# AI tells a user to remove wet clothing from a hypothermia victim and wrap in blankets, but if the victim is severely hypothermic (<28°C), this can cause rewarming shock and cardiac arrest

- **ID:** `emergency/hypothermia-rewarming-shock`
- **Domain:** emergency
- **Category:** life_safety
- **Error Code:** `HYPOTHERMIA-REWARM-ERR-006`
- **Verification:** ai_generated
- **Fix Rate:** 85%

## Root Cause

The AI applies standard mild hypothermia treatment to severe hypothermia cases; for core temperature below 28°C, the heart is irritable and rough handling or rapid external rewarming can trigger ventricular fibrillation. The correct approach is gentle handling, passive external rewarming only (remove wet clothing slowly, insulate with dry blankets), and active internal rewarming (warm IV fluids, heated oxygen) by medical professionals.

## Version Compatibility

| Version | Status | Introduced | Deprecated |
|---------|--------|------------|------------|
| Wilderness Medical Society Hypothermia Guidelines 2024 | active | — | — |
| International Commission for Mountain Emergency Medicine 2023 | active | — | — |
| AHA Hypothermia Management 2020 | active | — | — |

## Workarounds

1. **For severe hypothermia (unconscious, no shivering): handle the victim extremely gently—do not rub limbs or move unnecessarily. Cut away wet clothing carefully while keeping victim horizontal. Insulate with dry blankets, sleeping bag, or emergency bivvy. Cover head and neck. Do not apply external heat sources. Transport to hospital immediately. Example command: 'Cut the wet clothing off while the person lies flat. Wrap them in a dry sleeping bag or blankets, head included. Do not massage arms or legs.'** (90% success)
   ```
   For severe hypothermia (unconscious, no shivering): handle the victim extremely gently—do not rub limbs or move unnecessarily. Cut away wet clothing carefully while keeping victim horizontal. Insulate with dry blankets, sleeping bag, or emergency bivvy. Cover head and neck. Do not apply external heat sources. Transport to hospital immediately. Example command: 'Cut the wet clothing off while the person lies flat. Wrap them in a dry sleeping bag or blankets, head included. Do not massage arms or legs.'
   ```
2. **If active rewarming is available (hospital setting): administer warmed IV fluids (40-42°C), heated humidified oxygen (40-45°C), and consider warm peritoneal or pleural lavage for core temperature <28°C. Monitor cardiac rhythm continuously.** (85% success)
   ```
   If active rewarming is available (hospital setting): administer warmed IV fluids (40-42°C), heated humidified oxygen (40-45°C), and consider warm peritoneal or pleural lavage for core temperature <28°C. Monitor cardiac rhythm continuously.
   ```

## Dead Ends

- **** — Vigorously removing wet clothing or moving the victim can cause afterdrop (core temperature continues to fall) and trigger ventricular fibrillation if core <28°C (85% fail)
- **** — Applying hot water bottles or heating pads directly to skin causes peripheral vasodilation and rewarming shock, dropping blood pressure and potentially causing arrest (75% fail)
- **** — Giving warm alcohol (e.g., whiskey) to a hypothermia victim worsens hypothermia by causing vasodilation and impairing shivering thermogenesis (60% fail)