Deck 25: Submersion Incidents: Drowning and Diving Emergencies

Question 1

A 24-year-old intoxicated female patient was pulled from a pool by hotel personnel. The primary assessment reveals her airway to be open and her breathing adequate. Her radial pulse is strong but fast and she is persistently coughing. Vital signs are pulse 144, respirations 24, blood pressure 166/100; and SpO2 93%. Which one of the following would be considered appropriate in the care of this patient?

A) Abdominal thrusts to remove water from the lungs
B) Supplemental oxygen through a nasal cannula
C) Deep oral suctioning to remove water from the airway
D) Precautionary application of the automated external defibrillator

Answer 1

B

Question 2

You have been called to a hotel swimming pool for a confused adult male. Patrons state that the man has been drinking most of the afternoon and has been in and out of the pool. The man is very confused and noncompliant with your requests. His airway is open and his breathing is adequate. His radial pulse is strong, and his skin is wet with water from the pool. While conducting the secondary assessment, you note a large hematoma to the back of his head. Which one of the following should you do next?

A) Take in-line spinal stabilization and apply a cervical collar.
B) Apply a cold pack to the hematoma and continue the assessment.
C) Check the man's pupils and hand grips for equality.
D) Transfer the patient to the stretcher and provide immediate transport.

Answer 2

A

Question 3

Which statement by the EMT indicates proper application of the term drowning?

A) "A drowning occurs when a person dies while in water, regardless of cause."
B) "A drowning occurs any time a person is submerged in water and dies as a result."
C) "A drowning occurs any time a person is submerged in a liquid and suffers some sort of respiratory impairment."
D) "A drowning occurs any time a person is submerged in a liquid and dies; also the incident must be deemed to have been preventable."

Answer 3

C

Question 4

You are by the side of a young male patient who hit his head after diving from a hillside into a shallow lake. The patient is unresponsive and has a large hematoma to his chin. A paramedic asks you to apply painful stimuli to his arms and legs. You recognize that the paramedic wants you to assess for which one of the following?

A) Alcohol intoxication
B) True unresponsiveness
C) Extremity fractures
D) Spinal injury

Question 5

When working the scene of a water rescue, any time that the EMT is within 10 feet of the water's edge, it is essential that she have what equipment for personal safety?

A) Rope secured to the waist
B) Examination gloves
C) Personal flotation devices
D) SCUBA equipment

Question 6

The EMT shows she understands the concept of the mammalian diving reflex by stating:

A) "It is a protective mechanism that occurs when the spinal column is compressed as would occur in a diving accident."
B) "It occurs in warm water and serves to increase blood flow to the vital organs."
C) "It may provide benefit to the patient by diverting oxygen-rich blood to the brain and heart."
D) "It occurs in cold water and increases the activity of the vital organs, thus protecting them."

Question 7

You and several other EMTs are on location where a young female lost control of her car, and ended up in a shallow lake. The car is approximately 20 feet from shore and upright with the wheels touching the bottom of the lake. The woman is on the car's roof stating that she is not hurt but is scared. Which of the following should the EMT do to rescue the patient?

A) Swim out to retrieve the patient.
B) Toss a rope with a throw bag to the patient.
C) Extend a ladder across the water to the car and patient.
D) Encourage the patient to swim to shore.

Question 8

The head of the water rescue team has just informed you that the divers have retrieved a young woman who fell through ice on a pond while walking her dog. The estimated submersion time is 22 minutes. Another EMT asks you if you think it is going to be necessary to start resuscitation, given the length of submersion. Which one of the following is the most appropriate reply?

A) "Let's assess her first. If she does not have a pulse, then we will contact medical direction for orders to not resuscitate."
B) "Our resuscitation will consist of CPR only. The AED is contraindicated if the patient is hypothermic."
C) "Probably not. Given the amount of time she was submerged in the water, there is most likely little that can be done."
D) "Absolutely! Given that she has been in cold water, she may still have a chance at living."

Question 9

Which one of the following rescuers would be the most appropriate choice to rescue an injured man clinging to an overturned boat in a shallow lake?

A) A seasoned EMT who is a good swimmer and has personal flotation devices on and a rope around his waist
B) A firefighter wearing personal flotation devices with no medical training but who is a good swimmer and trained in water rescue
C) An EMT who is a good swimmer and has personal flotation devices in place
D) A firefighter who is also an EMT and worked as a lifeguard before becoming a firefighter

Question 10

A patient who was found face down in a pond is unresponsive, apneic, and pulseless. Friends state that the patient was hot and wanted to take a summer's swim in the pond. Which one of the following should be included in your care of this patient?

A) Hyperventilation with a bag-valve mask and high-concentration oxygen
B) Positive pressure ventilations at 10-12 per minute with oxygen
C) Position in a prone position to evacuate water from the lungs
D) Application of the AED with the delivery of no more than one shock

Question 11

Torrential rains have been falling over the past few days and your service area is experiencing major flooding. While returning to the disaster command post, you are flagged down by a group of people who inform you that a woman is clinging to a tree in the middle of a rapidly moving and swollen stream. She is screaming for help and states that she does not know how much longer she can hang on. Which one of the following should you do immediately?

A) Throw a rope toward the patient.
B) Call for a water rescue team and boat.
C) Swim out and retrieve the patient.
D) Toss a life preserver in the vicinity of the patient.

Question 12

Friends pulled an unresponsive 15-year-old male from a lake. They say they were swimming when they lost track of him. Assessment reveals labored breathing and a weak pulse. Which of the following questions would give the EMT the most information related to the prognosis of the patient?

A) "Does he have a history of breathing problems?"
B) "How long was he under the water?"
C) "Was he drinking or doing drugs?"
D) "Is there any chance he hit his head?"

Question 13

The EMT is correctly using a rope with a throw bag when he:

A) tosses the throw bag using an underhand motion toward the patient.
B) throws the rope overhand and slightly beyond the patient's location.
C) goes downstream and floats the throw bag toward the patient.
D) ties the throw bag to a stationary object and throws the rope to the patient.

Question 14

A teenage female has been removed from a pool. Your assessment reveals her to be responsive to painful stimuli with decorticate posturing. Her airway has water in it and she appears to be vomiting water. Breathing is agonal at 8 breaths per minute. Her pulse is weak and slow. Which one of the following should you do immediately?

A) Place a nasopharyngeal airway.
B) Administer abdominal thrusts.
C) Start positive pressure ventilation.
D) Suction water from the airway.

Question 15

You have been asked to present information on water safety and drowning to a community civic group. In regards to prevention, which of the following points would you emphasize?

A) The vast majority of children who drown do so in public swimming pools.
B) A significant number of drownings are preventable due to the involvement of alcohol.
C) Those with seizure disorders are safe in the water if they wear personal flotation devices.
D) Most authorities agree that children under the age of 3 years should be taught to swim.

Question 16

Which one of the following statements about drowning is true?

A) Actual drownings are responsible for only a small number of water-related deaths.
B) Children less than 1 year of age most commonly drown in swimming pools.
C) Fences around swimming pools are the most effective means of preventing a child from drowning.
D) Personal flotation devices afford little protection to a patient if he or she panics while in the water.

Question 17

You have been dispatched to a pool party for a 19-year-old male with shoulder pain. He states that he dove off the diving board and hit the bottom of the pool with his right shoulder and back. Although there is alcohol at the party, he has not been drinking. He is alert and oriented and has obvious redness and abrasions to his right shoulder, neck, and back. He denies pain or discomfort to any other part of the body. Your next action would be to:

A) measure and apply a cervical collar.
B) establish manual in-line spinal stabilization.
C) provide supplemental oxygen.
D) perform the secondary assessment.

Question 18

A 49-year-old man was fishing in a stream of cold water when he became submerged after getting tangled in some hidden roots. The patient was pulled from the stream by friends after approximately 5 minutes of submersion. Your assessment reveals him to be responsive to painful stimuli and breathing 5 times per minute. His pulse is weak and rapid. Which of the following instructions should you give to the team of rescuers?

A) "Do not wipe the water off him. It will keep his body cool and protect vital organs like his brain and heart."
B) "Do not apply the AED if he goes into cardiac arrest. The water was very cold and the AED is contraindicated in hypothermia."
C) "I need someone to perform abdominal thrusts to see if he took water into his stomach."
D) "Let's move him into the warm ambulance as quickly as possible, and then cut off his clothes and cover him."

Question 19

A child has been pulled from the pool after being submerged for less than 30 seconds. The child is crying and hyperventilating, as well as coughing up water and vomiting. The EMT should:

A) place the child prone to help evacuate water from the lungs.
B) administer abdominal thrusts with the child in a supine position.
C) place the child on his side and perform a primary assessment.
D) insert an oral airway and provide oxygen via nonrebreather mask.

Question 20

Which patient has the best chance for an optimal outcome after drowning?

A) 34-year-old female submerged for 9 minutes in 39°F water
B) 47-year-old male submerged for 8 minutes in a heated swimming pool
C) 22-year-old female submerged for 10 minutes in a whirlpool with 90°F water
D) 17-year-old female submerged for 10 to 12 minutes in warm salt water

Question 21

As a patient rises too quickly from a deep sea dive, the nitrogen in his bloods forms ever-enlarging bubbles. The bubbles then cause damage to internal organs and tissues. The EMT would recognize this as applying to:

A) Boyle law.
B) Dalton law.
C) Charles law.
D) Henry law.

Question 22

A 23-year-old diver has been brought to the surface by fellow divers after behaving erratically while in the water. Your assessment reveals him to be confused and uncoordinated with an open airway and adequate breathing. He has a strong radial pulse and a SpO₂ of 98%. He is diabetic and your partner reports that his blood sugar is 91 mg/dL. The remainder of your assessment is unremarkable. Based on this presentation and history, which one of the following would be the most likely cause of his condition?

A) Hypoglycemia
B) Increased nitrogen levels in the blood
C) Hypoxia and hypoglycemia
D) Seizure activity

Question 23

You are assessing a young child who was briefly submerged after falling approximately 20 feet from an observation platform into the shallow portion of a lake. Family members jumped into the lake immediately and pulled the girl to safety. She is confused and begins to vomit water. Which one of the following should you do immediately?

A) Suction, using a rigid-tip catheter.
B) Place her in a side-lying position.
C) Check her breath sounds.
D) Perform the head-tilt, chin-lift.

Question 24

A young male has been pulled from a lake by his friends after being submerged for several minutes. Assessment reveals his airway to be patent, respirations absent, and a weak carotid pulse of 12 beats per minute. At this time, you should:

A) attach the AED, provide one shock if indicated, start CPR, and transport to the hospital.
B) administer one shock with the AED, start CPR, and withhold additional shock until the patient is rewarmed.
C) insert an oropharyngeal airway, provide positive pressure ventilation, start CPR, and transport.
D) start positive pressure ventilation, place on a long board, and transport to the hospital.

Question 25

You have been put in charge of creating a protocol that will direct care provided by EMS. In regards to a drowning patient who is severely hypothermic and in cardiac arrest, what would you propose?

A) Provide CPR only and withhold the AED.
B) Withhold resuscitation if the patient's temperature is lower than 86∘F.
C) Apply the AED and shock once if indicated. Contact medical direction if additional shocks are needed
D) Administer the usual care provided to any other patient in cardiac arrest.

Question 26

While at a public pool obtaining a refusal from a patient who was stung by a bee, you hear screaming. Patrons are waving you over to a 13-year-old boy who hit the diving board with his head while diving and is now in the water motionless. The lifeguard is in the water and informs you that the patient's eyes are open and he is breathing with a pulse, but not talking. Which one of the following should you do next?

A) Instruct the lifeguard to carefully float the boy to the side of the pool so you can assess and immobilize him.
B) Have the lifeguard quickly remove the patient from the pool so assessment and emergency medical care can be given.
C) Position the boy upright against the lifeguard with in-line spinal precautions observed during removal from the pool.
D) Pass a cervical collar and long board into the water to immobilize the patient prior to extrication from the water.

Question 27

A 22-year-old male was fishing when he was submerged for approximately 30 seconds after he moved into deeper water to untangle his fishing line. He states that he did take some water into his lungs but feels better now and does not see the need to be transported to the hospital. Which one of the following responses is most appropriate?

A) "We will wait here with you for another 20 minutes. If you do not cough, then you should be okay, and I will feel better about letting you refuse transport."
B) "Let me listen to your breath sounds again. If they are clear, then you should be okay to refuse additional care and transport."
C) "You seem okay now, but it may take a day or two for complications to become apparent. You really should be checked out in the hospital."
D) "Your pulse oximetry reading is 97% on room air, which indicates that you are breathing adequately. You should be okay to refuse, but keep an eye on yourself."

Question 28

A confused and lethargic 22-year-old male patient with no medical history came up from a deep sea dive and is now complaining of shortness of breath and sharp pain, which he localizes to the right side of his chest. He denies nausea, vomiting, or dizziness. You have applied oxygen and are getting ready for transport. How will you transport this patient on the stretcher?

A) Lateral recumbent
B) Semi-Fowler's
C) Supine
D) Trendelenburg (shock position)

Question 29

A patient is in cardiac arrest after being submerged in a pond for 15 minutes. You note that his abdomen is greatly distended and it is very difficult to ventilate him. Which one of the following should you do next?

A) Ventilate more forcibly at a rate of 20-24 breaths per minute.
B) Administer chest compressions to evacuate water from the body.
C) Place the patient on his side and firmly press on the abdomen.
D) Administer five abdominal thrusts (Heimlich maneuver).

Question 30

A 57-year-old diver has been brought to the surface by fellow divers. He is complaining of difficulty breathing, dizziness, and severe chest pain. He states that he has a cardiac history and takes nitroglycerin, which is in his belongings nearby. Emergency Medical Responders report the following vital signs: pulse 128, respirations 18, blood pressure 88/56 mmHg, and SpO₂ at 96%. After applying oxygen to the patient, your next action should be to:

A) perform a secondary assessment.
B) assist the patient in taking his nitroglycerin.
C) administer a bronchodilator through a metered-dose inhaler.
D) transport the patient in a head-down position (Trendelenburg).

Question 31

A fisherman fell through the ice and was submerged in a lake for approximately 4 minutes before being pulled out by friends. You find the man to be unresponsive, not breathing, and without a pulse. Which one of the following should you do immediately?

A) Start cardiopulmonary resuscitation.
B) Apply the automated external defibrillator.
C) Immobilize the patient.
D) Determine the patient's core temperature.

Question 32

An alert and oriented 29-year-old male diver surfaced and called 911 for severe right ear pain. When asked, he specifically denies nausea, dizziness, or pain other than in his ear. Assessment reveals no threats to the airway, breathing, or circulation. The ear shows no obvious injury or discharge. His vital signs are: pulse 96, respirations 16, blood pressure 146/76, and SpO₂ at 97%. Which one of the following is the best and proper care for this patient?

A) Transport to a recompression chamber
B) Immobilization with a cervical collar and backboard
C) Oxygen and transport to the emergency department
D) Gauze in the ear canal to decrease outside pressure

Question 33

At a pool party, a 48-year-old female was pulled from the water after being submerged for 10 seconds. The patient responds to verbal stimuli by moaning and has an intact airway with adequate respirations. Her heart rate is 116 beats per minute and SpO₂ 97%. Which statements made by friends would be considered most important at this time?

A) "She is scheduled for knee surgery next week."
B) "She is allergic to many medications."
C) "She is not a very good swimmer."
D) "She takes insulin for her sugar condition."

Question 34

A patient has been pulled from a pool in which he was submerged for several minutes. He is pulseless and apneic. An Emergency Medical Responder asks you if you want to press on the man's abdomen to remove the water from his stomach. Which one of the following is the most appropriate reply?

A) "That sounds good. We need to get that water out of him to minimize the risk for an infection."
B) "Let's hold off on that until we see how well we can ventilate the patient."
C) "That is no longer recommended in the care of the submersion patient."
D) "Yes. But let's turn the patient onto his front so the water can drain naturally."

Question 35

You are by the side of a male patient who was deep sea diving earlier in the day. The 32-year-old informs you that he thinks he pulled a muscle in his shoulder, which has been hurting more as the day goes on. When questioned, he admits to having a headache and blurred vision. You are suspicious of decompression sickness. Which one of the following statements made by the patient would be most significant given the situation?

A) "I spent some time in a pocket of warm water."
B) "I ate seafood the night before."
C) "I saw a shark and came up as fast as I could."
D) "I took Tylenol before the dive for a headache."

Question 36

You have been called to a local emergency department to transfer a male patient to a specialty facility for further care. The man was involved in a deep sea dive emergency and has been diagnosed with barotrauma. As such, which of the following should be expected?

A) Pain and deafness to the ears
B) Right upper quadrant pain and vomiting
C) Itchy, blotchy, or mottled skin
D) Weakness or paralysis to the extremities

Question 37

A diver has summoned 911 after he came to the surface and became short of breath and "itchy" all over. Additionally he complains of a headache. Assessment reveals a patent airway, adequate breathing, clear breath sounds, and the following vital signs: pulse 92, respirations 20, blood pressure 156/62, and SpO₂ at 96%. Proper care of this patient should include which one of the following?

A) High-concentration oxygen and epinephrine via Epi-pen
B) High-concentration oxygen through a nonrebreather face mask
C) Epinephrine through an Epi-pen, and immediate transport to the hospital
D) Oxygen, epinephrine through an Epi-pen, and bronchodilator from an MDI