In a patient who is unresponsive and apneic after rescue in cold weather, what is the first step during the primary assessment?

• A. Open airway and give two rescue breaths.
• B. apply AED and assess his cardiac rhythm.
• C. apply chemical heat packs to his groin and axillae.
• D. assess for a carotid pulse for up to 60 seconds.

Answer: (D)

During the primary assessment, the first step is to determine whether there is any circulation by palpating the carotid pulse. In cold weather or suspected hypothermia, the heart rate can be very slow and pulse may be faint, so you may need to check for up to 60 seconds before deciding there is no pulse. If a carotid pulse is present but the patient is not breathing, provide rescue breaths. If no pulse is detected, begin chest compressions immediately (and apply AED as available). Warming measures can be started, but they should not delay resuscitation.