Environmental Quiz

Question 1

What temperature does the body have to be to be considered hypothermic?

Answer 1

<35 degrees

Question 2

What are 8 signs of hypothermia?

Answer 2

• Pale
• Shivering
• Loss of concentration
• Drowsiness
• Confusion
• Dizziness
• Slurred speech
• Dilated pupils
• Decreased respiratory rate

Question 3

What are the ‘voluntary’ ways that the body increases its temperature?

Answer 3

• wearing warm clothes
• hand running
• physical activity/muscular activity
• Pacing
• Huddling
• Sheltering

Question 4

What are the ‘involuntary’ ways the increase body temperature?

Answer 4

Stimulation of the sympathetic nervous system?
- Peripheral vasoconstriction
- Brown fat oxidation (infants)
- Piloerection
- Increase basal metabolic rate (rate catecholamine’s from adrenal medulla)
- Shivering (involuntary skeletal muscle contractions - hypothalamus activates the brain stem motor centre)

Question 5

What are the 3 classifications of hypothermia?

Answer 5

Mild - 32-35 degrees
Moderate - 28-32 degrees
Severe - <28 degrees

Question 6

At what temperature do we see cardiac arrythmias?

Answer 6

<33 degrees

Question 7

How are paramedics able to administer warmed IV fluids?

Answer 7

• We can’t!
• No IV fluid warmers are stocked

Question 8

What time frame is Adrenaline administered in the cardiac arrest patient with a temp <30 degrees?

Answer 8

8 minutely

Question 9

How can you warm the hypothermic patient?

Answer 9

• Remove all wet clothes and dry patient
• Ensure heaters are on in the ambulance (Target temp of 24 degrees in the truck)
• Cover the patient with a sheet/space blanket/blanket wrap (usually found premade in the rear of the ambulance)
• Minimise scene time
• If agitated (ie unable to obtain VSS due to extreme shivering and distress of patient) consider using the agitated guideline to enable warming techniques and monitoring of the patient (make sure you keep an eye on respiratory status)

Question 10

You attend a 50yoM out jogging on a 38 degree day. He was witnessed to stagger and collapse. What signs and symptoms would suggest that this patient is suffering from heat stroke?

Answer 10

• tachycardia
• hypotension
• hyperthermia >39 degrees
• dry mucous membranes
• Confused/ACS
• incoherent speech
• dizziness/collapse
• nausea/vomiting
• abnormal gait
• seizures

Question 11

What is your target temperature for the hyperthermic patient?

Answer 11

<40 degrees within 30 minutes of onset of symptoms

Question 12

What is the maximum dose of IV fluids that you can administer?

Answer 12

40mls/kg

Question 13

Why is toxin induced hyperthermia a concern?

Answer 13

Serotonin syndrome

Question 14

What are the 3 types of heat stroke?

Answer 14

• Non exertional (classic)
• Exertional
• Chemically mediated

Question 15

Why is shivering a problem (when cooling) in the hyperthermic patient?

Answer 15

Shivering may increase heat productions (cooling measures need to be adjusted to avoid this occuring)

Question 16

Which cohort of patients are most likely to suffer from classic hyperthermia?

Answer 16

• elderly and young

Question 17

How much cold IV fluids are you going to administer to your patient?

Answer 17

• titrated to adequate perfusion and consideration of temperature
• consider a slower administration in the patient with impaired renal or cardiac function
• Not passing uring (common in hyperthermic patient) is considered renal impairment

Question 18

Why is it important to identify if the patient is suffering from a toxin induced hyperthermia?

Answer 18

• standard cooling techniques are unlikely to be effective alone, as the intrinsic cause cannot be fully addressed pre hospital
• Pt will usually require neuromuscular paralysis (MICA)