FISDAP FISDAP Special Populations and Environmental Emergencies 5 — Questions and Answers
Question 1: A 3-year-old is found unresponsive with irregular breathing and a glucose of 38 mg/dL. What is the most appropriate pediatric dextrose dose?
- D50W 25 mL IV push
- D25W 2 mL/kg IV (Correct answer)
- D10W 5 mL/kg IV
- D50W 1 mL/kg IV
Correct answer: D25W 2 mL/kg IV
For pediatric hypoglycemia, D25W at 2 mL/kg (0.5 g/kg) is the standard prehospital dose, as D50W can cause vascular sclerosis and osmotic injury in small children.
Question 2: An elderly patient on warfarin sustains a minor head impact and initially refuses transport. What is the most critical reason to strongly encourage transport?
- Warfarin causes immediate intracranial hemorrhage in all head injuries
- Anticoagulation significantly increases the risk of delayed intracranial bleeding even after minor trauma (Correct answer)
- CT scans cannot detect hemorrhage in anticoagulated patients
- All anticoagulated patients require ICU admission regardless of mechanism
Correct answer: Anticoagulation significantly increases the risk of delayed intracranial bleeding even after minor trauma
Anticoagulated patients face substantially elevated risk of delayed or expanding intracranial hemorrhage after seemingly minor head trauma, making hospital evaluation with CT imaging essential.
Question 3: A pregnant patient at 32 weeks gestation is hypotensive and diaphoretic after a motor vehicle collision. What positioning modification is most important?
- Keep her supine to facilitate CPR if needed
- Tilt the backboard or manually displace the uterus to the left (Correct answer)
- Place her in Trendelenburg position only
- Maintain right lateral decubitus position throughout transport
Correct answer: Tilt the backboard or manually displace the uterus to the left
Left lateral uterine displacement (LLUD) relieves aortocaval compression by the gravid uterus, improving venous return and cardiac output in the supine hypotensive syndrome of pregnancy.
Question 4: A rescue team extracts a collapsed miner after a building entrapment of 6 hours. As the patient is freed, he becomes hypotensive and develops dysrhythmias. What syndrome is occurring?
- Neurogenic shock from spinal cord injury
- Crush syndrome with reperfusion releasing myoglobin and potassium (Correct answer)
- Tension pneumothorax from rib fractures
- Anaphylaxis from dust inhalation
Correct answer: Crush syndrome with reperfusion releasing myoglobin and potassium
Crush syndrome occurs when prolonged muscle compression causes rhabdomyolysis; reperfusion upon release floods the circulation with myoglobin, potassium, and lactic acid, causing dysrhythmias and renal failure.
Question 5: You are treating a victim of a lightning strike who is in cardiac arrest. Bystanders are reluctant to help because of concern about residual electrical charge. What is your best response?
- Scene safety requires waiting 30 minutes before approaching
- Lightning strike victims retain no electrical charge and rescuers are safe to touch them immediately (Correct answer)
- Use rubber gloves only when delivering shocks with an AED
- Avoid touching the patient until they are moved indoors
Correct answer: Lightning strike victims retain no electrical charge and rescuers are safe to touch them immediately
Unlike high-voltage electrical contact, lightning victims do not retain electrical charge and can be safely touched immediately; prompt CPR dramatically improves survival in lightning cardiac arrest.
Question 6: A patient with autism spectrum disorder becomes extremely agitated during your assessment after a minor injury. Which de-escalation strategy is most effective?
- Gather a large team around the patient to prevent elopement
- Reduce sensory stimuli, speak calmly using simple direct language, and maintain predictable movements (Correct answer)
- Administer sedation early to prevent self-injury
- Restrain the patient immediately for safety during transport
Correct answer: Reduce sensory stimuli, speak calmly using simple direct language, and maintain predictable movements
Patients with ASD are often highly sensitive to sensory overload and unpredictability; minimizing lights, noise, and crowd while using calm, direct communication reduces agitation without chemical or physical restraint.
Question 7: A hiker is rescued from a remote mountain trail with a core temperature of 28°C, absent pulse, and fixed dilated pupils. What is the most appropriate action?
- Declare death in the field based on pupillary findings
- Begin CPR and transport to a hospital with rewarming and ECMO capability (Correct answer)
- Perform one defibrillation attempt then cease resuscitation
- Rewarm passively in the field until pulse returns before initiating CPR
Correct answer: Begin CPR and transport to a hospital with rewarming and ECMO capability
Severe hypothermia can mimic death; the principle 'not dead until warm and dead' applies, and patients at 28°C with cardiac arrest may survive with CPR, active rewarming, and ECMO-assisted rewarming at a hospital.
FISDAP FISDAP Special Populations and Environmental Emergencies 5
A 3-year-old is found unresponsive with irregular breathing and a glucose of 38 mg/dL.
What is the most appropriate pediatric dextrose dose?