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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?
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?
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?
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?
A patient with severe hypothermia has a pulse but is not breathing. Which of the following actions is most appropriate?
A patient with severe hypothermia has regained a pulse after rewarming. What is the next step in management?
A patient with severe hypothermia has regained a pulse after rewarming. What is the next step in management?
Which of the following is a reason why rewarming extremities in a patient with severe hypothermia is discouraged?
Which of the following is a reason why rewarming extremities in a patient with severe hypothermia is discouraged?
Which of the following is NOT a consideration when managing a patient with severe hypothermia?
Which of the following is NOT a consideration when managing a patient with severe hypothermia?
A patient with severe hypothermia is unresponsive, and you are unable to feel a pulse. What is the most appropriate course of action?
A patient with severe hypothermia is unresponsive, and you are unable to feel a pulse. What is the most appropriate course of action?
Which of the following are recommended treatment steps for a patient experiencing heat exhaustion?
Which of the following are recommended treatment steps for a patient experiencing heat exhaustion?
What is the recommended initial fluid volume for intravenous fluid (IV) administration in a pediatric patient experiencing heat exhaustion?
What is the recommended initial fluid volume for intravenous fluid (IV) administration in a pediatric patient experiencing heat exhaustion?
Which of the following is a critical sign that differentiates heat stroke from heat exhaustion?
Which of the following is a critical sign that differentiates heat stroke from heat exhaustion?
According to the provided content, what is the recommended contact number for assistance from Divers Alert Network (DAN)?
According to the provided content, what is the recommended contact number for assistance from Divers Alert Network (DAN)?
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?
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?
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?
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?
When should KETAMINE be considered as a de-escalation strategy for a patient exhibiting physical aggression and posing a high safety risk?
When should KETAMINE be considered as a de-escalation strategy for a patient exhibiting physical aggression and posing a high safety risk?
What is the primary rationale for the use of restraints in managing an agitated patient?
What is the primary rationale for the use of restraints in managing an agitated patient?
Which of the following is NOT a recommended safety precaution when using restraints?
Which of the following is NOT a recommended safety precaution when using restraints?
What is the significance of monitoring a patient's GCS (Glasgow Coma Scale) and RASS (Richmond Agitation-Sedation Scale) following sedation or restraint?
What is the significance of monitoring a patient's GCS (Glasgow Coma Scale) and RASS (Richmond Agitation-Sedation Scale) following sedation or restraint?
What is the primary purpose of documenting untoward events after sedation or restraint?
What is the primary purpose of documenting untoward events after sedation or restraint?
Why is it crucial to avoid prone, hogtie (hobble) positioning, and placing a restrained patient under a backboard or mattress?
Why is it crucial to avoid prone, hogtie (hobble) positioning, and placing a restrained patient under a backboard or mattress?
What is the recommended frequency for monitoring vital signs, such as SpO2, EtCO2, and ECG, during restraint or sedation?
What is the recommended frequency for monitoring vital signs, such as SpO2, EtCO2, and ECG, during restraint or sedation?
What is the most crucial consideration when assessing the risk factors for suicide?
What is the most crucial consideration when assessing the risk factors for suicide?
What action should be taken if a submersion victim appears alert but requires resuscitation?
What action should be taken if a submersion victim appears alert but requires resuscitation?
What is a consideration for rescuers entering moving or deep water?
What is a consideration for rescuers entering moving or deep water?
What is indicated if a submersion victim is hypothermic?
What is indicated if a submersion victim is hypothermic?
If a patient shows signs of hypovolemia after cold exposure, which should be monitored?
If a patient shows signs of hypovolemia after cold exposure, which should be monitored?
What should be done for a victim showing increased respiratory effort but congested?
What should be done for a victim showing increased respiratory effort but congested?
In what situation should C-PAP be removed from a patient?
In what situation should C-PAP be removed from a patient?
What is true regarding SpO2 readings in cold water immersion victims?
What is true regarding SpO2 readings in cold water immersion victims?
Which of the following is a critical action if a patient is unresponsive with ineffective ventilations?
Which of the following is a critical action if a patient is unresponsive with ineffective ventilations?
Which of the following options is NOT considered an anticoagulant that may be used in the 48 hours prior to assessment?
Which of the following options is NOT considered an anticoagulant that may be used in the 48 hours prior to assessment?
What should be observed during a secondary assessment of a seizure patient?
What should be observed during a secondary assessment of a seizure patient?
In seizure assessment, which of the following is typically NOT listed as possible etiologies?
In seizure assessment, which of the following is typically NOT listed as possible etiologies?
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?
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?
Which of the following conditions does NOT typically warrant a stroke alert according to the outlined procedures?
Which of the following conditions does NOT typically warrant a stroke alert according to the outlined procedures?
In the history assessment for seizures, which aspect is NOT typically recorded?
In the history assessment for seizures, which aspect is NOT typically recorded?
Which of the following conditions is NOT a common possible etiology for seizures?
Which of the following conditions is NOT a common possible etiology for seizures?
What is the significance of recording eye deviations during a seizure?
What is the significance of recording eye deviations during a seizure?
Which medication from the list is primarily a platelet inhibitor and not an anticoagulant?
Which medication from the list is primarily a platelet inhibitor and not an anticoagulant?
What information is critical when assessing a patient with seizures who has a history of drug or alcohol use?
What information is critical when assessing a patient with seizures who has a history of drug or alcohol use?
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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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