EMT: Chapter 32 [environmental emergencies]

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

young children can drown in as little as _________________ of water if left unattended.

1 inch

small infants have a poor ability to thermoregulate and are unable to shiver to control heat loss until about the age of:

12-18 months

most heat stroke cases occur when the temperature is around ______________ and the humidity is 80%.

80 F

What is the most dangerous, and most common, emergency in scuba diving?

air embolism

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

Drowning is MOST accurately defined as:

death from suffocation after submersion in water

in a diving emergency, ________________________ occurs when bubbles of gas, especially nitrogen, obstruct the blood vessels.

decompression sickness

the three phases of a dive, in the order they occur, are:

descent, bottom, ascent

A frostbitten foot can be identified by the presence of:

mottling and blisters

Heatstroke occurs when:

the body's heat-eliminating mechanisms are overwhelmed

Rough handling of a patient with severe hypothermia may cause which of the following dysrhythmias?

v-fib

The body's natural protective mechanisms against heat loss are:

vasoconstriction and shivering

A person's ability to shiver is lost when his or her body temperature falls below:

90 F

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

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 unconscious, pale, and apneic. You should:

assess for a carotid pulse for up to 45 seconds

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

barometric pressure

When the body loses sweat, it also loses:

electrolytes

as you assess a patient in humid, 105 F weather, you recognize he is unconscious. he has cold clammy skin and a dry tongue. you suspect that:

he has suffered heat exhaustion

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

increasing the metabolic rate

In order for sweating to be an effective cooling mechanism:

it must be able to evaporate from the body

Which of the following statements regarding drowning is correct?

laryngospasm following submersion in water makes rescue breathing difficult

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

The venom of a black widow spider is toxic to the:

nervous system

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:

open the unresponsive patient's airway with the jaw-thrust maneuver, assess his ABCs, and begin CPR and attach the AED as soon as possible

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

pale skin

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:

protect the affected part from further injury

A 20-year-old male was pulled from cold water by his friends. The length of his submersion is not known and was not witnessed. You perform a primary assessment and determine that the patient is apneic and has a slow, weak pulse. You should:

provide rescue breathing, remove wet clothing, immobilize his spine, keep him warm, and transport carefully

High air temperature reduces the body's ability to lose heat by:

radiation

treatment of drowning and/or near drowning begins with:

rescue and removal from the water

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′. On assessment, you note that he has cyanosis around his lips and has pink froth coming from his nose and mouth. You should:

suction his mouth and nose, apply high-flow oxygen, position him on his left side with his head down, and contact medical control regarding transport to a recompression facility

While drinking beer with his friends near a creek, 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:

supine positioning, splinting the leg, and transporting

The two MOST efficient ways for the body to eliminate excess heat are:

sweating and dilation of skin blood vessels

What is often the first sign of heat stroke?

change in behavior

black widow spiders may be found in all of the following EXCEPT:

Alaska

To assess a patient's general temperature, pull back on your glove and place the back of your hand on his or her skin at the:

abdomen

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

Which of the following medications increases a person's risk of a heat-related emergency?

diuretics

In which of the following environmental emergencies are you most likely to encounter laryngospasm?

drowning

evaporation, the conversion of a liquid to a gas, is a process that requires:

energy

The body's natural cooling mechanism, in which sweat is converted to a gas, is called:

evaporation

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

exhibit poor thermoregulation

Common signs and symptoms of heat exhaustion include all of the following, EXCEPT:

hot, dry skin

Which of the following conditions would be the LEAST likely to increase a person's risk of hypothermia?

hyperglycemia

(see #131) you pull back on your glove and place the back of your hand on his skin at the abdomen, and the skin feels cool. again, you suspect:

hypothermia

(see #131) as you look closer, you note that he is shivering and his respirations are 20 breaths/min. you begin to have a stronger suspicion that he is now getting:

hypothermic

To obtain the MOST accurate reading of a patient's core body temperature, you should place a special hypothermia thermometer:

into the pts' rectum

A 48-year-old male was stung on the leg by a jellyfish while swimming in the ocean. He is conscious and alert, but complains of intense pain at the wound site. Specific treatment for this patient includes:

irrigating the wound with vinegar and immersing his leg in hot water

In contrast to the brown recluse spider, the black widow spider:

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

Which of the following statements regarding lightning strikes is correct?

lightning strikes may cause cardiac dysrhythmias that spontaneously resolve

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. In addition to administering 100% oxygen, you should:

load him into the ambulance and begin rapid cooling interventions

Which of the following is an early sign of pit viper envenomation?

local swelling and ecchymosis

management of hypothermia in the field consists of all of the following EXCEPT:

massaging the cold extremities

You suspect that the patient you are treating was bitten by a rattlesnake. What should you do first?

place the pt in a supine position

The EMT must assume that any unwitnessed water-related incident is accompanied by:

possible spinal injury

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

rapid breathing

Burns associated with lightning strikes are typically:

superficial

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)?

tachycardia

An air embolism associated with diving occurs when:

the diver holds his or her breath during a rapid ascent

areas usually affected by descend problems include:

the lungs

you should never give up on resuscitating a cold-water drowning victim because:

the resulting hypothermia can protect vital organs from the lack of oxygen

In the context of an environment that is 90°F with 85% humidity, what does moist, pale, cool skin indicate?

there has been excessive fluid and salt loss (in a hot environment)

Heat loss from the body through respiration occurs when:

warm air is exhaled into the atmosphere

Shivering stops and muscle activity ceases once the body's core temperature reaches what?

90 F

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 nauseated and, as you assess him, he loses consciousness. Which of the following should you suspect?

HACE

Covering a patient's _________ will significantly minimize radiation heat loss.

HEAD

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

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:

a black widow spider bite

The MOST prominent symptom of decompression sickness is:

abdominal or joint pain

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

Hypothermia can worsen internal bleeding secondary to:

blood clotting abnormalities

the characteristic appearance of blue lips and/or fingertips seen in hypothermia is the result of:

blood vessels constricting

the organs most severely affected by air embolism are the:

brain and spinal cord

most spinal injuries in diving accidents affect the:

cervical spine

often, the first sign of heatstroke is:

change on behavior

signs of envenomation by a pit viper include all of the following EXCEPT:

chest pain

Geriatric patients are at a higher risk for heatstroke because:

circulation to the skin is reduced

never assume that a(n) _______________, pulseless pt is dead.

cold

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

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