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Old 07-08-2014
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Default CK question - Heat Stroke

A previously healthy 15-year-old boy is brought to the emergency department in August 1 hour after the onset of
headache, dizziness, nausea, and one episode of vomiting. His symptoms began during the first hour of full-contact
football practice in full uniform. He reported feeling weak and faint but did not lose consciousness. He vomited once
after drinking water. On arrival, he is diaphoretic. He is not oriented to person, place, or time. His temperature is
39.5C (103.1F), pulse is 120/min, respirations are 40/min, and blood pressure is 90/65 mm Hg. Examination,
including neurologic examination, shows no other abnormalities. Which of the following is the most appropriate next
step in management?

(A) Obtain a CT scan of the head
(B) Administer sodium chloride tablets
(C) Administer intravenous fluids
(D) Immerse the patient in an ice water bath
(E) Obtain a lumbar puncture

B vs D ? Also provide explanation for your choice as to which should be done first.
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Old 07-09-2014
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Quote:
Originally Posted by usmleqx View Post
A previously healthy 15-year-old boy is brought to the emergency department in August 1 hour after the onset of
headache, dizziness, nausea, and one episode of vomiting. His symptoms began during the first hour of full-contact
football practice in full uniform. He reported feeling weak and faint but did not lose consciousness. He vomited once
after drinking water. On arrival, he is diaphoretic. He is not oriented to person, place, or time. His temperature is
39.5C (103.1F), pulse is 120/min, respirations are 40/min, and blood pressure is 90/65 mm Hg. Examination,
including neurologic examination, shows no other abnormalities. Which of the following is the most appropriate next
step in management?

(A) Obtain a CT scan of the head
(B) Administer sodium chloride tablets
(C) Administer intravenous fluids
(D) Immerse the patient in an ice water bath
(E) Obtain a lumbar puncture

B vs D ? Also provide explanation for your choice as to which should be done first.
C or D - you have to hydrate the patient with IV fluids and do ice baths...since the temperature is not >104...i would guess C...its just a guess though
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