CPEN Environmental Emergencies 2 — Questions and Answers
Question 1: A 4-year-old is brought in after playing in a hot car for 45 minutes. Temperature is 41.2°C (106.2°F), skin is hot and dry, and the child is confused. Which cooling method is MOST appropriate as initial therapy?
- Immersion in ice water bath
- Evaporative cooling with misting fans and cool water spray (Correct answer)
- Application of ice packs to groin and axillae only
- Oral rehydration with cold fluids
Correct answer: Evaporative cooling with misting fans and cool water spray
Evaporative cooling (misting cool water with fan) is the fastest, most effective, and best-tolerated method for classic heat stroke in children.
Question 2: A 10-year-old swimmer is rescued from a cold lake (water temperature 10°C). Core temp is 30°C, the child is shivering vigorously, and is conscious but confused. This presentation represents which stage of hypothermia?
- Mild hypothermia (Stage I) (Correct answer)
- Moderate hypothermia (Stage II)
- Severe hypothermia (Stage III)
- Profound hypothermia (Stage IV)
Correct answer: Mild hypothermia (Stage I)
Mild hypothermia (32–35°C) is characterized by shivering, confusion, and preserved consciousness.
Question 3: During a lightning strike incident, a 9-year-old has no pulse and is apneic. Which resuscitation principle is UNIQUE to lightning-strike cardiac arrest compared to other causes?
- Begin CPR only after AED analysis confirms shockable rhythm
- Prioritize resuscitation of the apparently dead over those who appear alive (Correct answer)
- Avoid BVM ventilation due to risk of barotrauma
- Administer epinephrine before initiating chest compressions
Correct answer: Prioritize resuscitation of the apparently dead over those who appear alive
In lightning mass-casualty events, reverse triage applies — those in cardiac arrest from lightning have a high survival rate and should be resuscitated first.
Question 4: A 7-year-old presents after a jellyfish sting with tentacles still on the skin. What is the CORRECT first step in management?
- Rinse with fresh water to remove tentacles
- Apply isopropyl alcohol to deactivate nematocysts
- Rinse with seawater and remove tentacles with a card or forceps (Correct answer)
- Apply meat tenderizer paste to neutralize venom
Correct answer: Rinse with seawater and remove tentacles with a card or forceps
Seawater rinse (not fresh water) followed by mechanical removal of tentacles with a card prevents further nematocyst discharge.
Question 5: A 6-year-old with sickle cell disease presents after prolonged sun exposure with priapism and fever of 38.8°C. Which environmental factor most likely precipitated this complication?
- UV radiation causing direct vascular endothelial injury
- Dehydration-induced hemoconcentration and sickling (Correct answer)
- Hyperthermia causing direct hemolysis
- Sunburn activating mast cell degranulation
Correct answer: Dehydration-induced hemoconcentration and sickling
Dehydration from heat exposure causes hemoconcentration, increased blood viscosity, and sickling, precipitating vaso-occlusive crisis including priapism.
Question 6: A 3-year-old is found unconscious in a backyard pool. After rescue and CPR restoration of pulse, the child has a respiratory rate of 32 with crackles bilaterally. SpO₂ is 88% on room air. What is the PRIMARY concern in the next 24 hours?
- Cerebral edema from hypoxic-ischemic injury
- Secondary drowning from delayed pulmonary edema (Correct answer)
- Hypothermia-related coagulopathy
- Aspiration pneumonia from pool water bacteria
Correct answer: Secondary drowning from delayed pulmonary edema
Secondary drowning (pulmonary edema with progressive respiratory failure) can develop hours after a submersion event and requires monitoring and respiratory support.
Question 7: A 13-year-old football player collapses during summer practice with a rectal temperature of 40.8°C, diaphoresis, tachycardia, and altered mental status. Labs show Na 128 mEq/L. What fluid intervention is MOST appropriate?
- 1 L bolus of 0.9% NS rapidly IV
- Hypertonic saline (3%) at 1–2 mL/kg/hr (Correct answer)
- D5W at maintenance rate to correct hypernatremia
- Restricted fluid intake until cooling is achieved
Correct answer: Hypertonic saline (3%) at 1–2 mL/kg/hr
Symptomatic hyponatremia with altered mental status in heat stroke requires cautious correction with hypertonic saline to prevent cerebral herniation from cerebral edema.
CPEN Environmental Emergencies 2
A 4-year-old is brought in after playing in a hot car for 45 minutes.
Temperature is 41.2°C (106.2°F), skin is hot and dry, and the child is confused.
Which cooling method is MOST appropriate as initial therapy?