Review the supplied clinical scenarios involving environmental or physical emergencies. Identify the likely condition, interpret the important clinical findings, outline appropriate initial management and recognize life-threatening complications requiring urgent intervention.

Heat stroke: Severe hyperthermia with central nervous system dysfunction requires immediate active cooling and resuscitation.

Hypothermia: Core temperature below 35°C indicates hypothermia; prevent further heat loss, handle gently and begin appropriate rewarming.

Drowning/electrocution: Ensure scene safety, assess airway, breathing and circulation, provide CPR or ventilation when indicated, and evaluate for respiratory or cardiac complications.

Altitude/diving emergencies: Give oxygen and arrange descent for severe altitude illness; suspected decompression sickness requires high-concentration oxygen and urgent hyperbaric specialist assessment.

1. Ensure safety and recognize the emergency: Identify environmental exposure and assess scene safety, particularly electrical hazards, water rescue and extreme temperatures. Call for assistance.
2. Perform initial assessment: Assess airway, breathing, circulation, consciousness and temperature. Record vital signs, oxygen saturation and ECG when indicated.
3. Recognize heat illness: Differentiate heat exhaustion from heat stroke by the presence of severe hyperthermia and neurological dysfunction, including confusion, seizures or coma. Start immediate active cooling for heat stroke.
4. Identify and manage hypothermia: Measure core temperature where possible, remove wet clothing, insulate the patient and use appropriate passive or active rewarming. Monitor for arrhythmias and circulatory instability.
5. Interpret drowning and electrical injury: Following drowning, prioritize oxygenation and ventilation; after electrocution, ensure electrical isolation and assess for cardiac arrest, arrhythmias, burns and associated trauma.
6. Recognize altitude and diving emergencies: Identify headache, ataxia or altered consciousness after ascent as possible high-altitude illness; recognize joint pain, neurological deficits or breathlessness after diving as possible decompression sickness.
7. Initiate treatment and escalate: Provide appropriate cooling or warming, oxygen and resuscitation as required. Arrange urgent descent for severe altitude illness, hyperbaric assessment for decompression sickness and emergency referral for life-threatening complications.

Exam Pearl: Heat stroke is a clinical emergency characterized by severe hyperthermia with central nervous system dysfunction. Sweating may still be present; dry skin is not essential for diagnosis.

Safety Warning: Do not delay active cooling in suspected heat stroke. Never touch an electrical injury victim before the power source is isolated. In severe hypothermia, handle the patient gently because the myocardium is vulnerable to arrhythmias.