Chapter 35 | Environmental Emergencies

Question 1

Define:

conduction

Answer 1

transfer of heat from one material to another through direct contact

Question 2

Define:

water chill

Answer 2

chilling caused by conduction of heat from the body when the body or clothing is wet

Question 3

Fill in the blank:

Water chill is a form of [CONDUCTION/CONVECTION].

Answer 3

Water chill is a form of conduction.

Question 4

Define:

convection

Answer 4

carrying away of heat by currents of air, water, or other gases or liquids

indirect transfer of heat

Question 5

Define:

wind chill

Answer 5

chilling caused by convection of heat from the body in the presence of air currents

Question 6

Fill in the blank:

Wind chill is a form of [CONDUCTION/CONVECTION].

Answer 6

Wind chill is a form of convection.

Question 7

Define:

radiation

Answer 7

sending out energy (such as heat) in waves into space

Question 8

Describe:

how evaporation causes heat loss

(2 words)

Answer 8

evaporative cooling

Question 9

Describe:

how respiration causes heat loss

Answer 9

warm air is exhaled

Question 10

List:

ways that the body loses heat

5 points

Answer 10

• conduction
• convection
• radiation
• evaporation
• respiration

Question 11

Define:

hypothermia

Answer 11

generalized cooling that reduces body temperature below normal

life-threatening condition in its extreme

Question 12

Define:

frostnip

Answer 12

early/superficial localized cold injury

Question 13

Define:

frostbite

Answer 13

late/deep localized cold injury

Question 14

Define:

passive rewarming

Answer 14

covering a hypothermic patient and taking other steps to prevent further heat loss and help the body rewarm itself

Question 15

Define:

active rewarming

Answer 15

application of an external heat source to rewarm the body of a hypothermic patient

Question 16

Choose:

Active rewarming of frozen parts is [BLANK] recommended.

A: always

B: often

C: seldom

D: never

Answer 16

C

Active rewarming of frozen parts is seldom recommended.

the chance of permanently injuring frozen tissues with active rewarming is too great

consider it only if local protocols recommend it, if you are instructed to do so by medical direction, or if transport will be severely delayed and you cannot reach medical direction for instructions

Question 17

Define:

hyperthermia

Answer 17

increase in body temperature above normal

life-threatening condition in its extreme

Question 18

Fill in the blank:

Since evaporative heat loss is [INCREASED/REDUCED] in a humid environment, moist heat can produce dramatic body changes in a short time.

Answer 18

Since evaporative heat loss is reduced in a humid environment, moist heat can produce dramatic body changes in a short time.

Question 19

Answer:

Why are infants and young children especially prone to hypothermia?

Answer 19

infants/children are small with proportionally large skin surface areas

(little body mass, little body fat, lots of surface area)

Question 20

Define:

paradoxical undressing

Answer 20

innate urge to undress in response to extreme cold

Question 21

Define:

terminal burrowing

Answer 21

pattern of behaviour seen in death from hypothermia in which patient hides in confined space to seek warmth or because of the confusion caused by hypothermia

(aka hide and die syndrome)

Question 22

List:

primary treatments for heat exhaustion

3 points

Answer 22

• remove from hot environment
• supplemental oxygen
• small sips of water

(passive cooling)

Question 23

List:

primary treatments for heat stroke

4 points

Answer 23

• remove from hot environment
• remove clothing
• apply cool packs
• administer oxygen

(active cooling)

Question 24

List:

levels of hyperthermia

3 points

Answer 24

1. heat cramps
2. heat exhaustion
3. heat stroke

Question 25

Describe:

primary treatments for drowning

2 points

Answer 25

provide supplemental oxygen and remove wet clothes

Question 26

Fill in the blank:

Most diving accidents involve the [BLANK].

(anatomy)

Answer 26

Most diving accidents involve the head and neck.

may also involve spine, hands, feet, and/or ribs

Question 27

List:

possible scuba-diving accidents

2 points

Answer 27

• air embolism (caused by holding breath)
• decompression sickness (caused by surfacing too quickly)

Question 28

Define:

decompression sickness

Answer 28

injuries caused by a rapid decrease in pressure that surrounds body (of either air or water)

common scuba-diving accident

Question 29

Fill in the blank:

Decompression sickness takes [BLANK] hours to appear.

Answer 29

Decompression sickness takes 1-48 hours to appear.

Question 30

List:

steps in water rescue

4 points

Answer 30

1. reach: hold object for patient to grab
2. throw: thow floatation device to patient
3. row: row boat to patient
4. go: swim to patient (last resort)

Question 31

List:

environmental factors of high altitudes

2 points (think of problem for athletes in Denver)

Answer 31

• less air to breathe
• decreased air pressure

Question 32

Define:

acute mountain sickness

(think of problem for athletes in Denver)

Answer 32

relatively mild case of person experiencing problems adjusting to thinner air

Question 33

Define:

HACE

(abbreviation)

Answer 33

high-altitude cerebral edema

relatively severe severe case of problems adjusting to thinner air

Question 34

Define:

high-altitude cerebral edema (HACE)

Answer 34

relatively severe case of person experiencing problems adjusting to thinner air

Question 35

Fill in the blank:

Insect stings and bites are [OFTEN/SELDOM] dangerous.

Answer 35

Insect stings and bites are seldom dangerous.

Question 36

Fill in the blank:

[DO/DON’T] suck on a patient’s snake bite.

Answer 36

Do not suck on a patient’s snake bite.

Question 37

Fill in the blank:

Water conducts heat away from the body [BLANK] times [FASTER/SLOWER] than still air.

Answer 37

Water conducts heat away from the body 25 times faster than still air.

Heat will flow from a warmer material to a cooler one.

Question 38

Choose:

The factors that could predispose a patient to hypothermia include all of the following except:

A. burns.

B. diabetes.

C. spinal-cord injuries; spinal trauma.

D. headache.

Answer 38

D

having a headache does not predispose a person to hypothermia

factors that predisrose a person to hypothermia include burns, diabetes, and spinal-cord injuries

other predisposing factors include shock, head injuries, generalized infection, and hyroglycemia

the elderly, infants, and young children are most at risk

Question 39

Choose:

You are treating a 58-year-old male patient with an open right tibia fracture. He was found lying on his cold garage floor by his son, who states, “He must have been lying there all night.”

Besides the fracture, you should consider:

A. stroke/CVA.

B. hypothermia.

C. pulmonary edema.

D. hyperperfusion.

Answer 39

B

Question 40

Choose:

You are treating a 68-year-old female who was found wandering around intoxicated on a cold evening. She was not wearing a coat, and you determine that her body temperature is below 90°F.

With a core body temperature in this range, she:

A. may be shivering uncontrollably.

B. may no longer be shivering.

C. will be pulseless.

D. will suddenly become alert.

Answer 40

B

Question 41

Choose:

You are treating a 68-year-old male who stepped out of his house in his pajamas on a winter morning to grab the newspaper and accidentally locked himself out of the house. He wandered around the neighborhood for 20 minutes until he found a neighbor who would let him in and call 911 for help. Your protocol calls for passive rewarming of this patient.

This procedure involves:

A. applying heat packs to the patient.

B. covering the patient.

C. administering heated oxygen to the patient.

D. massaging the patient’s limbs.

Answer 41

B

Passive rewarming involves simply covering the patient. Administering heated oxygen and applying heat racks are pan of active rewarming. Never massage the limbs of any hypothermic patient.

Question 42

Choose:

You are assessing a 28-year-old female patient who got caught outdoors in a cold rain for three hours. She is alert and responding, but she is very cold, and you suspect that she is hypothermic.

Her treatment may include all of the following except:

A. removal of all the patient’s wet clothing.

B. actively rewarming the patient during transport.

C. rapidly giving the patient plenty of hot liquids.

D. providing care for shock and providing oxygen.

Answer 42

C

never give hot liquids quickly to a hypothennic patient

you can give warm liquids slowly

the treatment of the hypothermic patient includes removal of all of the patient’s wet clothing, actively rewarming the patient during transport, providing care for shock, and providing oxygen

Question 43

Choose:

Once the decision has been made to rewarm a hypothermic patient, central rewarming should be used.

The reason why you should rewarm the body’s core first is to:

A. prevent blood from collecting in the extremities due to vasodilation.

B. quickly circulate cold blood throughout the body.

C. speed up the blood flow to the extremities.

D. increase blood flow to the brain to prevent unconsciousness.

Answer 43

A

You should rewarm the body’s core first to prevent blood from collecting in the extremities as a result of vasodilation, which could cause a fatal form of shock.

Question 44

Choose:

You are treating an unresponsive 33-year-old female hypothermia patient who is not responding appropriately.

You should:

A. keep her head raised above her feet for transport to the hospital.

B. place her in a bath of warm for at least 20 minutes.

C. provide high-concentration oxygen passed through a warm humidifier.

D. massage her extremities for 35 to 45 seconds.

Answer 44

C

If an unresponsive hypothermia patient is not responding appropriately to treatment, provide high-concentration oxygen that has been passed through a warm-water humidifier. If necessary, the oxygen that has been kept warm in the ambulance passenger compartment can be used. If there is no other choice, oxygen from a cold cylinder may be used.

Question 45

Choose:

You are treating a 65-year-old male who was found by his mailbox in the snow. He is unconscious and very cold to your touch. You suspect that he slipped, fell on the ice, and struck his head. Once in the ambulance, you check his core body temperature and find that it is below 80°F.

Because patients with extreme hypothermia might not reach biological death for over 30 minutes, the medical philosophy is:

A. If there is a pulse, start CPR.

B. They are not dead until they are warm and dead.

C. Resuscitate for no longer than 30 minutes.

D. Always resuscitate very aggressively.

Answer 45

B

Because patients with extreme hypothermia may not reach biological death for over 30 minutes. the medical philosophy is “They are not dead until they’re warm and dead.” In other words, a patient is not considered dead until after she or he has been rewarmed and resuscitative measures have been applied.

Question 46

Choose:

Your 50-year-old male patient fell on an outstretched arm and sustained a fractured right radius and ulna. While he waited for help to arrive, the arm was exposed, and you suspect that there is a local superficial cold injury.

You should:

A. splint the arm and leave it uncovered.

B. rub the arm briskly.

C. not re-expose the injury to cold.

D. immerse the arm in hot water.

Answer 46

C

If a superficial local cold injury is on an extremity, the EMT should not re-expose the injury to cold. Immersion in hot water will burn the injury. The extremity should he splinted, but it should be covered.

Question 47

Choose:

You are treating a 22-year-old female who has local deep frostbite injuries to her fingers. You have contacted medical control and received permission to provide active rewarming of the frozen parts.

This procedure:

A. is seldom recommended in the field.

B. includes using very hot water.

C. is performed without removing the patient’s clothing.

D. includes covering the patient’s face.

Answer 47

A

Active rapid rewarming of frozen parts is seldom recommended in the field. Very hot water may burn the part. The patient’s face should he left uncovered.

Question 48

Choose:

You are treating a 45-year-old male who was installing a new roof on a very hot day. You suspect that he may have heat exhaustion, which means that he is likely to have:

A. dry, hot skin.

B. moist, pale, normal-to-cool skin.

C. a lack of sweating.

D. a rapid, strong pulse.

Answer 48

B

A patient with heat exhaustion presents with moist, pale, normal-to-cool skin. A rapid, strong pulse and lack of sweating are sometimes found with heat stroke.

Question 49

Fill in the blank:

Because patients with extreme hypothermia might not reach biological death for over 30 minutes, the medical philosophy is that “they are not dead until [BLANK].”

Answer 49

“they are not dead until they’re warm and dead.”

patient not considered dead until after rewarming & resuscitation tried

Question 50

Choose:

While working a local sporting event on a warm summer day, a 40-year-old female approaches you stating she suddenly began feeling light-headed and confused while watching the event. She is pale and sweaty but denies chest pain/shortness of breath. You move her into the cooler environment of your unit.

Which of the following should you do next?

A. Begin active cooling procedures for heat emergency

B. Begin slow passive cooling procedures to combat heat exhaustion and rule out heat stroke

C. Assess her vitals including blood sugar level with a glucometer

D. Have her lie flat and elevate her feet to improve circulation

Answer 50

C

While this patient is most likely suffering from heat exhaustion an initial assessment of vitals (including glucose due to confusion) are vital to determine the severity of the underlying process leading to her symptoms.

Question 51

Choose:

You are dispatched on an early spring day to a river where an 18-year-old male was pulled out of the water just prior to your arrival. His core temp is 85°F, and his ECG indicates ventricular fibrillation.

Which of the following best describes his condition?

A. Mild hypothermia

B. Moderate hypothermia

C. Severe hypothermia

D. Death

Answer 51

B

The core temp (82-90°) indicates MODERATE hypothermia. The patient exhibiting V-Fib does not recategorize the severity of the hypothermia. Arrhythmias are common in both moderate and severe stages. As always, moving a hypothermic patient should be done carefully, as it can cause the patient to go into V-Fib, which seems to be the case here in pulling him out.

Question 52

Choose:

In the treatment of hyperthermia what is the best place to apply targeted cooling during transit?

A. The head

B. The axilla

C. The hands/feet

D. The abdomen

Answer 52

B

Of all the options listed the axilla is the most appropriate. The axilla and the groin have large blood vessels that allow for a larger amount of the heat from the body to “pass by” (in close proximity to) the ice. Placing the ice in the other areas listed will cool those areas, but not the body as a whole to as great a degree.

Question 53

Choose:

You are called to treat a patient exposed to alpha-emitting material after an accidental spill.

Which of the following would be an adequate level of shielding against alpha radioactive particles?

A. A plastic sheet

B. A lead apron

C. Aluminum foil

D. A concrete wall

Answer 53

A

Alpha particles carry very little energy. A plastic or cloth sheet is adequate protection against the radiation emitted by these substances. Aluminum can block beta particles, and gamma emitters require lead or concrete. Note that inhaling of ingesting even a small amount of any radiation emitter can be rapidly fatal. Most of the deaths from a radioactive spill would not come from the radiation in the environment but from people ingesting food and water contaminated by the radioactive substance or by breathing air with airborne radioactive dust, always wear full PPE in any B-NICE situation.