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Clinical Review Quiz

Accidental Hypothermia

Faris A. Khasawneh, MD, and Sajan Thomas, MD

Dr. Khasawneh is an internal medicine resident, and Dr. Thomas is an assistant program director, Internal Medicine Residency Program; both are at Westlake Hospital, Melrose Park, IL.



The questions below are based on the article
“Accidental Hypothermia”.


Choose the single best answer for each question.


1. A 76-year-old nursing home resident is found unresponsive in his room in July. A nurse had last seen him watching television the previous evening. The patient’s past medical history is significant for hypertension and a stroke, which rendered him aphasic and bed-bound for the past 3 months. On examination, the patient is unresponsive to painful stimuli. His blood pressure is 110/70 mm Hg, heart rate is 51 bpm, temperature is 30°C, and respiratory rate is 10 breaths/min. What is the most likely cause of this patient’s hypothermia?
  1. Decreased ambient temperature due to air conditioning
  2. Hypoadrenalism
  3. Hypoglycemia
  4. Hypothyroidism
  5. Sepsis
Click here to compare your answer.


2. A 35-year-old man is found undressed under the stairs of an abandoned building in January. Upon initial evaluation, the patient’s heart rate is 40 bpm, and his blood pressure is 100/50 mm Hg. A temperature could not be recorded by rectal thermometer. There are no signs of trauma. Which of the following initial management options should be avoided in this patient?

  1. Blood draw for routine laboratory work-up and blood cultures
  2. Endotracheal intubation for airway protection
  3. Infusing intravenous dextrose with thiamine
  4. Oxygen therapy
  5. Wrapping the patient with a blanket
Click here to compare your answer.


3. A 60-year-old homeless man is brought to the emergency department by the emergency medical services team. He was found in asystole in the field where resuscitative efforts were initiated 30 minutes ago. Initial evaluation reveals no heart rate, and a temperature of 27°C is recorded by a bladder probe. According to ACLS guidelines, cardiorespiratory resuscitation efforts should not be terminated until the core body temperature is at least which of the following?

  1. 25°C
  2. 28°C
  3. 32°C
  4. 35°C
  5. 37°C
Click here to compare your answer.


4. In the hospital setting, which of the following is considered the most reliable method of documenting core body temperature?
  1. Bladder probes
  2. Oral thermometer
  3. Pulmonary artery probe
  4. Rectal thermometer
  5. Tympanic membrane probe
Click here to compare your answer.


5.  In a patient with severe hypothermia and cardiovascular compromise, which of the following is the rewarming modality of choice?

  1. Closed thoracic lavage
  2. Extracorporeal blood rewarming
  3. Heated humidified air
  4. Peritoneal dialysis
  5. Warmed intravenous fluids
Click here to compare your answer.


6. An 80-year-old woman is found unresponsive at home. During initial evaluation, temperature could not be recorded by oral thermometer. The patient opens her eyes to noxious stimulus. Which of following signs suggests severe hypothermia?

  1. Dilated pupils
  2. Hypertension
  3. Loss of reflexes
  4. No shivering response
  5. Tachycardia
Click here to compare your answer.


 

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