Chapter 32 – Environmental Emergencies

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. radiation.
B. conduction.
C. convection.
D. evaporation.

B. conduction.

Which of the following is an early sign of pit viper envenomation?
Select one:
A. Local swelling and ecchymosis
B. General weakness and diaphoresis
C. Syncope and bleeding at distal sites
D. Signs and symptoms of hypoperfusion

A. Local swelling and ecchymosis

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.

D. increasing fluid intake.

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. immediately begin CPR on the unresponsive patient, but cease resuscitation efforts if there is no response after 5 minutes of treatment.
B. focus your initial treatment efforts on the patients who are conscious because the unresponsive patient is likely in irreversible cardiac arrest.
C. assess the unresponsive patient’s pulse, begin CPR starting with chest compressions if he is pulseless, and attach the AED as soon as possible.
D. recognize that the patients who are conscious are at high risk for developing cardiac arrest and quickly assess them for potentially life-threatening injuries.

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

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.

D. normal thirst.

In contrast to Lyme disease, Rocky Mountain spotted fever:
Select one:
A. may be confused with rheumatoid arthritis.
B. can cause paralysis and cardiorespiratory collapse.
C. presents with flu-like symptoms and a bull’s-eye rash.
D. causes painful joint swelling after a few days or weeks.

B. can cause paralysis and cardiorespiratory collapse.

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.

C. shivering.

Most of the serious injuries associated with scuba diving are caused by:
Select one:
A. cold water temperature.
B. too rapid of a descent.
C. alcohol consumption.
D. too rapid of an ascent.

D. too rapid of an ascent.

Hypothermia occurs when the core body temperature falls below:
Select one:
A. 98°F (37°C).
B. 95°F (35°C).
C. 90°F (32°C).
D. 88°F (31°C).

B. 95°F (35°C).

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. rewarm his foot in 102°F to 104°F (38.9°C to 40°C) water.
B. administer oxygen via a nonrebreathing mask.
C. cover his foot with chemical heat compresses.
D. protect the affected part from further injury.

D. protect the affected part from further injury.

Common signs and symptoms of heat exhaustion include all of the following, EXCEPT:
Select one:
A. nausea.
B. headache.
C. tachycardia.
D. hot, dry skin.

D. hot, dry skin.

The venom of a black widow spider is toxic to the:
Select one:
A. renal system.
B. nervous system.
C. respiratory system.
D. cardiovascular system.

B. nervous system.

Drowning is MOST accurately defined as:
Select one:
A. temporary survival after submersion in water.
B. death from suffocation after submersion in water.
C. water in the lungs following submersion in water.
D. death beyond 24 hours after submersion in water.

B. death from suffocation after submersion in water.

The MOST prominent symptom of decompression sickness is:
Select one:
A. tightness in the chest.
B. difficulty with vision.
C. dizziness and nausea.
D. abdominal or joint pain.

D. abdominal or joint pain.

The EMT must assume that any unwitnessed water-related incident is accompanied by:
Select one:
A. an air embolism.
B. alcohol intoxication.
C. possible spinal injury.
D. cold-water immersion.

C. possible spinal injury.

The body’s natural cooling mechanism, in which sweat is converted to a gas, is called:
Select one:
A. radiation.
B. convection.
C. conduction.
D. evaporation.

D. evaporation.

All of the following terms refer to a body part that is cold but not frozen, EXCEPT:
Select one:
A. frostnip.
B. frostbite.
C. trench foot.
D. immersion foot.

B. frostbite.

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.

A. brain and spinal cord.

Burns associated with lightning strikes are typically:
Select one:
A. superficial.
B. third-degree.
C. full-thickness.
D. partial-thickness.

A. superficial.

Which of the following statements regarding the brown recluse spider is NOT true?
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. Its venom is not neurotoxic.
D. Bites rarely cause systemic signs and symptoms.

A. It is larger than the black widow spider.

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. 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.
B. 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.
C. 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.
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.

A. 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.

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. open his airway and give two rescue breaths.
D. apply chemical heat packs to his groin and axillae.

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

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. perform a head-to-toe assessment and look for signs of trauma.
B. place him in a sitting position and have him drink 1 L of water.
C. load him into the ambulance and begin rapid cooling interventions.
D. administer one tube of oral glucose and reassess his mental status.

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

Treatment of drowning 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.

D. rescue and removal from the water.

Which of the following MOST accurately describes hyperthermia?
Select one:
A. The core body temperature exceeds 99.5°F (37°C).
B. The body is exposed to more heat than it can lose.
C. Heat evaporates a significant amount of body water.
D. The body eliminates more heat than it can generate.

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

…

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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. applying ice to the wound and transporting quickly.
B. transporting only with close, continuous monitoring.
C. elevating the lower extremities and giving antivenin.
D. supine positioning, splinting the leg, and transporting.

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