A 55-year-old male patient with a history of alcoholism presents to the emergency department during winter with slurred speech, confusion, and a rectal temperature of 34.4°C (93.9°F). He was found outdoors by a passerby. Which of the following is the most appropriate initial management for this patient?
Gradual rewarming using warm blankets and a controlled environment
Administration of room temperature intravenous fluids to maintain hydration
Immediate immersion in a warm bath to quickly raise core temperature
The patient is presenting with symptoms consistent with mild to moderate hypothermia. Gradual rewarming with blankets and a controlled environment is appropriate to avoid rapid vasodilation and potential hypotension. Warming methods such as heated IV fluids and airway rewarming are generally reserved for moderate to severe hypothermia with a temperature below 32°C (89.6°F). Active external rewarming such as a warm bath can lead to afterdrop, where cold peripheral blood returns to the central circulation, further decreasing core temperature and leading to worsening hypothermia. Preventing further heat loss is crucial, but will not treat the existing hypothermia.
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BCEN CEN
Environment and Toxicology Emergencies, and Communicable Diseases
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