EMT Chapter 32 - Environmental Emergencies

Respiration

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

convection

the loss of body heat caused by air movement (e.g., a 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)

Homeostasis

A balance of all systems of the body.

hyperthermia

A condition in which the body core temperature rises to 101°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.

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

C. abdominal or joint pain.

Which of the following is an early sign of pit viper envenomation? Select one: A. Local swelling and ecchymosis B. Signs and symptoms of hypoperfusion C. General weakness and diaphoresis D. Syncope and bleeding at distal sites

A. Local swelling and ecchymosis

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

A. death from suffocation after submersion in water.

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

A. frostbite.

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

A. superficial.

air embolism

Air bubbles in the blood vessels.

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

Air embolism is the most dangerous, and most common, emergency in scuba diving.

Hypothermia occurs when the core body temperature falls below: Select one: A. 88°F (31°C). B. 95°F (35°C). C. 98°F (37°C). D. 90°F (32°C).

B. 95°F (35°C).

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: Select one: A. apply chemical heat packs to his groin and axillae. B. assess for a carotid pulse for up to 60 seconds. C. open his airway and give two rescue breaths. D. apply an AED and assess his cardiac rhythm.

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

You receive a call to a residence for a sick patient. Upon your arrival, you find the patient, 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 blood pressure is 90/50 mm Hg. You should: Select one: A. administer one tube of oral glucose and reassess his mental status. B. load him into the ambulance and begin rapid cooling interventions. C. perform a head-to-toe assessment and look for signs of trauma. D. place him in a sitting position and have him drink 1 L of water.

B. load him into the ambulance and begin rapid cooling interventions.

You are transporting a 28-year-old man with a frostbitten foot. The patient's vital signs are stable and he denies any other injuries or symptoms. The weather is treacherous and your transport time to the hospital is approximately 45 minutes. During transport, you should: Select one: A. cover his foot with chemical heat compresses. B. protect the affected part from further injury. C. administer oxygen via a nonrebreathing mask. D. rewarm his foot in 102°F to 104°F (38.9°C to 40°C) water.

B. protect the affected part from further injury.

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 feet. On assessment, you note that he has cyanosis around his lips and has pink froth coming from his nose and mouth. You should: Select one: A. place him in a semi-sitting position, suction his mouth and nose, apply a continuous positive airway pressure (CPAP) device, and transport to the closest emergency department. B. 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. 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°, suction his mouth and nose, hyperventilate him with a bag-valve mask, and contact medical control for further guidance.

B. 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.

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

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

In contrast to Lyme disease, Rocky Mountain spotted fever: Select one: A. presents with flu-like symptoms and a bull's-eye rash. B. may be confused with rheumatoid arthritis. C. can cause paralysis and cardiorespiratory collapse. D. causes painful joint swelling after a few days or weeks.

C. can cause paralysis and cardiorespiratory collapse.

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

C. conduction.

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

C. evaporation.

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

C. hot, dry skin.

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

C. nervous system.

Most of the serious injuries associated with scuba diving are caused by: Select one: A. cold water temperature. B. too rapid of a descent. C. too rapid of an ascent. D. alcohol consumption.

C. too rapid of an ascent.

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

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

Which of the following MOST accurately describes hyperthermia? Select one: A. Heat evaporates a significant amount of body water. B. The body eliminates more heat than it can generate. C. The core body temperature exceeds 99.5°F (37°C). D. The body is exposed to more heat than it can lose.

D. The body is exposed to more heat than it can lose.

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

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

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

D. possible spinal injury.

Symptoms of air embolism may not occur for several hours.TrueFalse

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

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

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

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 __________ . Heat cramps Heat exhaustion Heat stroke Heat asphyxia

Heat stroke Correct. 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.

Hypothermia is diagnosed when the core body temperature falls below what temperature? 98°F (36.7°C) 95°F (35°C) 92°F (33.3°C) 90°F (32.2°C)

Hypothermia occurs when the core temperature falls below 95°F (35°C).

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

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

Laryngospasm is usually encountered in drowning accidents when water irritates the larynx and vocal cords.

breath-holding syncope

Loss of consciousness caused by a decreased breathing stimulus.

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

Moist, pale, cool skin in a hot environment indicates there has been excessive fluid and salt loss.

What is often the first sign of heat stroke? Change in behavior Muscle cramps Low pulse rate and blood pressure Profuse sweating

Often, the first sign of heat stroke is a change in behavior.

heat cramps

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

Shivering stops and muscle activity ceases once the body's core temperature reaches what? 95°F (35°C) 90°F (32.2°C) 85°F (29.4°C) 80°F (26.7°C)

Shivering stops at 90°F (32.2°C). This is a sign of severe hypothermia.

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

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

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).

radiation

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

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? HACE HAPE Mountain sickness Rocky Mountain spotted fever

These are signs and symptoms of HACE (high-altitude cerebral edema).

It is difficult to find a pulse in a drowning victim.TrueFalse Correct. 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. T/F

True Correct. 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.

The diving reflex may cause immediate bradycardia.TrueFalse

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

Rough handling of a patient with severe hypothermia may cause which of the following dysrhythmias? Ventricular fibrillation Sinus bradycardia Asystole Sinus tachycardia

Ventricular fibrillation Rough handling of a patient with moderate to severe hypothermia may cause the heart to go into ventricular fibrillation.

bends

a common name for decompression sickness.

hypothermia

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

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 decreased.

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.

frostbite

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

turgor

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

Evaporation

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

diving reflex

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

ambient temperature

the temperature of the surrounding enviornment