EMT Ch 32 Environmental

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: A. an air embolism. B. a pneumothorax. C. pneumomediastinum. D. decompression sickness.

A. an air embolism Rationale: Signs of an air embolism, which present after a person rapidly ascends to the surface of the water while holding his or her breath, include skin mottling, pink froth at the mouth or nose, muscle or joint pain, dyspnea and/or chest pain, dizziness, nausea or vomiting, visual impairment, paralysis or coma, and even cardiac arrest.

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 Rationale: Treatment for heat exhaustion begins by moving the patient to a cooler environment. Remove excess clothing, administer oxygen as needed, and place the patient supine. Elevating the patient's legs may improve blood flow to the brain and prevent another syncopal episode. If the patient is not nauseated, give a salt-containing solution by mouth. Give nothing by mouth if the patient is nauseated; doing so increases the risks of vomiting and aspiration.

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:

B. Convection Rationale: Convection occurs when heat is transferred to circulating air, as when cool air moves across the body surface. A person wearing lightweight clothing and standing outside in cold, windy weather is losing heat to the environment mostly by convection.

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-active rewarming Rationale: Passive rewarming involves allowing the patient's body temperature to rise gradually and naturally. Removing cold, wet clothing; turning up the heat in the ambulance; and covering the patient with warm blankets are examples of passive rewarming. Administering warmed fluids by mouth or intravenously is an example of active rewarming; this should be avoided in the uncontrolled prehospital setting.

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? A. Group 1 B. Group 2 C. Group 3 D. Groups 1 and 2; Group 3 should be tagged as deceased

C. Group 3 Rationale: The process of triaging multiple patients who were struck by lightning differs from standard triage; it is called "reverse triage." If the patients are alive at the scene, survival is likely. Delayed cardiac arrest following a lightning strike is uncommon. If the patients are in cardiac arrest, there is a good chance that they can be resuscitated with early, high-quality CPR and defibrillation. Therefore, Group 3 should be treated first.

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

C. body is trying to generate more heat through muscular activity Rationale: Shivering in the presence of hypothermia indicates that the body is trying to generate more heat (thermogenesis) through muscular activity. In early hypothermia, shivering is a voluntary attempt to produce heat; as hypothermia progresses, shivering becomes involuntary.

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: A. give her ice water to drink. B. place her in the recovery position. C. cover her with wet sheets and fan her. D. take her temperature with an axillary probe.

C. cover her with wet sheets and fan her Rationale: This patient is experiencing heat stroke. After moving her to a cooler area, managing her airway, and administering oxygen, the single most important treatment for her involves rapid cooling. Turn on the AC in the back of the ambulance, cover her with a wet sheet, and begin fanning her. Consider applying chemical ice packs to her groin and axillae (follow local protocols). Untreated heat stroke almost always results in death due to brain damage.

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

C. less water will have entered the patient's lungs. Rationale: Even small amounts of salt or fresh water will irritate the larynx, causing it to spasm (laryngospasm). This is the body's protective mechanism. If the EMT can safely remove the patient from the water before the laryngospasm relaxes, the amount of water that enters the lungs will be minimized. It will also be easier to ventilate the patient.

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: A. rubbing her feet gently with your own warm hands. B. trying to restore circulation by helping her to walk around. C. removing her wet clothing and rubbing her feet briskly with a warm, wet cloth. D. removing her wet clothing and covering her feet with dry, sterile dressings.

D. removing her wet clothing and covering her feet with dry, sterile dressings. Rationale: When treating a patient with frostbite, you should remove any wet clothing and cover the injured area with dry, sterile dressings. Do not break any blisters, and do not apply heat to try to rewarm the area.

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: A. turn her head to the side and give five back slaps. B. turn her head to the side and begin rescue breathing. C. rotate her entire body as a unit and carefully remove her from the pool. D. rotate the entire upper half of her body as a unit, supporting her head and neck.

D. rotate the entire upper half of her body as a unit, supporting her head and neck. Rationale: When caring for a patient who is in the water and has possibly been injured, rotate the upper half of the body as a unit, supporting the head and neck, until the patient is face up. Open the airway with the jaw-thrust maneuver and begin artificial ventilation.