8 free EMT practice questions: Environmental Emergencies

Severe hypothermia developing quickly enough to stop the heart: Hypothermia severe enough to stop the heart is a real way cold water kills. Hypothermia takes far longer than a minute. The core temperature has to fall a lot, and that takes tens of minutes to hours even in very cold water. Water pulls heat out of the body much faster than air does, but the cooling is still not instant.

Rapid loss of muscle strength and coordinated swimming ability: Losing muscle strength and the ability to swim, called swim failure, is the second phase. Swim failure comes after several minutes, as the cold reaches the nerves and muscles of the arms and legs. The patient can no longer keep their head above water. This patient was out within a minute, before swim failure sets in.

Sudden loss of consciousness caused by a cold-induced arrhythmia: A cold-induced arrhythmia with sudden collapse is mostly a danger during and after the rescue. A cold, irritable heart can be set off by rough handling or by lifting the patient straight up out of the water. The arrhythmia happens later, in a colder patient. This patient is conscious and breathing.

Triage the pulseless patient as expectant and treat them last: In most other mass-casualty incidents, like blunt trauma, penetrating trauma, or a blast, a pulseless patient is triaged as expectant. The crew then works on the patients who can be saved. Lightning reverses that rule. Treating the pulseless patient last here gives up on the patient most likely to survive with immediate care.

Fully assess the walking patients before starting resuscitation: A triage sweep often comes first at a mass-casualty scene. The walking patients here are conscious and report only minor burns, so they have already survived the strike. The pulseless patient is losing the only minutes when a lightning arrest can be reversed. Assessing the walking patients first spends those minutes on information that will not change anyone's outcome.

Transport the walking, minor-burn patients first: Patients who are walking with minor burns are the walking wounded, the lowest priority in any triage system. Lightning burns are usually superficial. Transporting the walking patients first ties up the crew and the ambulance while the only critical patient goes untreated.

Heat cramps from electrolyte loss in sweat: Heat cramps are at the mild end of heat illness and come from the same cause. Heat cramps are painful spasms in the muscles that have been working hard. Cramps do not cause the dizziness and weakness this patient has.

Heat stroke from a core temperature above 101°F: Heat stroke is defined by altered mental status and a cooling system that has failed. A temperature number alone does not make it heat stroke. This patient is oriented to person, place, time, and situation and is still sweating. A core temperature of 101.5°F with a normal mental status is still heat exhaustion.

Dehydration unrelated to the heat exposure: Dehydration is part of this patient's problem. Calling the dehydration unrelated ignores 5 hours of work in 95°F heat. The heat exposure caused both the fluid loss and the high core temperature.

Wait on scene for the advanced life support unit to start intravenous fluids: Waiting for IV fluids would make sense if the low blood pressure were the main problem. Here the heat is causing the shock, so cooling is more urgent than the fluids ALS can give. The ALS unit is 11 minutes out and the hospital is 14 minutes away. Sitting on scene for 11 minutes delays both the cooling and the trip to the hospital.

Cool the patient on scene until the skin no longer feels hot, then transport: Cooling on scene before transport is right only when a cold water immersion bath is already there. This question says there is none. Skin that no longer feels hot is also the wrong place to stop. The core temperature stays high after the skin cools. You would spend transport time on a skin check that does not tell you the core has cooled.

Transport without active cooling to avoid inducing shivering: Watching for shivering is how you prevent overcooling. Not cooling at all is a much bigger danger than overcooling. This patient is unresponsive with hot, dry skin and needs to be cooled now. If shivering starts, stop the cooling then.

Suction the frothy sputum from the mouth before doing anything else: Suction is for vomit and debris in the airway. This airway is clear of vomit and debris. Frothy sputum does not need to be suctioned, and suctioning first only delays the oxygen and warming this patient needs.

Roll the patient onto the side to drain water from the lungs: Rolling a patient onto the side is for an airway that is obstructed. Rolling does not drain water from the lungs. This airway is clear, and the patient is coughing and moving air.

Perform abdominal thrusts to clear water from the airway: Abdominal thrusts are for an obstructed airway. Like rolling, abdominal thrusts will not remove water from the lungs. This patient is alert, coughing, and moving air on both sides. Abdominal thrusts here can also cause vomiting and aspiration.

Finish active cooling at the scene before beginning transport: This patient does need active cooling. Finishing the cooling on scene delays transport. Active cooling keeps going in the ambulance on the way to the hospital.

Transport promptly, but give oral fluids en route to rehydrate: Oral fluids are for an alert patient with heat exhaustion. This patient has heat stroke and does not respond to voice. A patient who does not respond cannot swallow safely.

Reassess in 15 minutes before deciding whether to transport: Waiting to recheck might fit a mild case. An unresponsive patient with hot, dry skin has a life threatening problem. This patient needs action now, not 15 minutes of watching.

Begin rapid active cooling with ice packs to the neck, groin, and armpits: Rapid active cooling with ice packs is for heat stroke, where the patient has altered mental status. This patient is alert and oriented. That puts this patient in the heat exhaustion and heat cramps group.

Withhold fluids until vital signs are reassessed at the hospital: Holding fluids until the hospital delays the treatment this patient needs now. The patient is alert and can swallow safely, so oral fluids are appropriate on scene.

Apply high-flow oxygen and prepare for immediate active cooling: High-flow oxygen and immediate active cooling are for heat stroke with altered mental status. This patient is alert, with cramping and heavy sweating. Option D treats a problem this patient does not have.

Move the patient to shade, give oral fluids, and reassess in 15 minutes: Shade, oral fluids, and a recheck in 15 minutes is how you treat heat exhaustion. A heat exhaustion patient stays alert and is usually sweating. This patient is confused with hot, dry skin, which is heat stroke. Heat stroke needs active cooling now, not 15 minutes of watching.

Withhold cooling until the patient becomes more alert: The confusion here comes from the heat. This patient will not get more alert until the body temperature comes down. Withholding cooling until the patient is more alert delays the one treatment that fixes the confusion.

Apply a cool compress to the forehead and allow the patient to rest: A cool compress on the forehead cools far too little for a patient who is altered with hot, dry skin. Heat stroke calls for aggressive cooling, like ice packs to the neck, groin, and armpits.