Chapter 25

A 57-year-old diver has been brought to the surface by fellow divers. He complains of difficulty breathing, dizziness, and severe chest pain. He states that he has a cardiac history and takes nitroglycerin, which is in his belongings nearby. Emergency Medical Responders report the following vital signs: pulse 128 beats/min, respirations 18 breaths/min, blood pressure 88/56 mmHg, and SpO2 93%. After applying supplemental oxygen to the patient, your next action should be to: A) Perform a secondary assessment B) Assist the patient in taking his nitroglycerin C) Administer a bronchodilator through a metered-dose inhaler D) Transport the patient in a head-down position (Trendelenburg)

A

A confused and lethargic 22-year-old male patient with no medical history came up from a deep-sea dive and is now complaining of shortness of breath and sharp pain, which he localizes to the right side of his chest. He denies nausea, vomiting, or dizziness. You have applied oxygen and are getting ready for transport. How will you transport this patient on the stretcher? A) Lateral recumbent position B) Semi-Fowler's position C) Supine position D) Trendelenburg position

A

A fisherman fell through the ice and was submerged in a lake for approximately 4 minutes before being pulled out by friends. You find the man to be unresponsive, not breathing, and without a pulse. What should you do immediately? A) Start cardiopulmonary resuscitation B) Apply the automated external defibrillator C) Provide spine motion restriction precautions D) Determine the patient's core temperature

A

As a diver rises too quickly from a deep-sea dive, the nitrogen in his bloods forms ever-enlarging bubbles. The bubbles then cause damage to internal organs and tissues. The EMT would recognize this outcome as demonstrating: A) Boyle's law B) Dalton's law C) Charles's law D) Henry's law

A

The EMT is correctly using a rope in a throw bag when he: A) Tosses the throw bag using an underhand motion toward the patient B) Throws the rope overhand and slightly beyond the patient's location C) Goes downstream and floats the throw bag toward the patient D) Ties the throw bag to a stationary object and throws the rope to the patient

A

Which one of these statements about drowning is true? A) Actual drownings are responsible for only a small number of water-related deaths B) Children younger than 1 year most commonly drown in swimming pools C) Fences around swimming pools are the most effective means of preventing a child from drowning D) Personal flotation devices afford little protection to an individual if he or she panics while in the water

A

Which patient has the best chance for an optimal outcome after drowning? A) A 34-year-old female who was submerged for 9 minutes in 39°F water B) A 47-year-old male who was submerged for 8 minutes in a heated swimming pool C) A 22-year-old female who was submerged for 10 minutes in a whirlpool with 90°F water D) A 17-year-old female who was submerged for 10 to 12 minutes in warm salt water

A

You are assessing a young child who was briefly submerged after falling approximately 20 feet from an observation platform into the shallow portion of a lake. Family members jumped into the lake immediately and pulled the girl to safety. She is confused and begins to vomit profuse amounts of water. What should you do immediately? A) Suction using a rigid-tip catheter, while maintaining manual spine motion restriction precautions B) Place the patient in a side-lying position and tell her to "vomit all the water out" C) Check the patient's breath sounds with a stethoscope to determine whether she aspirated any water D) Perform the head-tilt, chin-lift maneuver and use the flexible catheter to suction out the water while maintaining spine motion restriction precautions

A

You have been called to a hotel swimming pool for a confused adult male. Patrons state that the man was drinking most of the afternoon and was in and out of the pool. The man is now very confused and noncompliant with your requests. The patrons moved the patient so that he is lying on the ground, away from the water's edge, when you arrive. His airway is open and his breathing is adequate. His radial pulse is strong, and his skin is wet with water from the pool. While conducting the secondary assessment, you note a large hematoma to the back of his head. What should you do next? A) Perform manual spine motion restriction of his head and neck B) Apply a cold pack to the hematoma and continue the assessment C) Check the patient's pupils and hand grips for equality D) Transfer the patient to the stretcher and provide immediate transport

A

You have been called to a local emergency department to transfer a male patient to a specialty facility for further care. The man was involved in a deep-sea dive emergency and has been diagnosed with barotrauma. Which finding should be expected with this condition? A) Pain and deafness to the ears B) Right upper quadrant pain and vomiting C) Itchy, blotchy, or mottled skin D) Weakness or paralysis to the extremities

A

A 23-year-old diver has been brought to the surface by fellow divers after behaving erratically while in the water. Your assessment reveals him to be confused and uncoordinated, with an open airway and adequate breathing. He has a strong radial pulse and SpO2 of 98%. The patient has diabetes, and your partner reports that his blood sugar is 91 mg/dL. The remainder of your assessment is unremarkable. Based on this presentation and history, what would be the most likely cause of his condition? A) Hypoglycemia B) Increased nitrogen levels in the blood C) Hypoxia and hypoglycemia D) Seizure activity

B

A 24-year-old intoxicated female patient was pulled from a pool by hotel personnel. The primary assessment reveals her airway to be open and her breathing adequate. Her radial pulse is strong but fast, and she is persistently coughing. Vital signs are pulse 144 beats/min, respirations 24 breaths/min, blood pressure 166/100 mmHg, and SpO2 92%. What would be considered appropriate care for this patient? A) Abdominal thrusts to remove water from the lungs B) Supplemental oxygen through a nonrebreather mask C) Deep oral suctioning to remove water from the airway D) Precautionary application of the automated external defibrillator

B

A diver has summoned 911 after he came to the surface and became short of breath and "itchy" all over. Additionally, he complains of a headache. Assessment reveals a patent airway, adequate breathing, clear breath sounds, and the following vital signs: pulse 92 beats/min, respirations 20 breaths/min, blood pressure 156/62 mmHg, and SpO2 96%. Proper care of this patient should include: A) High-concentration oxygen and epinephrine via EpiPen B) High-concentration oxygen through a nonrebreather face mask C) Epinephrine through an EpiPen, and immediate transport to the hospital D) Oxygen, epinephrine through an EpiPen, and a bronchodilator from an MDI

B

A patient has been pulled from a pool in which he was submerged for several minutes. He is pulseless and apneic. An Emergency Medical Responder asks you if you want to press on the man's abdomen to remove the water from his stomach. What is the most appropriate reply? A) "That sounds good. We need to get that water out of him to minimize the risk for an infection." B) "Let's hold off on that until we see how well we can ventilate the patient." C) "That is no longer recommended in the care of the submersion patient." D) "Yes, but let's turn the patient onto his front so the water can drain naturally."

B

A patient who was found face-down in a pond is unresponsive, apneic, and pulseless. Friends state that the patient was hot and wanted to take a swim in the pond. Which intervention should be included in your care of this patient? A) Hyperventilation with a bag-valve mask and high-concentration oxygen B) Positive pressure ventilations at 10 ventilations per minute with supplemental oxygen C) Placement of the patient in a prone position to evacuate water from the lungs D) Application of the AED with the delivery of no more than one shock

B

Friends pulled an unresponsive 15-year-old male from a lake. They were swimming when they lost track of him. Assessment reveals labored breathing and a weak pulse. Which question would give the EMT the most information related to the prognosis of the patient? A) "Does he have a history of breathing problems?" B) "How long do you think he under the surface of the water?" C) "Was he drinking or doing drugs?" D) "Is there any chance he hit his head?"

B

Torrential rains have been falling over the past few days and your service area is experiencing major flooding. While returning to the disaster command post in the ambulance, you are flagged down by a group of people who inform you that a woman is clinging to a tree in the middle of a rapidly moving and swollen stream. She is screaming for help and states that she does not know how much longer she can hang on. What should you do immediately? A) Throw a rope toward the patient B) Call for a water rescue team and boat C) Swim out and retrieve the patient D) Toss a life preserver upstream from the patient, in the vicinity of her location

B

Which rescuer would be the most appropriate choice to rescue an injured man clinging to an overturned boat in a shallow lake? A) A seasoned EMT who is a good swimmer, is wearing a personal flotation device, and has a rope around his waist B) A firefighter who is wearing a personal flotation device, does not have any medical training, and is a good swimmer who is trained in water rescue C) An EMT who is a good swimmer and has a personal flotation device in place D) A firefighter who is also an EMT and worked as a lifeguard before becoming a firefighter

B

You and several other EMTs are on location where a young female lost control of her car and ended up in a shallow lake. The car is approximately 20 feet from shore and upright, with the wheels touching the bottom of the lake. The woman is on the car's roof; she states that she is not hurt but is scared. What should the EMT do to rescue the patient? A) Swim out to retrieve the patient B) Toss a rope in a throw bag to the patient C) Extend a ladder across the water to the car and the patient D) Encourage the patient to swim to shore

B

You have been asked to present information on water safety and drowning to a community civic group. In regard to prevention, which point would you emphasize? A) The vast majority of children who drown do so in public swimming pools B) A significant number of drownings are preventable due to the involvement of alcohol C) Individuals with seizure disorders are safe in the water if they wear personal flotation devices D) Most authorities agree that children younger than 3 years should be taught to swim

B

You have been dispatched to a pool party for a 19-year-old male with shoulder pain. He states that he dove off the diving board and hit the bottom of the pool with his right shoulder and back. Although there is alcohol at the party, he denies drinking. The patient is alert and oriented and has obvious redness and abrasions to his right shoulder, neck, and back. He complains of neck pain and tingling in his right arm, but denies any other discomfort to any other part of the body. Your next action would be to: A) Measure and apply a cervical collar B) Establish manual spine motion restriction C) Provide supplemental oxygen D) Perform the secondary assessment

B

A 22-year-old male was fishing when he was submerged for approximately 30 seconds after he moved into deeper water to untangle his fishing line. He states that he did take some water into his lungs but feels better now and does not see the need to be transported to the hospital. Which response is most appropriate? A) "We will wait here with you for another 20 minutes. If you do not cough, then you should be okay, and I will feel better about letting you refuse transport." B) "Let me listen to your breath sounds again. If they are clear, then you should be okay to refuse additional care and transport." C) "You seem okay now, but it may take a day or two for complications to become apparent. You really should be checked out in the hospital." D) "Your pulse oximetry reading is 97% on room air, which indicates that you are breathing adequately. You should be okay to refuse care, but keep an eye on yourself."

C

A child has been pulled from the pool after being submerged for less than 30 seconds. The child is crying and hyperventilating, as well as coughing up water and vomiting. The EMT should: A) Place the child prone to help evacuate water from the lungs B) Administer abdominal thrusts with the child in a supine position C) Place the child on his side and initiate a primary assessment D) Provide supplemental oxygen

C

A patient is in cardiac arrest after being submerged in a pond for 15 minutes. You note that his abdomen is greatly distended and it is very difficult to ventilate him. What should you do next? A) Ventilate more forcibly at a rate of 20-24 breaths/min B) Administer chest compressions to evacuate water from the body C) Place the patient on his side and firmly press on the abdomen D) Administer five abdominal thrusts

C

An alert and oriented 29-year-old male diver surfaced and called 911 for severe right ear pain. When asked, he specifically denies nausea, dizziness, or pain other than in his ear. Assessment reveals no threats to the airway, breathing, or circulation. The ear shows no obvious injury or discharge. His vital signs are pulse 96 beats/min, respirations 16 breaths/min, blood pressure 146/76 mmHg, and SpO2 97%. What is the proper care for this patient? A) Transport to a recompression chamber 45 minutes away B) Provide spine motion restriction precautions prior to transport C) Transport to the emergency department 15 minutes away D) Pack gauze in the ear canal to decrease outside pressure changes and reduce pain

C

The EMT shows she understands the concept of the mammalian diving reflex by stating: A) "It is a protective mechanism that occurs when the spinal column is compressed, such as would occur in a diving accident." B) "It occurs in warm water and serves to increase blood flow to the vital organs." C) "It may provide a benefit to the submerged patient by diverting oxygen-rich blood to the brain and heart." D) "It occurs in cold water and increases the activity of the vital organs, thereby protecting them."

C

When working the scene of a water rescue, anytime that the EMT is within 10 feet of the water's edge, it is essential that she don which equipment for personal safety? A) Rope secured to the waist B) Examination gloves C) Personal flotation devices D) SCUBA equipment

C

Which statement by the EMT indicates proper application of the term drowning? A) "A drowning occurs when a person dies while in water, regardless of the cause." B) "A drowning occurs anytime a person is submerged in water and dies as a result." C) "A drowning occurs anytime a person is submerged in a liquid and suffers some sort of respiratory impairment." D) "A drowning occurs anytime a person is submerged in a liquid and dies; also, the incident must be deemed to have been preventable."

C

You are by the side of a male patient who participated in deep-sea diving earlier in the day. The 32-year-old patient informs you that he thinks he pulled a muscle in his shoulder, which has been hurting more as the day goes on. When questioned, he admits to having a headache and blurred vision. You are suspicious of decompression sickness. Which statement made by the patient would be most significant given the situation? A) "I spent some time in a pocket of warm water." B) "I ate seafood the night before." C) "While diving, I saw a shark and came up as fast as I could." D) "I took Tylenol before the dive for a headache."

C

You have been put in charge of creating a protocol that will direct care provided by EMS. In regard to an ice-water drowning patient who is severely hypothermic and in cardiac arrest, what treatment would you propose? A) Provide CPR only and withhold the AED B) Withhold resuscitation if the patient's temperature is lower than 86°F C) Apply the AED and give one shock if indicated. Contact medical direction if additional shocks are indicated by the AED D) Administer the usual care provided to any other patient in cardiac arrest

C

A 49-year-old man was fishing in a stream of cold water when he became submerged after getting tangled in some hidden roots. The patient was pulled from the stream by friends after approximately 5 minutes of submersion. Your assessment reveals that he is responsive to painful stimuli and breathing 5 times per minute. His pulse is weak and rapid. Which set of instructions would be appropriate to relay to the team of rescuers? A) "Do not wipe the water off him. It will keep his body cool and protect vital organs like his brain and heart." B) "Do not apply the AED if he goes into cardiac arrest. The water was very cold and the AED is contraindicated in hypothermia." C) "I need someone to perform abdominal thrusts to see if he took water into his stomach." D) "Let's move him into the warm ambulance as quickly as possible, and then cut off his clothes and cover him."

D

A teenage female has been removed from a pool. Your assessment reveals her to be responsive to painful stimuli with decorticate posturing. Her airway has water in it, and she appears to be vomiting water. Breathing is agonal at 8 breaths per minute; you hear a gurgling noise with each attempt at breathing. The patient's pulse is weak and slow. What should be the priority treatment you would render next? A) Place a nasopharyngeal airway B) Administer abdominal thrusts C) Start positive pressure ventilation D) Suction water from the airway

D

A young male has been pulled from a lake by his friends after being submerged for several minutes. Assessment reveals his airway to be patent, respirations absent, and a weak carotid pulse of 12 beats/min. Which care should you provide at this time? A) Attach the AED, provide one shock if indicated, start CPR, and transport to the hospital B) Administer one shock with the AED, start CPR, and withhold additional shocks until the patient is rewarmed C) Insert an oropharyngeal airway, provide positive pressure ventilation, start CPR, and transport D) Start positive pressure ventilation, place the patient on a long board, and transport to the hospital

D

At a pool party, a 48-year-old female was pulled from the water after being submerged for 10 seconds according to bystanders. The patient responds to verbal stimuli by moaning and has an intact airway with adequate respirations. Her heart rate is 116 beats/min and SpO2 is 97%. Which statement made by friends would be considered most important at this time? A) "She is scheduled for knee surgery next week." B) "She is allergic to many medications." C) "She is not a very good swimmer." D) "She takes insulin for her sugar condition."

D

The head of the water rescue team has just informed you that the divers have retrieved a young woman who fell through ice on a pond while walking her dog. The estimated submersion time is 22 minutes. Another EMT asks you if it will be necessary to start resuscitation, given the length of submersion. What is your most appropriate reply? A) "Let's assess her first. If she does not have a pulse, then we will contact medical direction for orders to not resuscitate." B) "Our resuscitation will consist of CPR only. The AED is contraindicated if the patient is hypothermic." C) "Probably not. Given the amount of time she was submerged in the water, there is most likely little that can be done." D) "Absolutely! Given that she has been in cold water, she may still have a chance of survival."

D

While at a public pool obtaining a refusal of care from a patient who was stung by a bee, you hear screaming. Patrons are waving you over to a 13-year-old boy who hit the diving board with his head while diving. He is now in the water and is motionless. The lifeguard is in the water and informs you that the patient's eyes are open and he is breathing with a pulse, but not talking. What should you do next? A) Instruct the lifeguard to carefully float the boy to the side of the pool so you can assess and get him on a backboard B) Have the lifeguard quickly remove the patient from the pool so assessment and emergency medical care can be given C) Position the boy upright against the lifeguard with spine motion restriction precautions observed during removal from the pool D) Pass a cervical collar and long board into the water for providing spine motion restriction precautions to the patient prior to his extrication from the water

D

You are by the side of a young male patient who hit his head after diving from a hillside into a shallow lake. The patient is unresponsive and has a large hematoma to his forehead with abrasions all over his face. A paramedic asks you to apply painful stimuli to his arms and legs. You recognize that the paramedic wants you to assess for which type of injury or condition? A) Alcohol intoxication B) True unresponsiveness C) Extremity fractures D) Spinal injury

D