A homeless adult arrives with core temperature 28.4 C, lethargic, HR 38, BP 86/52, and Osborne (J) waves on ECG. Which interventions are appropriate? Select all that apply.

Select All That Apply

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1 Handle the client gently to avoid triggering ventricular fibrillation 2 Remove wet clothing and apply forced-air warming blanket (Bair Hugger) 3 Anticipate possible ECMO if cardiac arrest occurs and not responding to ACLS 4 Administer warmed IV crystalloid via central or large peripheral access 5 Apply rapid external cooling to bring temperature down quickly

Explanation

Severe hypothermia (under 28 C) management: GENTLE handling (rough movement triggers VF), remove wet clothing, ACTIVE core rewarming (forced-air blanket, warmed IV fluids 40-42 C, warmed humidified oxygen, body cavity lavage if available, ECMO/CPB for arrest or instability — most effective at 6-10 C/hr). Osborne (J) waves are pathognomonic. CPR continued during rewarming — "not dead until warm and dead." External cooling is INCORRECT — patient is HYPO not hyperthermic.

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A homeless adult arrives with core temperature 28.4 C, lethargic, HR 38, BP 86/52, and Osborne (J) waves on ECG. Which interventions are appropriate? Select all that apply.

Select All That Apply

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