Environmental Emergencies

What is the primary symptom of altitude sickness? A. Headache. B. Nausea. C. Vertigo. D. Pulmonary edema. E. All of the above.

A. Headache. At high altitudes, air pressure and partial pressure of oxygen are lower than at sea level. When pressure is different between the environment and the tissues and cavities inside of the body, the condition is known as dysbarism. Dysbarism injury can cause problems in both the central nervous system and pulmonary system. High-Altitude Pulmonary Edema, or HAPE, occurs when fluid fills the lungs in high altitude. High-Altitude Cerebral Edema HACE, occurs when the brain swells with fluid at high altitudes. Altitude sickness is hypoxia resulting from lower partial pressure of oxygen at higher altitudes. Altitude sickness is hypoxia resulting from lower partial pressure of oxygen at higher altitudes. Symptoms of these conditions include fatigue and weakness, difficulty sleeping, lightheadedness, dizziness, vomiting, nausea, and anorexia. The principle symptom will be a headache. Primary treatment include slowly lowering altitude, or, if necessary, providing a portable hyperbaric chamber. The responder should be aware of the medications used for acclimatization and within the scope of practice.

Which of the following constitutes best practice in drowning patients or those with diving injuries? A. Use the head-chin-lift maneuver if the patient is suspected if having spinal injury. B. Assess the patient for signs of breath-holding syncope. C. Assess the patient for altered levels of consciousness. D. Begin defibrillation immediately. E. All of the above.

B. Assess the patient for signs of breath-holding syncope. Even experienced divers and swimmers can drown, and drowning can occur even in shallow water. The responder should be familiar with the mechanism of drowning and the common emergencies that occur when diving, including resuscitation efforts, recovery techniques, and the potential for spinal injuries. Assessment of the scene includes water temperature, water purity, and submersion timeframe. One challenge is that the responder is often unable to get information about length of exposure or the nature of the incident itself. The EMT should be familiar with signs and symptoms of drowning, as well as complications introduced by drug and alcohol usage, medication, and additional injuries. Typical protocol should be followed in the assessment of diving emergencies, near drowning, and drowning. This begins with scene size up and MOI, taking into consideration all hazards of the environment and details offered regarding the nature of the incident. In assessment, look for underlying cause and related injuries. If spinal injury is suspected, the spine should be immobilized while checking airway, breathing, and circulation. This should be performed prior to removing the victim from the water. The patient should be assessed for symptoms and signs of breath-holding syncope, as well as bleeding injuries or critical head injuries. Treatment includes supplemental oxygen. Patients should be assessed for decompression illness, pneumothorax, and any other conditions which require immediate care. Pediatric patients should be stabilized after treatment, even if they appear to be completely stable. The key to reducing the likelihood of drowning and diving accidents is prevention. Responders can share water safety information with the public to aid prevention. This includes the use of fences around pools, the buddy system when swimming, and ensuring trained lifeguards are present in public swimming areas. Public swimming areas should also contain working phones and AEDs. Finally, drug and alcohol use should be avoided when swimming or bathing.

Which of the following is NOT a symptom of hypothermia? A. Shivering. B. Rapid breathing. C. Confusion or memory loss. D. Bright red, cold skin. E. Slurred speech or mumbling.

B. Rapid breathing is not a sign of hypothermia. Signs include shivering, slurred speech or mumbling, slow, shallow breathing, weak pulse, clumsiness or lack of coordination, drowsiness or very low energy, confusion or memory loss, loss of consciousness, and cold bright red skin. An individual's capability to tolerate extreme temperatures depends on nutrition and hydration levels, environmental impact, age, and physical condition. The body requires a core temperature of 95 degrees. When it is exposed to cold beyond certain levels, it is no longer capable of self-regulating body temperature. After continued exposure, the cold can impact body system and organ functions. This is known as hypothermia. Exposure of only a part of the body to cold can cause a local cold injury. If this extends only to the level of the skin, it is known as frostnip or trench foot. Cell damage occurs if the cold extends to deeper levels, leaving the skin frozen, firm or waxy. This is known as frostbite, and it can leave the tissue cyanotic, mottled, or blistered. The responders should first wear personal protective equipment to limit their exposure. Assessment follows the typical protocol, and, when it can be done safely, should be transferred to an indoor or sheltered environment. The patient should not be forced to walk. Wet clothing should be removed and replaced with dry blankets. Frostbite should be covered with thick sterile cotton gauze. The responder should not massage the affected area or subject it to friction. The patient should not be allowed to smoke or ingest stimulants. Responders should be familiar with the characteristics of systemic hypothermia, and patients should be transferred to the appropriate center if the exposure is significant. To treat hypothermia, be gentle when handling the patient. Move them out of the cold and into a warm, dry location. Remove all wet clothing and cover the patient with layers of dry blankets of coats. Insulate them from the cold ground or other surface. Monitor breathing and begin CPR if breathing appears to stop or become too shallow or low. Provide warm, non-caffeinated, non-alcoholic beverages. Apply warm, dry compresses to the neck, chest wall, or groin of the patient, but do not apply direct heat. Avoid providing heat to the extremities, as this can force cold blood back into the heart and stress the system.

What is best practice for primary treatment in the event of a lightning strike? A. Supplemental oxygen. B. Resuscitation. C. Nitroglycerin. D. Direct pressure on the wound. E. All of the above.

B. Resuscitation. Another environmental hazard is lightning. Patients may be struck directly or indirectly, most often in open areas. The resulting injury is produced by heat, electricity, and mechanical energy. The first step is to assess the hazards and ensure that the patients and responders are in a safe area. The electrical shock of a lightning strike often causes asystole or cardiac dysrhythmias that spontaneously resolve. Revers triage should be performed for multiple lightning strike patients, meaning that those without breathing and circulation should receive medical attention first. Lightning injuries will often impact tissues as well as the nervous and cardiovascular systems, and the severity of lightning strikes are classed in categories of mild, medium, and severe. Patients should be assessed for exit and entry wounds. After resuscitation and assessment, the patient should be transported and inspected by a physician for a wide range of potential complications.

Which of the following is a symptom of heat exhaustion? A. Extreme sweating. B. Lightheadedness. C. Headache. D. Fatigue. E. All of the above.

E. All of the above. If a patient is exposed to heat beyond their capacity to self-regulate, they can suffer hyperthermia. A patient's capacity to self-regulate their temperature is a factor of their physical condition, medical conditions, substances, the level of exercise, and the environmental conditions. The core temperatures, the patient will experience symptoms of heat stroke, heat exhaustion, or heat cramps, or any combination thereof. Heat cramps are muscular spasms causes be excess heat and insufficient fluids or electrolytes. Severe dehydration can reduce in a loss of turgor or elasticity to the skin. Signs of heat exhaustion include extreme sweating, lightheadedness, headache, and fatigue. Proper treatment is rehydration, rest, and cooling. If heat exhaustion proceeds further, it will become heat stroke. Signs include hot, flushed skin, and the perspiration will cease. If untreated, heat stroke will progress to seizures and unresponsiveness, and eventually, brain damage or death. When encountering patients with heat exposure, responders must first limit their exposure with proper ppe. Next, the scene should be sized up and the MOI should be determined. Skin assessment should be made to determine temperature, moisture, turgor, and condition. the patient should be moved to a cooler location or into the shade, and the skin should be dampened or cooled with a fan.