NLE Emergency & Critical Care Nursing — Trauma, Poisoning & Environmental EmergenciesExam Answer Templates

Marks

1

Topic

Multiple Trauma

Difficulty

easy

Template Id

T1

Examiner Tip

The word 'preventable' is key in this question. Examiners want 'hemorrhage' specifically — it distinguishes a bleeding problem (preventable with direct pressure/tourniquet) from injuries like brain trauma (less immediately preventable in the field).

Model Answer

Hemorrhage (uncontrolled bleeding) is the leading cause of preventable death in multiple trauma patients.

Question Type

very_short_answer

Answer Structure

• Line 1: State the correct answer using the exact clinical term [1 mark]

Scoring Breakdown

Common Mark Deductions

• Writing 'infection' or 'pain' — these are not the leading preventable cause
• Leaving the answer incomplete by writing only 'bleeding' without the clinical context
• Writing 'hypovolemic shock' — while related, the direct cause is hemorrhage

Key Phrases To Include

• hemorrhage
• uncontrolled bleeding
• preventable death
• trauma

Marks

2

Topic

Multiple Trauma

Difficulty

easy

Template Id

T2

Examiner Tip

Examiners expect all three components named correctly and in the context of how they interact. A simple list earns the first mark; the explanation of their cyclical relationship earns the second. Use the word 'self-reinforcing' or 'vicious cycle' to signal clinical understanding.

Model Answer

The trauma lethal triad refers to the three deadly conditions that occur together in severe trauma: hypothermia, metabolic acidosis, and coagulopathy. This triad is dangerous because each condition worsens the others in a self-reinforcing cycle — hypothermia impairs clotting, which worsens bleeding, which causes more acidosis and heat loss — ultimately leading to irreversible shock and death if not interrupted early.

Question Type

short_answer

Answer Structure

• Line 1: Name and define the three components of the triad [1 mark]
• Line 2: Explain why the triad is dangerous or self-reinforcing [1 mark]

Scoring Breakdown

Common Mark Deductions

• Naming only two of the three components — you must list all three to earn the first mark
• Stating the triad is dangerous without explaining the mechanism or cycle
• Confusing 'coagulopathy' with 'clot formation' — coagulopathy means impaired clotting ability

Key Phrases To Include

• hypothermia
• acidosis
• coagulopathy
• self-reinforcing
• lethal triad
• severe trauma

Marks

2

Topic

Emergency Burn Care

Difficulty

medium

Template Id

T3

Examiner Tip

The Parkland formula is a guaranteed high-yield item in the NLE. Memorize it exactly: 4 mL × kg × %TBSA = total LR in 24 hours. Examiners frequently ask about the timing — emphasize 'from the time of injury' not from hospital arrival. The urine output target differentiates a well-resuscitated patient.

Model Answer

Parkland formula: 4 mL × body weight (kg) × %TBSA burned of Lactated Ringer's solution over 24 hours. Administration: Give half (50%) of the total calculated volume in the first 8 hours from the time of injury, and the remaining half over the next 16 hours. Target urine output is 0.5 mL/kg/hr in adults to confirm adequate resuscitation.

Question Type

short_answer

Answer Structure

• Line 1: Write the complete formula with all variables and fluid type [1 mark]
• Line 2: Describe the administration schedule — half in first 8 hours, half over next 16 hours — and state the urine output target [1 mark]

Scoring Breakdown

Common Mark Deductions

• Using normal saline instead of Lactated Ringer's solution
• Forgetting to specify that the 8-hour period is timed from the moment of injury, not from hospital arrival
• Omitting the urine output target — this is a key monitoring parameter that examiners often include in the marking scheme
• Writing '2 mL' or '3 mL' instead of the correct '4 mL' coefficient

Key Phrases To Include

• 4 mL
• body weight in kg
• %TBSA
• Lactated Ringer's
• first 8 hours
• next 16 hours
• urine output
• 0.5 mL/kg/hr

Marks

1

Topic

Emergency Burn Care / Poisoning

Difficulty

medium

Template Id

T4

Examiner Tip

This is a classic NLE trap question. The key word is 'falsely normal' — students often assume monitoring would show a low reading, but it shows a dangerously misleading normal reading. This is exactly what makes CO poisoning so deadly.

Model Answer

Pulse oximetry is unreliable in CO poisoning because it cannot distinguish carboxyhemoglobin from oxyhemoglobin, resulting in falsely normal oxygen saturation readings even when the patient is severely hypoxic.

Question Type

very_short_answer

Answer Structure

• Line 1: State the mechanism — carboxyhemoglobin reads as oxyhemoglobin, giving a falsely normal SpO2 [1 mark]

Scoring Breakdown

Common Mark Deductions

• Writing only 'CO affects hemoglobin' without explaining the false reading mechanism
• Saying SpO2 is 'falsely low' — it is actually falsely NORMAL or falsely HIGH
• Not using the term 'carboxyhemoglobin'

Key Phrases To Include

• carboxyhemoglobin
• oxyhemoglobin
• falsely normal
• pulse oximetry
• CO poisoning

Marks

2

Topic

Heat-Related Illness

Difficulty

easy

Template Id

T5

Examiner Tip

Examiners design questions specifically to test this distinction. Always lead with mental status as the primary differentiator. A simple comparison table in your mind: Heat Exhaustion = Alert + Sweating; Heat Stroke = Confused/Unconscious + Temp >40°C = EMERGENCY.

Model Answer

Heat exhaustion presents with heavy sweating, weakness, nausea, and headache, with a normal or mildly elevated core temperature and — most importantly — an INTACT mental status. The patient is alert and oriented. Heat stroke is a medical emergency characterized by a core temperature above 40°C (104°F) WITH altered mental status (confusion, disorientation, seizures, or coma). Classic heat stroke shows hot, dry skin. The key distinguishing feature is mental status: intact in heat exhaustion, altered in heat stroke.

Question Type

short_answer

Answer Structure

• Line 1: Describe heat exhaustion — normal/mildly elevated temperature, intact mental status [1 mark]
• Line 2: Describe heat stroke — core temp >40°C, altered mental status, emergency [1 mark]

Scoring Breakdown

Common Mark Deductions

• Reversing the mental status findings — stating heat exhaustion has altered mental status
• Not specifying the temperature threshold of 40°C for heat stroke
• Omitting the word 'emergency' when describing heat stroke
• Describing skin findings only without mentioning mental status — mental status is the KEY differentiator

Key Phrases To Include

• intact mental status
• altered mental status
• core temperature
• >40°C
• medical emergency
• heat exhaustion
• heat stroke

Marks

2

Topic

Poisoning and Overdose

Difficulty

medium

Template Id

T6

Examiner Tip

For list-type questions, write in clear numbered format. Each point should be specific and contain the clinical rationale. Listing 'unconscious patient' alone is acceptable for 0.5 mark, but adding 'due to aspiration risk' demonstrates deeper understanding and secures the mark if there is any ambiguity.

Model Answer

Activated charcoal is contraindicated or ineffective in the following situations: (1) Unprotected airway — patient is unconscious or has decreased level of consciousness without a secured airway, due to high aspiration risk. (2) Ingestion of caustic or corrosive substances — charcoal does not bind corrosives and may worsen esophageal injury. (3) Ingestion of hydrocarbons — risk of aspiration pneumonitis. (4) Ingestion of substances it does not adsorb — including alcohols, iron, lithium, and heavy metals.

Question Type

short_answer

Answer Structure

• Point 1: Unprotected airway / decreased consciousness [0.5 mark]
• Point 2: Caustic or corrosive ingestion [0.5 mark]
• Point 3: Hydrocarbon ingestion [0.5 mark]
• Point 4: Substances not adsorbed (alcohols, iron, lithium) [0.5 mark]

Scoring Breakdown

Common Mark Deductions

• Listing only 2-3 contraindications when 4 are requested
• Writing general statements like 'dangerous patient' without specifying the clinical reason
• Confusing contraindications with general precautions

Key Phrases To Include

• unprotected airway
• aspiration risk
• caustic
• corrosive
• hydrocarbon
• alcohols
• iron
• lithium
• does not adsorb

Marks

2

Topic

Poisoning and Overdose

Difficulty

easy

Template Id

T7

Examiner Tip

Poison-antidote matching is among the most frequently tested items in the NLE. Create a personal mnemonic table and review it daily before the exam. Examiners sometimes offer a hint by describing the toxidrome (e.g., SLUDGE for organophosphates) rather than naming the poison directly.

Model Answer

(a) Opioid overdose → Naloxone. Reverses respiratory depression by competitively blocking opioid receptors. (b) Acetaminophen/Paracetamol overdose → N-acetylcysteine (NAC). Most effective within 8 hours; replenishes glutathione to prevent hepatic necrosis. (c) Organophosphate poisoning → Atropine (primary, reverses muscarinic effects) PLUS Pralidoxime/2-PAM (reactivates cholinesterase). (d) Digoxin toxicity → Digoxin-specific antibody fragments (Fab/Digibind). Used for life-threatening dysrhythmias or severe hyperkalemia.

Question Type

short_answer

Answer Structure

• Each correct poison-antidote pair earns 0.5 mark
• 4 pairs × 0.5 = 2 marks total

Scoring Breakdown

Common Mark Deductions

• Writing 'activated charcoal' as a universal antidote — it is a decontaminant, not a specific antidote
• Writing only 'atropine' for organophosphate without mentioning pralidoxime in questions that ask for complete management
• Confusing flumazenil (benzodiazepine antidote) with naloxone (opioid antidote)

Key Phrases To Include

• naloxone
• N-acetylcysteine
• NAC
• atropine
• pralidoxime
• digoxin-specific Fab
• Digibind

Marks

3

Topic

Bites and Stings

Difficulty

medium

Template Id

T8

Examiner Tip

In snakebite questions, examiners often test what you should NOT do as much as what you should do. Avoid listing contraindicated actions as interventions. If given space, briefly note: 'Do NOT apply ice, do NOT cut and suck, do NOT apply tourniquet' — this demonstrates clinical awareness and may earn bonus consideration.

Model Answer

Initial nursing interventions for snakebite: (1) Immobilize the bitten extremity at or below the level of the heart — this slows the spread of venom by reducing lymphatic and venous circulation from the site. (2) Keep the patient calm and still — movement and anxiety increase heart rate and circulation, accelerating venom distribution. (3) Mark the advancing edge of swelling with a pen and note the time — this objectively monitors envenomation progression and guides antivenom therapy decisions. (4) Prepare for and administer antivenom as ordered when signs of systemic envenomation are present, following the physician's prescription per RA 9173 scope of practice. The nurse must also remove rings, watches, and tight clothing from the affected limb to prevent tourniquet effect as edema worsens.

Question Type

short_answer

Answer Structure

• Point 1: Immobilize limb at or below heart level + rationale [0.75 mark]
• Point 2: Keep patient calm and still + rationale [0.75 mark]
• Point 3: Mark swelling edge with time + rationale [0.75 mark]
• Point 4: Prepare antivenom / remove constricting items [0.75 mark]

Scoring Breakdown

Common Mark Deductions

• Recommending ice application — this is contraindicated and is a major clinical error
• Recommending cut-and-suck technique — this is outdated, ineffective, and harmful
• Recommending an arterial tourniquet — this causes ischemic injury
• Failing to include rationale for interventions when the question implies clinical reasoning

Key Phrases To Include

• immobilize
• below heart level
• calm and still
• mark swelling
• antivenom
• remove constricting items
• no ice
• no cut and suck
• no tourniquet

Marks

2

Topic

Hypothermia

Difficulty

medium

Template Id

T9

Examiner Tip

This is a conceptual question that tests understanding, not memorization. Examiners want to see that you understand WHY the maxim is true — the metabolic cold protection is the reason. Use the phrase 'metabolic suppression' or 'cold-induced organ protection' to score the second mark.

Model Answer

'Not dead until warm and dead' means that CPR and resuscitative efforts must continue in a hypothermic cardiac arrest patient until the core temperature has been raised to near-normal levels before terminating resuscitation. This is because severe hypothermia causes profound metabolic suppression that protects the brain and vital organs from hypoxic damage, allowing survival even after prolonged cardiac arrest. A patient who appears dead from hypothermia may fully recover with aggressive rewarming. Resuscitation should never be stopped based on clinical appearance alone in a hypothermic patient.

Question Type

short_answer

Answer Structure

• Line 1: Define what the maxim means — continue CPR and resuscitation until patient is rewarmed [1 mark]
• Line 2: Explain the physiological rationale — hypothermia provides metabolic protection enabling survival after prolonged arrest [1 mark]

Scoring Breakdown

Common Mark Deductions

• Stating only that 'you should not give up' without providing the physiological rationale
• Confusing this principle with other resuscitation endpoints
• Failing to mention that core temperature must be raised before determining death

Key Phrases To Include

• continue CPR
• until rewarmed
• metabolic suppression
• brain protection
• prolonged arrest
• do not terminate resuscitation

Marks

2

Topic

Near-Drowning

Difficulty

medium

Template Id

T10

Examiner Tip

Use the clinical term 'secondary drowning' or 'delayed pulmonary edema' — vague answers like 'they might get worse' will not earn full marks. Mention the need for observation even in apparently well patients; this demonstrates safe nursing practice.

Model Answer

Near-drowning is an emergency even in apparently recovered patients because of the risk of delayed pulmonary complications, specifically secondary drowning or delayed pulmonary edema, which can develop hours (typically 4–8 hours) after the submersion event. During submersion, aspiration of water (even small amounts) causes surfactant washout and alveolar damage, leading to progressive hypoxia, pulmonary edema, and respiratory failure that may not be clinically apparent immediately. All submersion victims — including those who appear well — must be observed in a healthcare facility for at least 4–8 hours after the event.

Question Type

short_answer

Answer Structure

• Line 1: Identify the specific delayed complication — secondary drowning / delayed pulmonary edema [1 mark]
• Line 2: Explain the mechanism and the need for observation [1 mark]

Scoring Breakdown

Common Mark Deductions

• Writing only 'complications may develop' without naming the specific complication
• Confusing wet drowning with dry drowning mechanisms
• Stating that fresh vs. saltwater drowning requires different management — this is not clinically significant in acute management

Key Phrases To Include

• secondary drowning
• delayed pulmonary edema
• surfactant
• progressive hypoxia
• observation
• 4-8 hours

Marks

3

Topic

Emergency Burn Care

Difficulty

easy

Template Id

T11

Examiner Tip

For list questions, more specific answers earn more credit. 'Singed nasal hair' is more specific and earns more credit than just 'facial signs.' Stridor is particularly important to mention as it signals imminent life-threatening airway obstruction and the need for immediate intubation.

Model Answer

Clinical signs suggestive of inhalation injury include: (1) Facial burns or burns around the mouth and nose. (2) Singed nasal hair or eyebrows. (3) Soot or carbonaceous deposits in the mouth, nose, or sputum. (4) Hoarseness or voice changes indicating laryngeal edema. (5) Stridor — a high-pitched inspiratory sound indicating significant upper airway obstruction. Additional signs may include: progressive respiratory distress, coughing with carbonaceous sputum, or a history of being in an enclosed space during a fire.

Question Type

short_answer

Answer Structure

• Sign 1: Facial burns [0.6 mark]
• Sign 2: Singed nasal hair [0.6 mark]
• Sign 3: Soot in mouth/nose/sputum [0.6 mark]
• Sign 4: Hoarseness [0.6 mark]
• Sign 5: Stridor [0.6 mark]

Scoring Breakdown

Common Mark Deductions

• Listing general respiratory symptoms like 'difficulty breathing' without specificity
• Repeating the same sign in different words
• Missing stridor — this is the most critical sign indicating imminent airway obstruction

Key Phrases To Include

• facial burns
• singed nasal hair
• soot
• hoarseness
• stridor
• carbonaceous sputum
• enclosed space

Marks

5

Topic

Multiple Trauma

Difficulty

hard

Template Id

T12

Examiner Tip

For 5-mark long-answer questions, examiners use a component-by-component marking scheme. Missing even one letter of ABCDE costs you marks. Write each component as a mini-paragraph with: (1) what you assess, (2) what you find that is dangerous, and (3) what you do. Including at least one NANDA nursing diagnosis shows integration of the nursing process, which reflects NLE expectations under RA 9173 standards of practice.

Model Answer

The primary survey in multiple trauma follows the ABCDE framework, which provides a systematic, priority-based approach to identify and treat immediately life-threatening conditions. A — AIRWAY with Cervical Spine Control: The highest priority. Assess for airway patency. In trauma, assume a cervical spine injury until proven otherwise. Open the airway using the jaw-thrust maneuver (NOT head-tilt-chin-lift, which could worsen a spinal injury). Apply a cervical collar. If the patient cannot maintain the airway, prepare for endotracheal intubation. B — BREATHING and Ventilation: Assess respiratory rate, depth, breath sounds, and chest wall movement. Identify and treat immediately life-threatening chest injuries: (1) Tension pneumothorax — needle decompression at the 2nd intercostal space, midclavicular line; (2) Open pneumothorax — three-sided occlusive dressing; (3) Massive hemothorax — chest tube insertion. Administer high-flow oxygen to all trauma patients. C — CIRCULATION with Hemorrhage Control: Hemorrhage is the leading cause of preventable trauma death. Assess pulse, skin color, capillary refill, and blood pressure. Apply direct pressure to external bleeding wounds. For uncontrolled limb hemorrhage, apply a tourniquet. Establish two large-bore (16G or larger) peripheral IV lines and begin fluid and blood product resuscitation. Monitor for occult bleeding into the chest, abdomen, pelvis, and thighs. D — DISABILITY (Neurological Status): Assess the Glasgow Coma Scale (GCS) — eye opening, verbal response, and motor response. Assess pupils for size, equality, and reactivity. A decreasing GCS or unequal pupils may indicate rising intracranial pressure, requiring urgent neurosurgical consultation. E — EXPOSURE and Environmental Control: Fully remove all clothing to expose and assess for hidden injuries (wounds, deformities, contusions). After full exposure, aggressively prevent hypothermia with warm blankets, warmed IV fluids, and a warm environment. Hypothermia is part of the lethal triad and worsens coagulopathy and mortality. Nursing Diagnosis (NANDA): Risk for Decreased Cardiac Output related to hypovolemia secondary to hemorrhage. Impaired Spontaneous Ventilation related to chest trauma. Risk for Ineffective Cerebral Tissue Perfusion related to increased intracranial pressure. Key Principle: The primary survey is repeated continuously — a stable trauma patient can deteriorate rapidly from ongoing internal bleeding. The nurse's most critical role is vigilant reassessment.

Question Type

long_answer

Answer Structure

• Introduction: State the purpose and framework of the primary survey [0.5 mark]
• A — Airway with C-spine control: jaw-thrust, C-collar, intubation [1 mark]
• B — Breathing: assess and treat tension pneumothorax, open pneumothorax, hemothorax [1 mark]
• C — Circulation: hemorrhage control, IVs, fluid resuscitation, occult bleeding [1 mark]
• D — Disability: GCS, pupils, ICP monitoring [1 mark]
• E — Exposure and Environment: full exposure, hypothermia prevention [0.5 mark]
• Nursing diagnoses or key principle of continuous reassessment [partial credit across components]

Scoring Breakdown

Common Mark Deductions

• Using head-tilt-chin-lift instead of jaw-thrust for airway opening — this is a critical clinical error in trauma
• Not mentioning cervical spine precautions in the airway component
• Writing 'give IV fluids' for circulation without specifying large-bore access and hemorrhage control priority
• Omitting the E component or treating it as trivial — hypothermia prevention is a resuscitation priority
• Not including any nursing diagnoses in a 5-mark answer — these demonstrate application of the nursing process
• Listing ABCDE as a list without explaining the priority action or rationale for each component

Key Phrases To Include

• ABCDE
• jaw-thrust
• cervical spine
• tension pneumothorax
• needle decompression
• hemorrhage
• tourniquet
• Glasgow Coma Scale
• intracranial pressure
• hypothermia prevention
• lethal triad
• reassessment

Marks

5

Topic

Poisoning and Overdose

Difficulty

hard

Template Id

T13

Examiner Tip

Case study questions test your clinical reasoning and ability to prioritize. Examiners award marks for correct sequencing — ABCs always come first. The highest-risk error in this scenario is applying activated charcoal to an unconscious patient; acknowledging this contraindication shows patient safety awareness, which is heavily weighted in NLE marking.

Model Answer

Nursing Management for Suspected Poisoning: Step 1 — Primary Survey / Stabilize ABCs First: Assess and secure the airway — the patient is unconscious, so position in recovery position if breathing, or prepare for intubation. Assess breathing rate, depth, and oxygen saturation (use caution as SpO2 may be unreliable if CO poisoning is suspected). Establish IV access and assess circulation. Apply cardiac monitoring. Administer supplemental oxygen. Do NOT proceed with decontamination until the airway is protected. Step 2 — History and Toxin Identification: Collect all available information: what substance was ingested, how much, when (time of ingestion is critical), and whether the patient ingested anything else (polysubstance). Check for pill bottles, blister packs, or evidence at the scene. Contact the Philippine Poison Control Center or refer to toxicology resources. Step 3 — Decontamination (if appropriate): Activated charcoal 1 g/kg may be given if: (1) ingestion occurred within approximately 1 hour, (2) the substance is charcoal-adsorbable (not alcohols, iron, lithium, or corrosives), and (3) the airway is secured. Since this patient is unconscious, activated charcoal is CONTRAINDICATED unless the airway is first secured by intubation. Do NOT induce vomiting. Step 4 — Specific Antidote Administration (as ordered): Administer antidotes based on identified or suspected toxin: Naloxone for suspected opioid toxidrome (respiratory depression, miosis, decreased consciousness); N-acetylcysteine for acetaminophen; Atropine + Pralidoxime for organophosphates (SLUDGE toxidrome). Administer per physician's order as required under RA 9173 scope of nursing practice. Step 5 — Continuous Monitoring and Reassessment: Monitor GCS every 15 minutes, vital signs, oxygen saturation, and cardiac rhythm. Document all findings, interventions, and responses. Prepare for potential complications: aspiration, respiratory failure, cardiac dysrhythmias, seizures, and hepatic failure (acetaminophen). Nursing Diagnoses: (1) Risk for Aspiration related to decreased level of consciousness (2) Impaired Gas Exchange related to respiratory depression secondary to toxic ingestion (3) Ineffective Breathing Pattern related to central nervous system depression Key Principle: Supportive care is the backbone of poisoning management. Specific antidotes are the exception, not the rule. Never compromise the ABCs to administer decontamination.

Question Type

case_study

Answer Structure

• Step 1: ABCs — stabilize airway, breathing, circulation FIRST, mention airway being secured before charcoal [1 mark]
• Step 2: History and toxin identification — time of ingestion, substance, amount [1 mark]
• Step 3: Decontamination — activated charcoal with correct conditions and contraindications in this unconscious patient [1 mark]
• Step 4: Antidote administration — at least 2-3 specific examples with correct pairings [1 mark]
• Step 5: Monitoring, reassessment, documentation, and nursing diagnoses [1 mark]

Scoring Breakdown

Common Mark Deductions

• Administering activated charcoal to an unconscious patient without mentioning the need for a secured airway first — this is a patient safety error
• Not mentioning time of ingestion as critical historical data
• Recommending gastric lavage or ipecac — these are no longer standard of care
• Omitting the RA 9173 reference for antidote administration (requires physician's order)
• Not including nursing diagnoses in a 5-mark case study answer

Key Phrases To Include

• ABCs first
• secured airway
• activated charcoal contraindicated
• time of ingestion
• naloxone
• N-acetylcysteine
• atropine
• physician's order
• RA 9173
• supportive care
• monitoring GCS
• aspiration risk

Marks

1

Topic

Heat-Related Illness

Difficulty

easy

Template Id

T14

Examiner Tip

The most common wrong answer here is 'give antipyretics.' Examiners specifically test whether students know that antipyretics are NOT effective in heat stroke. The rationale is critical: heat stroke is not caused by a changed hypothalamic set point (fever) — it is caused by an inability to dissipate environmental heat. This distinction earns marks.

Model Answer

The immediate priority nursing intervention for heat stroke is aggressive, rapid cooling — remove all clothing and begin immediate cooling measures such as ice/cold-water immersion, cool misting and fanning, or application of ice packs to the groin, axillae, and neck. Cooling must not be delayed for transport or diagnostics as prolonged hyperthermia causes irreversible organ damage.

Question Type

very_short_answer

Answer Structure

• Line 1: State aggressive/immediate cooling as the priority action [1 mark]

Scoring Breakdown

Common Mark Deductions

• Writing 'administer antipyretics' — antipyretics do NOT work in heat stroke because the problem is environmental heat load, not an elevated hypothalamic set point
• Writing 'give fluids' as the priority — fluids support circulation but cooling is the primary life-saving intervention
• Writing 'call the doctor' without naming the specific nursing intervention

Key Phrases To Include

• immediate cooling
• aggressive cooling
• remove clothing
• do not delay
• ice packs
• evaporative cooling

Marks

3

Topic

Hypothermia

Difficulty

medium

Template Id

T15

Examiner Tip

This question rewards students who know the specific methods of active internal rewarming. Listing 'warm blankets' for both mild and severe will only earn partial credit. Use the exact terms: passive external, active external, and active internal rewarming to show comprehensive knowledge.

Model Answer

Key differences in hypothermia management based on severity: (1) Rewarming Method: Mild hypothermia (core temp 32–35°C) is managed with passive external rewarming — warm blankets, warm dry environment, and removing wet clothing. The patient's own metabolic heat production is sufficient. Severe hypothermia (core temp <28°C) requires active internal rewarming — warmed humidified oxygen, warmed IV fluids (39–42°C), warmed body cavity lavage, or cardiopulmonary bypass in extreme cases. (2) Cardiac Monitoring and Handling: In severe hypothermia, the myocardium is irritable and prone to ventricular fibrillation with even minor physical stimulation. The patient must be handled very gently. Continuous cardiac monitoring is mandatory. In mild hypothermia, this risk is lower and standard monitoring is sufficient. (3) Duration and Approach to Resuscitation: In mild cases, recovery is straightforward with warming. In severe hypothermic cardiac arrest, resuscitation efforts must be prolonged — following the principle of 'not dead until warm and dead' — with CPR continued until core temperature is restored before declaring resuscitation failure.

Question Type

short_answer

Answer Structure

• Difference 1: Rewarming method — passive external (mild) vs. active internal (severe) [1 mark]
• Difference 2: Cardiac monitoring and gentle handling requirement (severe VF risk) [1 mark]
• Difference 3: Duration/approach to resuscitation — 'not dead until warm and dead' principle in severe cases [1 mark]

Scoring Breakdown

Common Mark Deductions

• Not specifying the type of rewarming for each severity level
• Failing to mention the VF risk and gentle handling requirement
• Writing the same intervention for both mild and severe cases

Key Phrases To Include

• passive external rewarming
• active internal rewarming
• warmed IV fluids
• warmed humidified oxygen
• gentle handling
• ventricular fibrillation
• not dead until warm and dead