CPEN Environmental Emergencies 5 — Questions and Answers
Question 1: A 3-year-old is brought in after a backyard bee sting with urticaria, vomiting, and audible stridor. Blood pressure is 70/40. Which is the CORRECT epinephrine dose and route for anaphylaxis in this child?
- 0.01 mg/kg of 1:1,000 concentration IV push
- 0.01 mg/kg of 1:1,000 concentration IM in the anterolateral thigh (Correct answer)
- 0.1 mg/kg of 1:10,000 concentration IM in the deltoid
- 0.01 mg/kg of 1:10,000 concentration SQ in the forearm
Correct answer: 0.01 mg/kg of 1:1,000 concentration IM in the anterolateral thigh
Epinephrine 0.01 mg/kg (max 0.5 mg) of 1:1,000 solution IM into the anterolateral thigh is the first-line treatment for anaphylaxis.
Question 2: A 8-year-old presents with a dog bite to the hand sustained 12 hours ago. The wound is red, swollen, and has purulent discharge. Gram stain shows gram-negative rods. Which organism is MOST likely?
- Staphylococcus aureus
- Pasteurella multocida (Correct answer)
- Capnocytophaga canimorsus
- Eikenella corrodens
Correct answer: Pasteurella multocida
Pasteurella multocida, a gram-negative rod, is the most common pathogen in early dog (and cat) bite infections and is typically sensitive to amoxicillin-clavulanate.
Question 3: A 5-year-old sustains a partial-thickness sunburn to both arms after a day at the beach. Parents ask about home wound care. Which recommendation is CORRECT?
- Apply butter or petroleum jelly to cool and protect the skin
- Cover with cool, moist cloths and use ibuprofen for pain; do not break blisters (Correct answer)
- Pop blisters with a sterile needle to prevent infection
- Apply topical diphenhydramine cream for itch relief
Correct answer: Cover with cool, moist cloths and use ibuprofen for pain; do not break blisters
Cool compresses, oral NSAIDs, hydration, and leaving blisters intact are the correct management for partial-thickness burns from sunburn.
Question 4: A 14-year-old fell into a frozen pond and was submerged for 8 minutes. He is now alert with core temp of 34°C and mild confusion. Frostbitten fingers are white and wooden. Which rewarming approach for the frostbitten fingers is CORRECT?
- Rub the fingers briskly to restore circulation
- Rewarm in water at 40–42°C for 15–30 minutes if there is no risk of refreezing (Correct answer)
- Apply dry heat pads directly to the affected fingers
- Do not rewarm the fingers until core temperature is fully corrected
Correct answer: Rewarm in water at 40–42°C for 15–30 minutes if there is no risk of refreezing
Rapid rewarming in water at 40–42°C is the standard treatment for frostbite, and should be performed only when refreezing is not a risk.
Question 5: A 7-year-old from rural Texas is brought to the ED with sudden ascending paralysis over 6 hours. Parents report a camping trip last weekend. Cranial nerves are intact and there is no fever. CSF is normal. Which is the MOST likely diagnosis?
- Guillain-Barré syndrome
- Tick paralysis (Correct answer)
- Botulism
- Transverse myelitis
Correct answer: Tick paralysis
Tick paralysis presents with ascending flaccid paralysis without fever, normal CSF, and intact sensation — caused by neurotoxin in tick saliva that blocks neuromuscular junction.
Question 6: A 10-year-old presents after a snakebite with progressive arm swelling, nausea, and vomiting. The parents bring the dead snake in a bag. It has a triangular head, heat-sensing pits, and a rattle. Which antivenom is INDICATED?
- Crotalidae Polyvalent Immune Fab (CroFab) (Correct answer)
- Antivenin (Micrurus fulvius) for coral snakes
- Centruroides immune F(ab')2 (Anascorp)
- No antivenom is available; supportive care only
Correct answer: Crotalidae Polyvalent Immune Fab (CroFab)
CroFab is the antivenom indicated for North American pit viper (crotalid) envenomation, including rattlesnakes, cottonmouths, and copperheads.
Question 7: A 9-year-old swimmer is rescued from a warm lake after a 3-minute submersion. She is coughing, alert, and mildly tachypneic with SpO₂ of 94% on room air. Her parents want to take her home after she 'seems fine.' What is the CORRECT disposition recommendation?
- Discharge with return precautions after 30 minutes of observation
- Admit for 24 hours of cardiac monitoring
- Observe for a minimum of 6–8 hours with repeat respiratory assessment (Correct answer)
- Discharge immediately as she is neurologically intact
Correct answer: Observe for a minimum of 6–8 hours with repeat respiratory assessment
All submersion victims with any initial symptoms should be observed for 6–8 hours for signs of secondary drowning or worsening respiratory failure.
CPEN Environmental Emergencies 5
A 3-year-old is brought in after a backyard bee sting with urticaria, vomiting, and audible stridor.
Blood pressure is 70/40.
Which is the CORRECT epinephrine dose and route for anaphylaxis in this child?