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Chapter 38
Trauma: Environmental Emergencies
145
Medical
Not Applicable
11/15/2016
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Term
Thermoregulation is a function of the:
 Definition
anterior hypothalamus
Term
Which of the following statements regarding thermoregulation is correct?
 Definition
Skin temperature can fluctuate a great deal, which is why it plays a major role in thermoregulation.
Term
In situations where the environment is a factor, the MOST accurate means of determining a person's core temperature is to:
 Definition
use a rectal thermometer that is capable of measuring extremes of temperature
Term
The thermolytic tissues in the hypothalamus are mediated by the
 Definition
parasympathetic nervous system
Term
The basal metabolic rate is MOST accurately defined as:
 Definition
the heat energy produced at rest from normal body metabolic reactions
Term
Of the many factors that affect the basil metabolic rate, the MOST important factor is
 Definition
the person's body surface area.
Term
An increase in core temperature causes the:
 Definition
hypothalamus to send signals via efferent pathways in the autonomic nervous system, causing vasodilation and sweating.
Term
The transfer of heat from a hotter object to a cooler object by direct physical contact is called:
 Definition
conduction
Term
A person blowing on hot food in an attempt to cool it is an example of
 Definition
convection
Term
Which of the following factors decreases the body's ability to eliminate excess heat through evaporation?
 Definition
high humidity
Term
When the outside temperature approaches or exceeds skin surface temperature, heat loss by _________ and _________ diminishes and eventually ceases
 Definition
radiation, convection
Term
For evaporation of sweat to be an effective cooling mechanism
 Definition
ambient air must be relatively unsaturated with water
Term
In a cold environment, the body produces and conserves heat through all of the following mechanisms, EXCEPT:
 Definition
hyperventilation
Term
An increase in core body temperature due to inadequate thermolysis is called
 Definition
heat illness
Term
Older people are at increased risk for heat-related illnesses because
 Definition
they are more likely to have chronic medical conditions that interfere with normal heat regulation
Term
Which of the following medications would be the LEAST likely to increase a person's risk for a heat-related illness?
 Definition
Alpha antagonists
Term
A person taking levothyroxine (Synthroid) is at an increased risk for a heat-related illness secondary to:
 Definition
an increased metabolic rate
Term
Factors that increase internal heat production include all of the following, EXCEPT:
 Definition
hypothyroidism
Term
Impaired vasodilation:
 Definition
interferes with heat dissipation
Term
All of the following factors contribute to heat cramps, EXCEPT
 Definition
gender
Term
Heat cramps are caused by:
 Definition
sodium loss due to sweating
Term
The FIRST step in treating a patient with a heat emergency is to:
 Definition
move the patient to a cooler area
Term
The MOST likely cause of heat syncope is:
 Definition
vasodilation and dehydration.
Term
In contrast to salt-depleted heat exhaustion, water-depleted heat exhaustion:
 Definition
occurs primarily in geriatric patients and is due to factors such as decreased thirst sensitivity and immobility.
Term
Which of the following clinical findings would you NOT expect to encounter in a patient with heat exhaustion?
 Definition
Hypertension upon standing
Term
The diagnosis of heatstroke is usually made when a patient has a high core body temperature and:
 Definition
an altered mental status
Term
Classic heatstroke:
 Definition
typically affects older people and is not associated with exertion.
Term
In contrast to classic heatstroke, exertional heatstroke:
 Definition
affects young, healthy people
Term
Patients with heatstroke:
 Definition
have a core temperature greater than 104°F.
Term
Which of the following clinical findings suggests a cause of a patient's hyperthermia other than heatstroke?
 Definition
Intermittent chills
Term
The MOST important treatment for a patient experiencing heatstroke involves:
 Definition
removal from the hot environment and rapid cooling
Term
Which of the following statements regarding frostbite is correct?
 Definition
Frostbite is an ischemic injury that is classified as superficial or deep
Term
Cigarette smoking predisposes a person to frostbite because it:
 Definition
causes arteriolar constriction
Term
The MOST common symptom of superficial frostbite is:
 Definition
an altered sensation
Term
Treatment for a superficial frostbite injury includes
 Definition
elevating the frostbitten part
Term
A deeply frostbitten extremity
 Definition
is cold, hard, and without sensation
Term
When frozen tissues thaw slowly:
 Definition
partial refreezing of melted water may cause greater tissue damage
Term
In addition to your transport time to the hospital, prehospital treatment of a frostbitten body part is MAINLY dependent upon:
 Definition
whether the affected part has been partially or completely thawed prior to your arrival
Term
Hypothermia is defined as a decrease in core body temperature, generally starting at:
 Definition
95°F.
Term
A patient may become hypothermic for all of the following reasons, EXCEPT:
 Definition
decreased thermolysis
Term
Which of the following statements regarding shivering is correct?
 Definition
Shivering increases the basal metabolic rate by up to five times.
Term
A decreased wind chill factor increases heat loss through:
 Definition
convection
Term
A patient with diabetes would MOST likely experience heat loss secondary to:
 Definition
peripheral neuropathy
Term
Liver disease predisposes a patient to hypothermia secondary to:
 Definition
inadequate glycogen stores
Term
In trauma patients with shock, hypothermia:
 Definition
interferes with the coagulation of blood
Term
In mild hypothermia, an older person would likely present with all of the following, EXCEPT:
 Definition
shivering.
Term
The effects of hypothermia are MOST dramatically apparent in the:
 Definition
central nervous system
Term
Cold diuresis occurs when:
 Definition
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.
Term
If you are unsure if a patient became hypothermic prior to developing cardiac arrest, you should:
 Definition
begin resuscitative efforts.
Term
When a person experiences a crisis in the water, the amount of time the person can hold his or her breath depends on all of the following factors EXCEPT:
 Definition
the water's tonicity
Term
Which of the following statements regarding freshwater and saltwater drownings is correct?
 Definition
Both freshwater and saltwater can lead to pulmonary injuries
Term
If a small amount of water is aspirated into the trachea during a submersion event:
 Definition
laryngospasm occurs and temporarily protects the lower airway
Term
The initial hypoxic insult associated with a drowning occurs from
 Definition
apnea
Term
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?
 Definition
Diffuse alveolar collapse
Term
Immediately upon gaining access to an unresponsive victim who is in the water, you should:
 Definition
open the airway, using c-spine precautions if indicated.
Term
Other than personal safety, your MOST immediate concern when caring for a submersion victim should be:
 Definition
the risk of vomiting and aspiration
Term
In drowning victims, positive end-expiratory pressure is used to:
 Definition
prevent atelectasis and force fluid from the alveoli.
Term
During saturation diving:
 Definition
the diver remains at depth for prolonged periods of time.
Term
The MOST popular form of diving is:
 Definition
scuba diving
Term
An estimate of the pressure to which a diver is exposed is based on the:
 Definition
depth of the dive
Term
Gas-filled organs are affected by the pressure changes experienced during descent and ascent through water because they:
 Definition
are compressible
Term
Nitrogen causes decompression sickness
 Definition
on ascent because of the bubbles that form on reduction of pressure
Term
It is MOST pertinent to determine if the symptoms of a diving-related emergency began
 Definition
during ascent or descent
Term
Other than using a Nitrox system, the only effective way to counteract nitrogen narcosis is to:
 Definition
lower the nitrogen partial pressure through controlled ascent
Term
Pulmonary overpressurization syndrome occurs when a diver:
 Definition
holds his or her breath during ascent
Term
Any diver who loses consciousness immediately following a dive should be assumed to have experienced:
 Definition
an air embolism
Term
What is the pathophysiology of decompression sickness?
 Definition
An imbalance of nitrogen in the tissues and alveoli due to rapid ascent
Term
The MOST common clinical finding observed in patients with type I decompression sickness is:
 Definition
joint pain
Term
Shallow water blackout occurs when:
 Definition
a swimmer hyperventilates prior to entering the water
Term
Altitude illness is a problem caused by
 Definition
hypoxia due to low atmospheric pressures
Term
Which of the following signs and symptoms is MOST indicative of acute mountain sickness?
 Definition
A throbbing headache and fatigue
Term
A patient with high-altitude cerebral edema:
 Definition
presents with ataxia and confusion after experiencing acute mountain sickness for greater than 24 hours.
Term
A 45-year-old man presents with severe cramps in his legs, nausea, and lightheadedness after running laps at the track. The temperature outside is 95°F and the relative humidity is 80%. The patient is conscious and alert and is sweating profusely. His blood pressure is 100/60 mm Hg, pulse is 120 beats/min and weak, and respirations are 24 breaths/min and regular. The MOST appropriate treatment for this patient involves:
 Definition
offering him oxygen, starting an IV with normal saline, giving a 250- to 500-mL fluid bolus, and recommending transport to the hospital for evaluation.
Term
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:
 Definition
give oxygen, assess his blood glucose level, establish vascular access and give saline fluid boluses as needed, transport, and monitor his cardiac rhythm.
Term
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:
 Definition
strip her to her underclothing, begin rapid cooling measures, assess her rectal temperature if possible, establish vascular access, and assess her blood glucose level
Term
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. Treatment for this patient may include all of the following, EXCEPT:
 Definition
prostaglandin inhibitors
Term
You are caring for a young woman with a local cold injury to her hands. Your assessment reveals that her hands are hard to the touch, mottled, cold, and without sensation. Her body temperature is 96.3°F per tympanic thermometer. Your estimated transport time to the hospital is 45 minutes. The MOST appropriate treatment for this patient includes
 Definition
preventing further loss of body heat; protecting her hands from injury with dry, bulky dressings; and transporting without delay.
Term
Law enforcement requests your assistance for a 40-year-old man whom they found in an alley. According to one police officer, the patient is "probably drunk." The outside temperature is 37°F 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:
 Definition
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.
Term
A 39-year-old man's car broke down, stranding him out in the country for approximately 18 hours. The outside temperature is 23°F. When you arrive and assess the man, you determine that he is pulseless and apneic; his core body temperature is estimated to be below 86°F. CPR is immediately initiated and the man is loaded into the ambulance quickly. The ECG reveals ventricular fibrillation. How should you proceed with the treatment of this patient?
 Definition
Give a single shock, immediately resume CPR, place advanced airway, provide ventilations at 8 to 10 breaths/min with warm humidified oxygen if possible, establish vascular access, and provide rapid transport
Term
You are caring for a middle-aged woman who is pulseless and apneic. Per rectal thermometer, the patient's core body temperature is 90°F. The cardiac monitor displays ventricular tachycardia. How will your treatment for this patient differ from that of a normothermic patient?
 Definition
Increase the interval between cardiac medications.
Term
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 treat this situation is to:
 Definition
attach a portable ventilator that provides positive end-expiratory pressure.
Term
Approximately 5 minutes following ascent from the water, a 30-year-old male diver complains of sharp chest pain and mild dyspnea. By the time you arrive at the scene, the patient is unresponsive. You should be MOST suspicious for:
 Definition
an arterial gas embolism
Term
The hymenoptera family of insects includes ___________, which usually cause death secondary to ___________.
 Definition
yellow jackets, anaphylaxis
Term
Which of the following statements regarding the black widow spider is correct?
 Definition
Following a black widow spider bite, the patient's abdomen is often rigid due to severe muscle spasms.
Term
Pharmacologic management for a black widow spider bite may include:
 Definition
diazepam
Term
The bite of a brown recluse spider:
 Definition
may not result in immediate symptoms but generally presents as a painful, reddened area with an overlying blister
Term
Mortality and morbidity are greatest following the bite of a:
 Definition
rattlesnake
Term
The venom from a pit viper causes all of the following effects, EXCEPT:
 Definition
increased blood clotting
Term
The MOST common and reliable sign of pit viper envenomation is:
 Definition
rapidly developing edema around the bite area
Term
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 be MOST suspicious that this patient has a(n):
 Definition
brown recluse spider bite
Term
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:
 Definition
keeping him calm, administering high-flow oxygen, immobilizing the affected extremity and keeping it below heart level, and establishing vascular access
Term
Which of the following statements regarding lightning strikes is correct?
 Definition
Most lightning-related injuries occur when the person is standing near an object that is struck.
Term
Which of the following locations would provide the BEST protection from a lightning strike?
 Definition
A car with the windows rolled up
Term
After an adult victim is struck by lightning and experiences cardiac arrest:
 Definition
his or her heart may resume beating spontaneously.
Term
In early hypothermia, the cardiovascular system typically responds with:
 Definition
tachycardia
Term
On the ECG, an Osborne wave can be recognized as:
 Definition
a positive deflection immediately after the QRS complex.
Term
At a core body temperature of 90°F
 Definition
oxygen consumption decreases
Term
Which of the following is NOT a form of passive rewarming?
 Definition
Applying chemical heat packs
Term
Prehospital treatment for a patient with moderate hypothermia may include:
 Definition
warm IV fluids and heat packs.
Term
If a patient with severe hypothermia is pulseless and apneic, you should:
 Definition
attempt a single shock for V-fib or V-tach
Term
_____________ refers to the body processes that balance the supply and demand of the body's needs.
 Definition
Homeostasis
Term
The _____________ is considered the "master thermostat" in the body.
 Definition
hypothalamus
Term
The basal metabolic rate (BMR) is the:
 Definition
heat energy produced at rest from normal body reactions.
Term
The BMR of the average 70-kg adult is in the range of ______________ per hour.
 Definition
60 to 70
Term
Heat can be lost from a body in all of the following ways EXCEPT:
 Definition
ventilation.
Term
A healthy adult can sweat a maximum of about _____ but cannot maintain that rate for more than a few hours.
 Definition
1 L/h
Term
Heat illness is an increase in core body temperature due to inadequate thermolysis.
 Definition
TRUE
Term
With heat exhaustion, the skin will likely be _______; with heat stroke, the skin will likely be ________.
 Definition
moist and cool; dry and hot
Term
A patient suffering from heat cramps generally presents with incapacitating pain, hypotension, and _____________.
 Definition
nausea
Term
Two forms of heat exhaustion are described: water-depleted and ___________.
 Definition
salt-depleted
Term
You should automatically give endurance sports athletes fluids via large-bore IV and lots of oral fluids.
 Definition
FALSE
Term
Victims of exertional heat stroke tend to be:
 Definition
younger people.
Term
In a patient with heat stroke, massaging muscles to combat cutaneous vasoconstriction from cooling too much is beneficial.
 Definition
FALSE
Term
Frostbite is classified as __________ or ___________ depending on whether there is tissue loss.
 Definition
superficial; deep
Term
Which of the following is NOT a predisposing factor for frostbite?
 Definition
Staying hydrated
Term
Why should you never massage frostbitten tissue?
 Definition
The cells are full of ice crystals and massaging causes the ice crystals to lacerate the tissue.
Term
_______________ is the most common cause of heat loss leading to hypothermia in the urban setting.
 Definition
alcohol
Term
The treatment for moderate hypothermia includes all of the following EXCEPT:
 Definition
warm, caffeinated beverages.
Term
Which of the following is a risk factor for drowning?
 Definition
Seizure disorder
Term
_____________ is the term for severe constriction of the larynx in response to allergy, noxious stimuli, or illness.
 Definition
Laryngospasm
Term
Treatment for victims of submersion include ventilation, suction, supplemental oxygen, and _______________.
 Definition
chest compressions
Term
____________ is a state of altered mental status caused by breathing compressed air at depth.
 Definition
Nitrogen narcosis
Term
You are called to the scene of a diving emergency and find a patient whose voice is hoarse. You hear a crunching noise that is synchronous with her heartbeat. What condition do you suspect?
 Definition
Pulmonary overpressurization syndrome
Term
Treatment of suspected air gas embolism (AGE) includes:
 Definition
100% supplemental oxygen
Term
In decompression sickness, nitrogen bubbles in the blood and tissues do their damage in two ways: by interfering mechanically with tissue perfusion and _____________________.
 Definition
by triggering chemical changes within the body
Term
The condition most frequently seen among adolescent boys competing to see who can remain under water the longest is:
 Definition
shallow water blackout
Term
Which of the following is NOT considered a risk factor for altitude illnesses?
 Definition
Physical fitness
Term
Information about a diving emergency that you should pass along to the emergency department includes:
 Definition
All of the above
Term
You and your partner are working a day shift. It is a sunny day, and the temperature is 95 °F. You are dispatched to the town soccer field for an 85-year-old female complaining of cramping to her fingers. The patient denies any other complaint of dizziness, nausea, or vomiting. The patient tells you it feels like her arthritis but much worse. Her vital signs are all within normal limits, and her skin is warm and moist. What is the most likely problem this patient is experiencing?
 Definition
Heat cramps
Term
At what depth do most divers experience nitrogen narcosis?
 Definition
70 to 100 feet
Term
You and your partner are treating a drowning patient who had a submersion time of 10 minutes. Your partner wants to perform the Heimlich maneuver; you should:
 Definition
Advise your partner that the Heimlich maneuver should not be utilized for drowning victims
Term
Heat loss occurs in all the following ways EXCEPT:
 Definition
Ingestion
Term
Which of the following is a predisposing factor to hypothermia?
 Definition
All of the above are predisposing factors
Term
All of the following are part of the drowning sequence of a conscious person EXCEPT:
 Definition
PaCO2 in the blood falling below 50
Term
In superficial frostbite the tissue affected is the:
 Definition
Epidermal
Term
Which law of gases states that the amount of gas dissolved in a given volume of fluid is proportional to the pressure of the gas above it?
 Definition
Henry's law
Term
You and your partner are treating a 35-year-old female who is complaining of severe pain in her joints and abdomen. The patient tells you that she went diving approximately 12 hours prior to the onset of complaint. Which of the following would be part of a correct course of treatment for this patient?
 Definition
Oxygen via nonrebreather mask regardless of SpO2 reading, fluid replacement with lactated Ringer's, transport
Term
Boyle's law states that ________ the pressure of a gas will _______ its volume:
 Definition
Increasing, decrease
Term
You and your partner are treating a 25-year-old male with frostbite to the left hand. Your BLS unit is going to be delayed because of a severe winter storm that is occurring. You and your partner decide that you must rewarm the patient's hand while waiting for your BLS unit. You are in the patient's house, and there is no chance of the hand being refrozen. To rewarm the patient's hand, you are going to submerse the hand in water. You know that the water must be between ____ and ____ °F.
 Definition
98; 102
Term
In which of the following patients would you expect to see a subacute exposure to cold?
 Definition
A mountain climber
Term
According to the American Heart Association, if a hypothermic patient who is in cardiac arrest does not respond to initial defibrillation and initial drug therapy, subsequent defibrillation and medication administration should be avoided until the patient's core temperature is about ____ °F or higher:
 Definition
86
Term
Decompression sickness commonly occurs in divers who are diving below what level?
 Definition
33 feet
Term
During the hypoxic ventilatory response, what do the kidneys do?
 Definition
Increase the removal of bicarbonate
Term
Patients are considered to be hypothermic when their core temperature drops below:
 Definition
35°C
Term
In the prehospital setting active rewarming should not be attempted unless the emergency department is greater than ____ minutes away.
 Definition
15
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