EM Cases · Hypothermia
Hypothermic cardiac arrest — the cold water fisherman
An ACEM Fellowship OSCE clinical-management (resus) station. Tests recognition of severe hypothermia, application of the modified advanced life support (gentle handling, up to three shocks then delay below 30 C, adrenaline withheld below 30 C, prolonged CPR), activation of extracorporeal rewarming (ECMO), and refusal to call death on downtime alone. Maps to the OSCE clinical-management domain. ACEM-primary, globally tagged.
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Station brief
Format. Clinical-management (resus) station, 11 minutes total — 4 minutes reading, 7 minutes active assessment. You are the Emergency Medicine consultant leading the resuscitation.
Candidate instructions. You are handed over a 52-year-old fisherman recovered from harbour water after an unwitnessed fall from his boat, submerged for an estimated 30 minutes. He is in cardiac arrest. Read the observations and the brief scenario, then manage the patient. The examiner will play the nursing team and respond to your instructions. State your actions and your reasoning aloud.[3]
References7ShowHide
- [1]Brown DJA, Brugger H, Boyd J, Paal P. Accidental hypothermia. New England Journal of Medicine, 2012.PMID 23150960
- [3]Lott C, Truhlář A, Alfonzo A, et al. European Resuscitation Council Guidelines 2021: Cardiac arrest in special circumstances. Resuscitation, 2021.PMID 33773826
- [4]Wanscher M, Agersnap L, Ravn J, et al. Outcome of accidental hypothermia with or without circulatory arrest: experience from the Danish Praesto Fjord boating accident. Resuscitation, 2012.PMID 22634431
- [5]Pasquier M, Rousson V, Darocha T, et al. Hypothermia outcome prediction after extracorporeal life support for hypothermic cardiac arrest patients: An external validation of the HOPE score Resuscitation, 2019.PMID 30940473
- [7]Pasquier M, Hugli O, Paal P, Darocha T, Blancher M, Husby P, Silfvast T, Carron PN, Rousson V. Hypothermia outcome prediction after extracorporeal life support for hypothermic cardiac arrest patients: The HOPE score Resuscitation, 2018.PMID 29481910
- [10]Reed RL 2nd, et al. The disparity between hypothermic coagulopathy and clotting studies J Trauma, 1992.PMID 1404519
- [12]Australian and New Zealand Committee on Resuscitation Guideline 11.10 Resuscitation in Special Circumstances ANZCOR, 2026.Source