Environmental emergencies

Question 1

What is the BCEHS definition of hypothermia?

Answer 1

Drop in core body temperature below 35C

Question 2

Describe usefulness of peripheral thermometers in hypothermia management

Answer 2

inaccurate (vary by up to 2C) but may be useful for trending

Question 3

Describe patient handling and positioning in severe hypothermia

Answer 3

gentle handling and supine positioning

Question 4

Give temperature ranges for mild, moderate, and severe hypothermia

Answer 4

• Mild: 32°C to 35°C
• Moderate: 28°C to 32°C
• Severe: 24°C to 28°C

Less than 24°C is considered “profound” hypothermia

Question 5

How long should vital signs be assessed for in hypothermic patients?

Answer 5

30-45 seconds

Question 6

What is a characteristic ECG finding in hypothermia

Answer 6

J-Waves

Question 7

How many times should defibrillation/rhythm analysis be attempted in hypothermic cardiac arrest?

Answer 7

No more than 3 times

Question 8

Should active rewarming be attempted in mild hypothermia?

Answer 8

No, only moderate or severe hypothermia

Question 9

What is definitive in-hospital management for severe hypothermia?

Answer 9

ECMO

Question 10

In what cases should transcutaneous pacing be attempted for hypothermic patients?

Answer 10

Bradycardic patients with temperature between 32°C and 35°C

These patients likely have bradycardia that is independent of hypothermia, since mild hypothermia is associated with tachycardia.

Question 11

How many doses of epinephrine should be given in hypothermic cardiac arrest?

Answer 11

up to 3

Question 12

What is the BCEHS definition of hyperthermia?

Answer 12

a core temperature over 40°C

Question 13

What is the electrolyte imbalance which is associated with heat cramps?

Answer 13

hyponatremia

Question 14

What are risk factors for heat stroke?

Answer 14

• Age:
  
  • very young or very old
• Duration of exposure to heat
• Fluid status
• Humidity!
  
  • High humidity reduced effectiveness of heat loss through sweating
• strenous activity (exertional heat loss)
• Medications or conditions which interfere with thermoregulation

Question 15

Describe prehospital management of heat stroke

Answer 15

• protect from further exposure
• Remove clothing
• use wet towels to reduce temperature
• Give IV fluids in cases of hypotension
• Correct hypoglycemia
• If necessary:
  
  • Terminate status seizures
  • Induction
  • ETI