FISDAP FISDAP Special Populations and Environmental Emergencies 4 — Questions and Answers
Question 1: A 7-year-old child is found unresponsive after submersion in a cold lake. Water temperature was 4°C (39°F). Which statement best guides resuscitation?
- Hypothermia provides no protective benefit in drowning victims
- Cold water submersion may extend the resuscitation window due to neuroprotection (Correct answer)
- Resuscitation should be stopped after 10 minutes without ROSC
- Core temperature below 30°C is an absolute contraindication to CPR
Correct answer: Cold water submersion may extend the resuscitation window due to neuroprotection
Cold water immersion can induce protective hypothermia that slows cerebral metabolism, potentially extending the viable resuscitation window in pediatric submersion victims.
Question 2: When treating a bariatric patient weighing 180 kg, which airway management consideration is most important?
- Use a smaller endotracheal tube to reduce airway resistance
- Elevate the head of the stretcher 20-30 degrees to improve respiratory mechanics (Correct answer)
- Avoid BVM ventilation as it is ineffective in obese patients
- Nasopharyngeal airways are contraindicated in bariatric patients
Correct answer: Elevate the head of the stretcher 20-30 degrees to improve respiratory mechanics
Positioning a morbidly obese patient with the head elevated (reverse Trendelenburg or ramped position) displaces abdominal contents, improving diaphragmatic excursion and oxygenation.
Question 3: A nursing home patient with dementia is combative and appears to be in pain but cannot verbalize symptoms. Which assessment approach is most appropriate?
- Defer pain assessment until family is available
- Use a behavioral pain scale such as PAINAD to assess nonverbal cues (Correct answer)
- Administer benzodiazepines empirically to reduce combativeness
- Assume pain is absent if no vocalizations of distress are noted
Correct answer: Use a behavioral pain scale such as PAINAD to assess nonverbal cues
The PAINAD (Pain Assessment in Advanced Dementia) scale uses behavioral indicators such as breathing, vocalizations, facial expressions, and body language to estimate pain in nonverbal patients.
Question 4: An infant presents with a bulging fontanelle, high-pitched cry, fever of 39.8°C, and petechial rash. What is the most likely diagnosis and priority intervention?
- Febrile seizure; cool the patient and monitor airway
- Bacterial meningitis; establish IV access and transport rapidly (Correct answer)
- Roseola; supportive care and parental education
- Intussusception; assess for currant-jelly stools
Correct answer: Bacterial meningitis; establish IV access and transport rapidly
A bulging fontanelle, high-pitched cry, fever, and petechial rash are classic signs of bacterial meningitis, which requires rapid transport for IV antibiotics and possible lumbar puncture.
Question 5: During a heat wave, a 72-year-old man is found confused in a non-air-conditioned apartment with a core temperature of 40.6°C (105°F) and anhidrosis. Which cooling method is most appropriate in the field?
- Passive cooling by moving to shade only
- Ice packs to groin and axillae combined with misting and fanning (Correct answer)
- Immersion in ice water bath
- Oral hydration with cold sports drinks
Correct answer: Ice packs to groin and axillae combined with misting and fanning
For classic heat stroke, evaporative cooling (misting and fanning) combined with ice packs to high-blood-flow areas (groin, axillae, neck) is the preferred prehospital method due to practical feasibility.
Question 6: A 16-year-old athlete collapses during football practice on a hot day. He is conscious, sweating profusely, and has muscle cramps. Vital signs are BP 100/60, HR 120, core temp 38.2°C. What is the most likely condition?
- Heat stroke
- Heat exhaustion (Correct answer)
- Exercise-associated hyponatremia
- Exertional rhabdomyolysis
Correct answer: Heat exhaustion
Heat exhaustion is characterized by heavy sweating, weakness, mild hypotension, tachycardia, and core temperature below 40°C, distinguishing it from the neurological dysfunction of heat stroke.
Question 7: A diver surfaces rapidly after a deep dive and develops joint pain, skin mottling, and neurological deficits. What condition do these signs suggest and what is the definitive treatment?
- Arterial gas embolism; immediate decompression in a hyperbaric chamber
- Decompression sickness (the bends); recompression therapy in a hyperbaric chamber (Correct answer)
- Nitrogen narcosis; 100% oxygen by nonrebreather mask
- Pulmonary barotrauma; needle decompression
Correct answer: Decompression sickness (the bends); recompression therapy in a hyperbaric chamber
Decompression sickness results from nitrogen bubble formation in tissues during rapid ascent, causing joint pain and neurological signs that require hyperbaric recompression therapy.
FISDAP FISDAP Special Populations and Environmental Emergencies 4
A 7-year-old child is found unresponsive after submersion in a cold lake.
Water temperature was 4°C (39°F).
Which statement best guides resuscitation?