# 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.

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=375136&lang=en  
> language: en  
> subject: Physiological Adaptation  
> category: PA

## Question

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.

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.

## In-depth explanation

ECMO/CPB rewarming is gold standard in severe hypothermic arrest with reasonable survival even with prolonged downtime if hypothermia preceded arrest.

## Clinical scenario

Severe hypothermia. Wet clothing. No trauma evident.

## Key concepts

- **accidental hypothermia** — Unintentional core temperature drop below 35 C.
- **Osborne wave** — Positive deflection at QRS-ST junction; classic hypothermia ECG sign.
- **active core rewarming** — Internal warming techniques (warmed fluids, lavage, ECMO) for severe hypothermia.

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