Chapter 24

As an EMT working at a mountain​ resort, you are presented with a​ 50-year-old female who states that she does not feel well. From your​ assessment, which of these findings would seemingly indicate that the patient is being adversely affected by the high​ altitude?

Complaint of dyspnea on exertion

A patient has been bitten by what appears to be a black widow spider. The bite to her left hand is dull and​ achy, and the patient states that the muscles in her shoulders and back are starting to​ hurt, as if they are cramping up. After ensuring that no​ life-threatening conditions are present and administering​ oxygen, the EMT​ should:

Keep the hand below the level of the heart

You are called for an elderly woman who has slipped on the ice. On​ arrival, you find her supine on an icy sidewalk and responsive to painful stimuli with decorticate posturing​ (flexion). She has blood coming from a laceration on the back of her head and is breathing agonally at 4 times a minute. What should you do​ immediately?

Perform the manual​ jaw-thrust maneuver

A​ 31-year-old groundskeeper has been stung by bees three times in his right arm and twice to his left ankle. After performing the primary and secondary​ assessments, which reveal no acute​ disturbances, what should you do​ next?

Attempt removal of any embedded stingers

An intoxicated​ 24-year-old female patient has been struck by lightning and is conscious but confused. Which of these assessment findings should the EMT investigate further​ first?

Irregular heartbeat

The EMT is correctly assessing the skin temperature of a patient who has been exposed to cold temperatures for an extended period of time when​ he:

Places the back of his hand on the​ patient's abdomen

After ensuring that there are no​ life-threatening conditions to the​ airway, breathing, and​ circulation, the priority in caring for a patient with hypothermia​ is:

Preventing additional heat loss

You are accompanying a team of hikers climbing a high mountain. In the​ morning, you are summoned to a tent and find one of the climbers confused and complaining of a headache. His airway is patent and respirations adequate. He has no medical history and was in good health until found this morning by his friend. You are suspicious of​ high-altitude cerebral edema​ (HACE). What should you do to help the​ patient?

Provide supplemental oxygen

In which of these settings will sweating be less effective as a means to cool the​ body?

Relative humidity of​ 98%

Which of these findings would present earliest in a patient with​ hypothermia?

Shivering

A patient with hypothermia is in cardiac arrest. The automated external defibrillator​ (AED) is applied and delivers one shock. Following the​ shock, what should the EMT do​ next?

Start cardiopulmonary resuscitation

The primary assessment of a teenage male patient who is unresponsive with​ hot, moist, and flushed skin reveals his airway to be​ open, breathing​ shallow, and radial pulse weak. You have initiated positive pressure ventilation with supplemental oxygen. What should you consider doing​ next?

Transfer the patient into the ambulance

Consumption of large amounts of water during prolonged periods of exertion can result in which​ disorder?

hyponatremia

A young female patient was weeding her garden when she was bitten on her left hand by an unidentified snake. The primary assessment does not reveal any life threats and vital signs are stable. In caring for this patient and her​ injury, it is critical that the​ EMT:

Have the patient remove her wedding ring from her left hand

You are treating a patient with suspected heat cramps. Your medical director has issued standing orders for such treatment given the high number of​ heat-related emergencies to which your service routinely responds in the summer months. Regarding these standing​ orders, which of these instructions would seem most​ appropriate?

Mix one teaspoon salt in one quart of water and administer half of a glass every 15 minutes

A patient is confused and combative after playing football in the open sun on an extremely hot day. On the​ field, you find his airway​ open, respirations tachypneic but​ adequate, and radial pulse rapid. The​ patient's skin is hot and dry. After deciding whether to provide spine motion restriction​ precautions, your next action would be​ to:

Move the patient to the​ air-conditioned ambulance

A patient has been struck by lightning at a picnic. A doctor on scene states that the patient was in cardiac arrest after the​ strike, but with 1 minute of​ CPR, has a heartbeat and weak sonorous respirations. The patient remains unresponsive. Which priority care should the EMT​ provide?

Perform the​ jaw-thrust maneuver

You are en route to the hospital with a patient who is unresponsive and has​ hot, dry skin. His friends state that the patient had been drinking and passed out in the hot sun for several hours before 911 was called. An Emergency Medical Responder is ventilating the patient with a​ bag-valve mask attached to supplemental oxygen. Which of these actions would be most beneficial to the patient​ next?

Place cold packs to the​ patient's groin and armpits

Which of these​ conditions, in addition to cool​ temperatures, is necessary for trench foot to​ develop?

Prolonged exposure to moisture

A young boy complains of pain to his fingers after spending several hours outside riding a sled in cold winter temperatures. After ensuring he has no​ life-threatening conditions, you turn your attention to his hands and note that the fingers are cold to the touch. You suspect that he is suffering from a superficial freezing cold injury. Which sign or symptom would help confirm this​ suspicion?

Skin on the fingers that is soft and numb

You have been called to a hunting camp for a patient with a severe freezing cold injury to his hand and fingers. The patient is suffering no​ life-threatening conditions and you elect to rewarm the affected areas. Which of these warming techniques would be most appropriate for this​ patient?

Thaw and rewarm the tissue as quickly as possible

Regarding​ snakebites, which of these statements is​ true?

The majority of snakebites involve nonpoisonous snakes

The stinger of a bee is evident in the left thigh of a female patient who states that she is allergic to bees and has an EpiPen for such occasions. According to the​ patient, the sting occurred two hours ago and she just now noticed that the stinger remains in place. She did not take her epinephrine and appears asymptomatic for an allergic reaction. At this​ time, you​ would:

Attempt removal of the stinger

Which of these patients with heat emergency would be the highest priority for​ transport?

A​ 19-year-old responsive to verbal stimuli with hot dry skin and tachycardia

The EMT should recognize which of these patients is experiencing generalized​ hypothermia?

A​ 21-year-old female who was trapped in cold water for 10 minutes before being rescued

An​ 18-month-old child has a temperature of 105.2degreesF. Without​ treatment, what will most likely​ occur?

Cellular dysfunction or seizures

You have been asked by your medical director to put together an emergency kit specifically for patients who have been stung or bitten by small marine life animals. Which of these items should you place in that​ kit?

Vinegar

What is the most significant mechanism by which the body can lose​ heat?

radiation

You are transporting a​ 44-year-old male patient who was stung multiple times by fire ants. Which of these statements made by the patient should concern you​ most?

​"I am beginning to feel itchy all over and​ I'm developing​ hives."

When moving a patient with severe generalized​ hypothermia, which of these instructions is most appropriate to relay to your fellow EMS​ providers?

​"I want everyone to take extra care in moving the patient very gently to the stretcher. We do not want her to go into cardiac​ arrest."

The EMT shows that he understands the danger of heat stroke when he​ states:

​"In heat​ stroke, the body loses its ability to rid itself of excess​ heat, causing the core temperature to​ rise."

Which of these patients is losing body heat by the mechanism of​ convection?

A​ 30-year-old male in a cool temperature and exposed to a light breeze

What of these patients is most accurately described as suffering an environmental​ emergency?

An intoxicated male patient who collapsed in the snow and is complaining that he feels cold

Following a direct lightning​ strike, which symptoms should the EMT expect the patient to​ display?

Apnea

A patient with hypothermia is alert and​ confused, but complains of left arm pain. His friends found him​ outside, where the patient spent the night after he got drunk and passed out in the cold. It appears as though he has a localized freezing cold injury to the arm in question. In caring for this​ patient, which of these treatments would be​ acceptable?

Board splint the arm to keep it from moving

A patient has been bitten by a nonpoisonous grass snake. Your care would​ include:

Cleaning and dressing the wound

After successfully rewarming a​ patient's frozen foot and frozen​ toes, the EMT​ should:

Cover the foot and toes with​ dry, sterile dressings

When cooling a patient with possible heat​ stroke, which of these findings would be of most concern to the​ EMT?

Determining that the patient is now shivering after having cold packs applied to the neck

You have been called to a residence for a patient who is sick. On​ scene, the family tells you that the patient is being treated for​ "stomach flu" and has had a fever of 102degreesF for the past two days. She has been taking all of the medications prescribed by her​ doctor, but this evening became very​ "sweaty." Assessment shows her to be stable with a pulse of​ 88, respirations of 18​ breaths/min, adequate blood pressure of​ 128/68 mmHg, and an oral temperature of 100.2degreesF. Based on these​ data, the EMT should recognize​ that:

The​ patient's body is cooling itself by transferring heat into the​ sweat, which is then evaporated into the air

In addition to brain injury from the high voltage and​ amperage, the patient who experiences a lightning strike also typically​ develops:

Trauma from air rushing out of and back in to the strike location

You are treating a male patient who is hypothermic. What should you do to decrease heat loss caused by​ radiation?

Wrap a towel around the​ patient's head

Medical direction has ordered you to begin rewarming an unresponsive patient with a core temperature of 93degreesF. Which of these measures would most benefit this​ patient?

Wrap the patient in several warm blankets

You are managing a patient who has been consuming large amounts of water while playing a sport outside for several hours. The patient presents with general​ malaise, has a severe​ headache, has vomited​ once, and complains of photophobia. The​ patient's core temperature is just slightly​ elevated, and you see bloating in his hands. During​ transport, in which position should this patient be​ placed?

fowler's position

When obtaining a history of a​ 5-year-old boy with generalized​ hypothermia, which question should be asked before all​ others?

​"How long was he out in the​ cold?"

The EMT should recognize heat cramps as the probable cause of a​ patient's problem when the patient​ states:

​"I have pain in my belly and​ legs."

Which thermometer should be utilized by an EMT when assessing the temperature of a patient with​ hypothermia?

​Medical-grade thermometer in the​ patient's rectum

You are giving a talk on hunting safety. A hunter asks you when someone should attempt to rewarm a hand or foot that is frostbitten. What is your best​ response?

​"Rewarming should take place only when there is no chance that the tissue will​ refreeze."

You are called to a construction site on a hot and humid day for a male patient with a heat emergency. On​ scene, you find a​ 49-year-old man who is responsive to verbal stimuli. Coworkers state that the patient had been moving concrete blocks all day in the hot weather and had not​ rested, eaten, or had anything to drink in the past two hours. During the primary​ assessment, you note the​ patient's airway to be open and breathing rapid but adequate. His radial pulse is rapid and​ bounding, and his skin is hot and dry. Which of these findings makes this patient a priority for immediate and rapid​ transport?

Hot and dry skin

You have been called for an alert and oriented male patient. Upon your​ arrival, his roommate states that the patient spent several hours locked out of his house in the cold temperatures after an evening of drinking since no one was home and the patient lost his house keys. Since the primary and secondary assessments have ruled out immediate​ life-threatening conditions, you have decided to rewarm the patient. Which of these warming techniques would be most appropriate for this​ patient?

Hot packs to the​ patient's chest,​ groin, and armpits

You are called to treat a homeless person who complains of an inability to walk due to sores and numbness of his feet. The EMR tells you that the patient is well oriented with good pulses and respiration but that his feet are edematous with open sores and​ broken-down skin. This finding is the typical result of which​ condition?

Immersion foot

Which of these statements about immersion hypothermia is​ false?

Immersion hypothermia typically does not occur until the water temperature is less than 35degreesF

A person is in a hot environment and his body is successfully compensating to​ off-load excess heat. Which assessment findings best illustrate this​ process?

Warm and diaphoretic​ skin, elevated heart​ rate, and increased respirations

You are providing a​ "stand-by" service at the county fair. At​ midmorning, a​ 50-year-old male patient approaches your tent and states that he was bitten in the right shoulder by some sort of insect and has tremendous pain. Assessment reveals his shoulder to have a large reddened area with a sting mark in the middle. The skin is warm to the touch. Your care of this patient should​ include:

Applying a cold pack to the site

You have been summoned to a field where a​ 32-year-old male patient has been struck by lightning. Emergency Medical Responders are with the​ patient, providing manual spine motion restriction. Once you arrive at the​ patient's side, what should you do​ first?

Assess the airway and breathing

You are first to arrive at the side of a pond where a boy playing hockey has fallen through the ice. The child is holding onto the ice at the edge of the break and has a distressed look on his face. Your immediate action would be​ to:

Instruct the patient to remain still until the rescue team arrives

You have been chosen by the medical director to give a​ 15-minute presentation on​ cold-related emergencies to a local volunteer fire department. In preparing the​ talk, which teaching point should you​ emphasize?

Emergency responders play a critical role in caring for hypothermic patients since the most important phase of care occurs during the first 30 minutes

On entering an apartment for a call related to a confused elderly female​ patient, you note that the air conditioner is running on high and the room is extremely cold. Which other clue obtained during the scene​ size-up would best indicate that this patient may be suffering from urban​ hypothermia?

Fan blowing directly onto the patient

Medical direction has asked you to remove a tick from behind the left ear of a​ 5-year-old girl. You​ would:

Grab the tick close to its head and pull directly outward

Which sign or symptom best indicates that the patient with cold skin is experiencing generalized​ hypothermia?

Heart rate of 48​ beats/min

You are transporting a patient who was bitten on her hand by a spider approximately 20 minutes ago. On​ scene, the primary assessment revealed no life threats and vital signs were stable. While conducting the​ reassessment, which of these findings would be of most concern to the​ EMT?

Hives to the chest and abdomen

When treating a confused patient who has been exposed to high​ temperatures, which of these findings is most​ concerning?

Hot and dry skin

You have been called to a park for a teenage boy who is​ "sick." On​ scene, you find a​ 16-year-old male patient who knows his name but is confused about place and time. Friends state that they have been playing basketball most of the morning and afternoon. The temperature is in the 90s and the humidity is high. The​ patient's airway is patent and his breathing is fast but adequate. His pulse is weak and rapid. Observation of his skin reveals it to be​ pale, cool, and moist. Oxygen is being administered via nonrebreather face mask by Emergency First Responders. Which other step would be appropriate care for this​ patient?

Place him supine on the stretcher with feet elevated

A patient at a mountain ski resort presents to you with notable shortness of breath. She denies any past medical history and takes no medications. Your assessment reveals crackles to the bases of both lungs. After applying​ oxygen, you realize that the key to helping this patient improve is​ to:

Remove her to a lower altitude

A patient who is conscious and breathing has been pulled from a stream of cold water. To decrease her loss of heat via the mechanism of​ conduction, the EMT should​ immediately:

Remove her wet clothing

A​ 23-year-old female patient has been stung in the right arm by some unidentified marine life. Her arm and hand are swollen and red. The primary assessment is unremarkable and she is complaining of pain to the site of injury. You​ would:

Remove rings from the​ patient's right hand

A​ 24-year-old female who was hiking in shorts informs you that she has been bitten by an insect on her leg. She states no other complaints. Assessment reveals a tick embedded in her leg. As an​ EMT, you should provide care to this patient​ by:

Removing the tick with tweezers

You are assessing a conscious but confused hunter who became lost in the woods on a cold day. Your assessment shows him to have an open​ airway, adequate​ breathing, and a weak radial pulse. His skin is cold to the touch and he is shivering. The EMT should recognize that​ the:

Shivering is a protective means by which the body is attempting to warm itself

The EMT would recognize that a hypothermic​ patient's condition is deteriorating when he​ observes:

Slurred speech

A young man has been struck by lightning on a golf course and is in cardiac arrest. Other golfers say that he was struck​ 8-10 minutes ago. What should the EMT do​ immediately?

Start cardiopulmonary resuscitation

A landscaper who has been working in 105degreesF weather is found collapsed in a​ client's yard. He is responsive to painful stimuli and has an open airway. His breathing is​ shallow, alveolar breath sounds are​ absent, and radial pulse is weak. The​ patient's skin is hot and dry and appears to be sunburned. The EMT should​ immediately:

Start positive pressure ventilation

You are reassessing a patient whom you are treating for heat exhaustion. Which of these findings indicates that the patient is​ improving?

The mental status is now alert and oriented

A young male patient who was angry with friends wandered away from a party and spent the night outside uncovered in ​40-50degreesF temperatures. He is​ confused, has decreased but adequate​ breathing, and has a weak radial pulse. His skin is cool and capillary refill delayed. You note that he is not shivering. Based on this​ presentation, what can you safely​ conclude?

The​ patient's body temperature is most likely dangerously low

Bystanders have called 911 for a female patient who lives on the street. She has been outside in the cold all night and is muttering incomprehensible words. Her airway is open and her breathing is adequate. Her skin is​ cold, and a radial pulse is present but weak. What should the EMT do​ next?

Transfer the patient to the ambulance

You have been called for a​ 78-year-old female patient who slipped while getting out of her bathtub. She is confused and cold to the touch. You learn that the patient slipped 24 hours ago and has been on the​ bathroom's tile floor ever since. Since it is​ summer, she also had her air conditioner running on high. The EMT would best categorize this emergency​ as:

Urban hypothermia with heat loss caused by conduction

The EMT shows she understands the regulation of temperature in the human body when she​ states:

​"If the body becomes too hot or too​ cold, the brain will send instructions out to the body to either retain or lose​ heat."

A patient has been bitten by an unidentified snake. Which of these statements made by the patient would lead the EMT to believe that the snake was​ poisonous?

​"Its head was​ triangular."

An Emergency Medical Responder​ (EMR) quickly checks the breathing and pulse of a patient with​ Alzheimer's disease who has been sleeping outside in the cold for several hours. The EMR informs you that the patient grimaces to painful stimuli but is not breathing and does not have a pulse. What is your best​ response?

​"Let's perform the primary assessment​ again, and this time take longer to assess for breathing and a​ pulse."

You have been summoned to a beach for a young male patient who has been stung by jellyfish on both forearms. As the senior EMT on​ scene, which directions should you provide to the other EMS providers in providing proper care to this​ patient?

​"Let's soak the arms in hot​ water."

You are on scene with a patient who has a freezing cold injury. The patient stated that he had no sensation in his hand or fingers prior to the initiation of a rewarming process. You have subsequently begun rewarming his hand and fingers. Which of these statements made by the patient following the rewarming process is of greatest​ concern?

​"There is no pain when I rub my fingers with my other​ hand."

During an​ in-service program, your medical director asks if anyone can tell her the cause of heat cramps. What response would be most​ appropriate?

​"They are caused when the​ patient's electrolytes such as salt and calcium become deranged and are too low in the​ body."

A​ 43-year-old male patient has removed a tick from his arm prior to your arrival. He is refusing all care at this time. Which of these statements made by the EMT would be most​ appropriate?

​"Tick bites can result in bacterial​ infections, which can be very​ serious."

You have been called to a residence for a spider bite. On​ scene, the homeowner states that he was moving some boxes in his garage when he accidentally grabbed a spider and it bit him. He killed the spider and shows you a​ brown-colored spider with a​ "violin shape" on its back. He then states that the bite does not hurt and he sees no need to go to the hospital. As a knowledgeable​ EMT, you should​ state:

​"You really need to go because the bite of that spider does not heal very well and will put you at risk for​ infection."

During the summer​ months, you work as an EMT at a first aid station that helps people who hike trails in the high mountains of the western United States. One​ afternoon, you are presented with a​ 42-year-old male patient who was just at an altitude of​ 14,000 feet while hiking. The patient states that while at this altitude he experienced a severe​ headache, became very uncoordinated and stumbled​ often, and felt very nauseous. He became​ scared, so he left the trail to be seen in the first aid station. The patient indicates that he feels better now. Given this​ description, what would be the most likely differential​ diagnosis?

​High-altitude cerebral edema

During the summer​ months, you work as an EMT at a first aid station that helps people who hike trails in the high mountains of the western United States. One​ afternoon, you are presented with a​ 13-year-old male patient who presents as alert and​ oriented, but complains of chest​ pain, dyspnea, and a headache. He is tachypneic and tachycardic and has slight inspiratory crackles. Given this​ presentation, what would be the most likely differential​ diagnosis?

​High-altitude pulmonary edema

You have been called to a football practice field on a very hot day for a​ heat-related emergency. On​ scene, you find a young male patient panting and lying under a tree. His skin is​ flushed, and teammates are continually wiping the sweat off his​ face, arms, and chest with towels. Which of these statements to his teammates would be most​ appropriate?

​"Please let him sweat. It is helping his body cool​ down."

Which of these statements made by your EMT partner would require immediate correction when treating a patient with hypothermia and a deep freezing cold injury to his left​ foot, ankle, and lower​ leg?

​"We will need to gradually rewarm the patient at a rate of ​2-3degreesF per​ hour."

Which of these statements made by an EMT shows that he understands the care of a patient with a freezing cold injury to the​ foot?

​"While it is recommended to remove wet clothing from the​ patient, it is best to leave clothing that is frozen to the skin in​ place."

A​ 44-year-old female patient was hiking in a state park when she was bitten by a snake in her left calf. To get​ help, she had to hike 4 miles to the​ first-aid station where you are located. The hike took her​ 1½ hours. Your assessment reveals a red and swollen area to her​ leg, and the patient complains of discomfort to that area. Closer inspection reveals two puncture wounds in the center of the affected area. The patient asks you if she is going to die from the snake bite. What would be your most appropriate​ reply?

​"While you still need to get checked​ out, if venom was​ injected, the signs and symptoms of a generalized reaction typically appear very​ quickly."

You are caring for a patient with an extensive freezing cold injury to his right hand and arm. Which of these instructions would be appropriate to give to your EMT​ partner?

​"Why don't we get that ring off his right ring​ finger."

When providing needed oxygen to a patient with a core temperature of 95degreesF and adequate​ breathing, which strategy is the best​ option?

Warmed and humidified oxygen delivered through a nonrebreather mask

You have been called by a family for their​ mother, who is​ "not acting​ right." On​ scene, you find the​ 69-year-old woman to be confused and seemingly slow in talking. Her airway is open and respirations are 12​ breaths/min. Her pulse is 58​ beats/min, and her skin is cool to the​ touch, despite the thermostat keeping the house at normal room temperature. The family states that she has been this way for about three​ days, but before then seemed to be doing well. Your partner obtains a blood pressure reading of​ 104/52 mmHg. When getting a medical​ history, which of these statements made by the family would make​ sense, given the presentation of the​ patient?

​"Mom suffers from a low​ thyroid."

The primary center for controlling the temperature in the human body is located in​ the:

Hypothalamus