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Posterolateral corner injury — MRCEM SBA MCQ

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HardKnee InjuriesPosterolateral corner injuryMRCEM SBA

A climber in ventricular fibrillation has a core temperature of 27°C. Three shocks have failed and advanced life support continues during active rewarming. What modification is appropriate until the temperature exceeds 30°C?

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Correct answer: A — Withhold further shocks and adrenaline while rewarming continues

The best answer is “Withhold further shocks and adrenaline while rewarming continues”. In severe accidental hypothermia below 30°C, drug metabolism is markedly slowed and repeated defibrillation is often ineffective. After up to three unsuccessful shocks, further shocks are deferred until core temperature rises above 30°C; adrenaline is also withheld below 30°C, then dosing intervals are modified during rewarming. High-quality CPR, airway management, gentle handling and active internal/external rewarming continue. Failure of initial shocks is not a reason to stop because profound hypothermia can preserve neurological viability and extracorporeal rewarming may permit recovery after prolonged arrest.

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