Chapter 33 Environmental Emergencies:

Drowning is MOST accurately defined as: A. death from suffocation after submersion in water. B. temporary survival after submersion in water. C. water in the lungs following submersion in water. D. death beyond 24 hours after submersion in water.

A. death from suffocation after submersion in water.

What is often the first sign of heatstroke? Change in behavior Muscle cramps Low pulse rate and blood pressure Profuse sweating

Change in behavior

You are dispatched to a residence for a young female who is sick. The patient complains of a rash to her lower extremities and truncal area. Your assessment reveals a small, painful blister on her inner thigh. As your partner is taking the patient's vital signs, she states that she and her family returned from a camping trip 2 days ago. On the basis of this patient's presentation, you should suspect:

Lyme disease

Shivering stops and muscle activity ceases once the body core temperature reaches what? 95°F (35°C) 90°F (32.2°C) 85°F (29.4°C) 80°F (26.7°C)

90°F (32.2°C)

Hypothermia is diagnosed when the core body temperature falls below what temperature? 98°F (36.7°C) 95°F (35°C) 92°F (33.3°C) 90°F (32.2°C)

95°F (35°C)

Which of the following conditions would be the LEAST likely to increase a person's risk of hypothermia? A. Hyperglycemia B. Spinal cord injury C. Severe infection D. Head injury

A. Hyperglycemia

Which of the following is an early sign of pit viper envenomation? A. Local swelling and ecchymosis B. General weakness and diaphoresis C. Signs and symptoms of hypoperfusion D. Syncope and bleeding at distal sites

A. Local swelling and ecchymosis

Which of the following is an early sign of pit viper envenomation? Select one: A. Local swelling and ecchymosis B. Signs and symptoms of hypoperfusion C. General weakness and diaphoresis D. Syncope and bleeding at distal sites

A. Local swelling and ecchymosis

Rough handling of a patient with severe hypothermia may cause which of the following dysrhythmias? A. Ventricular fibrillation B. Sinus bradycardia C. Asystole D. Sinus tachycardia

A. Ventricular fibrillation

A 30-year-old male was rescued after being lost in the woods for approximately 18 hours. The outside temperature is 30°F (-1°C). He is immediately placed in the warmed ambulance, where you perform a primary assessment. He is unresponsive, pale, and apneic. You should: A. assess for a carotid pulse for up to 60 seconds. B. open his airway and give two rescue breaths. C. apply chemical heat packs to his groin and axillae. D. apply an AED and assess his cardiac rhythm.

A. assess for a carotid pulse for up to 60 seconds.

Drowning is MOST accurately defined as: Select one: A. death from suffocation after submersion in water. B. temporary survival after submersion in water. C. death beyond 24 hours after submersion in water. D. water in the lungs following submersion in water.

A. death from suffocation after submersion in water.

All of the following terms refer to a body part that is cold but not frozen, EXCEPT: Select one: A. frostbite. B. trench foot. C. frostnip. D. immersion foot.

A. frostbite.

Covering a patient's __________ will significantly minimize radiation heat loss. A. head B. chest C. extremities D. abdomen

A. head

To obtain the MOST accurate reading of a patient's core body temperature, you should place a special hypothermia thermometer: A. into a patient's rectum B. under the patient's armpit C. behind the patient's knee D. under the patient's tongue

A. into the patient's rectum

Burns associated with lightning strikes are typically: A. superficial. B. third-degree. C. full-thickness. D. partial-thickness.

A. superficial.

Burns associated with lightning strikes are typically: Select one: A. superficial. B. third-degree. C. full-thickness. D. partial-thickness.

A. superficial.

Most of the serious injuries associated with scuba diving are caused by: A. too rapid of an ascent. B. cold water temperature. C. alcohol consumption. D. too rapid of a descent.

A. too rapid of an ascent.

What is the most dangerous, and most common, emergency in scuba diving? Air embolism Decompression sickness Diving reflex Drowning

Air embolism

Shivering stops and muscle activity ceases once the body core temperature reaches: A. 95°F (35°C). B. 90°F (32.2°C). C. 85°F (29.4°C). D. 80°F (26.7°C).

B. 90°F (32.2°C).

Hypothermia is diagnosed when the core body temperature falls below what temperature? A. 98°F (36.7°C) B. 95°F (35°C) C. 92°F (33.3°C) D. 90°F (32.2°C)

B. 95°F (35°C)

Hypothermia occurs when the core body temperature falls below: A. 88°F (31°C). B. 95°F (35°C). C. 90°F (32°C). D. 98°F (37°C).

B. 95°F (35°C).

Hypothermia occurs when the core body temperature falls below: Select one: A. 88°F (31°C). B. 95°F (35°C). C. 98°F (37°C). D. 90°F (32°C).

B. 95°F (35°C).

A 30-year-old male was rescued after being lost in the woods for approximately 18 hours. The outside temperature is 30°F (-1°C). He is immediately placed in the warmed ambulance, where you perform a primary assessment. He is unresponsive, pale, and apneic. You should: Select one: A. apply chemical heat packs to his groin and axillae. B. assess for a carotid pulse for up to 60 seconds. C. open his airway and give two rescue breaths. D. apply an AED and assess his cardiac rhythm.

B. assess for a carotid pulse for up to 60 seconds.

Common signs and symptoms of heat exhaustion include all of the following, EXCEPT: A. headache. B. hot, dry skin. C. nausea. D. tachycardia.

B. hot, dry skin.

In order for sweating to be an effective cooling mechanism: A. the relative humidity must be above 90% B. it must be able to evaporate from the body. C. the body must produce at least 1 L per hour. D. several layers of clothing must be worn.

B. it must be able to evaporate from the body.

You receive a call to a residence for a sick patient. Upon your arrival, you find the patient, a 53-year-old diabetic male, lying down on his front porch. His wife tells you that he had been mowing the lawn in the heat for the past 3 hours. The patient is confused and has hot, moist skin. His pulse is weak and thready, and his blood pressure is 90/50 mm Hg. You should: Select one: A. administer one tube of oral glucose and reassess his mental status. B. load him into the ambulance and begin rapid cooling interventions. C. perform a head-to-toe assessment and look for signs of trauma. D. place him in a sitting position and have him drink 1 L of water.

B. load him into the ambulance and begin rapid cooling interventions.

The EMT must assume that any unwitnessed water-related incident is accompanied by: A. an air embolism B. possible spinal injury C. alcohol intoxication D. cold-water immersion

B. possible spinal injury

You are transporting a 28-year-old man with a frostbitten foot. The patient's vital signs are stable and he denies any other injuries or symptoms. The weather is treacherous and your transport time to the hospital is approximately 45 minutes. During transport, you should: Select one: A. cover his foot with chemical heat compresses. B. protect the affected part from further injury. C. administer oxygen via a nonrebreathing mask. D. rewarm his foot in 102°F to 104°F (38.9°C to 40°C) water.

B. protect the affected part from further injury.

Cardiorespiratory response when core body temperature falls into the range of 89°F to 92°F (31.7°C to 33.3°C) involves A. constricted blood vessels and rapid breathing B. slowing respirations and a slow pulse C. weak pulse, dysrhythmias, and very slow respirations D. cardiac arrest

B. slowing respirations and a slow pulse

You respond to a local lake where a diver complains of difficulty breathing that occurred immediately after rapidly ascending from a depth of approximately 30 feet. On assessment, you note that he has cyanosis around his lips and has pink froth coming from his nose and mouth. You should: Select one: A. place him in a semi-sitting position, suction his mouth and nose, apply a continuous positive airway pressure (CPAP) device, and transport to the closest emergency department. B. suction his mouth and nose, apply high-flow oxygen, monitor the patient's breath sounds for a pneumothorax, and contact medical control regarding transport to a recompression facility. C. suction his mouth and nose, keep him supine and elevate his legs to prevent air bubbles from entering his brain, administer high-flow oxygen, and transport to a hyperbaric chamber. D. position him supine with his head elevated 30°, suction his mouth and nose, hyperventilate him with a bag-valve mask, and contact medical control for further guidance.

B. suction his mouth and nose, apply high-flow oxygen, monitor the patient's breath sounds for a pneumothorax, and contact medical control regarding transport to a recompression facility.

A 31-year-old male was bitten on the leg by an unidentified snake. The patient is conscious and alert and in no apparent distress. Your assessment of his leg reveals two small puncture marks with minimal pain and swelling. In addition to administering oxygen and providing reassurance, further care for this patient should include: A. transporting only with close, continuous monitoring. B. supine positioning, splinting the leg, and transporting. C. applying ice to the wound and transporting quickly. D. elevating the lower extremities and giving antivenin.

B. supine positioning, splinting the leg, and transporting.

A 31-year-old male was bitten on the leg by an unidentified snake. The patient is conscious and alert and in no apparent distress. Your assessment of his leg reveals two small puncture marks with minimal pain and swelling. In addition to administering oxygen and providing reassurance, further care for this patient should include: Select one: A. transporting only with close, continuous monitoring. B. supine positioning, splinting the leg, and transporting. C. applying ice to the wound and transporting quickly. D. elevating the lower extremities and giving antivenin.

B. supine positioning, splinting the leg, and transporting.

The patient has a respiratory rate of 4 breaths per minute. Your partner assists ventilations with a bag-mask device while you perform a pulse check. How long should you assess for a carotid pulse? A. 5 to 10 seconds B. 15 to 30 seconds C. 30 to 45 seconds D. 45 to 60 seconds

C. 30 to 45 seconds

Hypothermia occurs when the core body temperature falls below: A. 98F (37C) B. 88F (31C) C. 95 F (35C) D. 90F (32C)

C. 95F

A 31-year-old male was bitten on the leg by an unidentified snake. The patient is conscious and alert and in no apparent distress. Your assessment of his leg reveals two small puncture marks with minimal pain and swelling. In addition to administering oxygen and providing reassurance, further care for this patient should include: A. transporting only with close, continuous monitoring. B. elevating the lower extremities and giving antivenin. C. supine positioning, splinting the leg, and transporting. D. applying ice to the wound and transporting quickly.

C. Supine positioning, splinting the leg, and transporting.

Which of the following would be the LEAST likely to occur in a patient with a core body temperature of between 89°F (32°C) and 92°F (33°C)? A. Confusion B. Stiff muscles C. Tachycardia D. Bradypnea

C. Tachycardia

Compared to adults, infants and children are at higher risk for hypothermia for all of the following reasons, EXCEPT: A. a smaller amount of body fat. B. a decreased ability to shiver. C. a relatively small surface area. D. a smaller overall muscle mass.

C. a relatively small surface area.

The MOST prominent symptom of decompression sickness is: Select one: A. tightness in the chest. B. dizziness and nausea. C. abdominal or joint pain. D. difficulty with vision.

C. abdominal or joint pain.

A 30=year-old male was rescued after being lost in the woods for approximately 18 hours. The outside temperature is 30°F (-1°C). He is immediately placed in the warmed ambulance, where you perform a primary assessment. He is unresponsive, pale, and apneic. You should: A. apply an AED and assess his cardiac rhythm. B. apply chemical heat packs to his groin and axillae. C. assess for a carotid pulse for up to 60 seconds. D. open his airway and give two rescue breaths.

C. assess for a carotid pulse for up to 60 seconds.

In contrast to Lyme disease, Rocky Mountain spotted fever: Select one: A. presents with flu-like symptoms and a bull's-eye rash. B. may be confused with rheumatoid arthritis. C. can cause paralysis and cardiorespiratory collapse. D. causes painful joint swelling after a few days or weeks.

C. can cause paralysis and cardiorespiratory collapse.

When a warm hand is immersed in water that is 70°F (21°C), heat is transferred from the hand to the water through a process called: Select one: A. radiation. B. convection. C. conduction. D. evaporation.

C. conduction.

The body's natural cooling mechanism, in which sweat is converted to a gas, is called: A. convection B. radiation C. evaporation D. conduction

C. evaporation

The body's natural cooling mechanism, in which sweat is converted to a gas, is called: A. convection. B. radiation. C. evaporation. D. conduction.

C. evaporation.

The body's natural cooling mechanism, in which sweat is converted to a gas, is called: Select one: A. convection. B. radiation. C. evaporation. D. conduction.

C. evaporation.

Common signs and symptoms of heat exhaustion include all of the following, EXCEPT: Select one: A. tachycardia. B. headache. C. hot, dry skin. D. nausea.

C. hot, dry skin.

In contrast to the brown recluse spider, the black widow spider: A. is very small and has a violin-shaped marking on its back. B. has a bite that usually produces local pain but no systemic signs or symptoms. C. is large and has a red-orange hourglass mark on its abdomen. D. has a bite that is typically painless until a blister develops.

C. is large and has red-orange hourglass mark on its abdomen.

The venom of a black widow spider is toxic to the: Select one: A. renal system. B. cardiovascular system. C. nervous system. D. respiratory system.

C. nervous system.

The EMT must assume that any unwitnessed water-related incident is accompanied by: A. an air embolism. B. cold-water immersion. C. possible spinal injury. D. alcohol intoxication.

C. possible spinal injury.

The patient's core body temperature is 80°F (26.7°C). At this temperature, the patient's hypothermia would be classified as: A. mild. B. moderate. C. severe. D. extreme.

C. severe.

Burns associated with lightning strikes are typically: A. partial-thickness B. third-degree C. superficial D. full-thickness

C. superficial

Most of the serious injuries associated with scuba diving are caused by: Select one: A. cold water temperature. B. too rapid of a descent. C. too rapid of an ascent. D. alcohol consumption.

C. too rapid of an ascent.

A person who stands outside in windy, wintry weather and wears only lightweight clothing is mainly experiencing heat loss by what method? Conduction Convection Evaporation Respiration

Convection

Which of the following medications increases a person's risk of a heat-related emergency? A. Tylenol B. Asprin C. Motrin D. Diuretics

D. Diuretics

All of the following terms refer to a body part that is cold but not frozen, EXCEPT: A. Immersion Foot B. Trench Foot C. Frostnip D. Frostbite

D. Frostbite

Which of the following MOST accurately describes hyperthermia? Select one: A. Heat evaporates a significant amount of body water. B. The body eliminates more heat than it can generate. C. The core body temperature exceeds 99.5°F (37°C). D. The body is exposed to more heat than it can lose.

D. The body is exposed to more heat than it can lose.

Your partner observes a medical alert bracelet on the patient's wrist. It says that the patient has diabetes. Other risk factors for hypothermia include all the following EXCEPT: A. burns. B. head injury. C. shock. D. acclimatization to cold.

D. acclimatization to cold.

You and your partner respond to a park where several people were reportedly struck by lightning. When you arrive, you find three patients. The first patient is lying supine on the ground; he is unresponsive and does not appear to be breathing. The second patient is ambulatory, appears confused, and is holding his arm against his chest. The third patient is sitting on the ground holding the sides of his head . After calling for backup, you should: A. recognize that the patients who are conscious are at high risk for developing cardiac arrest and quickly assess them for potentially life-threatening injuries. B. immediately begin CPR on the unresponsive patient, but cease resuscitation efforts if there is no response after 5 minutes of treatment. C. focus your initial treatment efforts on the patients who are conscious because the unresponsive patient is likely in irreversible cardiac arrest. D. assess the unresponsive patient's pulse, begin CPR starting with chest compressions if he is pulseless, and attach the AED as soon as possible.

D. assess the unresponsive patient's pulse, begin CPR starting with chest compressions if he is pulseless, and attach the AED as soon as possible.

You and your partner respond to a park where several people were reportedly struck by lightning. When you arrive, you find three patients. The first patient is lying supine on the ground; he is unresponsive and does not appear to be breathing. The second patient is ambulatory, appears confused, and is holding his arm against his chest. The third patient is sitting on the ground holding the sides of his head. After calling for backup, you should: Select one: A. immediately begin CPR on the unresponsive patient, but cease resuscitation efforts if there is no response after 5 minutes of treatment. B. focus your initial treatment efforts on the patients who are conscious because the unresponsive patient is likely in irreversible cardiac arrest. C. recognize that the patients who are conscious are at high risk for developing cardiac arrest and quickly assess them for potentially life-threatening injuries. D. assess the unresponsive patient's pulse, begin CPR starting with chest compressions if he is pulseless, and attach the AED as soon as possible.

D. assess the unresponsive patient's pulse, begin CPR starting with chest compressions if he is pulseless, and attach the AED as soon as possible.

In contrast to Lyme disease, Rocky Mountain spotted fever: A. presents with flu-like symptoms and a bull's-eye rash. B. may be confused with rheumatoid arthritis. C. causes painful joint swelling after a few days or weeks. D. can cause paralysis and cardiorespiratory collapse.

D. can cause paralysis and cardiorespiratory collapse.

All of the following terms refer to a body part that is cold but not frozen, EXCEPT: A. frostnip. B. immersion foot. C. trench foot. D. frostbite.

D. frostbite.

The EMT must assume that any unwitnessed water-related incident is accompanied by: Select one: A. an air embolism. B. alcohol intoxication. C. cold-water immersion. D. possible spinal injury.

D. possible spinal injury.

High air temperature reduces the body's ability to lose heat by: A. evaporation B. convection C. conduction D. radiation

D. radiation

An air embolism associated with diving occurs when: A. the alveoli completely collapse due to high pressure. B. high water pressure forces air into the mediastinum. C. the diver hyperventilates prior to entering the water. D. the diver holds his or her breath during a rapid ascent.

D. the diver holds his or her breath during a rapid ascent.

The body's natural protective mechanisms against heat loss are: A. respiration and vasoconstriction. B. shivering and vasodilation. C. vasodilation and respiration. D. vasoconstriction and shivering.

D. vasoconstriction and shivering.

In which of the following environmental emergencies are you most likely to encounter laryngospasm? Coral snake bite Drowning Hyperthermia Tick bite

Drowning

Three ambulances respond to a golf course where a group of six golfers were struck by lighting. Two of the golfers are conscious and alert with superficial skin burns (Group 1). The next two golfers have minor fractures and appear confused (Group 2). The last two golfers are in cardiac arrest (Group 3). According to reverse triage, which group of golfers should be treated FIRST? Group 1 Group 2 Group 3 Groups 1 and 2; Group 3 should be tagged as deceased.

Group 3

You are treating a patient who was climbing a 10,000-foot mountain when he began to experience a severe, constant, throbbing headache, ataxia, and extreme fatigue. He is nauseous and, as you assess him, he loses consciousness. Which of the following should you suspect? HACE HAPE Mountain sickness Rocky Mountain spotted fever.

HACE

You arrive at the scene and find the patient sitting under a tree in his garden; he is conscious, but confused. His wife tells you that he has been working outside all day. She further states that he refused to take a break and drink some water. Your assessment finds a flushed appearance; weak and rapid radial pulses; and hot, moist skin. Based on this, you suspect that your patient is suffering from __________ . Heat cramps Heat exhaustion Heat stroke Heat asphyxia

Heat stroke

Which of the following statements regarding drowning is correct?

Laryngospasm following submersion in water makes rescue breathing difficult.

Which of the following statements regarding lightning strikes is correct?

Lightning strikes may cause cardiac dysrhythmias that spontaneously resolve.

You suspect that the patient you are treating was bitten by a rattlesnake. What should you do first? Apply ice to the wound. Catch the snake so you can take it to the ED. Place the patient is a supine position. Apply suction to the wound to suck out the venom.

Place the patient is a supine position.

In the context of an environment that is 90°F with 85% humidity, what does moist, pale, cool skin indicate? The body can no longer regulate core body temperature. The patient is hypothermic. There has been excessive fluid and salt loss. Core body temperature and ambient temperature are equal.

There has been excessive fluid and salt loss.

Rough handling of a patient with severe hypothermia may cause which of the following dysrhythmias? Ventricular fibrillation Sinus bradycardia Asystole Sinus tachycardia

Ventricular fibrillation

Breath-holding syncope is caused by a decreased stimulus to breathe and occurs when:

a swimmer hyperventilates prior to entering the water.

Signs of late heat stroke include:

a weak, rapid pulse.

After being stung on the leg by a jellyfish, a man complains of severe pain to his leg, dizziness, and difficulty breathing. He has a red rash covering his trunk and his blood pressure is 90/50 mm Hg. The EMT should:

administer oxygen and epinephrine and prepare for rapid transport.

All of the following are examples of passive rewarming techniques, EXCEPT: removing cold, wet clothing. administering warm fluids by mouth. turning up the heat inside the ambulance. covering the patient with warm blankets.

administering warm fluids by mouth.

Shortly after ascending rapidly to the surface of the water while holding his breath, a 29-year-old diver begins coughing up pink, frothy sputum and complains of dyspnea and chest pain. You should suspect and treat this patient for: an air embolism. a pneumothorax. pneumomediastinum. decompression sickness.

an air embolism.

A dysbarism injury refers to the signs and symptoms related to changes in:

barometric pressure.

You are assessing a 33-year-old male who complains of severe abdominal pain, weakness, and nausea. He tells you that he was gathering wood to build a fire when he felt a sudden, sharp pain on the back of his hand. Your assessment reveals that the patient's abdomen is rigid and painful to palpation. You should suspect:

black widow spider bite.

Shivering in the presence of hypothermia indicates that the: musculoskeletal system is damaged. nerve endings are damaged, causing loss of muscle control. body is trying to generate more heat through muscular activity. thermoregulatory system has failed and body temperature is falling.

body is trying to generate more heat through muscular activity.

The diving reflex may cause immediate tachycardia hypotension bradycardia hypertension

bradycardia

The diving reflex may allow a person to survive extended periods of submersion in cold water secondary to:

bradycardia and a slowing of the metabolic rate.

The venom of a brown recluse spider is cytotoxic, meaning that it:

causes severe local tissue damage.

When a person is exposed to cold temperatures and strong winds for an extended period of time, he or she will lose heat mostly by: radiation. convection. conduction. evaporation.

convection

The transfer of heat to circulating air, such as when cool air moves across the body's surface, is called:

convection.

All of the following snakes are pit vipers, EXCEPT for the:

coral snake.

You are assessing a 27-year-old woman with a heat-related emergency. Her skin is flushed, hot, and moist, and her level of consciousness is decreased. After moving her to a cool environment, managing her airway, and administering oxygen, you should: give her ice water to drink. place her in the recovery position. cover her with wet sheets and fan her. take her temperature with an axillary probe.

cover her with wet sheets and fan her.

Geriatric patients, newborns, and infants are especially prone to hyperthermia because they:

exhibit poor thermoregulation

A 30-year-old male, who has been playing softball all day in a hot environment, complains of weakness and nausea shortly after experiencing a syncopal episode. Appropriate treatment for this patient includes all of the following, EXCEPT: giving a salt-containing solution by mouth. moving him to a cooler environment at once. administering oxygen via nonrebreathing mask. placing him in a supine position and elevating his legs.

giving a salt-containing solution by mouth.

Shivering is a mechanism in which the body generates heat by:

increasing the metabolic rate.

It is important to remove a drowning victim from the water before laryngospasm relaxes because: the patient will suffer less airway trauma. the risk of severe hypothermia is lessened. less water will have entered the patient's lungs. you can ventilate the patient with laryngospasm.

less water will have entered the patient's lungs.

A frostbitten foot can be identified by the presence of:

mottling and blisters.

You and your partner are standing by at a large social event at a river resort when a frantic woman tells you that she found a young male floating face-down in the water. Nobody claims to have witnessed the event. After you and your partner enter the water and reach the patient, you should:

move him as a unit to a supine position.

You are dispatched to a local high school track and field event for a 16-year-old male who fainted. The outside temperature is approximately 95°F (35°C) with high humidity. Upon your arrival, the patient is conscious, alert, and complains of nausea and a headache. His skin is cool, clammy, and pale. You should:

move him into the cooled ambulance

Signs and symptoms of an air embolism include all of the following, EXCEPT:

pale skin.

Your assessment of a 23-year-old female reveals a core body temperature of 93.4°F (34°C). She is conscious, answers your questions appropriately, is shivering, and complains of nausea. Her skin is cold and pale, her muscles appear rigid, and her respirations are rapid. You should:

place heat packs to her groin, axillae, and behind her neck; cover her with warm blankets; and avoid rough handling.

A patient with a core body temperature of 95°F (35°C) will MOST likely experience:

rapid breathing.

A woman has frostbite in both feet after walking several miles in a frozen field. Her feet are white, hard, and cold to the touch. Treatment at the scene should include: rubbing her feet gently with your own warm hands. trying to restore circulation by helping her to walk around. removing her wet clothing and rubbing her feet briskly with a warm, wet cloth. removing her wet clothing and covering her feet with dry, sterile dressings.

removing her wet clothing and covering her feet with dry, sterile dressings.

A 13-year-old girl is found floating face down in a swimming pool. Witnesses tell you that the girl had been practicing diving. After you and your partner safely enter the water, you should: turn her head to the side and give five back slaps. turn her head to the side and begin rescue breathing. rotate her entire body as a unit and carefully remove her from the pool. rotate the entire upper half of her body as a unit, supporting her head and neck.

rotate the entire upper half of her body as a unit, supporting her head and neck.