Environmental Emergencies 1
How can over-hydration during prolonged exertion lead to hyponatremia?
Drinking excessive water without replacing sodium dilutes blood electrolytes. This causes confusion, headache, seizures, and can lead to brain swelling and death if not corrected.
Explain how trench foot develops and how it differs from frostbite.
Trench foot results from prolonged exposure to cold, damp environments without freezing, leading to numbness and tissue breakdown. Frostbite involves actual freezing of body tissues.
How can you minimize spinal movement when removing a patient from the water?
Use at least three rescuers to support the head, torso, and legs, maintaining alignment while transferring to a backboard or flotation device.
Why is supplemental oxygen vital for all suspected diving emergencies?
Oxygen helps shrink nitrogen bubbles and increases oxygen delivery to tissues.
Why is determining medication compliance important in psychiatric patients?
Noncompliance often leads to relapse or worsening of symptoms. Knowing whether the patient has taken their medication can guide your assessment and help anticipate possible behavior changes.
Describe the pathophysiology of hypothermia and what happens when shivering stops.
Hypothermia occurs when body heat loss exceeds production, reducing core temperature below 95°F. When shivering ceases, energy reserves are depleted, and the patient’s condition has progressed to a dangerous level.
What are the potential complications following re-warming of a hypothermic patient?
Rewarming shock can occur as cold blood returns to circulation, causing hypotension or arrhythmias. Continuous monitoring during transport is essential.
How is arterial gas embolism (AGE) different from decompression sickness?
AGE is caused by lung overexpansion that forces air into arteries, leading to sudden collapse. It appears immediately after ascent, unlike decompression sickness which develops more slowly.
Describe proper patient positioning for a diver with chest pain and shortness of breath.
Keep the patient supine and avoid Trendelenburg position. Provide high-flow oxygen and rapid transport for hyperbaric treatment.
Describe proper procedures and safety considerations for restraining a violent patient.
Use only as a last resort and with adequate personnel. Apply restraints to all four limbs, monitor airway and circulation, and document the reason and method used.
List early hypothermia and how severity is classified.
Mild hypothermia presents with shivering and confusion.
In a lightning-strike victim, which life-threatening problem should the EMT address first?
Check for cardiac arrest or apnea immediately and begin CPR if needed. These patients often respond well to early resuscitation.
What are the key signs and symptoms of decompression sickness?
Joint pain, fatigue, skin rash, or paralysis developing hours after surfacing are common. Administer oxygen and transport to a hyperbaric facility.
What are common environmental and human factors that contribute to diving emergencies?
Inadequate training, equipment failure, panic, rapid ascent, or diving under the influence all increase the risk of diving-related injury.
Why must EMTs never leave a potentially suicidal patient alone.
Suicidal patients can act impulsively, even if they appear calm. Continuous observation prevents sudden attempts and ensures the patient’s safety.
List late signs of hypothermia and how severity is classified.
Severe hypothermia leads to muscle rigidity, slow pulse, and decreased responsiveness. Severity is classified by temperature and level of consciousness.
Why can lightning-strike patients appear dead but still be viable?
Lightning can temporarily stop the heart or paralyze respiratory muscles, giving the appearance of death. Aggressive resuscitation often restores normal function.
Explain what causes decompression sickness and the 'bends.'
During rapid ascent, nitrogen dissolved in the blood forms bubbles in tissues and joints. This leads to pain, dizziness, and paralysis if not treated in a hyperbaric chamber.
What treatments should be provided to a patient experiencing high-altitude sickness?
Move the patient to a lower altitude, provide supplemental oxygen, and allow rest. Most mild cases resolve with descent and supportive care.
What are your obligations if a patient states they plan to harm themselves but refuses care?
Consider them a danger to themselves—invoke implied consent and transport under medical direction or law enforcement authority for psychiatric evaluation.
What are the signs and symptoms of frostbite and how should it be managed pre-hospital?
Frostbite presents with pale, waxy, or firm skin that may blister during rewarming. Protect the area, remove restrictive clothing, and never rub or expose the tissue to direct heat.
List key safety considerations when operating at a lightning or storm scene.
Do not approach victims until the scene is safe. Avoid tall objects, metal structures, and open areas, and stay low during ongoing storms.
Describe the assessment and treatment of barotrauma from rapid ascent or descent.
Barotrauma occurs when pressure changes damage lungs or ears. Symptoms include chest pain, shortness of breath, and ear discomfort. Administer oxygen and transport promptly.
How can EMTs prevent altitude illness during mountain operations?
Ascend gradually, stay hydrated, and avoid overexertion. Acclimatization allows the body to adapt to lower oxygen levels and prevents severe illness.
What should you do if a patient becomes suddenly aggressive or threatens violence?
Back away, protect yourself, and remove other people from danger. Request immediate law enforcement support and re-engage only when safe.