NREMT Environmental Emergencies 2 — Questions and Answers
Question 1: A patient is retrieved from cold water (58°F/14°C) after 25 minutes of submersion and is in cardiac arrest. Which statement regarding resuscitation is most accurate?
- Resuscitation should not be attempted after more than 15 minutes of submersion
- Cold water drowning victims may survive prolonged submersion due to the diving reflex and hypothermia-induced metabolic slowdown (Correct answer)
- Defibrillation is contraindicated in all hypothermic cardiac arrest patients
- Standard resuscitation guidelines do not apply to submersion victims
Correct answer: Cold water drowning victims may survive prolonged submersion due to the diving reflex and hypothermia-induced metabolic slowdown
Cold water submersion victims may survive prolonged cardiac arrest due to the mammalian diving reflex and the protective effects of hypothermia on cerebral metabolism — the principle 'not dead until warm and dead' applies.
Question 2: Which rewarming method is most appropriate for a moderate hypothermia patient in the prehospital setting?
- Active external rewarming with chemical heat packs placed directly on bare skin
- Active internal rewarming with warmed IV fluids administered rapidly in the field
- Passive external rewarming by removing wet clothing and covering with insulating blankets (Correct answer)
- Immersing the patient in warm water at the scene
Correct answer: Passive external rewarming by removing wet clothing and covering with insulating blankets
Passive external rewarming — removing wet clothing, protecting from wind and ground, and covering with blankets — is the appropriate prehospital method, preventing further heat loss while avoiding complications of aggressive rewarming.
Question 3: A patient presents with painful, red, blistered feet after wearing waterlogged boots for 48 hours in cold but non-freezing conditions. The tissue is not frozen but appears mottled. Which condition is most likely?
- Deep frostbite
- Immersion foot (trench foot) (Correct answer)
- Raynaud's disease
- Cellulitis
Correct answer: Immersion foot (trench foot)
Immersion foot (trench foot) results from prolonged exposure to cold and wet conditions without freezing; it presents with painful, blistered, mottled skin and is treated by gently drying and warming the affected area.
Question 4: When monitoring a severely hypothermic patient, which cardiac dysrhythmia are you most concerned about triggering through rough handling?
- Sinus bradycardia
- Supraventricular tachycardia
- Ventricular fibrillation (Correct answer)
- First-degree AV block
Correct answer: Ventricular fibrillation
Severely hypothermic patients are at high risk for ventricular fibrillation, which can be triggered by physical stimulation or movement; gentle handling and continuous cardiac monitoring are essential.
Question 5: A construction worker presents with painful muscle cramps in the legs and abdomen after working in high heat. Vital signs are stable and the patient is alert and oriented. What is the appropriate treatment?
- Rapid cooling with ice packs and immediate IV fluid bolus
- Rest, oral electrolyte-containing fluids, and gentle stretching of the affected muscles (Correct answer)
- Transport immediately to an ED without any field intervention
- Immerse the patient in cool water to lower core temperature
Correct answer: Rest, oral electrolyte-containing fluids, and gentle stretching of the affected muscles
Heat cramps result from electrolyte depletion caused by sweating and are treated with rest, oral electrolyte replacement, and gentle stretching; advanced interventions are rarely required for this mildest heat emergency.
Question 6: A hiker descending from 12,000 feet presents with a headache, nausea, fatigue, and difficulty sleeping that began shortly after ascending to altitude. Which condition do these symptoms most likely indicate?
- Heat exhaustion
- Acute Mountain Sickness (AMS) (Correct answer)
- Carbon monoxide poisoning from a camp stove
- Severe dehydration
Correct answer: Acute Mountain Sickness (AMS)
Acute Mountain Sickness (AMS) occurs at high altitude due to reduced oxygen availability and presents with headache, nausea, fatigue, and sleep disturbance; the primary treatment is descent to a lower altitude.
Question 7: Which situation represents a contraindication to rewarming frostbitten tissue in the field?
- The patient also has mild hypothermia
- The frostbitten tissue has developed clear blisters
- There is a risk that the tissue will refreeze before the patient reaches definitive care (Correct answer)
- The patient reports severe pain in the frostbitten area
Correct answer: There is a risk that the tissue will refreeze before the patient reaches definitive care
Frostbitten tissue should not be rewarmed in the field if refreezing is possible, as thaw-refreeze cycles cause significantly greater tissue damage than keeping the tissue frozen until definitive care is reached.
NREMT Environmental Emergencies 2
A patient is retrieved from cold water (58°F/14°C) after 25 minutes of submersion and is in cardiac arrest.
Which statement regarding resuscitation is most accurate?