Chapter 39 Flashcards
1
Q
The venom from a pit viper causes all of the following effects, except:
- local tissue necrosis.
- increased blood clotting.
- neuromuscular dysfunction.
- increased vascular permeability.
A
Increases blood clotting
2
Q
In a cold environment, the body produces and conserves heat through:
- hyperventilation.
- vasoconstriction.
- release of sodium.
- sweating.
A
Vasoconstriction
3
Q
In trauma patients with shock, hypothermia:
- enhances the shivering response.
- decreases internal hemorrhage.
- interferes with the coagulation of blood.
- facilitates the process of hemostasis.
A
Interferes with the coagulation of blood
4
Q
Which of the following medications would most likely cause malignant hyperthermia?
- Vecuronium
- Promethazine
- Succinylcholine
- Amitriptyline
A
Succinylcholine
5
Q
Patients with heatstroke:
- are typically bradypneic and hypotensive.
- usually have a low end-tidal carbon dioxide reading.
- have a core temperature greater than 106 degrees Fahrenheit.
- should routinely be given 50% dextrose.
A
Usually have low end-title carbon dioxide reading
6
Q
Treatment for a superficial frostbite injury includes:
- gently rubbing the frostbitten area.
- rewarming with radiant heat.
- elevating the frostbitten part.
- rewarming the area with hot water.
A
Elevating the frostbitten part
7
Q
When frozen tissues thaw slowly:
- the injured area becomes flushed or pale, but is relatively painless.
- the resultant ice crystals are smaller in size and cause less damage.
- partial refreezing of melted water may cause greater tissue damage.
- the risk of gangrene and subsequent amputation is much lower.
A
Partial refreezing of melted water may cause greater tissue damage
8
Q
In contrast to sodium-depleted heat exhaustion, water-depleted heat exhaustion:
- is much less likely to occur in a patient who takes diuretic medications for hypertension.
- is the result of prolonged exertion in a hot environment coupled with the excessive intake of hypotonic fluids.
- usually takes several hours or days to develop and occurs when regular water is used to replenish sodium and water.
- occurs primarily in geriatric patients and is due to factors such as decreased thirst sensitivity and immobility.
A
occurs primarily in geriatric patients and is due to factors such as decreased thirst sensitivity and immobility.
9
Q
On the ECG, an Osborn wave can be recognized as:
- an upward slurring at the beginning of the QRS complex.
- acute widening of the QRS complex during the R wave.
- a negative deflection that produces a biphasic P wave.
- a positive deflection immediately after the QRS complex.
A
A positive deflection immediately after the QRS complex
10
Q
Which of the following locations would provide the best protection from a lightning strike?
- Curled up in a ball in an open area
- An open shed or lean-to
- A spot at least 5 miles away from the storm
- A car with the windows rolled up
A
A car with he window rolled up
11
Q
Which of the following is a form of passive rewarming?
- Applying electric heating blankets
- Removing wet clothing
- Using forced-air warming blankets
- Applying large heat packs
A
Removing wet clothing
12
Q
The most common clinical finding observed in patients with type I decompression sickness is:
- unsteadiness.
- pruritus and rashes.
- a cough and dyspnea.
- joint pain.
A
Joint pain
13
Q
A 39-year-old woman’s car broke down, stranding her out in the country for approximately 18 hours. The outside temperature is 23 degrees Fahrenheit. When you arrive and assess the woman, you determine that she is pulseless and apneic; her core body temperature is estimated to be below 86 degrees Fahrenheit. CPR is immediately initiated and the woman is loaded into the ambulance quickly. The ECG reveals ventricular fibrillation. How should you proceed with the treatment of this patient?
- Give a single monophasic shock at 360 joules, reassess the rhythm and pulse, continue CPR, place an advanced airway, hyperventilate at 20 breaths/min, establish vascular access, give 300 mg of amiodarone, and provide rapid transport.
- Perform CPR for 2 minutes, give up to three stacked shocks, immediately resume CPR, reassess in 30 seconds, place an advanced airway, ventilate at 10 breaths/min, establish vascular access, give a saline bolus, and provide rapid transport.
- Provide immediate defibrillation with maximum energy, reassess the rhythm and pulse, continue CPR, place an advanced airway, give one breath every 3 to 5 seconds, establish vascular access, administer a vasopressor, and provide rapid transport.
- Give a single shock, immediately resume CPR, place an advanced airway, provide ventilations at 10 breaths/min with warm humidified oxygen if possible, establish vascular access, and provide rapid transport.
A
Give a single shock, immediately resume CPR, place an advanced airway, provide ventilations at 10 breaths/min with warm humidified oxygen if possible, establish vascular access, and provide rapid transport.
14
Q
In drowning victims, positive end-expiratory pressure is used to:
- prevent atelectasis and force fluid from the alveoli.
- force fluid from the interstitium back into the alveoli.
- increase cardiac contractility and improve stroke volume.
- increase the rate and depth of the victim’s breathing.
A
Prevent atelectasis and force fluid from the alveoli
15
Q
Older people are at increased risk for heat-related illnesses because:
- they acclimatize more rapidly than younger adults, which results in faster heat production.
- they are often taking beta adrenergic agonists, which can decrease the tachycardic response to heat.
- they have proportionately higher metabolic heat production compared to younger adults.
- they are more likely to have chronic medical conditions that interfere with normal heat regulation.
A
they are more likely to have chronic medical conditions that interfere with normal heat regulation.
16
Q
If you are unsure if a patient became hypothermic prior to developing cardiac arrest, you should:
- contact medical control.
- transport with BLS only.
- withhold resuscitation.
- begin resuscitative efforts.
A
Begin resuscitative efforts
17
Q
A 21-year-old man was removed from the water after being submerged for approximately 5 minutes. The patient’s friend, who was with him at the time of submersion, states that there was no trauma involved. Your assessment reveals that the patient is apneic; however, he has a slow, weak carotid pulse. After preoxygenating the patient, you insert an endotracheal tube. During auscultation of the lungs, you hear coarse crackles in all fields; the epigastrium is quiet. As you ventilate the patient, you note decreased compliance. The most effective way to address this situation is to:
- attach a portable ventilator that provides positive end-expiratory pressure.
- administer morphine sulfate to promote venous pooling and decreased preload.
- insert a nasogastric tube and remove any water from the patient’s stomach.
- increase your ventilation rate to 15 breaths/min and provide higher volume.
A
Attach a portable ventilator that provides positive end-expiratory pressure
18
Q
Which of the following statements regarding the black widow spider is correct?
- Because the mortality rate from a black widow spider bite is about 40%, a prehospital antidote is crucial.
- The venom of a black widow spider contains a necrotoxin, which results in local tissue necrosis.
- Following a black widow spider bite, the patient’s abdomen is often rigid due to severe muscle spasms.
- The male black widow spider, which is the sex that poses a danger to humans, contains a red hourglass on its back.
A
Following a black widow spider bite, the patient’s abdomen is often rigid due to severe muscle spasms.
19
Q
Approximately 5 minutes following ascent from the water, a 30-year-old diver complains of sharp chest pain and mild dyspnea. By the time you arrive at the scene, the patient is unresponsive. You should suspect:
- nitrogen narcosis.
- a tension pneumothorax.
- an arterial gas embolism.
- decompression sickness.
A
An arterial gas embolism
20
Q
In mild hypothermia, an older person would likely present with:
- sepsis.
- stroke.
- dysarthria.
- shivering.
A
Dysarthria
21
Q
Which of the following clinical findings suggests a cause of a patient’s hyperthermia other than heatstroke?
- Intermittent chills
- Dehydration
- Moist, pale, hot skin
- Pupillary constriction
A
Intermittent chills
22
Q
Gas-filled organs are affected by the pressure changes experienced during descent and ascent through water because they:
- are compressible.
- contain oxygen.
- do not compress.
- expand rapidly.
A
Are compressible
23
Q
Law enforcement requests your assistance for a 40-year-old man they found in an alley. According to one police officer, the patient is “probably drunk.” The outside temperature is 37 degrees Fahrenheit with a light wind and drizzle. The patient, who is conscious but confused, is shivering and has slurred speech. His skin is cold and pale, his heart rate is 68 beats/min and regular, and his respirations are 24 breaths/min and regular. After moving the patient into the warmed ambulance, you should:
- remove his wet clothing, apply warm blankets, administer supplemental oxygen, assess his blood glucose level and blood pressure, and start an IV with warm normal saline.
- assess his blood pressure; apply chemical heat packs to his neck, groin, and axillae; infuse 250 to 500 mL of warm normal saline; and administer one or two tubes of oral glucose.
- apply warm layered blankets, administer 100 mg of thiamine IM, administer oxygen via nasal cannula, start an IV line with lactated Ringer solution, and administer 25 g of 50% dextrose.
- remove his wet clothing, apply chemical heat packs directly to the groin, assess his blood glucose level and treat with dextrose if it is less than 80 mg/dL, and administer high-flow oxygen.
A
remove his wet clothing, apply warm blankets, administer supplemental oxygen, assess his blood glucose level and blood pressure, and start an IV with warm normal saline.
24
Q
Alcohol predisposes a patient to hypothermia due to:
- impaired shivering thermogenesis.
- increased liver glycogen storage.
- widespread cutaneous vasoconstriction.
- brain atrophy and impaired thermolysis.
A
Impaired shivering thermogenesis
25
What is the pathophysiology of decompression sickness?
- An imbalance of nitrogen in the tissues and alveoli due to rapid ascent
- Excess carbon dioxide accumulation in the muscles due to a rapid ascent
- Diffusion of nitrogen out of the tissues during too slow of an ascent
- Increasing quantities of nitrogen and oxygen in the blood during descent
An imbalance of nitrogen in the tissues and alveoli due to rapid ascent
26
A 19-year-old man presents with hot, moist skin; confusion; tachycardia; and tachypnea shortly after completing a marathon. According to his marathon registration form, he has no significant medical problems and takes no medications. Which of the following treatments are contraindicated for this patient?
- Prostaglandin inhibitors
- Immersion in ice water
- Ventilation assistance
- 25 g of 50% dextrose
Prostaglandin inhibitors
27
You are dispatched to a residence for an “ill person.” Upon arrival, you enter the residence and find the patient, a 72-year-old woman, lying on the couch; she is responsive to pain only. Her son, who arrived shortly before you, tells you that her air conditioner went out, and that he came over to her house to pick her up and found her in her present condition. He further tells you that his mother has diabetes, hypertension, and congestive heart failure. Assessment of the patient reveals that her skin is flushed, hot, and dry; her pulse is rapid and weak; and her blood pressure is low. After moving the patient to the ambulance and applying high-flow oxygen, you should next:
- intubate her to protect her airway, apply chemical ice packs to her trunk area only, start an IV and give a normal saline bolus, and assess her axillary temperature.
- strip her to her underclothing, begin rapid cooling measures, assess her rectal temperature if possible, establish vascular access, and assess her blood glucose level.
- remove any bulky clothing, assess her temperature, begin active cooling if her temperature is greater than 105 degrees Fahrenheit, and start a large-bore IV with normal saline.
- cover her with sheets that are soaked with water, start a large-bore IV and give a 20-mL/kg fluid bolus, and administer 50% dextrose for presumed hypoglycemia.
strip her to her underclothing, begin rapid cooling measures, assess her rectal temperature if possible, establish vascular access, and assess her blood glucose level.
28
When the outside temperature approaches or exceeds skin surface temperature, heat loss by which of the following diminishes and eventually ceases?
- Conduction and evaporation
- Evaporation and radiation
- Convection and conduction
- Radiation and convection
Radiation and convection
29
Cold diuresis occurs when:
- the sympathetic nervous system response in hypothermia increases blood flow to the kidneys, resulting in decreased sodium reabsorption and subsequent water excretion.
- the initial peripheral vasoconstriction response in hypothermia is interpreted by the volume receptors as an increase in volume, causing the kidneys to produce more urine.
- warmed IV fluids administered during severe hypothermia decrease the viscosity of the blood, resulting in an acute increase in output from the kidneys.
- massive systemic vasoconstriction shunts cold body water to the renal system, where it is excreted from the body in an attempt to increase the core body temperature.
the initial peripheral vasoconstriction response in hypothermia is interpreted by the volume receptors as an increase in volume, causing the kidneys to produce more urine.
30
Of the many factors that affect the basal metabolic rate, the most important factor is the person's:
- body surface area.
- sex.
- age.
- level of activity.
Body surface area
31
The most important treatment for a patient experiencing heatstroke is:
- antipyretic administration and high-flow oxygen.
- removal from the hot environment and rapid cooling.
- rehydration with IV fluids and ice water submersion.
- rapid transport and cooling to the point of shivering.
Removal from the hot environment, and rapid cooling
32
Rewarming efforts of a patient with severe hypothermia should continue until the core body temperature is at least:
- 95 degrees Fahrenheit.
- 97 degrees Fahrenheit.
- 99 degrees Fahrenheit.
- 92 degrees Fahrenheit.
95 degrees Fahrenheit
33
Liver disease predisposes a patient to hypothermia secondary to:
- increased bilirubin production.
- decreased glucagon uptake.
- inadequate glycogen stores.
- severe portal hypertension
Inadequate glycogen stores
34
Classic heatstroke:
- presents with a high core body temperature and profuse sweating.
- affects young people and is often accompanied by hypoglycemia.
- typically affects older people and is not associated with exertion.
- is also called active heatstroke and is usually seen in diabetics.
Typically affects older people and is not associated with exertion
35
At a core body temperature of 90 degrees Fahrenheit:
- shivering becomes involuntary.
- hyperventilation is profound.
- oxygen consumption decreases.
- ventricular fibrillation is likely
Oxygen consumption decreases
36
Prehospital treatment for a patient with moderate hypothermia may include:
- esophageal rewarming tubes.
- warm IV fluids and heat packs.
- extracorporeal rewarming.
- caffeine to increase metabolism.
Warm IV fluids and heat packs
37
The thermolytic tissues in the hypothalamus are mediated by the:
- parasympathetic nervous system.
- signals of the adrenergic nervous system.
- sympathetic nervous system.
- endocrine system.
Parasympathetic nervous system
38
A patient with diabetes would most likely experience heat loss secondary to:
- insulin use.
- ketoacidosis.
- peripheral neuropathy.
- acute hyperglycemia.
Peripheral neuropathy
39
Which of the following statements regarding thermoregulation is correct?
- Skin temperature can fluctuate a great deal, which is why it plays a major role in thermoregulation.
- Temperature of the brain and thoracoabdominal organs varies widely, depending on the body's needs.
- The body's metabolic reactions proceed at their optimal level at a constant temperature of 97.6 degrees Fahrenheit.
- Thermogenesis is how the human body eliminates excess heat in order to maintain homeostasis.
Skin temperature can fluctuate a great deal, which is why it plays a major role in thermoregulation
40
Other than personal safety, your most immediate concern when caring for a submersion victim should be:
- determining what caused the event.
- inserting an advanced airway device.
- the risk of vomiting and aspiration.
- hypothermia-induced dysrhythmias.
The risk of vomiting and aspiration
41
The bite of a brown recluse spider:
- results in a local reaction only because the spider's venom is cytotoxic and spreads slowly throughout the bloodstream.
- most often causes severe central nervous system depression because its venom contains a powerful neurotoxin.
- may not result in immediate symptoms but generally presents as a painful, reddened area with an overlying blister.
- manifests with immediate and intense pain and the formation of a blister and a white surrounding area of ischemia.
may not result in immediate symptoms but generally presents as a painful, reddened area with an overlying blister.
42
The effects of hypothermia are most dramatically apparent in the:
- integumentary system.
- central nervous system.
- hematopoietic system.
- cardiovascular system.
Central nervous system
43
The most common and reliable sign of pit viper envenomation is:
- rapidly developing edema around the bite area.
- swelling of the tongue and marked hypertension.
- tachycardia within 30 seconds of the bite.
- patient anxiety and a slow, bounding pulse.
Rapidly developing edema around the bite area
44
You are dispatched to the city park on a hot summer day for a 39-year-old man who fainted. When you arrive, you find the patient sitting under a tree. According to his wife, he had been playing softball all day and has consumed a significant amount of alcohol. She further confirms that he did faint and was “out” for about 2 minutes. The patient is conscious and tells you that he does not remember what happened. His skin is cool, moist, and pale, and his pulse is weak and rapid. You should:
- administer oxygen, apply a cervical collar in case he injured himself when he fainted, start an IV with normal saline, give a 20-mL/kg fluid bolus, and transport.
- give oxygen, assess his blood glucose level, establish vascular access and give saline fluid boluses as needed, transport, and monitor his cardiac rhythm.
- give oxygen via nasal cannula, start an IV of normal saline at a keep-vein-open rate, administer 50% dextrose IV, and transport with passive cooling en route.
- initiate immediate and aggressive cooling measures, begin transport, start two large-bore IV lines en route, and closely monitor his cardiac rhythm.
give oxygen, assess his blood glucose level, establish vascular access and give saline fluid boluses as needed, transport, and monitor his cardiac rhythm.
45
An increase in core temperature causes the:
- hypothalamus to send signals via afferent pathways in the parasympathetic nervous system, resulting in vasoconstriction and sweat production.
- hypothalamus to send signals via efferent pathways in the autonomic nervous system, causing vasodilation and sweating.
- anterior pituitary gland to send signals via afferent pathways in the sympathetic nervous system to increase the heart rate.
- anterior pituitary gland to send signals via efferent pathways in the sympathetic nervous system, causing widespread vasoconstriction.
hypothalamus to send signals via efferent pathways in the autonomic nervous system, causing vasodilation and sweating
46
A person blowing on hot food in an attempt to cool it is an example of:
- conduction.
- convection.
- passive cooling.
- radiation
Convection
47
A hiker was bitten on the left lower leg by a rattlesnake. He is conscious and alert, but complains of nausea and generalized weakness. The affected area, which has two distinct puncture wounds, is swollen markedly. The patient's blood pressure is 114/66 mm Hg, pulse rate is 120 beats/min and regular, and respirations are 22 breaths/min and regular. The most appropriate treatment for this patient involves:
- placing him in a supine position, elevating the affected extremity and applying ice to reduce the swelling, establishing vascular access, and administering fentanyl for pain.
- administering oxygen, providing emotional support, establishing vascular access, administering a 250-mL saline bolus, and splinting the affected extremity.
- applying venous tourniquets proximal and distal to the affected site, elevating the limb no more than 12 inches, applying a splint, and establishing vascular access.
- keeping him calm, administering high-flow oxygen, immobilizing the affected extremity and keeping it below heart level, and establishing vascular access.
keeping him calm, administering high-flow oxygen, immobilizing the affected extremity and keeping it below heart level, and establishing vascular access.
48
Which of the following contributes to heat cramps?
- Gender
- Mental status
- Time of day
- Dehydration
Dehydration
49
In contrast to classic heatstroke, exertional heatstroke:
- is associated with diuretic use.
- can affect young, healthy people.
- presents with hot, dry skin.
- causes hyperglycemia.
Can affect young, healthy people
50
Hypothermia is defined as a decrease in core body temperature, generally starting at:
- 96 degrees Fahrenheit.
- 94 degrees Fahrenheit.
- 93 degrees Fahrenheit.
- 95 degrees Fahrenheit.
95 degrees Fahrenheit
51
A 56-year-old diabetic woman presents with a painful, reddened area on her left forearm, which she first noticed a few days ago. Closer examination reveals a blister in the center of the affected area. The patient denies being bitten or stung by anything and states that the only thing she has been doing is storing boxes in the attic. You should suspect a(n):
- brown recluse spider bite.
- poorly healed diabetic ulcer.
- infection caused by a tick.
- local reaction to an ant bite.
Brown recluse spider bite
52
In early hypothermia, the cardiovascular system typically responds with:
- bradycardia.
- conduction delays.
- tachycardia.
- atrial dysrhythmias.
Tachycardia
53
A patient may become hypothermic for which of the following reasons?
- Impaired vasoconstriction
- Fatigue
- Hypertension
- Decreased thermolysis
Impaired vasoconstriction
54
If a small amount of water is aspirated into the trachea during a submersion event:
- permanent laryngeal spasm occurs and requires cricothyrotomy.
- the victim asphyxiates, becomes profoundly acidotic, and dies.
- laryngospasm occurs and temporarily protects the lower airway.
- resulting hypoxemia causes the body to shift to aerobic metabolism.
Laryngospasm occurs and temporarily protects the lower airway
55
Shallow water blackout occurs when:
- cerebral vasodilation causes syncope during ascent.
- voluntary hypoventilation causes a drop in partial pressure of oxygen.
- a swimmer hyperventilates prior to entering the water.
- decreasing partial pressure of oxygen during descent results in syncope.
A swimmer hyperventilates prior to entering the water
56
Nitrogen causes decompression sickness:
- on ascent, because of a progressive increase in atmospheric absolute.
- on descent, because of the bubbles that form on reduction of pressure.
- on descent, because of a progressive increase in atmospheric absolute.
- on ascent, because of the bubbles that form on reduction of pressure.
On ascent, because of the bubbles that form on reduction of pressure
57
While attempting to ventilate an unresponsive, apneic drowning victim, you notice poor lung compliance. Which of the following would be the most likely cause of this?
- Diffuse alveolar collapse
- Excess pulmonary surfactant
- Water within the pleural space
- Acute pneumonitis
Diffuse alveolar collapse
58
When a person experiences a crisis in the water, the amount of time the person can hold their breath depends on:
- the victim's age.
- the water's tonicity.
- the victim's level of panic.
- the depth of the water.
The victims level of panic
59
Mortality and morbidity are greatest following the bite of a:
- coral snake.
- rattlesnake.
- copperhead.
- cottonmouth.
Rattlesnake
60
The first step in treating a patient with a heat cramps is to:
- move the patient to a cooler area.
- employ active cooling measures.
- ensure that the airway is patent.
- assess core body temperature.
Move the patient to cooler area
61
If a patient with severe hypothermia is pulseless and apneic, you should:
- infuse 4 L of warmed normal saline solution.
- attempt a single shock for V-fib or V-tach.
- avoid placement of an advanced airway device.
- perform high-quality CPR at half the normal rate.
Attempt a single shock of v-fib or v-tach
62
The most popular form of diving is:
- scuba diving.
- breath-hold diving.
- saturation diving.
- surface-tended diving.
Scuba diving
63
Any diver who loses consciousness immediately following a dive should be assumed to have experienced:
- nitrogen narcosis.
- decompression sickness.
- an air embolism.
- barotrauma.
An air embolism
64
Cigarette smoking predisposes a person to frostbite because it:
- causes peripheral vasodilation.
- causes arteriolar constriction.
- decreases the blood pressure.
- increases peripheral blood flow.
Causes arteriolar constriction
65
Other than using a Nitrox system, the only effective way to counteract nitrogen narcosis is to:
- lower the nitrogen partial pressure through controlled ascent.
- lower the nitrogen partial pressure through controlled descent.
- increase the nitrogen partial pressure through controlled descent.
- increase the nitrogen partial pressure through controlled ascent.
lower the nitrogen partial pressure through controlled ascent
66
Which of the following signs and symptoms is most indicative of acute mountain sickness?
- Excessive sleeping and abdominal pain
- Audible wheezing and chest tightness
- A throbbing headache and fatigue
- Chest congestion and dyspnea at rest
A throbbing headache and fatigue
67
Which of the following clinical findings would you expect to encounter in a patient with heat exhaustion?
- Abdominal cramping
- Cool, moist skin
- Hypertension upon standing
- Body temperature of 104 degrees Fahrenheit
Abdominal cramping
68
Which of the following results in an increase in internal heat production?
- Diabetes
- Hypothyroidism
- Infection response
- Multiple sclerosis
Infection response
69
It is most pertinent to determine if the symptoms of a diving-related emergency began:
- after the diver surfaced.
- before entering the water.
- during ascent or descent.
- at the time of water entry.
During ascent or descent
