NREMT Paramedic Cognitive ExamMedicalMedium
A 35-year-old male is found unconscious in a cold garage. His skin is cold to the touch, and he has shivering that has now ceased. His core body temperature is estimated at 90°F (32.2°C). His heart rate is 40 bpm and irregular, and his breathing is shallow at 8 bpm. What is the most appropriate rewarming strategy for this patient?
- APassive external rewarming with blankets and removal from cold environment
- BRapid rewarming with a forced-air warming device
- CActive internal rewarming with warmed IV fluids and lavage
- DActive external rewarming with warm water immersion
Show answer & explanationAnswer & explanation
Correct answer: C. Active internal rewarming with warmed IV fluids and lavage
The patient is in moderate to severe hypothermia (core temp 90°F, bradycardia, bradypnea, cessation of shivering). For moderate to severe hypothermia, active internal (core) rewarming is indicated, often with warmed IV fluids and potentially warmed humidified oxygen. Rapid external rewarming can cause 'rewarming shock' by dilating peripheral vessels and shunting cold, acidic blood to the core.
Why the other options are wrong
- A. Passive external rewarming is appropriate for mild hypothermia but insufficient for moderate to severe cases.
- B. Forced-air warming devices are a form of active external rewarming and carry risks of rewarming shock in moderate/severe hypothermia.
- D. Active external rewarming is generally reserved for mild hypothermia or can be dangerous in moderate/severe cases due to rewarming shock.
Hypothermia Rewarming
Strategies to increase core body temperature in hypothermic patients, varying based on severity and aiming to prevent complications like rewarming shock.
- Mild hypothermia (<95°F/35°C): Passive external rewarming.
- Moderate hypothermia (82-90°F/28-32°C): Active internal rewarming.
- Severe hypothermia (<82°F/28°C): Aggressive active internal rewarming and cardiac support.
Memory trick: COLD PATIENT: 'C'ore rewarming, 'O'xygen warm, 'L'iquids warm, 'D'on't move too much.