Chapter 33 Workbook Flashcards by Tom Bowl

The slowing of heart rate caused by submersion in cold water

Diving reflex

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The ability of the skin to resist deformation

Turgor

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A spasm of the larynx and vocal cords

Laryngospasm

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Respiratory impairment from submersion or immersion in liquid

Drowning

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Heat transfer between the body and a radiant energy source; examples include standing close to a fire or inside of a cold room

Radiation

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Bees, wasps, ants, and yellow jackets

Hymenoptera

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A core temperature less than 95°F (35°C)

Hypothermia

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Condition caused by air bubbles in the blood vessels

Air embolism

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Heat transfer between the body and circulating air; examples include exposure to windy, wintry weather with inadequate thermal insulation

Convection

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Heat transfer between the body and an object or substance that it is in direct contact with; examples include sitting in snow

Conduction

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Conversion of any liquid to a gas; examples include the body cooling itself through sweating

Evaporation

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Painful muscle spasms that occur after vigorous exercise

Heat cramps

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The temperature of the surrounding environment

Ambient temperature

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The temperature of the heart, lungs, and vital organs

Core temperature

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A core temperature greater than 101°F (38.3°C)

Hyperthermia

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________ causes body heat to be lost as warm air in the lungs is exhaled into the atmosphere and cooler air is inhaled.
A. Convection
B. Conduction
C. Radiation
D. Respiration

D. Respiration

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Evaporation, the conversion of a liquid to a gas, is a process that requires:
A. energy
B. circulating air
C. a warmer ambient temperature
D. high humidity

A. energy

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The rate and amount of heat loss by the body can be modified by all of the following EXCEPT:
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

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The characteristic appearance of blue lips and/or fingertips seen in hypothermia is the result of:
A. lack of oxygen in venous blood
B. frostbite
C. blood vessels constricting
D. bruising

C. blood vessels constricting

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Signs and symptoms of severe systemic hypothermia include all of the following EXCEPT:
A. weak pulse
B. coma
C. shivering
D. very slow respirations

C. shivering

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Hypothermia is more common among all of the following EXCEPT:
A. older individuals
B. long-distance athletes
C. infants and children
D. those who are already ill

B. long-distance athletes

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To assess a patient’s core body temperature, pull back your glove and place the back of your hand on the patient’s:
A. abdomen, underneath the clothing
B. forehead
C. forearm, on the inside of the wrist
D. neck, at the area where you check the carotid pulse

A. abdomen, underneath the clothing

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Never assume that a(n) ____________, pulseless patient is dead.
A. apneic
B. cyanotic
C. cold
D. hyperthermic

C. cold

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Management of hypothermia in the field consists of all of the following EXCEPT:
A. applying heat packs to the groin, axillary, and cervical regions
B. removing wet clothing
C. preventing further heat loss
D. massaging the cold extremities

D. massaging the cold extremities

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All of the following conditions refer to when exposed parts of the body become very cold, but not frozen, EXCEPT: A. frostnip B. trench foot C. immersion foot D. frostbite

D. frostbite

When heat gain exceeds heat loss, ____________ result(s). A. hyperthermia B. heat cramps C. heat exhaustion D. heatstroke

A. hyperthermia

Contributing factors to the development of heat illnesses include all of the following EXCEPT: A. high air temperature B. vigorous exercise C. high humidity D. increased fluid intake

D. increased fluid intake

When obtaining a SAMPLE history for a patient with a diving emergency, pay special attention to all of the following dive parameters EXCEPT: A. depth B. length of time the patient was underwater C. time of onset of symptoms D. time of day

D. time of day

Which of the following statements about heat cramps is FALSE? A. They only occur when it is hot outdoors. B. They may be seen in well-conditioned athletes. C. The exact cause of heat cramps is not well understood. D. Dehydration may play a role in the development of heat cramps.

A. They only occur when it is hot outdoors.

Signs and symptoms of heat exhaustion and associated hypovolemia include all of the following EXCEPT: A. cold, clammy skin with ashen pallor B. dizziness, weakness, or faintness C. normal vital signs D. moist oral mucosa

D. moist oral mucosa

Most spinal injuries in diving incidents affect the: A. cervical spine B. thoracic spine C. lumbar spine D. sacrum/coccyx

A. cervical spine

Often, the first sign of heatstroke is: A. a change in behavior B. an increase in pulse rate C. an increase in respirations D. hot, dry, flushed skin

A. a change in behavior

The least common but most serious illness caused by heat exposure, occurring when the body is subjected to more heat than it can handle and normal mechanisms for getting rid of the excess heat are overwhelmed, is: A. hyperthermia B. heat cramps C. heat exhaustion D. heatstroke

D. heatstroke

________ is the body’s reaction to inhaling very small amounts of water. A. Bronchoconstriction B. Laryngospasm C. Esophageal spasms D. Swelling in the oropharynx

B. Laryngospasm

Treatment of drowning and/or near drowning begins with: A. opening the airway B. ventilation with 100% oxygen via a 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

In a diving emergency, __________ occurs when bubbles of gas, especially nitrogen, obstruct the blood vessels. A. compression sickness B. decompression sickness C. pulmonary sickness D. nitrogen toxicity

B. decompression sickness

Young children can drown in as little as __________ of water if left unattended. A. 1 inch B. 2 inches C. 3 inches D. 4 inches

A. 1 inch

You should never give up on resuscitating a cold-water drowning victim because: A. when the patient is submerged in water colder than body temperature, heat is maintained in the body B. the resulting hypothermia can protect vital organs from the lack of oxygen C. the resulting hypothermia raises the metabolic rate D. heat is conducted from the water to the body

B. the resulting hypothermia can protect vital organs from the lack of oxygen

The three phases of a dive, in the order they occur, are: A. ascent, descent, and bottom B. descent, bottom, and ascent C. orientation, bottom, and ascent D. descent, orientation, and ascent

B. descent, bottom, and ascent

Areas usually affected by descent problems include: A. the lungs B. the skin C. the joints D. vision

A. the lungs

Potential problems associated with rupture of the lungs include all of the following EXCEPT: A. air emboli B. pneumomediastinum C. pneumothorax D. hemopneumothorax

D. hemopneumothorax

The organs most severely affected by air embolism are the: A. brain and spinal cord B. brain and heart C. heart and lungs D. brain and lungs

A. brain and spinal cord

Black widow spiders may be found in all of the following EXCEPT: A. New Hampshire B. woodpiles C. Georgia D. Alaska

D. Alaska

Coral snake venom is a powerful toxin that causes __________ of the nervous system. A. paralysis B. hyperactivity C. hypoactivity D. hemiparesis

A. paralysis

Rocky Mountain spotted fever and Lyme disease are both spread through the tick’s: A. saliva B. blood C. hormones D. excrement

A. saliva

Signs of envenomation by a pit viper include all of the following EXCEPT: A. swelling B. chest pain C. ecchymosis D. severe burning pain at the site of the injury

B. chest pain

Removal of a tick should be accomplished by: A. suffocating it with gasoline B. burning it with a lighted match to cause it to release its grip C. using fine tweezers to pull it straight out of the skin D. suffocating it with Vaseline

C. using fine tweezers to pull it straight out of the skin

Which of the following statements regarding the brown recluse spider is FALSE? A. It is larger than the black widow spider. B. It lives mostly in the southern and central parts of the country. C. Venom is not neurotoxic. D. Bites rarely cause systemic signs and symptoms.

A. It is larger than the black widow spider.

Treatment of a snakebite from a pit viper includes all of the following EXCEPT: A. calming the patient B. not giving anything by mouth C. marking the skin with a pen over the swollen area to note whether swelling is spreading D. providing water to drink

D. providing water to drink

At 1400 in July, the weather is 105°F (41°C) and very humid. You have been called for a “man down” at the park. As you arrive, you recognize him as an alcoholic who has been a “frequent flyer” with your service. As you begin to assess him, his speech is unintelligible, and he is clearly weak and confused. As you assess the patient, he has cold, clammy skin and a dry tongue. You suspect that: A. he is well hydrated B. he has suffered heat exhaustion C. he is hypothermic D. he has heatstroke

B. he has suffered heat exhaustion

At 1400 in July, the weather is 105°F (41°C) and very humid. You have been called for a “man down” at the park. As you arrive, you recognize him as an alcoholic who has been a “frequent flyer” with your service. As you begin to assess him, his speech is unintelligible, and he is clearly weak and confused. The patient suddenly loses consciousness, and you note that his skin is flushed, hot, and dry in many areas. You also note that he is no longer actively perspiring. You begin to suspect that his condition has evolved into: A. hyperthermia B. hypothermia C. intoxication D. heatstroke

D. heatstroke

At 1400 in July, the weather is 105°F (41°C) and very humid. You have been called for a “man down” at the park. As you arrive, you recognize him as an alcoholic who has been a “frequent flyer” with your service. As you begin to assess him, his speech is unintelligible, and he is clearly weak and confused. The direct transfer of heat from the hot air surrounding him to his body is: A. conduction B. convection C. radiation D. evaporation

B. convection

At 1400 in July, the weather is 105°F (41°C) and very humid. You have been called for a “man down” at the park. As you arrive, you recognize him as an alcoholic who has been a “frequent flyer” with your service. As you begin to assess him, his speech is unintelligible, and he is clearly weak and confused. Treat this patient by doing all of the following EXCEPT: A. promote conduction heat loss B. promote convection heat loss C. remove the patient from the environment D. handle him roughly

D. handle him roughly

Small infants have a poor ability to thermoregulate and are unable to shiver to control heat loss until about the age of: A. 4 to 6 months B. 6 to 12 months C. 12 to 18 months D. 18 to 24 months

C. 12 to 18 months

Most heatstroke cases occur when the temperature is above _______ and the humidity is 80%. A. 80°F (27°C) B. 90°F (32°C) C. 100°F (38°C) D. 110°F (43°C)

A. 80°F (27°C)

Often, the first sign of heatstroke is a change in _______. A. behavior B. skin turgor C. blood pressure D. perspiration

A. behavior

True/False Normal body temperature is 98°F (36.7°C).

True

True/False To assess the skin temperature in a patient experiencing a generalized cold emergency, you should feel the patient’s skin.

True

True/False Mild hypothermia occurs when the core temperature drops to 85°F (29°C).

False

True/False The body’s most efficient heat-regulating mechanisms are sweating and dilation of skin blood vessels.

True

True/False The people who are at greatest risk for heat illnesses are the elderly and children.

True

True/False The strongest stimulus for breathing is an elevation of oxygen in the blood.

False

True/False Immediate bradycardia after jumping in cold water is called the diving reflex.

True

True/False Ice should be promptly applied to any snakebite with swelling.

False

True/False The most common type of pit viper is the copperhead.

False

True/False Cottonmouths are known for aggressive behavior.

True

True/False Ticks should be removed by firmly grasping them with tweezers while rotating them counterclockwise.

False

True/False The pain of coelenterate stings may respond to flushing with cold water.

False

True/False If you are unsure as to whether a hypothermic patient has a pulse present, palpate the carotid artery for 15 to 20 seconds.

False

True/False The goal with the patient with moderate to severe hypothermia is to prevent further heat loss.

True

True/False After a lightning strike, you should practice reverse triage.

True

True/False Extremes in temperature and humidity are needed to produce hot or cold injuries.

False

True/False When approaching a water rescue scene, it is better to drive through moving water than through stagnant water.

False

True/False Potential safety hazards in the environment can include wet grass, mud, or icy streets.

True

True/False Long-sleeved shirts and long pants are considered dangerous for EMS responders in extreme heat and are not necessary because they provide only minimal protection from exposure.

False

Active rewarming of patients who have ________ to ________ is best accomplished in the emergency department.

moderate, severe

Most serious diving injuries occur during ________.

ascent

When treating a patient with frostbite, never attempt ________ if there is any chance that the part may freeze again before the patient reaches the hospital.

rewarming

A patient at an altitude above 8,000 feet (3,048 m) with shortness of breath and cough with pink sputum is likely to be suffering from ________-________ _________ _________.

high-altitude pulmonary edema

________, a common effect of hypothermia, is the body’s attempt to increase its heat production.

Shivering

Whenever a person dives or jumps into very cold water, the ________ ________ may cause immediate bradycardia.

diving reflex

________ is the transfer of heat by radiant energy.

Radiation

Mild hypothermia occurs when the core temperature is between ________ and ________.

93.2*F (34*C), 98*F (36.7*C)

The ________ and ________ systems are the most commonly injured during a lightning strike.

cardiovascular, nervous

________ is the fifth most common cause of death from isolated environmental phenomena.

Lightning

________ is a serum containing antibodies that counteracts venom.

Antivenin

________ (bees, wasps, ants, and yellow jackets) stings are painful but are not medical emergencies unless the patient is allergic to the venom.

Hymenoptera

Most snakebites occur between ________ and ________ when the animals are active.

April, October

In the United States, the most common form of pit viper is the ________.

rattlesnake

________ are eight-legged arachnids with a venom gland and stinger at the end of their tails.

Scorpions

Tick bites occur most commonly during the ________ months.

summer

The first symptoms of Lyme disease are generally fever and flulike symptoms, sometimes associated with a ________ rash.

bull's-eye

To treat a sting from a jellyfish, pour ________ on the affected area.

vinegar

Coelenterates are responsible for more ________ than any other marine animals.

envenomations

Toxins from the spines of urchins and stingrays are ________ ________.

heat sensitive

Short Answers What are three ways to modify heat loss? Give an example of each.

1. Increase or decrease heat production: shiver, jump, walk around, etc. 2. Move to an area where heat loss is decreased or increased: out of wind, into sun, etc. 3. Wear insulated clothing, which helps decrease heat loss in several ways: layer with wool, down, synthetics, etc.

Short Answers What are the steps in treating heatstroke?

1. Move the patient out of the hot environment and into the ambulance. 2. Set the air conditioning to maximum cooling. 3. Remove the patient’s clothing. 4. Administer high-flow oxygen if indicated. If needed, assist the patient’s ventilations with a bag-mask device and appropriate airway adjuncts as per your protocol. 5. Provide cold-water immersion in an ice bath, if possible. 6. Cover the patient with wet towels or sheets, or spray the patient with cool water and fan him or her to quickly evaporate the moisture on the skin. 7. Aggressively and repeatedly fan the patient with or without dampening the skin. 8. Exclude other causes of altered mental status and check blood glucose level, if possible. 9. Provide rapid transport to the hospital. 10. Notify the hospital as soon as possible so that staff can prepare to treat the patient immediately on arrival. 11. Do not overcool the patient. Call for ALS assistance if the patient begins to shiver.

Short Answers What is an air embolism, and how does it occur?

An air embolism is a bubble of air in the blood vessels caused by breath-holding during rapid ascent. The air pressure in the lungs remains at a high level while the external pressure on the chest decreases. As a result, the air inside the lungs expands rapidly, causing the alveoli in the lungs to rupture.

Short Answers For what diving emergencies are hyperbaric chambers used?

Treatment of air embolism and decompression sickness. The recompression treatment allows the bubbles of gas to dissolve into the blood and equalize the pressures inside and outside the lungs.

Short Answers How should a frostbitten foot be treated?

1. Remove the patient from further exposure to the cold. 2. Handle the injured part gently, and protect it from further injury. 3. Remove any wet or restricting clothing from the patient, especially over the injured part. 4. Remove any jewelry from the injured part and cover the injury loosely with a dry, sterile dressing. 5. Splinting a frostbitten extremity may also help prevent secondary injury by limiting use. 6. Evaluate the patient’s general condition for the signs or symptoms of systemic hypothermia. 7. Support the vital functions as necessary, and provide rapid transport to the hospital.

Short Answers What are four “Do Nots” in relation to local cold injuries?

1. Do not break blisters. 2. Do not rub or massage area. 3. Do not apply heat or rewarm unless instructed by medical control. 4. Do not allow patient to stand or walk on a frostbitten foot. 5. Do not reexpose the injury to cold.

Short Answers What treatments for a snakebite assist with slowing and monitoring the spread of venom?

1. Have the patient lie flat and stay quiet. 2. Wash the bite area with soapy water; consider a constricting band for hypotensive patients. 3. Splint the extremity. 4. Mark the skin with a pen to monitor advancing swelling.

Short Answers What are the two most common poisonous spiders in the United States, and how do their bites differ?

Black widow: Bite has a systemic effect (venom is neurotoxic). Brown recluse: Bite destroys tissue locally (venom is cytotoxic).

Ambulance Calls You are called to the local airport for a 52-year-old man who is the pilot of his own aircraft. He tells you that he is having severe abdominal pain and joint pain. History reveals that the patient is returning from a dive trip off the coast. He says he has had “the bends” before, and this feels similar. How would you best manage this patient?

Provide BLS. Administer oxygen. Transport the patient in the left lateral recumbent position with the head down. Transport to a facility with hyperbaric chamber access.

Ambulance Calls You are dispatched to a long-term care facility for an Alzheimer’s patient with an “unknown problem.” You arrive to find a staff member who greets you at the front door and escorts you to a resident’s room. He explains that the patient wandered out the back exit door of the Alzheimer’s unit when the nurse was on her other rounds. They aren’t sure how this happened because each patient wears a necklace that triggers an alarm if the patient leaves this specialized wing of the facility. They found the man outside in the snow, and he was possibly outdoors for 45 minutes. How would you best manage this patient?

Your main concern for this patient is hypothermia. Although this patient could also likely have localized cold injuries such as frostbite or frostnip, hypothermia can be fatal. You must handle this patient carefully, remove any wet clothing, and prevent further heat loss. Assessing the extent of the hypothermia through mentation will be difficult in this case because the patient is likely confused. Take note of the presence of shivering (this protective mechanism stops at core temperatures >90°F or 32°C), and if possible, take his temperature (rectally). Assess airway, breathing, and circulation. Provide warm, humidified oxygen (if possible) and passive rewarming measures, such as increasing the heat in the patient compartment. Promptly transport.

Ambulance Calls You are dispatched to the local high school for a “person down.” On arrival, you are directed to the football field, where the team is practicing for an upcoming game. You find a 16-year-old boy sitting on the bench, confused and lethargic. The coach tells you that they have been practicing for a couple of hours, and the temperature is 97°F (36°C). He says that he has encouraged the guys to drink continuously and that he thought they were all well hydrated. During your assessment of the patient, you notice that his skin is cool and clammy, with a rapid, weak pulse. His temperature is 102.9°F (39.4°C) orally. He says he is thirsty but also feels nauseated, so he stopped drinking a while ago. How would you best manage this patient?

This patient is suffering from heat exhaustion. The hot environment coupled with the strenuous activity and poor hydration has overwhelmed his ability to thermoregulate. Promptly move him to the back of the ambulance with the air conditioner on high. Remove any excessive clothing. Administer high-flow oxygen, and assess his glucose level because his mental status is altered. Cover the patient with cool, wet towels and place ice packs on the trunk of the body—groin, axillae, neck. Because he is already nauseated, transport as left lateral recumbent. Assess his skin turgor, and call for ALS rendezvous for more aggressive treatment if his symptoms do not clear up promptly.

Most frostbitten parts are: A. soft and moist B. hard and waxy C. soft and waxy D. hard and moist

B. hard and waxy

If a patient has a cold skin temperature, he or she is likely: A. hypothermic B. hyperthermic C. hypovolemic D. hypoglycemic

A. hypothermic

If a patient has a hot skin temperature, he or she is likely: A. hypothermic B. hyperthermic C. hypoglycemic D. hypervolemic

B. hyperthermic

When treating multiple victims of lightning strikes, whom should you concentrate your efforts on first? A. Conscious patients B. Unconscious patients in respiratory or cardiac arrest C. All unconscious patients D. Conscious patients with burn wounds

B. Unconscious patients in respiratory or cardiac arrest

What is the best method of inactivating a jellyfish sting? A. Urinating on it B. Flushing the site with cold water C. Applying vinegar D. Applying an ice pack

C. Applying vinegar

Chapter 33 Workbook Flashcards

(111 cards)