EMT Chapter 32: Environmental Emergencies
conduction
heat loss resulting from standing in a cold room
radiation
heat loss resulting from standing in a cold room
evaporation
heat loss resulting from sweating
Convection
heat loss that occurs from helicopter rotor blade down wash
In the United States, the most common form of pit viper is the _______
rattlesnake
core temperature
temperature of the central part of the body
Most heat stroke cases occur when the temperature is around _____°F and the humidity is 80%.
80
Shivering stops and muscle activity ceases once the body's core temp[erature reaches what? A) 95F B)85F C)90F D)80F
90F
A person's ability to shiver is lost when his or her body temperature falls below: A) 94F B) 90F C) 92F D) 95F
90F (32C)
The body's natural protective mechanisms against heat loss are: A Vasoconstriction and shivering B) respiration and vasoconstriction C) vasocodialation and respiration D) shivering and vasodilation
A Vasoconstriction and shivering
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 behavior B) Muscle cramps C) Low pulse rate and blood pressure D) Profuse sweating
A) Change in behavior
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 B) HAPE C) Mountain sickness D) Rocky Mountain spotted fever
A) HACE
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 Rough handling of a patient with moderate to severe hypothermia may cause the heart to go into ventricular fibrillation.
Compared to adults, infants and children are at higher risk for hypothermia for all of the following reasons, EXCEPT: A) a relatively small surface area B) a smaller amount of body fat C) a smaller overall muscle mass D) a decreased ability to shiver
A) a relatively small surface area
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) abdomen B) chest C) forehead D) neck
A) abdomen
The MOST prominent symptom of decompression sickness is: A) abdominal or joint pain B) difficulty with vision C) tightness in the chest D) dizziness and nausea
A) abdominal or joint pain
Patients with generalized hypothermia are at an increased risk of a local cold injury because: A) blood is shunted away from the extremities to the body's core B) the patient is usually unable to escape the cold ambient temperature C) peripheral vasodilation brings warm blood to the skin's surface D) the major muscles of the body become rigid during hypothermia
A) blood is shunted away from the extremities to the body's core
Hypothermia can worsen internal bleeding secondary to: A) blood-clotting abnormalities B) a decreased heart rate C) cardiac arrhythmias D) severe muscular rigidity
A) blood-clotting abnormalities
High humidity reduces the body's ability to lose heat through: A) evaporation B) radiation C) conduction D) convection
A) evaporation
Covering a patient's _________ will significantly minimize radiation heat loss. A) head B) abdomen C) extremities D) chest
A) head
Which of the following conditions would be the LEAST likely to increase a person's risk of hypothermia? A) hyperglycemia B) spinal cord injury C) severe infection D) head injury
A) hyperglycemia
In contrast to the brown recluse spider, the black widow spider: A) is large and has a red-orange hourglass mark on its abdomen B) has a bite that usually produces local pain but no systemic signs or symptoms C) is very small and has a violin-shaped marking on its back D) has a bite that is typically painless until a blister developes
A) is large and has a red-orange hourglass mark on its abdomen
Signs and symptoms of heat exhaustion and associated hypovolemia include all of the following, EXCEPT: A) normal thirst B) cold, clammy skin with ashen pallor C) normal vital signs D) dizziness, weakness, or faintness
A) normal thirst
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: A) protect the affected part from further injury B) cover his foot with chemical heat compresses C) administer oxygen via a nonrebreathing mask D) rewarm his foot in 102F to 104F water
A) protect the affected part from further injury
High air temperature reduces the body's ability to lose heat by: A) radiation B) convection C) evaporation D) conduction
A) radiation
Signs and symptoms of severe systemic hypothermia include all of the following, EXCEPT: A) shivering B) coma Cvery slow respirations D) weak pulse
A) shivering
Most of the serious injuries associated with scuba diving are caused by: A) too rapid of a descent B) too rapid of an ascent C) cold water temperature D) alcohol consumption
A) too rapid of a descent
Common signs and symptoms of heat exhaustion include all of the following, EXCEPT: A, hot, dry skin B. nausea C. headache D. tachycardia
A, hot, dry skin
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
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
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
Drowning is MOST accurately defined as: A) death beyond 24 hours after submersion in water B) death from suffocation after submersion in water C) water in the lungs following submersion in water D) temporary survival after submersion in water
B) death from suffocation after submersion in water
Which of the following medications increases a person's risk of a heat-related emergency? A) motrin B)diuretics C) aspirin D) tylenol
B) diuretics
The body's natural cooling mechanism, in which sweat is converted to a gas, is called: A) convection B) evaporation C) radiation D) conduction
B) evaporation
Which of the following statements regarding the brown recluse spider is NOT true? A) in venom is not neurotoxic B) it is larger than the black widow spider C) it lives mostly in the southern and central partys of the country D0 bites rearely cause systemic sign and symptoms
B) it is larger than the black widow spider
In order for sweating to be an effective cooling mechanism: A) the body must produce at least 1 L per hour B) it must be able to evaporate from the body C) several layers of clothing must be worn D) the relative humidity must be above 90%
B) it must be able to evaporate from the body
The EMT must assume that any unwitnessed water-related incident is accompanied by: A) alcohol intoxication B) possible spinal injury C) cold-water immersion D) an air embolism
B) possible spinal injury
Treatment of drowning or near drowning begins with: A) ventilation with 100% oxygen via a bag-mask device B) opening the airway B) rescue and removal from the water D) suctioning the lungs to remove the water
B) rescue and removal from the water
You are assessing a man with suspected hypothermia. The patient is conscious and alert, and is actively shivering. His respiratory rate is increased, but his breathing is unlabored, and the pulse oximeter reads 72%. The pulse oximetry reading is MOST likely: A) accurate because shivering affects hemoglobin binding B) secondary to decreased perfusion in the extremities C) a direct reflection of his increased respiratory rate D) accurate because he has signs of respiratory failure
B) secondary to decreased perfusion in the extremities
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: A) suction his mouth and nose, keep him supine and elevate his legs to prevent air bubbles from entering his breain, administer high flow oxygen, and transport to a hyperbaric chamber B) suction his mouth and nose, apply high flow oxygen, monitor the patients breath sounds for a pneumothorax, and contact medical control regarding transport to a recompression facility C) 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 D) position him supine with his head elevated 30 degrees, 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 patients breath sounds for a pneumothorax, and contact medical control regarding transport to a recompression facility
Which of the following would be the LEAST likely to occur in a patient with a core body temperature of between 89°F (32°C) and 92°F (33°C)? A) stiff muscles B) tachycardia C) confusion D) bradypnea
B) tachycardia
Heat stroke occurs when: A) the ambient temperature exceeds 90F and the humidity is high B) the body's heat-eliminating mechanisms are overwhelmed C) a person becomes dehydrated secondary to excess water loss D) a person's core body temperature rises about 103F
B) the body's heat-eliminating mechanisms are overwhelmed
Hypothermia is diagnosed when the core body temperature falls below what temperature? A) 90F B)98F C)95F D)92F
C) 95F
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.
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.
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) recognize that the patients who are conscious are at high risk for developing cardiac arrest and quickly assess them for potentially life-threatening injuries B) immediately begin CPR on the unresponsive patient, but cease resuscitation efforts if there is no response after 5 minutes of treatment C) assess the unrespoinsive patient's pulse, begin CPR starting with chest compressions if he is pulseless, and attach the AED as soon as possible D) focus your initial treatment efforts on the patients who are conscious because the unresponsive patient is likely in irreversible cardiac arrest
C) assess the unrespoinsive patient's pulse, begin CPR starting with chest compressions if he is pulseless, and attach the AED as soon as possible
In contrast to Lyme disease, Rocky Mountain spotted fever: A) may be confused with rheumatoid arthritis B) causes painful joint swelling after a few days or weeks C) can cause paralysis and cardiorespiratory collapse D) presents with flu-like symptoms and a bull's-eye rash
C) can cause paralysis and cardiorespiratory collapse
When the body loses sweat, it also loses: A) plasma B) nutrients C) electrolytes D) erythrocytes
C) electrolytes
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.
OST accurate reading of a patient's core body temperature, you should place a special hypothermia thermometer: A) behind the patients knee B) under the patients tongue C) into the patient's rectum D) under the patients armpit
C) into the patient's rectum
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: A) perform a head-to-toe assessment and look for signs of trauma B) place him in a sitting position and have him drink 1L of water C) load him into the ambulance and begin rapid cooling interventions D) administer one tube of oral glucose and reassess his mental status
C) load him into the ambulance and begin rapid cooling interventions
Which of the following is an early sign of pit viper envenomation? A) syncope and bleeding at distal sites B) signs and symptoms of hypoperfusion C) local swelling and ecchymosis D) general weakness and diaphoresis
C) local swelling and ecchymosis
The two MOST efficient ways for the body to eliminate excess heat are: A) hyperventilation and tachycardia B) respiration and bradycardia C) sweating and vasodilation D) perspiration and tachycardia
C) sweating and vasodilation
Which of the following MOST accurately describes hyperthermia? A) heat evaporates a significant amount of body water B) the body eliminates more heat than it can generate C) the body is exposed to more heat than it can lose D) the core body temperature exceeds 99.5 degrees (37C)
C) the body is exposed to more heat than it can lose
The organs most severely affected by air embolism are the: A) brain and lungs B) brain and heart C) heart and lungs D) brain and spinal cord
D) brain and spinal cord
The venom of a black widow spider is toxic to the: nervous system 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: A) evaporation B) radiation C) convection D) conduction
D) conduction
The rate and amount of heat loss by the body can be modified by all of the following, EXCEPT: A) wearing insulated clothing B) increasing heat production C) moving to an area where heat loss is decreased D) increasing fluid intake
D) increasing fluid intake
The venom of a black widow spider is toxic to the: A) renal system B) cardiovascular system C) respiratory system D) nervous system
D) nervous system
An air embolism associated with diving occurs when: A) high water forces air into the mediastinum B) the diver hyperventilates prior to entering the water C) the alveoli completely collapse due to high pressure D) the diver holds his or her breath during a rapid transport
D) the diver holds his or her breath during a rapid transport
Heat loss from the body through respiration occurs when: A) air temperature is greater than body temperature B) the core body temperature is greater than 98F C) cool air is inhaled and displaces warm air D) warm air exhaled into the atmosphere
D) warm air exhaled into the atmosphere
All of the following terms refer to a body part that is cold but not frozen, EXCEPT: A. frostnip B. trench foot C. immersion foot D. frostbite
D. frostbite
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. elevating the lower extremities and giving antivenin C. transporting only with close, continuous monitoring D. supine positioning, splinting the leg, and transporting
D. supine positioning, splinting the leg, and transporting
_____ is 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.
Heat stroke
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 checmical heaty packs to his groin and axillae
assess for a carotid pulse for up to 60 seconds.
Never assume that a(n) ______, pulseless patient is dead.
cold
