Heat illness (1 to 4 of 8) 29/04/24

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1) A 17-year-old boy is brought to the emergency department midway through a biking trip with his parents due to bizarre behavior and confusion over the last 30 minutes that was sudden in onset. It is summertime, and the humidity is 90%. He normally takes sertraline for generalized anxiety disorder, but according to his parents, he has not taken his medication in the last few days. His vitals are temperature 105 °F (40.6 °C), heart rate 107 bpm, blood pressure 90/60 mm Hg, and respiratory rate 26 breaths/min. On examination, the patient is hot to the touch, has a dry mouth and eyes, vomits periodically, and is unsteady on his feet. He was in his usual state of health this morning before he went biking. What is the most likely cause of this patient’s presentation? *

1 point

a. Serotonergic medication withdrawal

b. Denaturation of heat shock protein

c. Scorpion toxin effect

d. Increased presynaptic norepinephrine

2) A 35-year-old male construction worker is brought to the emergency department during a heatwave. He is confused, complaining of headache, nausea, and dizziness. His temperature is 40.5°C (104.9°F), and his skin is hot and dry. He has a rapid pulse and shallow breathing. Which of the following is the most appropriate initial management? *

1 point

a. Administer intravenous fluids

b. Apply ice packs to the groin and axillae

c. Immersion in an ice bath

d. Administer antipyretics

3) A 62-year-old man is brought to the emergency department following a syncopal episode. Vitals are heart rate 90 bpm, blood pressure 130/80 mm Hg, respiratory rate 12 breaths/min, and temperature 99.1 F (37.3 C). Physical exam demonstrates a fluent conversive man with no apparent abnormality. After the initial evaluation, the patient has another witnessed syncopal episode, with loss of consciousness for 1 minute. Upon waking, he has no complaints. What is the most appropriate management for this patient? *

1 point

a. Rehydrate and follow up with primary care provider in 2 weeks

b. Admit for telemetry monitoring and further evaluation

c. Admit to the intensive care unit for further management

d. Undergo orthostatic testing and, if normal, be discharged home.

4) An 18-year-old football player presents to the emergency department complaining of nausea after a training session at high heat. His coach was concerned because he was very warm to the touch and was sweating profusely. A couple of minutes after arrival at the ED, the patient had an episode of vomiting. His vital signs demonstrate a core temperature of 102.2 °F (38.9 °C), heart rate of 118 bpm, blood pressure of 119/82 mm Hg, and respiration rate of 22 breaths/min. His point-of-care glucose was 80 mg/dL, and his skin remains very sweaty. Which of the following is the most appropriate treatment to initiate now? *

1 point

a. Ice bath at 32 °F (0 °C)

b. IV fluids with normal saline

c. Mechanical cooling with a fan

d. Intravenous 50% dextrose

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