OEC 6th Edition Chapter 25

You are assessing a conscious but confused hiker who became lost in the woods on a cold day. Your assessment shows that he has an open airway, adequate breathing, and a weak radial pulse. His skin is cold to the touch, and he is shivering. OEC technicians should recognize that the:

A) cold caused the patient's brain to become dysfunctional, as evidenced by the shivering.

B) shivering actually represents a small seizure, which indicates that the brain is cold.

C) shivering is a protective means by which the body is attempting to warm itself.

D) shivering is the only indicator that the patient's core body temperature has fallen below 85°F.

C) shivering is a protective means by which the body is attempting to warm itself.

A young man who was angry with friends wandered away from a party and spent the night outside uncovered in 40-50°F. He is confused, has decreased but adequate breathing, and has a weak radial pulse. His skin is cool, and capillary refill is delayed. When looking to see if he is shivering, you note that he is not. Based on this presentation, OEC technicians can safely conclude that the:

A) patient is exhibiting signs indicating that he is ineffectively compensating and conserving heat.

B) patient's body temperature is most likely dangerously low.

C) absence of shivering indicates that body temperature is almost back to normal.

D) cause of his confusion is not related to exposure to the low overnight temperatures.

B) patient's body temperature is most likely dangerously low.

A young boy complains of pain in his fingers after spending several hours outside riding a sled in cold temperatures. After ensuring that he has no life-threatening conditions, you turn your attention to his hands and note that his fingers are cold, and the skin is pliable to the touch. Which of the following signs or symptoms would help confirm your suspicion that he is suffering from early or superficial frostbite?

A) Soft and tingling skin on the fingers

B) A history of being exposed to temperatures in the 70s

C) Swelling of and blisters on the fingers

D) Firm and numb cold skin on the fingers

A) Soft and tingling skin on the fingers

Which of the following statements about immersion hypothermia is true?

A) Death typically occurs within a few minutes of submersion in very cold water.

B) It can take more than 30 minutes for a person who has fallen into very cold water to become hypothermic.

C) Protective winter clothing will always protect a person from immersion hypothermia.

D) Immersion hypothermia is most typically associated with traumatized or critically ill patients.

B) It can take more than 30 minutes for a person who has fallen into very cold water to become hypothermic.

The continued drop in core body temperature after removal from exposure to the cold is known as:

A) afterdrop.

B) secondary hypothermia.

C) thermoregulation.

D) shock.

A) afterdrop.

The main cause of afterdrop is probably:

A) the return of cold blood from the extremities.

B) loss of fat.

C) remaining wet.

D) strong winds.

A) the return of cold blood from the extremities.

Which of the following statements concerning immersion hypothermia is true?

A) It occurs only when the entire body and head are submersed.

B) Death will typically occur within a few minutes.

C) The function of arm and leg muscles will not affect the outcome.

D) It can take more than 30 minutes for an individual to become hypothermic.

D) It can take more than 30 minutes for an individual to become hypothermic.

Which of the following instructions is most appropriate when moving a patient who has severe generalized hypothermia?

A) "I want everyone to take extra care in moving her very gently to the stretcher; we do not want her to go into cardiac arrest."

B) "Be careful when moving her to the stretcher; the cold makes her very prone to bone fractures."

C) "Let's place her on her side on the stretcher because her body temperature contraindicates placement of a nasal airway."

D) "Let's secure her with her arms and legs extended because this position promotes the retention of body heat."

A) "I want everyone to take extra care in moving her very gently to the stretcher; we do not want her to go into cardiac arrest."

When obtaining a history of a five-year-old boy with generalized hypothermia, which of the following questions provides the most important information?

A) "Are all of his childhood shots up to date?"

B) "Does he have any medical conditions?"

C) "When did he last eat or drink?"

D) "Why was he outside without adult supervision?"

B) "Does he have any medical conditions?"

A patient with moderate hypothermia will have:

A) a core body temperature above 95°F.

B) a slow pulse and/or slow respirations.

C) active shivering.

D) a high risk of ventricular fibrillation.

B) a slow pulse and/or slow respirations.

You and your friends are camping on a 20° F day. Which of the following assessment findings best illustrates that your bodies are no longer capable of compensating for the effects of the cold?

A) Cool and clammy skin

B) Loss of fine motor coordination

C) Shivering

D) Hypertension

B) Loss of fine motor coordination

Which of the following signs would you observe earliest in a hypothermic patient?

A) Confusion

B) Hypotension

C) Shivering

D) Bradycardia

C) Shivering

Which of the following findings best indicates that a patient with cold skin is suffering from moderate hypothermia?

A) Cold waxy fingers

B) Respirations at 28-30 per minute

C) A heart rate of 52 beats per minute

D) A pulse oximetry reading of 95 percent

C) A heart rate of 52 beats per minute

Which of the following findings is a sign of severe hypothermia?

A) Slurred speech

B) Active shivering

C) Coma

D) Confusion

C) Coma

You are with a candidate OEC technician who is attending to a snowboarder who has fallen. The candidate is very concerned that the snowboarder is shivering vigorously and asks you what this indicates. Which of the following statements would be your best response?

A) Shivering is a sign of mild hypothermia.

B) Shivering indicates moderate hypothermia.

C) Individuals who are shivering cannot maintain their normal body temperature.

D) It is good to try to get a shivering patient to stop because shivering burns energy.

A) Shivering is a sign of mild hypothermia.

A patient who is conscious and breathing has been pulled from a stream of cold water. To decrease her loss of heat via the mechanism of conduction, an OEC technician should immediately:

A) cover her with a blanket.

B) remove her wet clothing then cover her with blankets.

C) provide positive-pressure ventilation.

D) encourage her to stop shivering.

B) remove her wet clothing then cover her with blankets.

Prevention of heat loss in the care of a patient with a cold injury should include:

A) carefully removing wet clothing.

B) placing the OEC technician's jacket over the patient.

C) rubbing cold extremities.

D) placing the patient in a prone position

A) carefully removing wet clothing.

You have been called to aid an alert and oriented male patient whose friends state he spent several hours locked out of his house in cold temperatures. Given that the primary and secondary assessments have ruled out immediately life-threatening conditions, you have decided to rewarm the patient. Which of the following actions would be most appropriate for this patient?

A) Place the patient in a tub of warm water.

B) Apply hot packs to the patient's chest, groin, and armpits.

C) Massage the patient's arms and legs after applying warm blankets.

D) Blow hot air from a hair dryer over the patient's arms and legs.

B) Apply hot packs to the patient's chest, groin, and armpits.

You need to begin rewarming an unresponsive patient who has a core temperature of 93°F. Which of the following measures would most benefit this patient?

A) Give the patient warm drinks to increase internal body temperature.

B) Gently massage the patient's arms and legs.

C) Wrap the patient in several warm blankets.

D) Place one extremity at a time into warm water.

C) Wrap the patient in several warm blankets.

When assessing the vital signs of a severely hypothermic patient, OEC technicians should:

A) vigorously shake the patient to assess the true level of responsiveness.

B) check the patient's pulse and respirations for up to one minute.

C) check the patient's radial pulse to avoid exposing the patient's head and neck to the cold.

D) warm their own fingers for a full minute to ensure that they can feel the patient's pulse.

B) check the patient's pulse and respirations for up to one minute.

A severely hypothermic patient is in cardiac arrest. Most studies indicate that for patients who have been submerged in cold water for more than one hour, you should:

A) start cardiopulmonary resuscitation.

B) focus on rewarming and rapidly transporting the patient.

C) provide ventilations but not compressions.

D) do nothing because there is no chance such patients will survive.

B) focus on rewarming and rapidly transporting the patient.

Which of the following statements indicates that an OEC technician understands the care of a patient with a localized cold injury to the foot?

A) "Warming a frozen body part can cause severe pain."

B) "If the patient has blisters on his foot, it is beneficial to break them so that the fluid inside will not freeze and cause additional injury."

C) "Gentle massage of the foot is beneficial because it enhances the circulation of warm blood in the affected area."

D) "You should avoid immobilizing the foot because doing so will further decrease the circulation of blood in the affected area."

A) "Warming a frozen body part can cause severe pain."

You are facilitating a talk on cold emergencies in the backcountry. You are asked when one should attempt to rewarm a hand or foot that is frostbitten. Which of the following statements would be your best response?

A) "You never want to rewarm a frozen body part because doing so can cause additional damage."

B) "Attempt to rewarm a frozen body part only if the person still has some feeling in it."

C) "Rewarm the frozen body part if the patient needs to self-evacuate."

D) "Rewarming should take place only when there is no chance that the tissue will refreeze."

D) "Rewarming should take place only when there is no chance that the tissue will refreeze."

One of your friends on a hunting trip in Montana has suffered a severe localized cold injury to his hand and fingers. He does not have any life-threatening conditions, and you elect to rewarm the affected areas. Which of the following actions is most appropriate for your friend?

A) Immerse the hand and fingers in water that is hotter than 120°F.

B) Vigorously rub the hands and fingers.

C) Slowly and gradually warm the affected hand and fingers.

D) Thaw and rewarm the tissue as quickly as possible.

D) Thaw and rewarm the tissue as quickly as possible.

After successfully rewarming a foot that has frozen toes, an OEC technician should:

A) cover the foot and toes with dry dressings.

B) gently massage the foot and toes.

C) ambulate the patient to ensure return of adequate motor function.

D) place the foot below the level of the heart to enhance circulation.

A) cover the foot and toes with dry dressings.

A frostbitten skier stranded in the backcountry for three weeks may observe what happen to badly frostbitten toes?

A) Spontaneous rewarming

B) Autoamputation

C) Gradual healing

D) Regrowth of the toe

B) Autoamputation

It has taken you 45 minutes to extricate an avalanche victim. Based on your knowledge of hypothermia and avalanche victims, you know that:

A) hypothermia during an avalanche burial generally occurs quicker than during cold water immersion.

B) hypothermia can occur after extrication due to a cold, windy environment.

C) a pulseless victim can most likely be resuscitated after rewarming.

D) a patient who is responsive is not hypothermic.

B) hypothermia can occur after extrication due to a cold, windy environment.

The initial priority for avalanche victims is:

A) warming the extremities.

B) cervical stabilization.

C) ensuring adequate ventilation.

D) treating for hypothermia.

C) ensuring adequate ventilation.

Thermoregulation

Process of maintaining a normal body temperature. Initial response to cold is reducing blood flow to extremities so vital organs are still warm 

What are the four mechanisms through which body loses heat

Conduction, convection, evaporation, radiation

Conduction

When direct contact with nearby object like sitting on cold ground

Convection

Body heat lost to surrounding air like skiing without helmet or hat

Evaporation

Loss of heat when liquid evaporates from perspiration or wet skin

Radiation

When body heat lost to atmosphere without contac

Categories of cold exposure

Cold stressed, mild hypothermia, moderate hypothermia, severe hypothermia

Cold stressed

patient is alert, starting to shiver, can help themselves, core body temperature below 96.8 degrees fahrenheit but above 95 degrees

Mild hypothermia

Alert but maybe confused, shivering, core body temperature is 89.6-95 degrees fahrenheit

Moderate hypothermia

Drowsy, decreased LOR, not shivering, core body temperature 82.4-89.6 degrees fahrenheit

Severe hypothermia

Unresponsive, may not be breathing, body temperature less than 82.4 degrees fahrenheit

Frostnip

superficial frostbite due to vasoconstriction of blood vessels in response to cold, ears nose fingers toes susceptible

Frostbite

Actual freezing of body tissue, either freezing of tissue forms ice crystals between and within cells, OR loss of blood supply to tissues as capillaries supplying them are damaged

Management of frostbite

rapid rewarming, remove watches and rings and submerge in warm water 102-104 degrees F, constantly stir, dry sterile dressings can be applied after

Management of moderate and severe hypothermia

Rapid transport to definitive care, may have slow heartbeat and tissue rigidity, open airway and check for breathing and pulse for up to a minute, if no cardiac activity, initiate CPR, don’t begin CPR if slow pulse or respiratory effort, focus on heat loss prevention, warming, transport

Avalanche victim management

Race against time because of death from asphyxiation. Victims extricated within 15 minutes have 90% survival rate. Assess and manage injuries, hypothermia doesn’t develop as rapidly as submerged water patient

Full vs partial thickness frostbite

Partial-thickness frostbite (1st and 2nd degrees) involves the skin, with symptoms like numbness and clear blisters, while full-thickness frostbite (3rd and 4th degrees) extends deeper, affecting muscle, tendon, and bone, leading to hard, black tissue and potential amputation