Smo - Chapter 600

Front 1

Environmental Emergencies

Drowning / Near Drowning
For cold water drowning, resuscitate all victims (unless directed not to by ___________ ___________) unless obvious signs of death are present.

Back 1

Medical Control

Front 2

Near-drowning victims in cold water have had complete recovery without any neurologic deficit following documented periods of drowning in excess of how many minutes?

Back 2

45-50 minutes.

Front 3

Cold-water drowning victims are not considered dead until they are what?.

Back 3

“warm and dead”

Front 4

what does the AHA recommends that every submersion victim be what even if its only minor?

Back 4

evaluated at a medical facility even if only minor resuscitative efforts were required.

Front 5

Drowning/Near Drowning:
______ of rescue personnel is top priority.

Back 5

Safety

Front 6

Drowning/Near Drowning:
Initiate _______ ______ and ______ for suspected spinal injuries.

Back 6

Initiate C-spine precautions and immobilization

Front 7

Drowning/Near Drowning:
if LOC is decreased then provide what ?

Back 7

provide 100% Oxygen / BVM with assisted ventilations as needed.

Front 8

what are the final steps you should take when providing treatment to a patient who is drowning?

Back 8

Begin CPR if indicated.
Begin Cardiac Monitoring, record, and evaluate EKG strip.
Establish IV / INT Normal Saline at KVO rate.
Remove wet clothing, keep patient warm, protect from heat loss and wind.

Front 9

what are the steps taken to treating a patient with hypothermia?

Back 9

1) Moderate (30°C to 34°C [86°F to 93.2°F]): start CPR, attempt defibrillation if in v-fib, establish IV access, give IV medications spaced at longer intervals, provide active re-warming.

2) Severe (<30°C [86°F]): start CPR, attempt defibrillation once if in v-fib, withhold medications until temperature >30°C (86°F), provide active re-warming.

3) Patients with a core temperature of >34°C (>93.2°F) may be passively re-warmed with warmed blankets and a warm environment.

Front 10

In the treatment of Heat cramps/Exhaustion what are the risks that should be considered?

Back 10

1. Hot, humid weather, especially during a heat wave
2. Elderly or infants
3. Patients with chronic illness
4. Patients on the following meds: anticholinergic, Beta blockers Tranquilizers, Antidepressants, Antipsychotics, ETOH, LSD, PCP, Amphetamines Cocaine

Front 11

you should provide oxygen when needed for a patient suffering or Heat cramps/ exhaustion. If the LOC s decreases, then you should provide what?

Back 11

100% Oxygen / BVM with assisted ventilations as needed and then consider need for EARLY INTUBATION (Paramedic).

Front 12

after treating a patient with heat cramps/exhaustion with oxygen, what are the remaining steps that should be taken?

Back 12

1) Begin Cardiac Monitoring, record, and evaluate EKG strip.
2) Move patient out of hot environment into air conditioned environment.
3) Remove as much clothing as possible to facilitate cooling.
4) Soak towels or sheets with cool water and place on patient. Do not cause patient to shiver.
5) Consider need for oral fluid and electrolytes replacement
6) Establish IV Normal Saline with 250 - 500cc bolus if patient is too nauseated to drink.

•Titrated to SBP >90mmHg.

7) Contact Medical Control for repeat IV Normal Saline boluses.

Front 13

heat stroke:
what signs should you look for in treating heat stroke victims?

Back 13

Temperature greater than 104F, severe alteration in LOC, coma, red, hot, dry skin may or may not be present. Progression is not always from heat exhaustion and may occur at lower than expected temperatures.

Front 14

heat stroke:
after diagnosing a patient with a heat stroke, what is the next immediate step?

Back 14

Move patient to a cool environment and remove all clothing.

Front 15

heat stroke:
In treating a pt w/ heat stroke, you should soak the body with ____ _____, but prevent shivering?

Back 15

cool water

Front 16

heat stroke:
in treatment of heat stroke, you should apply cold packs to _____, ______, and _____.

Back 16

axilla, neck and groin

Front 17

heat stroke:
you should monitor pulse oximetroy and if LOC is decreased, provide what?

Back 17

If level of consciousness is decreased then provide 100% Oxygen / BVM with assisted ventilations as needed and Consider need for EARLY INTUBATION (Paramedic).

Front 18

heat stroke:
After providing oxygen, you should Begin Cardiac Monitoring. What should you do next?

Back 18

1) Establish large bore IV Normal Saline and titrate to SBP >90mmHg and

2) treat seizures per SMO Section 412.001

3) RAPID TRANSPORT

Front 19

Treating Human and Animal bites you should first do what?

Back 19

Obtain a detailed history:

Front 20

human/animal bites:
you should determine what type of animal and its ______.

Back 20

Status (ie. general health, rabies vaccine, and abnormal behavior)

Front 21

human/animal bites:
what are the necessary steps after receiving information about the health of the animal?

Back 21

1) Determine the nature of attack: Provoked vs. non-provoked attack.
2)Time and location of the event.
3) Location of the animal. Is it observable?
4) Control visible hemorrhage.

Front 22

when treating an animal bite with a visible hemorrhage, apply sterile dressing to open wounds. Be sure to consider the use of sterile moistened dressing because why?

Back 22

because of grossly exposed bone, muscles, tendons, and ligaments.

Front 23

human/animal bites:
what treatment do you administer for minor wounds?

Back 23

1. Can be cleaned with soap and water
2. Heavily contaminated or large wounds will need to be cleaned in the Emergency Department.
3. Cover wound with sterile gauze.

Front 24

treating bee, wasp, hornet and ant bites: what are the 6 steps that should be administered?

Back 24

1) LOC & ABC’s
2) Oxygen as needed. Monitor Pulse Oximetry.
3) Gently remove sting mechanism by scraping without squeezing the venom sac. Scrape with a straight edge and DO NOT use forceps.
4) Apply cool compress to site.
5) Observe for signs of systemic allergic reaction.
6) Treat anaphylaxis per SMO Section 403.001

Front 25

Black Widow Spider Bites:
What age groups are at the highest risk for severe reaction?

Back 25

Patients who are <16 years or >60 years are at highest risk for severe reaction.

Front 26

Black Widow Spider Bites:
signs and symptoms of envenomation include what?

Back 26

1. Progressive muscle spasms (usually starting in the abdomen and back then followed by all large muscle groups)
2. Severe back, chest, and shoulder pain. (Bite on an upper extremity).
3. Nausea and vomiting.
4. Sweating.
5. Seizures.
6. Paralysis.
7. Hypertension.

Front 27

Black Widow Spider Bite:
You should clean the affected area with what?

Back 27

Clean the affected area with saline, cover with sterile dressing, and intermittently apply ice.

Front 28

Black Widow Spider Bites:
In treatment, are obstruction and suction devices helpful in delaying absorption?

Back 28

No.
Obstruction and suction devices are not helpful in delaying absorption.

Front 29

Black Widow Spider Bites:
Moderate-severe symptoms include what?

Back 29

muscle spasms, severe headache, vomiting, and paraesthesia

Front 30

Black Widow Spider Bites:
with moderate-severe symptoms present, what steps should be established?

Back 30

Establish IV Normal Saline KVO or INT.

Front 31

Black Widow Spider Bites:
who should you contact for administration of analgesics for pain?

Back 31

Medical Control ( paramedic only)

Front 32

For Snake bites, there are 3 categories in grades of envenomation. Mild, Moderate and severe. What does "mild" mean?

Back 32

Mild: Confined to bite area i.e., local edema, erythemia, ecchymosis, and bleeding.

Front 33

For Snake bites, What does "moderate envenomation" mean?

Back 33

Moderate: Beyond bite area with vomiting, metallic taste, and fasciculations.

Front 34

For snake bites, What does "severe envenomation" mean?

Back 34

Severe: Hypotension, respiratory distress, and altered mental status.

Front 35

For safety precautions, what should you do to protect the patient in a snake bite?

Back 35

Remove patient and rescuers from the area of the snake.

Front 36

what are the treatment steps for snake bites?

Back 36

1. Place patient supine: calm and at rest.
2. Remove rings or other bands which may become tight with local swelling.
3. Clean the wound and cover with a sterile dressing.
4. Immobilized bitten extremity in a dependent position.

Front 37

you should NOT use ice or cold compresses on snake bites because?

Back 37

because their use may further tissue damage.

Front 38

mouth suction in a snake bite is absolutely ____________________________

Back 38

CONTRAINDICATED.

Front 39

With a snake bite, you should mark and time the border of advancing edema with a pen every ________ minutes

Back 39

15 minutes

Front 40

In a snake bite, rapid edema is usually indicative of a more severe ______________________________

Back 40

Envenomation.

Front 41

Snake Bites:
If systemic signs and symptoms become present, you should do what?

Back 41

Transport and establish IV normal saline KVO or INT

Front 42

Cold-water drowning victims are not considered dead until they are,

A. “Alive and well”
B. “Warm and dead”
C. “Cold and deceased”
D. “Blue and bloated”

SMO 601.00 A

Back 42

B. “Warm and dead”

Front 43

Moderate hypothermia is considered:

A. <86˚F
B. 86˚-93.2˚F
C. 93.2˚-94.6˚F
D. 94.6˚-96.8˚F

SMO 602.000 A

Back 43

B. 86˚-93.2˚F

Front 44

With a patient in severe hypothermia at, <86˚F, attempt defibrillation _________if in V-Fib.

A. once
B. twice
C. three times
D. none

SMO 602.000 B

Back 44

A. once

Front 45

Body temperature great than_________is considered heat stroke.

A. 101
B. 102
C. 103
D. 104

SMO 604.000 A

Back 45

D. 104

Front 46

When a patient is stung by a bee you want to:

A. suck out the stinger using the portable suction device
B. pull out the stinger with tweezers
C. scrape the site with a straight edge such as a credit card
D. none of the above

SMO 606.001 C

Back 46

C. scrape the site with a straight edge such as a credit card

Front 47

Signs and symptoms of a black widow spider bite include:

A. hypertension
B. seizures
C. paralysis
D. all of the above

SMO 606.002 C

Back 47

D. all of the above

Front 48

When treating a patient with a poisonous snake bite you want to do all of the following EXCEPT:

A. placed patient in the supine position
B. apply a cold pack
C. mark and time the advancing edema every 15 minutes with a pen
D. remove rings or other bands around the bite

SMO 606.003 C

Back 48

B. apply a cold pack

NEVER APPLY ICE TO SNAKE BITE!

Front 49

Application of cold packs to a patient suffering from heat stroke should be to the:

A. axilla
B. neck
C. groin
D. all of the above
E. none of the above

SMO 604.000 D

Back 49

D. all of the above

Front 50

UNLIKE a snake bite, YOU MAY apply a cold pack to the site of a bee sting.

A. True
B. False

SMO 606.001 D

Back 50

A. True

Front 51

In the case of a dog bite you must contact:

A. your company officer
B. MS2
C. law enforcement and/or animal control
D. battalion chief

SMO 605.000 H

Back 51

C. law enforcement and/or animal control