Environmental Emergencies

Question 1

Decompression Sickness accurate history of a dive

Answer 1

• Depth of dive
• Air mixture
• Number of dives
• Interval between dives

Question 2

Adult and pediatric decompression sickness treatment

Answer 2

• Transport supine
• Rule out tension pneumothorax
• Cardiac arrythmias
• 02: 15 LP regardless of spo2
• Normal saline: Adult 500mL Pediatric 10mL/kg max 250 mL

Question 3

Non- fatal drowning: Adult and pediatric without hypotension

Answer 3

• Must transport
• CPAP (1- cm H20)
  If hypotensive
• NS 500 mL

Question 4

Non- fatal drowning: Adult and pediatric. If hypotensive with Pulmonary Edema

Answer 4

• Push- Dose Epi 1:100,000

Question 5

Heat Emergencies signs and symptoms

Answer 5

• AMS
• Seizures
• Hypotension
• Sweating may be absent

Question 6

When treating heat stroke

Answer 6

“COOL FIRST, TRANSPORT SECOND”

Question 7

All heat emergencies treatment

Answer 7

• Move pt to the back of the rescue
• Obtain temperature
• Remove excessive clothing
• Provide oral hydration

Question 8

Heat cramps and heat exhaustion adult and pediatric

Answer 8

• Normal saline

Question 9

Heat stroke with temperature >103 or altered mental status

Answer 9

• Ice packs
• Normal saline

Question 10

Carbon monoxide exposure

Answer 10

• Chemical asphyxiant
• Colorless
• Odorless
• Tasteless
• Slightly less dense than air
• Toxic to humans when encountered in concentrations above 35 parts per million (ppm)
• Lower doses of CO can also be harmful due to a cumulative effect
• Patients exposed to carbon monoxide (smoke inhalation, etc.) require a full head to toe patient
  examination including SpCO monitoring with the rainbow sensor (located on the EMS Captains’ and
  Special Operations’ vehicles).
• All rescuing crew members shall wear their SCBA if the patient is in a hazardous environment.
• Consider cyanide exposure.

Question 11

Cyanide exposure treatment

Answer 11

• O2:15 LPM via NRB regardless of SpO2, unless the patient requires ventilatory support
  *Cyanokit 5g with 200mL NS using the transfer spike
• With the vial in the upright position, fill to the “fill line”
• Mix the solution by rocking or rotating the vial for 30 seconds. DO NOT SHAKE
• Use vented IV tubing and infuse as indicated below
• 5g IV/IO, infused over 10-15 minutes
  5gtts/sec (broken infusion stream)
  May repeat 1x prn
  -The Cyanokit should be administered through a separate/dedicated IV/IO line

Question 12

Organophosphate poisoning Mild symptoms

Answer 12

Runny nose, salivation, miosis, chest tightness, nausea, vomiting, tachy or bradycardia, muscle twitching, stomach cramps

Question 13

Organophosphate poisoning Mild treatment

Answer 13

• Airway management
• Atropine 2mg IV/IO

Question 14

If severe symptoms develop within 10 minutes

Answer 14

• Atropine 4mg IV/IO

Question 15

If no atropine is available for severe organophosphate poisoning

Answer 15

• 1 DuoDote Injection into mid-lateral thigh

Question 16

If severe symptoms develop within 15
minutes of Duodote administration

Answer 16

Administer 2 additional doses of DuoDote in rapid succession for a total of 3 DuoDote Injections

Question 17

Organophosphate poisoning severe symptoms

Answer 17

Strange/confused behavior, severe difficulty breathing, secretions from the
lungs or airway, severe muscle twitching, urination, defecation, seizures, or unconsciousness

Question 18

Organophosphate poisoning severe treatment

Answer 18

• ATROPINE 6mg IV/IO

Question 19

Pediatric organophosphate treatment

Answer 19

• Airway management for excessive secretions
• For patients weighing 40-90 lbs (18-41 kg), administer ATROPINE 1 mg IV/IO
• If severe symptoms develop within 10 minutes, administer ATROPINE 2 mg IV/IO
• For patients weighing less than 40 lbs (18 kg or less), administer ATROPINE 0.05 mg/kg IV/IO.
  Repeat every 20-30 minutes PRN for continued symptoms

Question 20

Pediatric organophosphate treatment severe

Answer 20

• For patients weighing 40-90 lbs (18-41kg) AtroPen (1mg), administer 3 doses into mid-lateral
  thigh in rapid succession OR ATROPINE 3mg IV/IO.
• For patients weighing less than 40 lbs (18kg or less), ATROPINE: 0.05mg/kg IV/IO. Repeat every 20-30 minutes prn for continued symptoms

Question 21

Infants organophosphate symptoms

Answer 21

1. Symptoms are sometimes observed in healthy infants and children and are less reliable than other symptoms.
2. Infants may become drowsy or unconscious, with muscle floppiness rather than muscle twitching, soon after exposure

Question 22

Hazmat exposure and WMD priorities

Answer 22

Patient decontamination and personnel protection

Question 23

Hazmat treatment adult and pediatric

Answer 23

1- Contact dispatch to ensure that the HazMat Team and or Special Operations
2- Medical treatment and patient preparation (decom), will be based on information obtained
3- The Special Operations Team will brief EMS treatment personnel on the identity, type, quantity, and hazard potential of the materials involved.
4- Protective measures for all personnel prior to patient contact.
5- Hazmat team will oversee the research, decon, and medical treatment.
5- Resuscitation can begin when safe to do so and when the patient presents no risk of secondary contamination
6- Pts will be transported in a properly prepared ground transport unit
7- If the number of patients overwhelms the amount of transport units, additional arriving units will be call
8- Early notification of the receiving emergency department