Heat illness, hypothermia and environmental emergencies — branching viva

Opening (candidate)

I have two time-critical resuscitations running in parallel. The runner has exertional heat stroke — a core above forty degrees with central nervous system dysfunction — and my priority is to remove the heat and cool him immediately by cold-water immersion to a core below thirty-nine degrees within thirty minutes, because the duration above forty degrees is the chief determinant of survival; I will not wait for investigations or give antipyretics, which do not work in heat stroke. The 7-year-old is profoundly hypothermic at twenty-seven degrees and now in ventricular fibrillation; I continue cardiopulmonary resuscitation, deliver a single shock, withhold further shocks and adrenaline until the core is above thirty degrees, rewar actively, and escalate to extracorporeal rewarming — because nobody is dead until warm and dead. ^{[1] [3] [7]}