Deviation in the Standard of Medical Care When Treating a Patient with Hyperthermia (Heat Stroke or Exhaustion)

Evaluate breaches in the standard of care when evaluating a Deviation in the Standard of Medical Care When Treating a Patient with Hyperthermia (Heat Stroke or Exhaustion)

Answer the following questions to find out if the standard of care was followed for your case.

  • From which of the following heat-related illness did the patient suffer?
    Heat exhaustion
    Heat stroke
    Why is this important?
    Environmental exposure to high temperatures can result in abnormalities ranging from mild heat exhaustion to heat stroke with multiorgan system failure.
    Click here for additional information at ClinicalKey.com

  • With which of the following signs and symptoms of heat exhaustion did the patient present? (Choose all that apply) Why is this important?
    Answer this question
    Heat exhaustion is a clinical syndrome characterized by volume depletion that occurs under conditions of heat stress. The two types of heat exhaustion are water depletion and salt depletion. The symptoms and signs associated with both types of heat exhaustion are variable and nonspecific and include weakness, fatigue, frontal headache, impaired judgment, vertigo, nausea and vomiting and occasionally muscle cramps. The core temperature is only moderately elevated, usually 40 degree Celsius and signs of severe Central Nervous System (CNS) dysfunction are not present
    Click here for additional information at ClinicalKey.com

  • Was a medical history obtained? Why is this important?
    Answer this question
    A complete medical history and carefully focused physical examination serve as the core of the diagnostic process. The information obtained guides the further direction of the patient's evaluation and enables the clinician to make the most judicious use of additional tests. It helps determine the value of incongruent and conflicting results that can emerge during the diagnostic process, and it can obviate the need for tests that are costly or expose the patient to discomfort or risk.
    Click here for additional information at ClinicalKey.com

  • Was a physical examination performed? Why is this important?
    Answer this question
    A complete medical history and carefully focused physical examination serve as the core of the diagnostic process. The information obtained guides the further direction of the patient's examination, enables the clinician to make educated evaluations, and be better equipped to advise the patient.
    Click here for additional information at ClinicalKey.com

  • For which of the following reasons was the patient not hospitalized? (Choose all that apply) Why is this important?
    Answer this question
    Young, otherwise healthy patients who do not have significant laboratory abnormalities and who respond rapidly to hydration do not require hospitalization. Admission should be considered if the patient is elderly, has significant electrolyte abnormalities or would be at risk of recurrence if discharged.
    Click here for additional information at ClinicalKey.com

  • Was hydration status evaluated? Why is this important?
    Answer this question
    Decisions regarding the type of fluid and electrolyte replacements should be based in serum electrolyte measurements and the estimation of hydration status by clinical and laboratory parameters.
    Click here for additional information at ClinicalKey.com

  • Was frequent reassessment performed for older patients with predisposing factors? Why is this important?
    Answer this question
    Older patients particularly those with cardiovascular disease or other predisposing factors require more cautious inpatient fluid and electrolyte replacement and frequent reassessment.
    Click here for additional information at ClinicalKey.com

  • Which of the following treatment options were not initiated? (Choose all that apply) Why is this important?
    Answer this question
    Patients with significant volume depletion or electrolyte abnormalities require intravenous fluids. If the patient is orthostatic, normal saline should be administered until the patient is hemodynamically stable. Free water deficits should be replaced slowly during 48 hrs to avoid a decrease of serum osmolality more than 2mOsm/hr. Treatment includes rest, cool environment, fluid replacements.
    Click here for additional information at ClinicalKey.com

  • Which of the following measures were initiated in patients with heat exhaustion? (Choose all that apply) Why is this important?
    Answer this question
    Antipyretics which act by interfering with the sequence of events, by which pyrogens induce fever, are ineffective in reducing nonfebrile hyperthermia. Alcohol sponge baths are also contraindicated, as a large amount of alcohol can be absorbed via dilated cutaneous vessels, resulting in alcohol toxicity. Use of antipyretics (aspirin and acetaminophen) may be harmful and have no role in the treatment of heatstroke. Acetaminophen may worsen liver damage, and aspirin may worsen the coagulopathy.
    (1999) 15 ECRICC 2 251-263

  • Was patient information/discharge instructions provided? Why is this important?
    Answer this question
    Patients can be discharged with instructions to drink plenty of fluids and to avoid heat stress for 24 to 48 hrs.
    Click here for additional information at ClinicalKey.com

  • Were follow-up evaluations advised? Why is this important?
    Answer this question
    Routine follow-up evaluations are necessary to offset any complications that may arise.
    Click here for additional information at ClinicalKey.com

  • Did the Emergency Medical Services (EMS) personnel initiate rapid cooling of the patient? Why is this important?
    Answer this question
    During evacuation iced sheets and ice packs can be easily used en route during transport.
    Click here for additional information at ClinicalKey.com

  • Did the Emergency Medical Services (EMS) personnel administer normal saline or lactated Ringers during transport? Why is this important?
    Answer this question
    Administration of normal saline or lactated Ringer’s solution should be started during evacuation. Many EMS vehicles now carry refrigerated intravenous fluid to initiate induction of therapeutic hypothermia in cardiovascular emergencies. (Pinpoint cite to “Emergency Medical Services Treatment”)
    Click here for additional information at ClinicalKey.com

  • Were blood glucose levels evaluated? Why is this important?
    Answer this question
    A blood glucose determination should be performed and adults with blood sugar level less than 60 mg/dL should be treated with 1 ampule of 50 percent IV dextrose solution. Children should be treated with 2 to 4 cc/kg of 25 percent IV dextrose solution.
    Click here for additional information at ClinicalKey.com

  • Was antipyretics administered? Why is this important?
    Answer this question
    The use of antipyretics is not effective and may potentially be harmful to heatstroke victims. Aspirin and acetaminophen lower core temperature by normalizing the elevated hypothalamic set point that is caused by pyrogens; in heatstroke, the set point is normal, with core temperature elevation reflecting a failure of normal cooling mechanisms.
    Click here for additional information at ClinicalKey.com

  • Did the Emergency Medical Services (EMS) personnel communicate the patient’s condition to the medical staff? Why is this important?
    Answer this question
    Emergency medical transport personnel should attempt to obtain this history before evacuating the victim and should communicate the information to medical staff. Of particular importance is the duration and the maximum degree of hyperthermia.
    Click here for additional information at ClinicalKey.com

  • With which of the following signs and symptoms of heat stroke did the patient present? (Choose all that apply) Why is this important?
    Answer this question
    The classic definition of heat stroke was a core body temperature higher than 40 degree C. Common symptoms are extreme thirst, dizziness, lightheadedness, fatigue, weakness, syncope, headache, malaise, and vomiting. Signs include tachycardia, orthostatic hypotension, tachypnea, and diaphoresis. The signs and symptoms of heat stroke are similar to those of heat exhaustion, except for the addition of CNS dysfunction in the form of delirium, hallucinations, ataxia, convulsions, or coma.
    Click here for additional information at ClinicalKey.com

  • Was a medical history obtained? Why is this important?
    Answer this question
    A complete medical history and carefully focused physical examination serve as the core of the diagnostic process. The information obtained guides the further direction of the patient's evaluation and enables the clinician to make the most judicious use of additional tests. It helps determine the value of incongruent and conflicting results that can emerge during the diagnostic process, and it can obviate the need for tests that are costly or expose the patient to discomfort or risk.
    Click here for additional information at ClinicalKey.com

  • Was a physical examination performed Why is this important?
    Answer this question
    A complete medical history and carefully focused physical examination serve as the core of the diagnostic process. The information obtained guides the further direction of the patient's evaluation and enables the clinician to make the most judicious use of additional tests. It helps determine the value of incongruent and conflicting results that can emerge during the diagnostic process, and it can obviate the need for tests that are costly or expose the patient to discomfort or risk.
    Click here for additional information at ClinicalKey.com