for a seizing patient.



3.  List the stages or phases of a seizure.





4.  List four steps of emergency medical care for a syncope patient.



Write the letter of the best answer in the space provided.


                  1.    A severe form of allergic reaction is called

A. an allergen.                                                     C. epinephrine.

B. anaphylaxis.                                                    D. an immune reaction.


                  2.    Harmless to most individuals, allergens are foreign substances that cause an abnormal immune system response known as

A. mitosis.                                                          C. an allergic reaction.

B. hypotoxemia.                                                  D. an immune response.


                  3.    An EMT who notices that his hands are red and itchy after a call may be experiencing an allergic reaction to

A. latex gloves.                                                    C. exercise.

B. talcum powder.                                               D. heat exposure.


                  4.    Signs and symptoms of an allergic reaction include all of the following except

A. itching.                                                          C. decreased blood pressure.

B. increased appetite.                                            D. watery eyes.


                  5.    A sign of a severe allergic reaction is

A. runny nose.                                                    C. mild edema.

B. cyanosis.                                                        D. malaise.


                  6.    The dose of epinephrine that should be given to an adult suffering severe allergic reaction is   mg.

A. 0.3                                                                C. 0.05

B. 0.5                                                                D. 0.15


                  7.    Epinephrine is most commonly administered as a(n)

A. tablet.                                                            C. prescribed inhaler.

B. gel.                                                                D. auto-injector.


                 8.     When administered as a medication, epinephrine will accomplish all of the following except

A. constrict blood vessels.                                    C. relax the bronchioles.

B. lower blood pressure.                                       D. stimulate the heartbeat.


                  9.    The dose of epinephrine that should be given to infants/children is             mg.

A. 0.5                                                                C. 0.15

B. 0.3                                                                D. 0.05


                10.    If the patient’s condition improves following the administration of epinephrine, you should

A. perform reassessment.                                       C. initiate CPR.

B. administer a second dose.                                 D. connect the AED.




Review the following real-life situations. Then answer the questions that follow.


The patient is an 8-year-old boy with a known history of allergies and asthma. His mother tells you that she administered his EpiPen® 5 minutes before your arrival. However, you believe that she gave it incor- rectly. “He pulled away when I tried to give the shot,” explains the mother. “I saw some of the medicine form a mist in the air.”


You examine the arm where the mother says that she gave the injection, but find no puncture mark. The child’s distress has worsened since your arrival, and he now seems barely conscious.

“I have three more EpiPens®,” offers the mother.


1. What action(s) should you take at this time?






Your next patient is an unconscious construction worker named Fred. “He had barely started to work with some fiberglass insulation when he fainted,” explains one of his coworkers.


You ask the coworkers more questions and find out that Fred was sneezing and coughing just before he fainted. They also noticed that he was using a handkerchief to wipe his watery eyes and runny nose. “He usually wears a respiratory mask on the job site,” adds one of the coworkers, “but he forgot to bring it today.”


Upon conducting a physical examination of the patient, you find a Medic Alert tag indicating that Fred has a number of allergies. His vital signs include a blood pressure of 70/42 and a weak pulse of 136. During your initial assessment, the foreman hands you an EpiPen® kit. “I found this in Fred’s lunch box,” he says. “Will it help?”


2. What action(s) should you take at this time?




Write the word or words that best complete each sentence in the space provided.


1.     An abnormal or excessive response of the body’s immune system to a foreign material is called a(n)




2.   Foreign substances recognized by the cells of the immune system and eventually destroyed by the body’s response are called          .

3.   A severe form of an allergic reaction is called




4.   Antibodies are proteins that search for the antigen, combine with it, and then help to destroy it in a process known as     .

5.                                                   ________________ from insect bites or stings, especially of wasps, hornets, yellow jackets, and fire ants, may cause an allergic reaction and anaphylaxis.

6.   Red, itchy, possibly raised blotches on the skin are known as                                                    .


7.   Management of the airway during anaphylaxis may require


, the placement of a tube in the trachea to facilitate breathing.


8.   When administered as a medication, epinephrine will                                                        blood vessels to improve the patient’s                                     .

9.   A spring-loaded needle and syringe with a single dose of epinephrine is known as a(n)


–                                               .


10.    The correct dose of epinephrine for an adult is                                                      mg; for a child, it is









Indicate if the following statements are true or false by writing T or F in the space provided.


                  1. Generally, an individual must come into contact with an allergen more than once for an anaphylactic reaction to occur.


                  2. Antibodies are proteins that search for an antigen, combine with it, and destroy it.


                  3. After 15 to 20 minutes, a patient suffering an allergic reaction has little risk of slipping into anaphylactic shock.


                  4. During an allergic reaction, you can expect to discover a higher-than-average blood pressure.


                  5. Epinephrine auto-injectors may not be administered to unconscious patients.


                  6. Epinephrine has no contraindications when used in a life-threatening situation.


                  7. A possible side effect of epinephrine use is chest pain.


                  8. Some anaphylactic reactions require repeated doses of epinephrine before the allergic reaction stops.


                  9. The two key categories of signs and symptoms that specifically indicate anaphylaxis are respiratory compromise and shock.


                10.  A patient experiencing an allergic reaction with no signs of respiratory distress or shock should receive epinephrine.



Place a check mark in front of the signs and symptoms commonly associated with anaphylaxis or anaphylactic shock.


increased pulse




decreased respirations


increased appetite




altered mental status


flushed skin


absent radial and/or pedal pulses




decreased pulse


increased respirations


decreased blood pressure


feeling of impending doom










Write in the missing information on the medication flash card below, and save the completed card for future reference.



Epinephrine Auto-Injector


Medication Names:


1. Generic:


2. Trade:











Medication Form:                                                                         











Side Effects:
















Write the letter of the best answer in the space provided.


                  1.  Any substance—liquid, solid, or gas—that impairs health or causes death by its chemical                                    action when it enters the body or comes into contact with the skin is called a(n)

A. allergen.                                                           C. antigen.

B. poison.                                                             D. caustic.


                  2.  The most common poisons ingested by children include all of the following except

A. fertilizers.                                                          C. cleaning products.

B. plants.                                                              D. toiletries.


                  3.  Carbon monoxide is an example of an _______ poison.

A. ingested                                                            C. absorbed

B. inhaled                                                             D. injected


                  4.  When treating an absorbed poisoning patient, if the poison is a liquid, you should irrigate all              parts of the patient’s body for at least _________ minutes.

A. 5                                                                     C. 20

B. 10                                                                   D. 45


                  5.  Use of activated charcoal is indicated in some cases of          poisoning.

A. injected                                                            C. absorbed

B. inhaled                                                             D. ingested


                  6.  Activated charcoal is administered in the form of a(n)

A. tablet.                                                              C. gel.

B. suspension.                                                       D. inhaler.


                  7.  All of the following are trade names for activated charcoal except

A. SuperChar.                                                        C. Liqui-Char.

B. CharCoal.                                                         D. Actidose.


                  8.  The usual dose of activated charcoal for an adult is

A. 12.5–25 grams.                                                  C. 30–100 grams.

B. 3 grams/kg of body weight.                                D. 10 grams/kg of body weight.


                  9.  In treating cases of inhaled poisons, the drug of first choice is

A. activated charcoal.                                              C. glucose.

B. syrup of ipecac.                                                 D. oxygen.


                10.  The most common sources of injected poisons are

A. drugs.                                                              C. plants.

B. bites and stings.                                                D. over-the-counter medications.


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