Chapter 32: Environmental Emergencies/ retention Q

Breath-holding syncope is caused by a decreased stimulus to breathe and occurs when: A. a swimmer breathes shallowly before entering the water. B. a diver holds his or her breath during a staged ascent. C. a swimmer hyperventilates prior to entering the water. D. a diver holds his or her breath for a long period of time.

C. a swimmer hyperventilates prior to entering the water.

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

C. coral snake

You arrive at the scene of a major motor vehicle crash. The patient, a 50-year-old female, was removed from her vehicle prior to your arrival. Bystanders who removed her state that she was not wearing a seatbelt. The patient is unresponsive, tachycardic, and diaphoretic. Your assessment reveals bilaterally clear and equal breath sounds, a midline trachea, and collapsed jugular veins. You should be MOST suspicious that this patient has experienced a: A. tension pneumothorax B. pericardial tamponade C. laceration of the aorta D. massive hemothorax

C. laceration of the aorta

A frostbitten foot can e identified by the presence of: A. gross deformity B. soft, smooth skin C. mottling and blisters D. yellowish skin

C. mottling and blisters

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

D. abdominal or joint pain

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

D. diuretics

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

D.vasoconstriction and shivering

Symptoms of air embolism may not occur for several hours. True/False

False: Air embolism occurs immediately on returning to the surface, but symptoms of decompression sickness may not occur for several hours.

Which of the following organs or structures does NOT reside within the mediastinum? A. Lungs B. Trachea C. Oesophagus D. Vena Cavae

A. Lungs

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

A. superficial.

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) That's Correct! Hypothermia occurs when the core temperature falls below 95°F (35°C).

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

B. Convection That's Correct! A person who stands outside in windy, wintry weather and wears only lightweight clothing is experiencing heat loss mainly by convection.

In which of the following environmental emergencies are you most likely to encounter laryngospasm? A. After being bitten by a coral snake B. Drowning C. Hyperthermia D. A tick bite

B. Drowning: That's Correct! Laryngospasm is usually encountered in drowning accidents when water irritates the larynx and vocal cords.

Cardiorespiratory response when core body temperature falls into the range of 89ºF to 92ºF (31.7ºC to 33.3ºC) involves __________. A. Constricted blood vessels and rapid breathing B. Slowing respirations and a slow pulse C. Weak pulse, dysrhythmias, very slow respirations D. Cardiac arrest

B. Slowing respirations and a slow pulse When core body temperature falls into the range of 89ºF to 92ºF (31.7ºC to 33.3ºC), respirations and pulses slow.

To assess a patient's general body temperature, pull back on your glove and place the back of your hand on his or her skin at the: A. neck B. abdomen C. chest D. forehead

B. abdomen

The MOST significant hazard associated with splinting is: A. reduction in circulation distal to the injury site. B. delaying transport of a critically injured patient C. compression of nerves, tissues, and vasculature D. aggravation of the injury or worsened pain.

B. delaying transport of a critically injured patient

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

B. evaporation

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

A. radiation

Signs of LATE heat stroke include: A. hot, moist skin B. nausea and vomiting C. a weak, rapid pulse D. a change in behaviour

C. a weak, rapid pulse

The venom of a brown recluse spider is cytotoxic, meaning that it: A. suppresses the respiratory drive B. destroys the body's red blood cells C. weakens the structure of the bones D. causes severe local tissue damage.

D. causes severe local tissue damage.

Moist, pale, cool skin indicates

Excessive fluid and salt loss

In an air embolism, the air pressure in the lungs remains constant while the external pressure on the chest increases. True/False

False: In an air embolism, the air pressure in the lungs remains at a high level while the external pressure on the chest decreases

The diving reflex may cause immediate bradycardia. True/False

True: The diving reflex, the slowing of the heart rate caused by submersion in cold water, may cause immediate bradycardia.

The organs most severely affected by air embolism are the: a. brain and spinal cord b. brain and heart c. heart and lungs d. brain and lungs

a. brain and spinal cord

When the body is exposed to more heat energy than it loses, __________ result(s). a. hyperthermia b. heat cramps c. heat exhaustion d. heatstroke

a. hyperthermia

_________ is the body's reaction to an irritation of water entering the lower respiratory tract. a. bronchoconstriction b. laryngospasm c. esophageal spasms d. swelling in the oropharynx

b. laryngospasm

Hypothermia is more common among all of the following except: a. older individuals b. long-distance athletes c. infants and children d. those who are already ill

b. long-distance athletes

Contributing factors to the development of heat illnesses include all of the following except: a. high air temperature b. vigorous exercise c. high humidity d. increased fluid intake

d. increased fluid intake

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

B. nervous system

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

A. Air embolism

What is often the first sign of heat stroke? A. Change in behaviour B. Muscle cramps C. Low pulse rate and blood pressure D. Profuse sweating

A. Change in behaviour That's Correct! Often, the first sign of heat stroke is a change in behaviour.

Which of the following statements regarding compartment syndrome is correct? A. Compartment syndrome typically develops within 6 to 12 hours after an injury B. Compartment syndrome occurs because of increased pressure within the bone cavity C. in most cases, Compartment syndrome develops within a few minutes after an injury D. Most cases of Compartment syndrome occur following a severe fracture of the pelvis

A. Compartment syndrome typically develops within 6 to 12 hours after an injury

Following a stab wound to the left anterior chest, a 25-year-old male presents with a decreased level of consciousness and signs of shock. Which of the following additional assessment findings should increase your index of suspicion for a cardiac tamponade? A. Engorged jugular veins B. Diminished breath sounds C. Widening pulse pressure D. A rapid, irregular pulse

A. Engorged jugular veins

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?

A. HACE (high-altitude cerebral edema)

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.

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: A. Lyme disease B. an allergic reaction C. exposure to poison ivy D. Rocky Mountain spotted fever

A. Lyme disease

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 That's Correct! Rough handling of a patient with moderate to severe hypothermia may cause the heart to go into ventricular fibrillation.

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. a black widow spider bite B. envenomation from a pit viper C. a brown recluse spider bite D. rocky Mountain spotted fever

A. a black widow spider bite

A fracture i MOST accurately defined as a(n): A. a break in the continuity of the bone B. total loss of function in a bone C. disruption in the midshaft of a bone D. abnormality in the structure of a bone.

A. a break in the continuity of the bone

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: A. administer oxygen and epinephrine and prepare for rapid transport. B. remove the stingers from his leg by scraping them with a stiff object C. begin transport and immerse his leg in hot water to help reduce pain D. apply warmth to the sting area and cover it with a dry, sterile dressing

A. administer oxygen and epinephrine and prepare for rapid transport.

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. apply an AED and assess his cardiac rhythm. C. open his airway and give two rescue breaths. D. apply chemical heat packs to his groin and axillae.

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

Patients with generalised hypothermia are at an increased risk of a local cold injury because Select one: A. blood is shunted away from the extremities to the body's core B. the major muscles of the body become rigid durning hypothermia C. peripheral vasodilation brings warm blood to the skin's surface D. the patient is usually unable to escape the cold ambient temperature

A. blood is shunted away from the extremities to the body's core

The diving reflex may allow a person to survive extended periods of submersion in cold water secondary to: A. bradycardia and a slowing of the metabolic rate B. laryngospasm that protects the lungs from water C. tachycardia and a lowering of the blood pressure D. increases in the metabolic rate and oxygen demand.

A. bradycardia and a slowing of the metabolic rate

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

A. frostbite.

Shivering is a mechanism in which the body generates heat by: A. increasing the metabolic rate B. decreasing the use of oxygen C. decreasing the metabolic rate D. retaining excess carbon dioxide

A. increasing the metabolic rate

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

A. into the patient's rectum

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: A. move him as a unit to a supine position. B. begin ventilations with a barrier device C. immediately secure him to a longboard D. open his airway with the jaw-thrust maneuver

A. move him as a unit to a supine position.

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: A. 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. B. place him in a semi-sitting position, suction his mouth and nose, apply a continuous positive airway pressure (CPAP) device, and transport to closest emergency department. 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 degrees, suction his mouth and nose, hyperventilate him with a bag-mask device, and contact medical control for further guidance

A. 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.

Heat loss from the body through respiration occurs when: A. warm air is exhaled into the atmosphere B. the core body temperature is greater than 98F (37C) C. cool air is inhaled and displaces warm air D. air temperature is greater than body temperature

A. warm air is exhaled into the atmosphere

Shivering stops and muscle activity ceases once the body's core temperature reaches what? 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) That's Correct! Shivering stops at 90°F (32.2°C). This is a sign of severe hypothermia.

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

B. conduction

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

B. it must be able to evaporate from the body

Signs and symptoms of an air embolism include all of the following EXCEPT: A. dysphasia B. pale skin C. dizziness D. joint pain

B. 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: A. Apply the AED in case she develops cardiopulmonary arrest, cover her with layers of blankets, and transport carefully B. place heat packs to her groin, axillae, and behind her neck, cover her with warm blankets, and avoid rough handling. C. cover her with warm blankets and let her move about on the stretcher in order to generate body heat and increase her temperature. D. sit her up and giver her small sips of warm water to drink, place heat packs to her axillae and groin, and cover her with blankets.

B. 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: A. a slow pulse B. rapid breathing C. muscle stiffness D. loss of consiousness

B. rapid breathing

The two MOST efficient ways for the body to eliminate excess heat are: A. perspiration and tachycardia B. sweating and vasodilation C. Hyperventilation and tachycardia D. respiration and bradycardia

B. sweating and vasodilation

Rough handling of a hypothermic patient with a pulse may cause: A. profound bradycardia B. ventricular fibrillation C. ventricular tachycardia D. pulseless electrical activity

B. ventricular fibrillation

Hot, dry skin indicates

Body is unable to regulate core temperature

Hot, moist skin indicates

Body is unable to regulate core temperature

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 __________ . A. Heat cramps B. Heat exhaustion C. Heat stroke D. Heat asphyxia

C. Heat stroke There are several clinical findings that indicate your patient is experiencing the most serious heat illness, heat stroke. Unlike other, less-severe forms of heat illness, patients with heat stroke have an altered LOC and flushed, hot skin. Your patient has both of these.

Which of the following musculoskeletal injuries would pose the greatest threat to a patient's life? A. An amputated extremity B. Bilateral femur fractures C. Pelvic fracture with hypotension D. Nondisplaced long bone fractures

C. Pelvic fracture with hypotension

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

C. Place the patient is a supine position That's Correct! If you suspect a patient has been bitten by a pit viper such as a rattlesnake, place the person in a supine position to keep the venom from spreading.

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

C. There has been excessive fluid and salt loss That's Correct! Moist, pale, cool skin in a hot environment indicates there has been excessive fluid and salt loss.

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. 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. assess the unresponsive patient's pulse, begin CPR starting with chest compressions if he is pulseless, and attack the AED as soon as possible D. recognise that the patients who are conscious are at high risk for developing cardiac arrest and quickly assess them for potentially life-threatening injuries

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

The transfer of heat to circulating air, such as when cool air moves across the body's surface, is called: A. radiation B. conduction C. convection D. evaporation

C. convection

Geriatric patients, newborns, and infants are especially prone to hyperthermia because they: A. have relatively smaller heads B. have less body fat C. exhibit poor thermoregulation D. have smaller body surface areas

C. exhibit poor thermoregulation

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

C. hot, dry skin

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

C. possible spinal injury

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. applying ice to the wound and transporting quickly. B. transporting only with close, continuous monitoring. C. supine positioning, splinting the leg, and transporting. D. elevating the lower extremities and giving antivenin.

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

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

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

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.

A flail chest occurs when: A. a segment of fractured ribs bulges during the inhalation phase. B. multiple ribs are fractured on both sides of the thoracic cage. C. more than three ribs are fractured on the same side of the chest. D. a segment of the chest wall is detached from the thoracic cage.

D. a segment of the chest wall is detached from the thoracic cage.

A dysbarism injury refers to the signs and symptoms related to changes in: A. rapid ascent. B. rapid descent. C. decompression. D. barometric pressure.

D. barometric pressure.

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

D. death from suffocation after submersion in water

contraction or tensing of the abdominal muscles in an effort to ease pain is called: A. referring B. withdrawing C. flexing D. guarding

D. guarding

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: A. give him a liquid salt solution to dring B. administer 100% supplemental oxygen C. apply chemical ice packs to his axillae D. move him into the cooled ambulance

D. move him into the cooled ambulance

Which of the following would be the LEAST likely to occur in a patient with a core body temperature of between 89F (32C) and 92F (33C)? A. bradypnea B. confusion C. stiff muscles D. tachycardia

D. tachycardia

Heatstroke occurs when: A. the ambient temperature exceeds 90ºF (32ºC) and the humidity is high B. a person becomes dehydrated secondary to excess water loss C. a person's core body temperature rises above 103ºF (39ºC) D. the body's heat-eliminating mechanisms are overwhelmed.

D. the body's heat-eliminating mechanisms are overwhelmed.

Most of the serious injuries associated with scuba diving are caused by: A. water temperature lower than 70F (21C) B. too rapid of a descent C. alcohol consumption D. too rapid of an ascent

D. too rapid of an ascent

It is difficult to find a pulse in a drowning victim. True/False

True: It is difficult to find a pulse in a drowning victim because of constriction of the peripheral blood vessels and low cardiac output, resulting in cyanosis.

Coral snake venom is a powerful toxin that causes __________ of the nervous system. a. paralysis b. hyperactivity c. hypoactivity d. hemiparesis

a. paralysis

Signs of envenomation by a pit viper include all of the following except: a. swelling b. chest pain c. ecchymosis d. severe burning pain at the site of the injury

b. chest pain

In a diving emergency, ___________ occurs when bubbles of gas, especially nitrogen, obstruct the blood vessels. a. compression sickness b. decompression sickness c. pulmonary sickness d. nitrogen toxicity

b. decompression sickness

At 1400 in July, the weather is 105 degrees F and very humid. You have been called for a "man down" at the park. As you arrive, you recognize him as an alcoholic who has been a "frequent flyer" with your service. It looks like he had been sitting under a tree when he fell over, unconscious. As you assess the patient, he has cold, clammy skin and a dry tongue. You suspect that: a. he is well-hydrated b. he has suffered heat exhaustion c. he is hypothermic d. he has heatstroke

b. he has suffered heat exhaustion

You should never give up on resuscitating a cold-water drowning victim because: a. when the patient is submerged in water colder than body temperature, heat is maintained in the body b. the resulting hypothermia can protect vital organs from the lack of oxygen c. the resulting hypothermia raises the metabolic rate d. all of the above

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

The characteristic appearance of blue lips and/or fingertips seen in hypothermia is the result of: a. lack of oxygen in venous blood b. frostbite c. blood vessels constricting d. bruising

c. blood vessels constricting

Never assume that a(n) __________, pulseless patient is dead. a. apneic b. cyanotic c. cold d. hypothermic

c. cold

Signs and symptoms of severe systemic hypothermia include all of the following except: a. weak pulse b. coma c. shivering d. very slow respirations

c. shivering

The least common but most serious illness caused by heat exposure, occurring when the body is subjected to more heat than it can handle and normal mechanisms for getting rid of the excess heat are overwhelmed, is: a. hyperthermia b. heat cramps c. heat exhaustion d. heatstroke

d. heatstroke

The rate and amount of heat loss by the body can be modified by all of the following except: a. increasing heat production b. moving to an area where heat loss is decreased c. wearing insulated clothing d. increasing fluid intake

d. increasing fluid intake

Management of hypothermia in the field consists of all of the following except: a. applying heat packs to the groin, axillary, and cervical regions b. removing wet clothing c. preventing further heat loss d. massaging the cold extremities

d. massaging the cold extremities

Signs and symptoms of heat exhaustion and associated hypovolemia include all of the following except: a. cold, clammy skin with ashen pallor b. dizziness, weakness, or faintness c. normal vital signs d. normal thirst

d. normal thirst

___________ causes body heat to be lost as warm air in the lungs is exhaled into the atmosphere and cooler air is inhaled. a. convection b. conduction c. radiation d. respiration

d. respiration