Management of Hypothermia in Pediatric Patients

Questions and Answers

A patient with severe hypothermia presents with a core temperature of 28°C (82.4°F), coma, and bradycardia. Which of the following is NOT a typical sign of severe hypothermia in this patient?

Muscle rigidity

Absence of shivering

Rapid, shallow breathing (correct)

Fixed and dilated pupils

What is the primary reason for administering warm normal saline (NS) fluid challenges to a patient with severe hypothermia?

To reduce the risk of cardiac dysrhythmias

To replace fluid lost due to vasodilation and leaky capillaries (correct)

To prevent hyperthermia from occurring during rewarming

To increase blood pressure and improve circulation

Which of the following is NOT recommended for managing a patient with severe hypothermia?

Administering oxygen at 12-15 L/min

Hyperventilating the patient to increase oxygenation (correct)

Rewarming extremities with hot packs

Using a bag-valve mask to ventilate the patient

A patient with severe hypothermia has a pulse but is not breathing. Which of the following actions is most appropriate?

Continue rewarming efforts and monitor for return of spontaneous circulation (ROSC) Signup and view all the answers

A patient with severe hypothermia has regained a pulse after rewarming. What is the next step in management?

Determine the cause of hypothermia and treat accordingly Signup and view all the answers

Which of the following is a reason why rewarming extremities in a patient with severe hypothermia is discouraged?

It can increase the risk of cardiac dysrhythmias Signup and view all the answers

Which of the following is NOT a consideration when managing a patient with severe hypothermia?

Administering antibiotics to prevent infection Signup and view all the answers

A patient with severe hypothermia is unresponsive, and you are unable to feel a pulse. What is the most appropriate course of action?

Begin CPR and continue rewarming efforts Signup and view all the answers

Which of the following are recommended treatment steps for a patient experiencing heat exhaustion?

Administer intravenous fluids (IV) with a focus on maintaining systolic blood pressure (SBP) at or above 90 mmHg, or mean arterial pressure (MAP) at or above 65 mmHg. Signup and view all the answers

What is the recommended initial fluid volume for intravenous fluid (IV) administration in a pediatric patient experiencing heat exhaustion?

10 mL/kg bolus Signup and view all the answers

Which of the following is a critical sign that differentiates heat stroke from heat exhaustion?

Altered mental status (AMS) Signup and view all the answers

According to the provided content, what is the recommended contact number for assistance from Divers Alert Network (DAN)?

919-684-9111 Signup and view all the answers

What is the minimum recommended systolic blood pressure (SBP) or mean arterial pressure (MAP) to maintain in a patient experiencing heat exhaustion during intravenous fluid (IV) administration?

SBP ≥ 90 mmHg or MAP ≥ 65 mmHg Signup and view all the answers

Which of the following medications is mentioned in the content as a potential treatment option for nausea and vomiting in a patient experiencing heat exhaustion?

Ondansetron Signup and view all the answers

When should KETAMINE be considered as a de-escalation strategy for a patient exhibiting physical aggression and posing a high safety risk?

When verbal de-escalation methods have been unsuccessful and the patient continues to pose an imminent threat. Signup and view all the answers

What is the primary rationale for the use of restraints in managing an agitated patient?

To prevent the patient from harming themselves, others, or the environment. Signup and view all the answers

Which of the following is NOT a recommended safety precaution when using restraints?

Use restraints only as a last resort when all other de-escalation methods have failed. Signup and view all the answers

What is the significance of monitoring a patient's GCS (Glasgow Coma Scale) and RASS (Richmond Agitation-Sedation Scale) following sedation or restraint?

All of the above. Signup and view all the answers

What is the primary purpose of documenting untoward events after sedation or restraint?

To provide a legal record of the events that transpired, protecting the healthcare provider from liability. Signup and view all the answers

Why is it crucial to avoid prone, hogtie (hobble) positioning, and placing a restrained patient under a backboard or mattress?

All of the above. Signup and view all the answers

What is the recommended frequency for monitoring vital signs, such as SpO2, EtCO2, and ECG, during restraint or sedation?

At least every 5 minutes. Signup and view all the answers

What is the most crucial consideration when assessing the risk factors for suicide?

The patient's current mood and any recent changes in their behavior or outlook. Signup and view all the answers

What action should be taken if a submersion victim appears alert but requires resuscitation?

Transport them to a hospital for evaluation. Signup and view all the answers

What is a consideration for rescuers entering moving or deep water?

Only rescuers with BLS training should attempt the rescue. Signup and view all the answers

What is indicated if a submersion victim is hypothermic?

Rewarming concurrently with resuscitation. Signup and view all the answers

If a patient shows signs of hypovolemia after cold exposure, which should be monitored?

Cardiac rhythm and hypotension. Signup and view all the answers

What should be done for a victim showing increased respiratory effort but congested?

Administer oxygen or C-PAP with specified pressure. Signup and view all the answers

In what situation should C-PAP be removed from a patient?

If MAP falls below 60. Signup and view all the answers

What is true regarding SpO2 readings in cold water immersion victims?

SpO2 may be unreliable and FiO2 may need adjustment. Signup and view all the answers

Which of the following is a critical action if a patient is unresponsive with ineffective ventilations?

Assessment for signs of cardiac arrest. Signup and view all the answers

Which of the following options is NOT considered an anticoagulant that may be used in the 48 hours prior to assessment?

clopidogrel/Plavix Signup and view all the answers

What should be observed during a secondary assessment of a seizure patient?

Presence of aura and focus of origin Signup and view all the answers

In seizure assessment, which of the following is typically NOT listed as possible etiologies?

Hypertension Signup and view all the answers

When transporting a patient suspected to have a large vessel occlusion (LVO), which of the following conditions indicates they should be taken to a Comprehensive Stroke Center?

Patient shows cortical signs of LVO and can be transported within 30 minutes Signup and view all the answers

Which of the following conditions does NOT typically warrant a stroke alert according to the outlined procedures?

Neurological deficits improving over time Signup and view all the answers

In the history assessment for seizures, which aspect is NOT typically recorded?

Family history of seizures Signup and view all the answers

Which of the following conditions is NOT a common possible etiology for seizures?

Post-surgical recovery Signup and view all the answers

What is the significance of recording eye deviations during a seizure?

It helps in determining potential causes of the seizure. Signup and view all the answers

Which medication from the list is primarily a platelet inhibitor and not an anticoagulant?

Ticagrelor/Brilinta Signup and view all the answers

What information is critical when assessing a patient with seizures who has a history of drug or alcohol use?

Time of last drug or alcohol consumption Signup and view all the answers

Study Notes

Hypothermia Management

Severe hypothermia (critical): core temp < 30°C (86°F), coma, muscle rigidity, cardiac dysrhythmias, bradycardia, VF (cardiac arrest/absent pulse), hypotension, slowed RR to apnea, pupils fixed and dilated, no shivering
Core rewarming: generally not available in the field; rewarm trunk only with hot packs, avoiding rewarming extremities
Airway management: consider need for advanced airway; use gentle technique to prevent vagal stimulus and VF
Oxygenation: provide 12-15 L/NRM or BVM (warm O2 to 42°C/107.6°F if possible); do not hyperventilate
Vascular access: administer warm NS 200 mL (peds 10 mL/kg) IVP/IO fluid challenges up to 1 L
May require large volume replacement due to leaky capillaries, fluid shift, and vasodilation during rewarming
If unresponsive with apnea or no normal breathing, check for a pulse; if no pulse, start CPR
ROSC: support cardiovascular status; look for and treat causes of severe hypothermia
If induced hypothermia (TTM) indicated, continue to warm to goal temp of 34°C/93.2°F
If hypothermia contraindicated (trauma patient), continue rewarming to normal temp

Submersion/Drowning

All victims of submersion requiring resuscitation should be transported to the hospital for evaluation and monitoring, even if appearing alert and demonstrating effective cardiorespiratory function at the scene
Rescue and removal: ensure EMS safety; only rescuers with appropriate training and equipment should attempt rescue
In-water ventilations may be considered by trained rescuers; chest compressions should not be attempted in the water
Keep patient in a horizontal position if possible; cold-induced hypovolemia, cold myocardium, and impaired reflexes may cause significant hypotension
If hypothermic, initiate appropriate rewarming concurrent with resuscitation
SMR only if circumstances/clinical signs suggest spine injury
SpO2 may be unreliable, particularly after cold water immersion, but increase FiO2 to meet ITC targets

Heat Emergencies

Heat cramps or tetany: IV may not be necessary; if cramps severe/vomiting and/or oral electrolyte replacement unavailable, administer IV NS
Move patient to a cool environment; remove excess clothing; do not massage cramped muscles
Heat exhaustion: NS IVF in consecutive 200 mL increments (peds 10 mL/kg) to maintain SBP ≥ 90 (MAP ≥ 65) or normal for age
Move patient to a cool environment; remove as much clothing as possible; monitor ECG and mental status
Heat stroke: high body temperature (above 103°F); hot, red, dry or moist skin; rapid pulse; AMS, possible unconsciousness
If physical aggression/violent, severe agitation, or uncooperative: inform patient, use verbal de-escalation, and consider sedation with ketamine or restraint

Stroke Alert

Destination options:
- Nearest hospital: patient unstable
- Nearest SC (primary or comprehensive): BEFAST+ or LVO not suspected or LKN > 24 hours or transport time to CSC > 30 min
- Nearest comprehensive SC: LVO cortical signs or SAH/ICH suspected or LKN ≤ 24 hours or transport time ≤ 30 min

Seizures

History: frequency and type of seizures, prescribed meds and patient compliance, recent or past head trauma, recent fever, headache, or stiff neck
Consider possible etiologies: anoxia/hypoxia, anticonvulsant withdrawal/noncompliance, infection, metabolic disorders, toxins/intoxication, tumor, or ↑ ICP
Secondary assessment: observe and record presence of an aura, focus of origin, simple or complex seizure, partial or generalized, progression and duration of seizure activity, eye deviation, abnormal behaviors, incontinence or oral trauma, and postictal coma or confusion

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Description

This quiz covers the management of hypothermia in pediatric patients, including warm IV fluid challenges and signs of severe hypothermia such as core temp < 30°C, coma, and cardiac dysrhythmias.