Chapter 32: Environmental Emergencies

evaporation

Conversion of water or another fluid from a liquid to a gas.

frostbite

Damage to tissues as the result of exposure to cold; frozen body parts.

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.

heat cramps

Painful muscle spasms usually associated with vigorous activity in a hot environment.

respiration

The loss of body heat as warm air in the lungs is exhaled into the atmosphere and cooler air is inhaled.

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.

Shivering in the presence of hypothermia indicates that the:

body is trying to generate more heat through muscular activity.

It is important to remove a drowning victim from the water before laryngospasm relaxes because:

less water will have entered the patient's lungs.

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:

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

air embolism

Air bubbles in the blood vessels.

diving reflex

The slowing of the heart rate caused by submersion in cold water

homeostasis

A balance of all systems of the body.

hypothermia

A condition in which the core body temperature falls below 95 F (or 35 C) after exposure to a cold environment.

hyperthermia

A condition in which the core body temperature rises to 101 degrees F (38.3 C) or more.

Hymenoptera

A family of insects that includes bees, wasps, ants, and yellow jackets.

heat exhaustion

A heat emergency in which a significant amount of fluid and electrolyte loss occurs because of heavy sweating; also called heat prostration or heat collapse.

heat stroke

A life-threatening condition of severe hyperthermia caused by exposure to excessive natural or artificial heat, marked by warm, dry skin; severely altered mental status; and often irreversible coma.

decompression sickness

A painful condition seen in divers who ascend too quickly, in which gas, especially nitrogen, forms bubbles in blood vessels and other tissues; also called "the bends."

antivenin

A serum that counteracts the effect of venom from an animal or insect.

scuba gear

A system that delivers air to the mouth and lungs at various atmospheric pressures, increasing with the depth of the dive; stands for self-contained underwater breathing apparatus.

reverse triage

A triage process used in treating multiple victims of a lightning strike, in which efforts are focused on those who are in respiratory and cardiac arrest. Reverse triage is different from conventional triage where such patients would be classified as deceased.

Which of the following statements regarding lightning strikes is correct? A. Lightning strikes may cause cardiac dysrhythmias that spontaneously resolve. B. The tissue damage pathway caused by lightning usually occurs through the skin. C. Victims who are struck by lightning often experience severe full-thickness burns. D.Cervical spine fractures are the most common cause of lightning-related deaths.

A. Lightning strikes may cause cardiac dysrhythmias that spontaneously resolve.

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: A. giving a salt-containing solution by mouth. B. moving him to a cooler environment at once. C. administering oxygen via nonrebreathing mask. D. placing him in a supine position and elevating his legs.

A. giving a salt-containing solution by mouth.

Dysbarism injuries

Any signs and symptoms caused by the difference between the surrounding atmospheric pressure and the total gas pressure in various tissues, fluids, and cavities of the body.

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

B. administering warm fluids by mouth.

All of the following snakes are pit vipers, EXCEPT for the: A. copperhead. B. rattlesnake. C. coral snake. D. cottonmouth

C. coral snake.

bends

Common name for decompression sickness.

Which of the following statements regarding drowning is correct? A. Hypoxia in the drowning victim initially occurs due to water in the lungs. B. Artificial ventilations can easily be performed in patients with a laryngospasm. C. Large amounts of water enter the lungs in a small number of drowning victims. D. Laryngospasm following submersion in water makes rescue breathing difficult.

D. Laryngospasm following submersion in water makes rescue breathing difficult.

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 3

breath-holding syncope

Loss of consciousness caused by a decreased breathing stimulus.

turgor

The ability of the skin to resist deformation; tested by gently pinching skin on the forehead or back of the hand.

convection

The loss of body heat caused by air movement (eg a breeze blowing across the body)

conduction

The loss of heat by direct contact (eq when a body part comes into contact with a colder object).

drowning

The process of experiencing respiratory impairment from submersion or immersion in liquid.

core temperature

The temperature of the central part of the body (eg, the heart, lungs, and vital organs).

ambient temperature

The temperature of the surrounding environment.

radiation

The transfer of heat to colder objects in the environment by radiant energy; for example, heat gain from a fire.

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.

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.

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

barometric pressure.

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.

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

convection.

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:

convection.

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:

cover her with wet sheets and fan her.

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

exhibit poor thermoregulation.

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

increasing the metabolic rate.

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 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:

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