peraspera
Forum Elite
Topics: 38
Posts: 233
|
An older woman, known to have a history of psychiatric
problems is found dead in the bathtub by local
police, the victim of a presumed suicide. She is taken to
the local morgue after the crime investigation is complete.
A few hours later, the funeral director is shocked to hear
the sounds of movement and voice emanating from the
“cadaver.” He calls the emergency medical technicians,
who upon arrival should
(A) assess the funeral director for a psychotic break
(B) administer epinephrine
(C) administer solumedrol
(D) commence rewarming
(E) commence cardiac monitoring to determine if resuscitation is appropriate
|
| Kamsi
Forum Guru
Topics: 103
Posts: 347
|
E
|
| doyoudig
Forum Guru
Topics: 144
Posts: 613
|
E.
|
| peraspera
Forum Elite
Topics: 38
Posts: 233
|
|
| Miradautas Vras
Forum Senior
Topics: 8
Posts: 155
|
i think first thing is to assess if she's dead or not. but since checking that is not given and we take fr granted that funeral director is in right set of mind ,i'd see two possible answers here rewarming and adrenalin.
Now things get confusing here. we can get her the first shot of epi and simultaneously rewarm her but deciding order on paper is tricky.
well here is my shot. If she is conscious enough to move and produce voice i think heart is pumping at least basal levels so I'd prefer rewarming here first.but i am not sure
One more thing coming to my mind is that she's psychotic and mostly on phenothiazines , and they are known to cause prolong QT syndrome which can easily lead to Torsades de pointes and syncope. And it can go in to VF if we administer adrenalin.
So I think if she's passably conscious, which looks to be case here I'd first rewarm her take the on the spot EKG and then go accordingly.
not sure though as i said.
___________________
Man who fights too long against the dragons becomes a dragon himself.
|
| dr.wad
Forum Senior
Topics: 3
Posts: 335
|
D_ you are not dead until you are warm and dead ( i read this statement in NMS ).
|
| Justice
Forum Fanatic
Topics: 101
Posts: 1,970
|
We have to remember that average temperature in freezing rooms in morgues is much lower that that of comfort. In addition, many antipsy drugs themselves cause hypothermia
(D) commence rewarming
___________________
Don't live in a town where there are no doctors
|
| hanialkhadher
Forum Elite
Topics: 16
Posts: 256
|
D-
___________________
"أقرأ بأسم ربك الذي خلق,خلق الأنسان من علق,أقرأ و ربك الأكرم, الذي علم بالقلم,علم الأنسان ما لم يعلم"
|
| peraspera
Forum Elite
Topics: 38
Posts: 233
|
The answer is D.
Hypothermia, or an unintentional drop of the body’s core temperature below 35C (95F), may occur as a direct result of exposing an abnormal individual to the cold (or even prolonged immersion in water), or as a consequence of a severe systemic disorder such as hypothyroidism, hypoglycemia, uremia, acute spinal cord or brain injury, or profound burns (excessive heat loss in the damaged skin). Older individuals or those who drink alcohol or take drugs such as phenothiazines, benzodiazepines, or barbiturates, which produce centrally mediated vasoconstriction, are more susceptible to cold weather. Once the diagnosis is made by the finding of a depressed core temperature, preferably at two sites, then oxygen therapy and cardiac monitoring should be initiated; rewarming should commence with resuscitative efforts as needed. In general, a patient should not be declared dead until warmed except in the presence of a known DNRorder, a frozen chest wall that cannot be compressed, or obviously lethal injuries. For patients with advanced hypothermia, active external rewarming is required (rather than simple warming of the head and extremities, which, by removing peripheral vasoconstriction, could actually lower the core temperature). Strategies for active external rewarming include heating blankets; heated intravenous or lavage fluids as well as hemodialysis, continuous arteriovenous rewarming, and even cardiopulmonary bypass constitute active internal rewarming.
|
| RitaM
Forum Newbie
Topics: 1
Posts: 61
|
This is a case of Hypotermia ,I agree
|
|
| |
| | | | | | | | | | |
