EMT Chapter 32 Environmental Emergencies

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

You and your partner are standing by at a large social event at a river resort when a frantic women tells you 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

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

The patient has a respiratory rate of 4 breaths per minute. Your partner assists ventilations with a BVM while you perform a pulse check. How long should you assess for a carotid pulse?

30 to 45 seconds

Hypothermia is diagnosed when the core body temperature falls below what temperature?

95°F (35°C)

Signs and symptoms of an air embolism include all of the following, EXCEPT: Dysphasia Pale skin Dizziness Joint pain`

Pale skin

A patient with a core body temperature of 95°F (35°C) will MOST likely experience:

Rapid breathing

Signs of late heat stroke include:

A weak, rapid pulse

A dysbarism injury refers to the signs and symptoms related to changes in:

Barometric pressure

All of the following snakes are pit vipers, EXCEPT for the: Copperhead Rattlesnake Coral snake Cottonmouth

Coral snake

After establishing unresponsiveness, what should be your next step in patient management?

Establish manual cervical spine immobilization

Geriatric patients, newborns, and infants are especially prone to hyperthermia because they:

Exhibit poor thermoregulation

Shivering is a mechanism in which the body generates heat by:

Increasing the metabolic rate

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 hen 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

Breath-holding syncope is caused by a decreased stimulus to breathe and occurs when:

A swimmer hyperventilates prior to entering the water

Your partner observes a medical alert bracelet on the patient's wrist. It says that the patient has diabetes. Other risk factors for hypothermia include all of the following EXCEPT: Burns Head injury Shock Acclimatization to cold

Acclimatization to cold

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

All of the following are examples of passive rewarming techniques, EXCEPT: Removing cold, wet clothing Administering warm fluids by mouth Turning up the heat inside the ambulance Covering the patient with warm blankets

Administering warm fluids by mouth Passive rewarming involves allowing the patient's body temperature to rise gradually and naturally. Administering warm fluids by mouth is an example of active rewarming and should not be done in the uncontrolled prehospital setting.

Shortly after ascending rapidly to the surface of the water while holding his breath, a 29-year-old diver begins coughing up pink, frothy sputum and complains of dyspnea and chest pain. You should suspect and treat this patient for:

An air embolism Signs of an air embolism, which present after a person rapidly ascends to the surface of the water while holding his or her breath, includes: Skin mottling Pink froth at the mouth or nose Muscle or joint pain Dyspnea and/or chest pain Dizziness N/V Visual impairment Paralysis/coma Cardiac arrest

Shivering in the presence of hypothermia indicates that the:

Body is trying to generate more heat (thermogenesis) through muscular activity

The transfer of heat to circulating air, such as when cool air moves across the body's surface, is called:

Convection

When a person is exposed to cold temperatures and strong winds for an extended period of time, he or she will lose heat mostly by:

Convection

You are assessing a 27-year-ld woman with a heat-related emergency. Her skin is flushed, hot, and moist, and her level of consciousness is decreased. After moving her to a cool environment, managing her airway, and administering oxygen, you should:

Cover her with wet sheets and fan her This patient is experiencing heat stroke. After moving her to a cooler environment, managing her airway, and administering oxygen, the single most important treatment for her involves rapid cooling. Turn on the AC in the back of the unit, cover her with a wet sheet, and begin fanning her. Consider applying chemical ice packs t her groin and axillae. Untreated heat stroke almost always results in death due to brain damage.

A 30-year-old male, who has been playing softball all day in a hot environment, complains of weakness and nausea shortly after experiencing a syncopal episode. Appropriate treatment for this patent includes all of the following EXCEPT: Giving a salt-containing solution by mouth Moving him to a cooler environment at once Administering oxygen via nonrebreathing mask Placing him in a supine position and elevating his legs

Giving a salt-containing solution by mouth Treatment for heat exhaustion begins by moving the patient to a cooler environment. Remove excess clothing, administer oxygen as needed, and place the patient supine. Elevating the patient's legs may improve blood flow to the brain and prevent another syncopal episode. If the patient is not nauseated, give a salt-containing solution by mouth.

Three ambulances respond to a golf course where a group of six golfers were struck by lighting. Two of the golfers are conscious and alert with superficial skin burns (Group 1). The next two golfers have minor fractures and appear confused (Group 2). The last two golfers are in cardiac arrest (Group 3). According to reverse triage, which group of golfers should be treated FIRST? A. Group 1 B. Group 2 C. Group 3 D. Groups 1 and 2; Group 3 should be tagged as deceased

Group 3 If patients are alive at the scene, survival is likely. Delayed cardiac arrest following a lightning strike is uncommon. If the patients are in cardiac arrest, there is a good chance that they can be resuscitated with earl, high-quality CPR and defibrillation.

Which of the following statements regarding drowning is correct?

Laryngospasm following submersion in water makes rescue breathing difficult

It is important to remove a drowning victim form the water before laryngospasm relaxes because:

Less water will have entered the patient's lungs

Which of the following statements regarding lightning strikes is correct?

Lightning strikes mat cause cardiac dysrhythmias that spontaneously resolve

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 her and her family returned from a camping trip 2 days ago. On the basis of the patient's presentation, you should suspect:

Lyme disease

A frostbitten foot can be identified by the presence of:

Mottling and blisters

Discuss the controversy regarding performing CPR in a patient with severe hyporthermia.

Physicians are split on the topic of CPR in patients with severe hypothermia. One school of thought is that the body is chilled to a state where it requires minimum metabolic support. Therefore, a heart rate as low as 1 to 2 beats per minute should be sufficient until the body begins to warm. As the body warms, the heart rate will increase. However, there is evidence showing that correctly performed CPR will provide blood to the critical areas of the body. The current American Heart Association guidelines recommend that CPR be initiated if the patient has no pulse or breathing.

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. In addition to monitoring her ABCs, administering oxygen, and turning up the heat in the back of the ambulance, you should:

Place heat packs to her groin, axillae, and behind her neck; cover her with warm blankets; and avoid rough handling

A woman has frostbite in both feet after walking several miles in a frozen field. Her feet are white, hard, and cold to the touch. Treatment at the scene should include

Removing her wet clothing and covering her feet with dry, sterile dressings When treating a patient with frostbite, you should remove any wet clothing and cover the injured area with dry, sterile dressings. Do not break any blisters and do not apply heat to try to rewarm the area.

A 13-year-old girl is found floating face down in a swimming pool. Witnesses tell you that the girl had been practicing diving. After you and your partner safely enter the water, you should:

Rotate the entire upper half of her body as a unit, supporting her head and neck until the patient is face up. Open the airway with the jaw-thrust remover and begin artificial ventilation.

The patient's core body temperature is 80°F (27°C). At this temperature, the patient's hypothermia would be classified as:

Severe

Rough handling of a patient with severe hypothermia may result in which of the following? Ventricular fibrillation Seizures Heart attack Rewarming shock

Ventricular fibrillation

Why are children and infants at a greater risk for hypothermia than adults?

Young children and infants are unable to dress and care for themselves; therefore, they are more vulnerable to their environmental surroundings. Remember that both children and infants have a relatively large surface area and less body fat than adults. Additionally, children may not be able to shiver as effectively as adults, and infants are unable to shiver until about 12 to 18 months.