EMT: Chapter 32 [environmental emergencies]
You are dispatched to a local high school track and field event for a 16-year-old male who fainted. The outside temperature is approximately 95°F (35°C) with high humidity. Upon your arrival, the patient is conscious, alert, and complains of nausea and a headache. His skin is cool, clammy, and pale. You should:
move him into the cooled ambulance
young children can drown in as little as _________________ of water if left unattended.
1 inch
small infants have a poor ability to thermoregulate and are unable to shiver to control heat loss until about the age of:
12-18 months
most heat stroke cases occur when the temperature is around ______________ and the humidity is 80%.
80 F
What is the most dangerous, and most common, emergency in scuba diving?
air embolism
The diving reflex may allow a person to survive extended periods of submersion in cold water secondary to:
bradycardia and a slowing of the metabolic rate
The venom of a brown recluse spider is cytotoxic, meaning that it:
causes severe local tissue damage
Drowning is MOST accurately defined as:
death from suffocation after submersion in water
in a diving emergency, ________________________ occurs when bubbles of gas, especially nitrogen, obstruct the blood vessels.
decompression sickness
the three phases of a dive, in the order they occur, are:
descent, bottom, ascent
A frostbitten foot can be identified by the presence of:
mottling and blisters
Heatstroke occurs when:
the body's heat-eliminating mechanisms are overwhelmed
Rough handling of a patient with severe hypothermia may cause which of the following dysrhythmias?
v-fib
The body's natural protective mechanisms against heat loss are:
vasoconstriction and shivering
A person's ability to shiver is lost when his or her body temperature falls below:
90 F
Breath-holding syncope is caused by a decreased stimulus to breathe and occurs when:
a swimmer hyperventilates prior to entering the water
Signs of late heat stroke include:
a weak, rapid pulse
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 unconscious, pale, and apneic. You should:
assess for a carotid pulse for up to 45 seconds
A dysbarism injury refers to the signs and symptoms related to changes in:
barometric pressure
When the body loses sweat, it also loses:
electrolytes
as you assess a patient in humid, 105 F weather, you recognize he is unconscious. he has cold clammy skin and a dry tongue. you suspect that:
he has suffered heat exhaustion
Shivering is a mechanism in which the body generates heat by:
increasing the metabolic rate
In order for sweating to be an effective cooling mechanism:
it must be able to evaporate from the body
Which of the following statements regarding drowning is correct?
laryngospasm following submersion in water makes rescue breathing difficult
You and your partner are standing by at a large social event at a river resort when a frantic woman tells you that she found a young male floating face-down in the water. Nobody claims to have witnessed the event. After you and your partner enter the water and reach the patient, you should:
move him as a unit to a supine position
The venom of a black widow spider is toxic to the:
nervous system
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:
open the unresponsive patient's airway with the jaw-thrust maneuver, assess his ABCs, and begin CPR and attach the AED as soon as possible
Signs and symptoms of an air embolism include all of the following, EXCEPT:
pale skin
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:
protect the affected part from further injury
A 20-year-old male was pulled from cold water by his friends. The length of his submersion is not known and was not witnessed. You perform a primary assessment and determine that the patient is apneic and has a slow, weak pulse. You should:
provide rescue breathing, remove wet clothing, immobilize his spine, keep him warm, and transport carefully
High air temperature reduces the body's ability to lose heat by:
radiation
treatment of drowning and/or near drowning begins with:
rescue and removal from the water
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′. On assessment, you note that he has cyanosis around his lips and has pink froth coming from his nose and mouth. You should:
suction his mouth and nose, apply high-flow oxygen, position him on his left side with his head down, and contact medical control regarding transport to a recompression facility
While drinking beer with his friends near a creek, 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:
supine positioning, splinting the leg, and transporting
The two MOST efficient ways for the body to eliminate excess heat are:
sweating and dilation of skin blood vessels
What is often the first sign of heat stroke?
change in behavior
black widow spiders may be found in all of the following EXCEPT:
Alaska
To assess a patient's general temperature, pull back on your glove and place the back of your hand on his or her skin at the:
abdomen
Your assessment of a 23-year-old female reveals a core body temperature of 93.4°F (34°C). She is conscious, answers your questions appropriately, is shivering, and complains of nausea. Her skin is cold and pale, her muscles appear rigid, and her respirations are rapid. You should:
place heat packs to her groin, axillae, and behind her neck; cover her with warm blankets; and avoid rough handling
Which of the following medications increases a person's risk of a heat-related emergency?
diuretics
In which of the following environmental emergencies are you most likely to encounter laryngospasm?
drowning
evaporation, the conversion of a liquid to a gas, is a process that requires:
energy
The body's natural cooling mechanism, in which sweat is converted to a gas, is called:
evaporation
Geriatric patients, newborns, and infants are especially prone to hyperthermia because they:
exhibit poor thermoregulation
Common signs and symptoms of heat exhaustion include all of the following, EXCEPT:
hot, dry skin
Which of the following conditions would be the LEAST likely to increase a person's risk of hypothermia?
hyperglycemia
(see #131) you pull back on your glove and place the back of your hand on his skin at the abdomen, and the skin feels cool. again, you suspect:
hypothermia
(see #131) as you look closer, you note that he is shivering and his respirations are 20 breaths/min. you begin to have a stronger suspicion that he is now getting:
hypothermic
To obtain the MOST accurate reading of a patient's core body temperature, you should place a special hypothermia thermometer:
into the pts' rectum
A 48-year-old male was stung on the leg by a jellyfish while swimming in the ocean. He is conscious and alert, but complains of intense pain at the wound site. Specific treatment for this patient includes:
irrigating the wound with vinegar and immersing his leg in hot water
In contrast to the brown recluse spider, the black widow spider:
is large and has a red-orange hourglass mark on its abdomen
Which of the following statements regarding lightning strikes is correct?
lightning strikes may cause cardiac dysrhythmias that spontaneously resolve
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. In addition to administering 100% oxygen, you should:
load him into the ambulance and begin rapid cooling interventions
Which of the following is an early sign of pit viper envenomation?
local swelling and ecchymosis
management of hypothermia in the field consists of all of the following EXCEPT:
massaging the cold extremities
You suspect that the patient you are treating was bitten by a rattlesnake. What should you do first?
place the pt in a supine position
The EMT must assume that any unwitnessed water-related incident is accompanied by:
possible spinal injury
A patient with a core body temperature of 95°F (35°C) will MOST likely experience:
rapid breathing
Burns associated with lightning strikes are typically:
superficial
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)?
tachycardia
An air embolism associated with diving occurs when:
the diver holds his or her breath during a rapid ascent
areas usually affected by descend problems include:
the lungs
you should never give up on resuscitating a cold-water drowning victim because:
the resulting hypothermia can protect vital organs from the lack of oxygen
In the context of an environment that is 90°F with 85% humidity, what does moist, pale, cool skin indicate?
there has been excessive fluid and salt loss (in a hot environment)
Heat loss from the body through respiration occurs when:
warm air is exhaled into the atmosphere
Shivering stops and muscle activity ceases once the body's core temperature reaches what?
90 F
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
Covering a patient's _________ will significantly minimize radiation heat loss.
HEAD
You are dispatched to a residence for a young female who is sick. The patient complains of a rash to her lower extremities and truncal area. Your assessment reveals a small, painful blister on her inner thigh. As your partner is taking the patient's vital signs, she states that she and her family returned from a camping trip 2 days ago. On the basis of this patient's presentation, you should suspect:
Lyme disease
You are assessing a 33-year-old male who complains of severe abdominal pain, weakness, and nausea. He tells you that he was gathering wood to build a fire when he felt a sudden, sharp pain on the back of his hand. Your assessment reveals that the patient's abdomen is rigid and painful to palpation. You should suspect:
a black widow spider bite
The MOST prominent symptom of decompression sickness is:
abdominal or joint pain
After being stung on the leg by a jellyfish, a man complains of severe pain to his leg, dizziness, and difficulty breathing. He has a red rash covering his trunk and his blood pressure is 90/50 mm Hg. The EMT should:
administer oxygen and epinephrine and prepare for rapid transport
Hypothermia can worsen internal bleeding secondary to:
blood clotting abnormalities
the characteristic appearance of blue lips and/or fingertips seen in hypothermia is the result of:
blood vessels constricting
the organs most severely affected by air embolism are the:
brain and spinal cord
most spinal injuries in diving accidents affect the:
cervical spine
often, the first sign of heatstroke is:
change on behavior
signs of envenomation by a pit viper include all of the following EXCEPT:
chest pain
Geriatric patients are at a higher risk for heatstroke because:
circulation to the skin is reduced
never assume that a(n) _______________, pulseless pt is dead.
cold
A person who stands outside in windy, wintry weather and wears only lightweight clothing is experiencing heat loss mainly by what method?
convection
The transfer of heat to circulating air, such as when cool air moves across the body's surface, is called:
convection
All of the following snakes are pit vipers, EXCEPT for the:
coral snake