NREMT Paramedic Cognitive ExamMedicalEasy
A 35-year-old male is found unconscious in an unheated garage. His skin is cold to the touch, and he is shivering uncontrollably. His core body temperature is measured at 92°F (33.3°C). His heart rate is 50 bpm, and respiratory rate is 10 bpm. Which of the following is the most appropriate initial rewarming strategy?
- AImmediate defibrillation for bradycardia.
- BAdministration of warm intravenous fluids and gastric lavage.
- CPassive external rewarming with removal from cold environment and insulation.
- DRapid active external rewarming with warm water immersion.
Show answer & explanationAnswer & explanation
Correct answer: C. Passive external rewarming with removal from cold environment and insulation.
The patient's core temperature of 92°F (33.3°C) indicates moderate hypothermia. For moderate hypothermia, passive external rewarming is generally preferred to avoid 'rewarming shock' and afterdrop. This involves removing the patient from the cold environment, removing wet clothing, and insulating them with blankets.
Why the other options are wrong
- A. Bradycardia in hypothermia is often physiological and does not typically warrant immediate defibrillation unless it progresses to a lethal arrhythmia. Attempting defibrillation in hypothermia can also be ineffective or induce ventricular fibrillation.
- B. Administration of warm intravenous fluids is an active internal rewarming technique, usually reserved for moderate to severe hypothermia. Gastric lavage is generally not indicated and can be harmful.
- D. Rapid active external rewarming is typically reserved for severe hypothermia or cardiac arrest, and carries risks like rewarming shock and afterdrop in moderate hypothermia.
Hypothermia Rewarming Stages
Different methods of rewarming a hypothermic patient based on the severity of their core body temperature.
- Mild (90-95°F / 32-35°C): Passive external rewarming
- Moderate (82-90°F / 28-32°C): Passive external + active external (trunk only), warm IV fluids
- Severe (<82°F / <28°C): Active internal rewarming (e.g., warm IV fluids, lavage, ECMO)
Memory trick: Cold Patient, Warm Blankets, Slow Warm-up!