Environment

Question 1

Which of the following statement is correct regarding heat exhaustion and heat stroke?

a) Heat exhaustion patients have a temp >40.5.
b) Heat exhaustion patients can have CNS changes.
c) Heat stroke only occurs in people exercising in the heat.
d) Ice water immersion is an optimal treatment for heat exhaustion.
e) Heat exhaustion can be treated with oral fluids.

Answer 1

E.

Heat exhaustion causes non-specific malaise, headache and fatigue. Body temp is usually under 40.5. There is no history of coma or seizures. Dehydration is present and patients can have orthostatic hypotension. Treatment is with rest in a cool environment, IV fluids if orthostatic hypotension is present otherwise oral fluids.

Heat stroke is divided into classical (occurs in high ambient temperature and usually to the elderly or those with comorbidities) and exertional (occurs with exercise in hot environments to young more active individuals who can actually have diaphoretic skin). Temps are usually over 40.5 and patients have dry skin (unless exertional). Altered GCS, seizures or coma. The classic heat stroke patient may have elevated AST/ALT whereas exertioan lheat stroke patients will also have raised lactate, DIC, acute renal failure and rhabdomyolysis.

Treatment involves water mist and fans, ice water immersion. Patients having seizures will need intubation and active cooling.

Question 2

Which of the following classic temps relate to the hypothermic symptoms or sign?

a) 32-34.9 hypotension
b) 32-34.9 Osborne waves
c) 28-31.9 loss of shivering
d) 28-31.9 acidaemia
e) <28 dilated pupils

Answer 2

C.

Mild hypothermia 32-34.9:

Tachypnea, tachycardia, ataxia, dysarthria, shivering

Moderate 28-31.9:

Loss of shivering, dysrhythmias, Osbourne (J) waves on ECG, decreased LOC, combative behaviour, muscle rigidity, dilated pupils.

Severe <28:

Coma, hypotension, acidaemia, VFib, asystole, flaccidity and apnoea

Question 3

Which of the following is passive external rewarming?

a) Insulating blanket
b) Warming blankets
c) Humidified oxygen
d) Warmed IV fluids
e) Peritoneal dialysis with warmed fluids

Answer 3

A.

Passive re-warming involves taking off any damp clothes, putting dry ones on and using an insultating blanket so the patient can use their own body to re-warm by shivering. As long as they are not losing heat they will re-warm (like what happens to most of us on a cold day.

Question 4

Which of the following is active external re-warming?

a) Insulating blanket
b) Warming blankets
c) Humidified oxygen
d) Warmed IV fluids
e) Peritoneal dialysis with warmed fluids

Answer 4

B.

Active external re-warming involves using an hot environment to warm the patient, wither turning up the room temp or adding a warm blanket. There is a risk of the ‘afterdrop’ phenomenon if active core re-warming is not also used.

Question 5

Which of the following is active core re-warming?

a) Insulating blanket
b) Warming blankets
c) Humidified oxygen
d) Warmed IV fluids
e) Peritoneal dialysis with warmed fluids