Chapter 32 Environmental Emergencies

Symptoms of air embolism may not occur for several hours.

FLASE

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

95°F (35°C).

Hypothermia occurs when the core body temperature falls below:

95°F (35°C).

bends

A common name for decompression sickness.

heat cramps

Painful muscle spasms usually associated with vigorous activity in a hot environment.

The diving reflex may cause immediate bradycardia.

TRUE

All of the following snakes are pit vipers, EXCEPT for the:

coral snake.

The venom of a black widow spider is toxic to the:

nervous system.

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 feet. 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, monitor the patient's breath sounds for a pneumothorax, and contact medical control regarding transport to a recompression facility.

Burns associated with lightning strikes are typically:

superficial.

Most of the serious injuries associated with scuba diving are caused by:

too rapid of an ascent

air embolism

Air bubbles in the blood vessels.

Which of the following statements regarding lightning strikes is correct?

Lightning strikes may cause cardiac dysrhythmias that spontaneously resolve.

Which of the following is an early sign of pit viper envenomation?

Local swelling and ecchymosis

What is often the first sign of heat stroke?

Often, the first sign of heat stroke is a change in behavior.

It is difficult to find a pulse in a drowning victim.

TRUE

turgor

The ability of the skin to resist deformation; tested by gently pinching skin on the forehead or back of the hand

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 unresponsive, pale, and apneic. You should:

assess for a carotid pulse for up to 60 seconds.

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:

assess the unresponsive patient's pulse, begin CPR starting with chest compressions if he is pulseless, and attach the AED as soon as possible

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

barometric pressure.

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.

You arrive at the scene and find the patient sitting under a tree in his garden; he is conscious, but confused. His wife tells you that he has been working outside all day. She further states that he refused to take a break and drink some water. Your assessment finds a flushed appearance; weak and rapid radial pulses; and hot, moist skin. Based on this, you suspect that your patient is suffering from __________ .

heat stroke

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

increasing the metabolic rate.

A frostbitten foot can be identified by the presence of:

mottling and blisters.

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.

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.

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.

homeostasis

A balance of all systems of the body.

hyperthermia

A condition in which the body core temperature rises to 101°F (38.3°C) or more.

hypothermia

A condition in which the internal or core body temperature falls below 95°F (35°C).

hymenoptera

A family of insects that includes bees, wasps, ants, and yellow jackets

heat exhaustion

A heat emergency in which a significant amount of fluid and electrolyte loss occurs because of heavy sweating; also called heat prostration or heat collapse.

heat stroke

A life-threatening condition of severe hyperthermia caused by exposure to excessive natural or artificial heat, marked by warm, dry skin; severely altered mental status; and often irreversible coma.

decompression sickness

A painful condition seen in divers who ascend too quickly, in which gas, especially nitrogen, forms bubbles in blood vessels and other tissues; also called bends.

A person who stands outside in windy, wintry weather and wears only lightweight clothing is experiencing heat loss mainly by what method?

A person who stands outside in windy, wintry weather and wears only lightweight clothing is experiencing heat loss mainly by convection.

antivenin

A serum that counteracts the effect of venom from an animal or insect.

scuba gear

A system that delivers air to the mouth and lungs at various atmospheric pressures, increasing with the depth of the dive; stands for self-contained underwater breathing apparatus.

reverse triage

A triage process used in treating multiple victims of a lightning strike, in which efforts are focused on those who are in respiratory and cardiac arrest; differs from conventional triage where such patients would be classified as deceased.

dysbarism injuries

Any signs and symptoms caused by the difference between the surrounding atmospheric pressure and the total gas pressure in various tissues, fluids, and cavities of the body.

frostbite

Damage to tissues as the result of exposure to cold; frozen or partially frozen body parts.

In an air embolism, the air pressure in the lungs remains constant while the external pressure on the chest increases.

FALSE

you suspect that the patient you are treating was bitten by a rattlesnake. What should you do first?

If you suspect a patient has been bitten by a pit viper such as a rattlesnake, place the person in a supine position to keep the venom from spreading.

Which of the following statements regarding drowning is correct?

Laryngospasm following submersion in water makes rescue breathing difficult.

In which of the following environmental emergencies are you most likely to encounter laryngospasm?

Laryngospasm is usually encountered in drowning accidents when water irritates the larynx and vocal cords.

breath-holding syncope

Loss of consciousness caused by a decreased breathing stimulus.

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.

In the context of an environment that is 90°F with 85% humidity, what does moist, pale, cool skin indicate?

Moist, pale, cool skin in a hot environment indicates there has been excessive fluid and salt loss.

Rough handling of a patient with severe hypothermia may cause which of the following dysrhythmias?

Rough handling of a patient with moderate to severe hypothermia may cause the heart to go into ventricular fibrillation.

Shivering stops and muscle activity ceases once the body's core temperature reaches what?

Shivering stops at 90°F (32.2°C). This is a sign of severe hypothermia.

Which of the following MOST accurately describes hyperthermia?

The body is exposed to more heat than it can lose.

evaporation

The conversion of water or another fluid from a liquid to a gas

convection

The loss of body heat caused by air movement (eg, a breeze blowing across the body).

conduction

The loss of heat by direct contact (eg, when a body part comes into contact with a colder object).

respiration

The physiologic process of exchanging oxygen and carbon dioxide, or, in the context of environmental emergencies, the loss of body heat as warm air in the lungs is exhaled into the atmosphere and cooler air is inhaled.

drowning

The process of experiencing respiratory impairment from submersion or immersion in liquid.

diving reflex

The slowing of the heart rate caused by submersion in cold water.

core temperature

The temperature of the central part of the body (eg, the heart, lungs, and vital organs).

ambient temperature

The temperature of the surrounding environment.

radiation

The transfer of heat to colder objects in the environment by radiant energy; for example, heat gain from a fire.

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.

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.

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.

In contrast to Lyme disease, Rocky Mountain spotted fever:

can cause paralysis and cardiorespiratory collapse.

The venom of a brown recluse spider is cytotoxic, meaning that it:

causes severe local tissue damage.

When a warm hand is immersed in water that is 70°F (21°C), heat is transferred from the hand to the water through a process called:

conduction.

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

convection.

Drowning is MOST accurately defined as:

death from suffocation after submersion in water.

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.

All of the following terms refer to a body part that is cold but not frozen, EXCEPT:

frostbite

Common signs and symptoms of heat exhaustion include all of the following, EXCEPT:

hot, dry skin.

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. You should:

load him into the ambulance and begin rapid cooling interventions.

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 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.

Cardiorespiratory response when core body temperature falls into the range of 89ºF to 92ºF (31.7ºC to 33.3ºC) involves __________ .

respirations and pulses slow.

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.