Chapter 31- Environmental Emergencies

A 45-year-old hiker was lost in the woods for approximately 24 hours. When he is rescued, you find that he is unresponsive; has profoundly slow respirations; and a weak, irregular pulse. This clinical presentation is MOST suggestive of a core body temperature of:

80°F to 88°F.

Which of the following patients has signs and symptoms that are MOST indicative of heatstroke?

A 31-year-old male with hot and moist skin, tachycardia, and confusion

Which of the following individuals would be at GREATEST risk for developing hypothermia?

A 68-year-old female with a generalized infection

Which of the following is a physiologic abnormality that occurs as a result of hypothermia?

Abnormal blood clotting

When assessing a patient with a heat-related emergency, which of the following clinical signs would indicate thermolytic inadequacy?

Altered mental status

How could the mammalian diving reflex protect the hypothermic patient who was submerged in water?

It slows the metabolic rate and decreases the body's oxygen demand

How could the mammalian diving reflex protect the hypothermic patient who was submerged in water?

It slows the metabolic rate and decreases the body's oxygen demand.

Which of the following statements regarding the brown recluse spider is correct?

Its venom is cytotoxic and causes severe local tissue destruction.

You are assessing a 24-year-old male who was bitten by a rattlesnake while hiking in the woods. Which of the following clinical signs would be MOST indicative of envenomation?

Progressive tissue swelling

Which of the following would be the LEAST reliable assessment parameter or treatment tool for a patient with significant hypothermia?

Pulse oximetry

The body loses heat to the environment through a process called:

Thermolysis

A 19-year-old male who was struck by lightning. He is unresponsive and apneic, but has a pulse. He also has widespread superficial burns. You should:

manually stabilize his head, ventilate him with a bag-mask device, and establish at least one-large bore IV.

Compared to classic heatstroke, exertional heatstroke commonly presents with:

moist, pale skin.

When treating a diver who complains of severe pain to his joints and abdomen after returning to the surface of the water, you should manage his airway accordingly and position him:

on his left side with his head down

When treating a diver who complains of severe pain to his joints and abdomen after returning to the surface of the water, you should manage his airway accordingly and position him:

on his left side with his head down.

A patient with a core body temperature of 85°F would be expected to present with:

profoundly slow respirations

Because heat always travels from a warm object to a cooler one, a person standing in a cold room will lose heat by:

radiation

Near-drowning is MOST accurately defined as:

recovery that lasts for at least 24 hours following submersion in water

Signs of an impending lightning strike include all of the following, EXCEPT:

sudden tachycardia

Prior to initiating CPR on an apneic, hypothermic patient, you should:

assess the carotid pulse for up to 45 seconds.

Patients with diabetes are especially prone to heat illnesses because:

autonomic neuropathy interferes with vasodilation

When treating a patient who is severely hypothermic, unresponsive, and is wearing wet clothes, the AEMT should:

avoid placing chemical heat packs anywhere on the body.

When treating a patient who is severely hypothermic, unresponsive, and wearing wet clothes, the AEMT should:

avoid placing chemical heat packs anywhere on the body.

Hyperthermia occurs when:

inadequate thermolysis causes reduced heat loss.

Shivering, which is a natural response of the body to cold temperatures, serves to:

increase the rate of cellular metabolism.

Gangrene and subsequent amputation of a frostbitten extremity will MOST likely occur if it:

is rewarmed and then refreezes.

Lethal cardiac dysrhythmias, such as ventricular fibrillation, may occur in the hypothermic patient if he or she:

is rewarmed too quickly.

Initially, following submersion in fresh water, the lungs are not inundated with fluid because:

the larynx spasms and protects the airway.

You are dispatched to a local golf course, where 3 people were struck by lightning. After ensuring your own safety, you begin triaging the patients. The first patient is conscious and has an apparent closed femur fracture. The second patient is conscious, confused, and complaining of hearing loss. The third patient is unconscious, pulseless, and apneic. You should focus your resuscitative efforts on the cardiac arrest patient because:

the other patients are less likely to develop cardiac arrest.

In addition to supplemental oxygen, the MOST appropriate treatment for a nauseated patient with heat exhaustion includes:

20 mL/kg saline boluses and transport.

An individual is considered to be hypothermic when his or her core body temperature falls below:

95°F

Which of the following patients is LEAST prone to a local cold injury?

A 45-year-old male with hypertension

Which of the following statements regarding hypothermia is correct?

Decreased thyroid gland function predisposes a person to hypothermia

Which of the following statements regarding decompression sickness is MOST correct?

Treatment at a recompression facility is a crucial treatment

Which of the following statements regarding scorpion stings is correct?

With the exception of one particular species of scorpion, most scorpion stings cause severe pain and swelling, but are not dangerous.

While stacking wood on a woodpile, a 60-year-old male experienced immediate, severe pain on the back of his hand. He complains of abdominal pain, nausea, and dizziness. Your assessment reveals that he is conscious and alert, but has an extremely rigid abdomen. You should suspect a/an:

a black widow spider bite

During your primary assessment of a 33-year-old male with severe hypothermia, you find that he is unresponsive and has agonal breathing. You should:

assess his carotid pulse for 30 to 45 seconds

During your primary assessment of a 33-year-old male with severe hypothermia, you find that he is unresponsive and has agonal breathing. You should:

assess his carotid pulse for 30 to 45 seconds.

When the core body temperature falls below 95°F, the patient's:

ability to regulate body temperature is lost.

General management for a moderately hypothermic patient with a decreased level of consciousness may include all of the following, EXCEPT:

active internal rewarming.

Shortly after returning to the surface of the water, a scuba diver experiences an acute onset of pleuritic chest pain and difficulty breathing. He is tachycardic and his pulse is irregular. You should suspect:

air embolism

Which of the following types of medications would increase a person's risk of developing a heat-related illness?

antihistamines

When rapidly cooling a semiconscious patient with heatstroke, you must stop the cooling process if the patient:

begins to shiver.

While stacking wood on a woodpile, a 60-year-old male experienced immediate, severe pain on the back of his hand. He complains of abdominal pain, nausea, and dizziness. Your assessment reveals that he is conscious and alert, but has an extremely rigid abdomen. You should suspect a(n):

black widow spider bite

You should assess a patient with systemic hypothermia for local cold injuries to the extremities because:

blood is shunted away from the extremities.

Heatstroke occurs when the:

body is subjected to more heat than it can remove.

Which of the following clinical signs would indicate a core body temperature of between 89°F and 92°F?

bradycardia

"Breath-holding syncope" commonly occurs when a swimmer:

breathes deeply and rapidly before entering the water.

When transporting a moderately hypothermic patient, you must avoid unnecessary bumps in the road. Not doing so may result in:

cardiac arrhythmia

A 44-year-old male was bitten by a black widow spider. He is conscious and alert, complains of nausea, and has a tense, painful abdomen. His blood pressure is 150/94 mm Hg, pulse is 110 beats/min and strong, and respirations are 24 breaths/min and unlabored. After administering 100% oxygen, you should:

clean the bite with soap and water, apply ice to the area, and transport.

When a warm hand touches a cold object, heat passes directly from the body to the colder object. This is an example of:

conduction

You are treating a 55-year-old male with heatstroke when he suddenly becomes unresponsive and stops breathing. Assessment of his carotid pulse reveals that it is weak and rapid. You should:

continue cooling measures, maintain his airway, ventilate him with a bag-mask device, transport, and request a paramedic intercept

A young male is wearing lightweight clothing and is standing outside in windy winter weather. He is losing heat to the environment mostly by:

convection

Treatment for a patient with a pit viper bite to an extremity and no signs of envenomation includes oxygen, as well as:

covering the area with a sterile dressing, splinting the extremity, and transporting.

Severe, persistent pain caused by a jellyfish sting should be treated by:

immersing the affected area in hot water for 30 minutes.

Heat cramps are typically the result of prolonged exposure to a hot environment, resulting in:

electrolyte depletion and severe muscle spasms.

In a cold environment, most of a person's body heat is lost:

from the head and neck areas

A frostbitten extremity is usually:

hard and waxy.

A 30-year-old female presents with signs of dehydration, generalized weakness, and cool, clammy skin. She is conscious and alert and has an oral temperature of 101.5°F. This clinical presentation is MOST consistent with:

heat exhaustion

You are dispatched to the residence of an 80-year-old female with a possible heat-related emergency. Your assessment reveals that she is semiconscious, has hot and dry skin, and signs of severe dehydration. You should:

move her to a cooler environment

You are dispatched to a ski resort for a 21-year-old female with a local cold injury to her hand. Upon making contact with the patient, your MOST immediate action should be to:

move her to a warmer environment

The signs and symptoms of Lyme disease resulting from a tick bite are MOST commonly confused with:

rheumatoid arthritis

A young female is found floating face-down in a lake. There were no witnesses to the event. Prior to removing her from the water, you must first:

rotate the pt into a supine position and protect her spine

Mild hypothermia is characterized by:

shivering, tachypnea, and peripheral vascular constriction.

In addition to causing local tissue destruction, the venom from a pit viper also causes:

spontaneous bleeding due to interference with the blood-clotting mechanisms.

You are treating a 40-year-old female who is experiencing severe heat cramps. You have moved her to a cooler environment, applied oxygen, and are giving her Gatorade to drink. When you reassess her, you find that her condition has not improved. You should:

start an IV of normal saline and transport her.

You are treating a 40-year-old female, who is experiencing severe heat cramps. You have moved her to a cooler environment, applied oxygen, and are giving her Gatorade to drink. When you reassess her, you find that her condition has not improved. You should:

start an IV of normal saline and transport her.

A 24-year-old male was pulled from the water following submersion for an unknown length of time. There were no witnesses to the patient's submersion. When you arrive at the scene, you determine that he is in cardiac arrest. Routine management for this patient should include all of the following, EXCEPT:

subdiaphragmatic thrusts.

The two MOST effective mechanisms for thermolysis are:

sweating and peripheral vasodilation

Patients who are struck by lightning rarely sustain full-thickness burns because:

the duration of the lightning strike is short.

Initially, following submersion in fresh water, the lungs are not inundated with fluid because:

the larynx spasms and protects the airway

You are dispatched to a local golf course, where three people were struck by lightning. After ensuring your own safety, you begin triaging the patients. The first patient is conscious and has an apparent closed femur fracture. The second patient is conscious, confused, and complaining of hearing loss. The third patient is unconscious, pulseless, and apneic. You should focus your resuscitative efforts on the cardiac arrest patient because:

the other patients are less likely to develop cardiac arrest.

When assessing the skin temperature of a patient with a cold-related emergency, you should feel the skin closest to the core of the body because:

the patient may be hemodynamically stable even if his or her extremities are cold.

Palpating for a pulse in a near-drowning victim may be difficult to assess because:

the peripheral vessels are constricted and cardiac output is low

A frostbitten extremity should never be rewarmed if:

there is a chance that it may refreeze.

Internal heat production is called:

thermogenesis

When treating an unconscious, breathing patient with moderate to severe hypothermia, you must avoid rough handling in order to avoid inducing:

ventricular fibrillation.

A 40-year-old female, who is conscious and alert with mild hypothermia, should receive active external rewarming. This involves:

wrapping her in blankets and applying heat packs to her groin