A 48-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 vital signs are BP 100/60 mmHg, HR 58 bpm, RR 10 bpm. Which rewarming method is most appropriate at this time?
- ARapid active external rewarming with warm water immersion.
- BPassive external rewarming with removal of wet clothing and insulation.
- CActive internal rewarming using warmed IV fluids and airway humidification.
- DWithholding all rewarming until core temperature drops below 90°F (32.2°C).
Show answer & explanationAnswer & explanation
Correct answer: B. Passive external rewarming with removal of wet clothing and insulation.
The patient exhibits signs of mild hypothermia (core temperature 92°F, shivering). For mild hypothermia, passive external rewarming is the preferred initial method. This involves removing wet clothing, insulating the patient with dry blankets, and protecting them from further heat loss. Aggressive active rewarming methods can cause 'rewarming shock' by dilating peripheral vessels and shifting cold, acidic blood to the core.
Why the other options are wrong
- A. Rapid active external rewarming is generally too aggressive for mild hypothermia and can cause 'rewarming shock' and cardiac arrhythmias.
- C. Active internal rewarming is reserved for moderate to severe hypothermia (below 90°F / 32.2°C) or patients who do not respond to passive rewarming.
- D. Rewarming should begin as soon as hypothermia is identified; waiting for a lower temperature is inappropriate and harmful.
Hypothermia Rewarming Stages
Rewarming strategies for hypothermia (core body temperature <95°F / 35°C) depend on the severity, ranging from passive external for mild to active internal for severe cases.
- Mild Hypothermia (90-95°F / 32.2-35°C): Passive external rewarming.
- Moderate Hypothermia (82-90°F / 28-32.2°C): Active external and passive internal rewarming.
- Severe Hypothermia (<82°F / 28°C): Active internal rewarming, careful handling.
Memory trick: Cold Patient: Classify, Insulate, Reheat, Prevent Shock.