A 30-year-old man was rescued after being lost in the woods for about 18 hours in 30°F (-1°C). He is unconscious and apneic. In the warmed ambulance, what should you do during the primary assessment?

• A. Assess for a carotid pulse for up to 45 seconds.
• B. Begin CPR immediately without checking pulse.
• C. Check for a radial pulse.
• D. Wait for spontaneous respirations.

Answer: (A)

In a cold, hypothermic patient, the heart often beats very weakly and pulse signals can be extremely hard to detect. During the primary assessment, you should check for a carotid pulse for as long as necessary—up to 45 seconds—to avoid missing a faint pulse. If a pulse is present, provide rescue breaths; if no pulse is detected after that extended check, begin CPR. Radial pulses are unreliable in this situation, and you should not wait for spontaneous respirations since the patient is apneic. This approach helps ensure you don’t delay life-saving interventions in a hypothermic collapse.