Chapter 33 Environmental Emergencies

Hypothermia

Generalized cooling that reduces body temperature below normal, which is a life-threatening condition in its extreme

in contrast to the brown recluse spider, the black widow spider

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

when assessing a hypothermic patient, you should palpate for a carotid pulse for approximately ___ seconds before determining that he or she is pulseless

30-45

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

90 degrees

hypothermia occurs when the core body temperature falls below

95 degrees F

Decompression Sickness

A condition resulting from nitrogen trapped in the body's tissues, caused by coming up too quickly from a deep, prolonged dive. A symptom of decompression sickness is "the bends", or deep pain in the muscles and joints.

Venom

A toxin (poison) produced by certain animals such as snakes, spiders, and some marine life forms.

Hyperthermia

An increase in body temperature above normal, which is a life-threatening condition in its extreme

Active Rewarming

Application of an external heat source to rewarm the body of a hypothermic patient. Only with patients who are alert and responding appropriately - and many services do not allow this at all

Central Rewarming

Application of heat to the lateral chest, neck, armpits, and groin of a hypothermic patient

Respiration

Breathing. During respiration, body heat is lost as warm air is exhaled from the body.

Convection

Carrying away of heat by currents of air, water, or other gases or liquids

Water Chill

Chilling caused by conduction of heat from the body when the body or clothing is wet

Wind Chill

Chilling caused by convection of heat from the body in the presence of air currents

Local Cooling

Cooling or freezing of particular (local) parts of the body - usually ears, nose, face, hands, feet, and toes

Passive Rewarming

Covering a hypothermic patient and taking other steps to prevent further heat loss and help the body rewarm itself. Unresponsive or not responding appropriately.

Air embolism

Gas bubble in the bloodstream. The plural is air emboli. The more accurate term is arterial gas embolism (AGE).

you are dispatched to a residence for a young female who is "sick." the patient complains of rash to her lower extremities and truncal area. your assessment reveals a small. painful blister on her inner thigh. as your partner is taking 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

Muscle cramps caused by loss of salts from excessive sweating

Heat Exhaustion

Prolonged exposure to excessive heat - moist, pale skin that may feel normal or cool to the touch

Radiation

Sending out energy, such as heat, in waves in space (mostly from head and neck)

Toxins

Substances produced by animals or plants that are poisonous to humans

Heat stroke

Temperature-regulating mechanisms fail and patient has hot, dry, or possibly moist skin. Patient will stop sweating due to loss of fluid and salt

Evaporation

The change from liquid to gas. When the body perspires or gets wet, evaporation of the perspiration or other liquid into the air has a cooling effect on the body

Drowning

The process of experiencing respiratory impairment from submersion/immersion in liquid, which may result in death, morbidity (illness or other adverse effects), or no morbidity. ED will want to know fresh/saltwater, cold/warm, and if related to diving.

Conduction

The transfer of heat from one material to another through direct contact

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

hypothermia

a condition in which the internal body temperature falls below 95 degrees F, usually as a result of prolonged exposure to cool or freezing temperatures

hyperthermia

a condition in which the internal body temperature rises to 101 degrees F or more

hymenoptera

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

heat exhaustion

a form of heat injury in which the body loses significant amounts of fluid and electrolytes because of heavy sweating; also called heat prostration or heat collapse

heatstroke

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

heat cramps are most likely the result of

a loss of water and electrolytes

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"

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

a relatively small surface area

antivenin

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

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

a swimmer hyperventilates prior to entering the water

SCUBA

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

reverse triage

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

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

the most prominent symptom of decompression sickness is

abdominal or joint pain

dysbarism injuries

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

a 30-year-old male was rescued after being lost in the woods for approximately 18 hours. the outside temperature is 30 degrees F. he is immediately placed in the warmed ambulance, where you perform an initial assessment. he is unconscious, pale, and apniec. after initiating artificial ventilations, you should

assess for a carotid pulse for up to 45 seconds

patients with generalized hypothermia are at an increased risk of a local cold injury because

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

bradycardia and slowing of the metabolic rate

the venom of a brown recluse is cytotoxic, meaning that it

causes severe local tissue damage

geriatric patients are at a higher risk for heatstroke because

circulation to the skin is reduced

bends

common name for decompression sickness

when a warm hand is immersed in water that is 70 degrees F, heat is transferred from the hand to the water through a process called

conduction

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

convection

evaporation

conversion of water or another fluid from a liquid to a gas

all of the following snakes are pit vipers, except for the: A) cottonmouth B) copperhead C) coral snake D) rattlesnake

coral snake

frostbite

damage to tissues as the result of exposure to cold; frozen or partially frozen body parts are frostbitten

high humidity reduces the body's ability to lose heat through

evaporation

the body's natural cooling mechanism, in which sweat is converted into a gas, is called

evaporation

geriatric patients, newborns, and infants are especially prone to hypothermia because they

exhibit poor thermoregulation

all of the following terms are used to describe a cold body part that is not frozen, except

frostbite

covering a patient's ___ will significantly minimize radiation heat loss

head

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

hyperglycemia

shivering is a mechanism which the body generates heat by

increasing the metabolic rate

to obtain the most accurate reading of a patient's core body temperature, you should place a special hypothermia thermometer

into the patient's 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 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 most correct?

laryngospasm following submersion in water makes rescue breathing difficult

which of the following statements regarding lightening strikes is most correct

lightening often results in a brief period of asystole that resolves spontaneously

you receive a call to a residence for a "sick patient." upon your arrival, you find 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 BP is 90/50 mm Hg. in addition to administering 100% oxygen, you should

load him intro the ambulance and begin rapid cooling interventions

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

local swelling and ecchymosis

breath-holding syncope

loss of consciousness caused by a decreased breathing stimulus

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 degrees F 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

the venom of a black widow spider is toxic to the

nervous system

heat cramps

painful muscle spasms usually associated with vigorous activity in a hot environment

signs and symptoms of an air embolism include all of the following except

pale skin

approximately 12 hours after scuba diving with her friends, a 29-year-old female presents with pain in her elbows and knees. she is conscious and alert and is breathing adequate tidal volume. when asked, she states that she may have ascended too rapidly during her dive, but didn't experience symptoms until now. when treating this patient, you should

place her in a left lateral recumbent position with her head down

the EMT-B must assume that any unwitnessed water-related incident is accompanied by

possible spinal 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 an initial 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

a patient with a core body temperature of 92 degrees F will most likely experience

rapid breathing

diving reflex

slowing of the heart rate caused submersion in cold water

burns associated with lightening strikes are typically

superficial

while drinking beer with his friends near a creek, a 32-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 vessel dilation

which of the following would be the least likely to occur in a patient with a core body temperature between 89 and 92 degres F

tachycardia

turgor

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

hyperthermia is most accurately defined as a condition in which

the body is exposed to more heat than it can lose

heatstroke occurs when

the body's heat-eliminating mechanisms are overwhelmed

an air embolism associated with diving occurs when

the diver holds his or her breath during a rapid ascent

convection

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

conduction

the loss of heat by direct contact (eg, when a body part comes into contact with a colder object)

air embolism

the presence of air in the veins, which can lead to cardiac arrest if it enters the heart

respiration

the process of exchanging oxygen and carbon dioxide

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

most of the serious injuries associated with scuba diving are caused by

too rapid of an ascent

the body;s natural protective mechanisms against heat loss are

vasoconstriction and shivering

rough handling of a hypothermic patient with a pulse may cause

ventricular fibrillation

heat loss from the body through respiration occurs when

warm air is exhaled into the atmosphere