Chapter 33: Environmental Emergencies Part 1

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:

Select one:

A. apply an AED and assess his cardiac rhythm.

B. assess for a carotid pulse for up to 60 seconds.

C. apply chemical heat packs to his groin and axillae.

D. open his airway and give two rescue breaths.

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:

Select one:

A. elevating the lower extremities and giving antivenom.

B. supine positioning, splinting the leg, and transporting.

C. applying ice to the wound and transporting quickly.

D. transporting only with close, continuous monitoring.

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

Select one:

A. immersion foot.

B. trench foot.

C. frostnip.

D. frostbite.

Burns associated with lightning strikes are typically:

Select one:

A. third-degree.

B. superficial.

C. full-thickness.

D. partial-thickness.

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

Select one:

A. nausea.

B. tachycardia.

C. hot, dry skin.

D. headache.

Drowning is MOST accurately defined as:

Select one:

A. temporary survival after submersion in water.

B. water in the lungs following submersion in water.

C. death beyond 24 hours after submersion in water.

D. death from suffocation after submersion in water.

Hypothermia occurs when the core body temperature falls below:

Select one:

A. 90°F (32°C).

B. 95°F (35°C).

C. 88°F (31°C).

D. 98°F (37°C).

In contrast to Lyme disease, Rocky Mountain spotted fever:

Select one:

A. causes painful joint swelling after a few days or weeks.

B. can cause paralysis and cardiorespiratory collapse.

C. may be confused with rheumatoid arthritis.

D. presents with flu-like symptoms and a bull’s-eye rash.

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

Select one:

A. cold water temperature.

B. alcohol consumption.

C. too rapid of a descent.

D. too rapid of an ascent.

The body’s natural cooling mechanism, in which sweat is converted to a gas, is called:

Select one:

A. convection.

B. conduction.

C. evaporation.

D. radiation.

The EMT must assume that any unwitnessed water-related incident is accompanied by:

Select one:

A. cold-water immersion.

B. an air embolism.

C. possible spinal injury.

D. alcohol intoxication.

The MOST prominent symptom of decompression sickness is:

Select one:

A. dizziness and nausea.

B. abdominal or joint pain.

C. difficulty with vision.

D. tightness in the chest.

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

Select one:

A. nervous system.

B. cardiovascular system.

C. respiratory system.

D. renal system.

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:

Select one:

A. conduction.

B. evaporation.

C. convection.

D. radiation.

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

Select one:

A. Syncope and bleeding at distal sites

B. Signs and symptoms of hypoperfusion

C. Local swelling and ecchymosis

D. General weakness and diaphoresis

Which of the following MOST accurately describes hyperthermia?

Select one:

A. Heat evaporates a significant amount of body water.

B. The body eliminates more heat than it can generate.

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

D. The core body temperature exceeds 99.5°F (37°C).

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:

Select one:

A. recognize that the patients who are conscious are at high risk for developing cardiac arrest and quickly assess them for potentially life-threatening injuries.

B. immediately begin CPR on the unresponsive patient, but cease resuscitation efforts if there is no response after 5 minutes of treatment.

C. focus your initial treatment efforts on the patients who are conscious because the unresponsive patient is likely in irreversible cardiac arrest.

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

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:

Select one:

A. cover his foot with chemical heat compresses.

B. protect the affected part from further injury.

C. rewarm his foot in 102°F to 104°F (38.9°C to 40°C) water.

D. administer oxygen via a nonrebreathing mask.

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:

Select one:

A. administer one tube of oral glucose and reassess his mental status.

B. load him into the ambulance and begin rapid cooling interventions.

C. perform a head-to-toe assessment and look for signs of trauma.

D. place him in a sitting position and have him drink 1 L of 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 feet. On assessment, you note that he has cyanosis around his lips and has pink froth coming from his nose and mouth. You should:

Select one:

A. place him in a semi-sitting position, suction his mouth and nose, apply a continuous positive airway pressure (CPAP) device, and transport to the closest emergency department.

B. suction his mouth and nose, keep him supine and elevate his legs to prevent air bubbles from entering his brain, administer high-flow oxygen, and transport to a hyperbaric chamber.

C. 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.

D. position him supine with his head elevated 30°, suction his mouth and nose, hyperventilate him with a bag-valve mask, and contact medical control for further guidance.

___________ causes body heat to be lost as warm air in the lungs is exhaled into the atmosphere and cooler air is inhaled.

Select One

A. Convection
B. Conduction
C. Radiation
D. Respiration

Evaporation, the conversion of a liquid to a gas, is a process that requires:

Select One

A. Energy
B. Circulation
C. A warmer ambient temperature
D. High humidity

The rate and amount of heat loss by the body can be modified by all of the following except:

Select One

A. increasing heat production
B. moving to an area where heat loss is decreased
C. wearing insulated clothing
D. increasing fluid intake

The characteristic appearance of blue lips and/or fingertips seen in hypothermia is the result of:

Select One

A. lack of oxygen in arterial blood
B. frostbite
C. blood vessels constricting
D. lack of oxygen in venous blood

Signs and symptoms of severe systemic hypothermia include all of the following except:

Select One

A. weak pulse
B. coma
C. shivering
D. very slow respirations

Hypothermia is more common among all of the following except:

Select One

A. older individuals
B. long-distance athletes
C. infants and children
D. those who are already ill

To assess a patient's general temperature, pull back your glove and place the back of your hand on the patient's:

Select One

A. abdomen, underneath clothing
B. forehead
C. forearm, on the inside of the wrist
D. neck, at the area where you check the carotid pulse

Never assume that a(n) __________, pulseless patient is dead.

Select One

A. apneic
B. cyanotic
C. cold
D. hypothermic

Management of hypothermia in the field consists of all of the following except:

Select One

A. applying heat packs to the groin, axillary, and cervical regions
B. removing wet clothing
C. preventing further heat loss
D. massaging the cold extremities

All of the following conditions refer to when exposed parts of the body become very cold, but not frozen, except:

Select One

A. frostnip
B. trench foot
C. immersion foot
D. frostbite

When the body is exposed to more heat energy than it loses, __ result(s).

Select One

A. hyperthermia
B. heat cramps
C. heat exhaustion
D. heatstroke

Contributing factors to the development of heat illnesses include all of the following except:

Select One

A. high air temperature
B. vigorous exercise
C. high humidity
D. increased fluid intake

It is important to remain hydrated while on duty. Drink at least of water per day, and more when exertion or heat is involved.

Select One

A. 8 glasses
B. 1 liter
C. 2 liters
D. 3 liters

Which of the following statements about heat cramps is false?

Select One

A. they only occur when it is hot outdoors
B. they may be seen in well-conditioned athletes
C. the exact cause of heat cramps is not well understood
D. dehydration may play a role in the development of heat cramps

Signs and symptoms of heat exhaustion and associated hypovolemia include all of the following except:

Select One

A. cold, clammy skin with ashen pallor
B. dizziness, weakness, or faintness
C. normal vital signs
D. normal thirst

Most spinal injuries in diving incidents affect the:

Select One

A. cervical spine
B. thoracic spine
C. lumbar spine
D. sacrum/coccyx

Often, the first sign of heatstroke is:

Select One

A. a change in behavior
B. an increase in pulse rate
C. an increase in respirations
D. hot, dry, flushed skin

The least common but most serious illness caused by heat exposure, occurring when the body is subjected to more heat than it can handle and normal mechanisms for getting rid of the excess heat are overwhelmed, is:

Select One

A. hyperthermia
B. heat cramps
C. heat exhaustion
D. heat stroke

_________ is the body's reaction to an irritation of water entering the lower respiratory tract.

Select One

A. bronchoconstriction
B. laryngospasm
C. esophageal spasms
D. swelling in the oropharynx

Treatment of drowning and/or near drowning begins with:

Select One

A. opening the airway
B. ventilation with 100% oxygen via bag-mask device
C. suctioning the lungs to remove the water
D. rescue and removal from the water

In a diving emergency, ___ occurs when bubbles of gas, especially nitrogen, obstruct the blood vessels.

Select One

A. compression sickness
B. decompression sickness
C. pulmonary sickness
D. nitrogen toxicity

If the near drowning victim has evidence of upper airway obstruction by foreign matter, which of the following would not be considered a method for clearing it?

Select One

A. remove the obstruction manually
B. apply suction
C. place the patient in the recovery position to allow drainage
D. use abdominal thrusts

You should never give up on resuscitating a cold-water drowning victim because:

Select One

A. when the patient is submerged in water colder than body temperature, heat is maintained in the body
B. the resulting hypothermia can protect vital organs from the lack of oxygen
C. the resulting hypothermia raises the metabolic rate
D. all of the above

The three phases of a dive, in the order they occur, are:

Select One

A. ascent descent, and bottom
B. descent, bottom, and ascent
C. orientation, bottom and ascent
D. descent, orientation, and ascent

Areas usually affected by descent problems include:

Select One

A. the lungs
B. the skin
C. the joints
D. vision

Potential problems associated with rupture of the lungs include all of the following except:

Select One

A. air emboli
B. pneumomediastinum
C. pneumothorax
D. hemopneumothorax

The organs most severely affected by air embolism are the:

Select One

A. brain and spinal cord
B. brain and heart
C. heart and lungs
D. brain and lungs

Black widow spiders may be found in:

Select One

A. New Hampshire
B. Woodpiles
C. California
D. All of the above

Coral snake venom is a powerful toxin that causes __ of the nervous system.

Select One

A. paralysis
B. hyperactivity
C. hypoactivity
D. hemiparesis

Rocky Mountain spotted fever and Lyme disease are both spread through the tick's:

Select One

A. saliva
B. blood
C. hormones
D. excrement

Signs of envenomation by a pit viper include all of the following except:

Select One

A. swelling
B. chest pain
C. ecchymosis
D. severe burning pain at the site of the injury

Removal of a tick should be accomplished by:

Select One

A. suffocating it with gasoline
B. burning it with a lighted match to cause it to release its grip
C. using fine tweezers to pull it straight out of the skin
D. suffocating it with Vasoline

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

Select One

A. it is larger than the black widow spider
B. it lives mostly in the southern and central parts of the country
C. venom is not neurotoxic
D. bites rarely cause systemic signs and symptoms

Treatment of a snake bite from a pit viper includes:

Select One

A. Calming the patient
B. Providing BLS as needed if the patient shows no sign of envenomation
C. Marking the skin with a pen over the swollen are to note whether swelling is spreading
D. All of the above

At 1400 in July, the weather is 105 degrees F and very humid. You have been called for a "man down" at the park. As you arrive, you recognize him as an alcoholic who has been a "frequent flyer" with your service. It looks like he had been sitting under a tree when he fell over, unconscious. As you assess the patient, he has cold, clammy skin and a dry tongue.

You suspect that:

A. he is well-hydrated
B. he has suffered heat exhaustion
C. he is hypothermic
D. he has heatstroke

Small infants have a poor ability to thermoregulate and are unable to shiver to control heat loss until about the age of:

Select One

A. 4-6 months
B. 6-12 months
C. 12-18 months
D. 18-24 months

Most heat stroke cases occur when the temperature is around _ and the humidity is 80%.

Select One

A. 80 degrees F
B. 90 degrees F
C. 100 degrees F
D. 110 degrees F

True or False

Normal body temperature is 98.6 degrees F.

True or False

To assess the skin temperature in a patient experiencing a generalized cold emergency, you should feel the patient's skin.

True or False

Mild hypothermia occurs when the core temperature drops to 85 degrees F.