You are transporting a 35-year-old male found unresponsive after prolonged exposure to below-freezing temperatures. On assessment, his mental status is impaired, he is no longer shivering, and his core temperature is 32°C (89.6°F). What is the most appropriate initial intervention to manage his hypothermia?
Initiate active external rewarming and administer warm IV fluids
Apply ice packs to his extremities to reduce tissue damage
Use passive rewarming with blankets and clothing
Administer vasopressors to stabilize his blood pressure
The patient's core temperature of 32°C and impaired mental status without shivering are classic signs of moderate hypothermia. For this stage, passive rewarming alone is insufficient. The standard of care is active rewarming, which includes both active external methods (e.g., forced-air warming, heat packs to the trunk) and active internal methods like warmed intravenous fluids to treat the life-threatening systemic condition. Vasopressors are generally contraindicated due to the risk of inducing dysrhythmias in a cold, irritable myocardium. Applying ice packs would be harmful and worsen the patient's condition.
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