How should severe hypothermia with pulselessness be managed in the field?

• A. Wait for spontaneous return of pulse before any warming
• B. Defibrillate repeatedly until a rhythm is achieved
• C. Start or continue CPR, handle gently, avoid excessive movement, apply passive or active external rewarming, rapid transport
• D. Administer warm IV fluids only, withhold CPR

Answer: (C)

In severe hypothermia with pulselessness, the priority is to restore some circulation and warmth to the body while you get the patient to definitive care. Start or continue CPR right away to keep blood flowing to vital organs, and handle the patient gently to minimize further cooling or arrhythmias. Begin passive external rewarming (remove wet clothes, insulate, cover with blankets) and add active external rewarming if available (warming devices, heat packs to the chest, neck, and groin areas). Do not wait for a spontaneous pulse to appear before warming or transporting; rapid transport to a facility capable of advanced rewarming is crucial. Defibrillation is unlikely to work reliably until the patient is adequately warmed, so repeated shocks in the field are not the main strategy. Warming alone without CPR won’t maintain circulation, so continue CPR alongside rewarming and rapid transport.