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Drowning with pulse — DipIMC MCQ

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HardEnvironmental MedicineDrowning with pulseDipIMC

A cold-water casualty has a core temperature of 27°C, heart rate 38/min, systolic pressure 82 mmHg and intermittent ventricular ectopy. He has spontaneous circulation. Which destination strategy is preferred?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: E — Direct transfer to an ECPR-capable centre for active rewarming

The best answer is “Direct transfer to an ECPR-capable centre for active rewarming”. Core temperature below 30°C, systolic pressure below 90 mmHg, marked bradycardia and ventricular arrhythmia are RCUK risk factors for imminent arrest. The patient should be handled gently, insulated and transported directly to an ECPR-capable rewarming centre where feasible. The presence of a pulse does not make local low-acuity management safe.

Reference: Resuscitation Council UK 2025, Special circumstances: https://www.resus.org.uk/professional-library/2025-resuscitation-guidelines/special-circumstances-guidelines