Cold to the Touch on the Kitchen Floor - Geriatric Medicine clinical simulation case. A 79-year-old male found by his daughter collapsed on the kitchen...
Age: 79 • Gender: Male • Setting: Emergency Triage
Clinical Presentation & History
A 79-year-old male found by his daughter collapsed on the kitchen floor overnight beside a malfunctioning space heater. He is cold to the touch, bradycardic, and obtunded. His core temperature reads 28.4°C via tympanic probe. He carries a history of atrial fibrillation, hypothyroidism on levothyroxine 100 mcg daily, type 2 diabetes on metformin, and stage 3 chronic kidney disease.
Acute Resuscitation Milestones & Priorities
Clinical phases and key interventions encountered in this emergency module:
Stabilization, Identification of Trigger & Disposition
High-Yield Clinical Pearls
Geriatric hypothermia often reflects a hidden precipitant (infection, myxedema, overdose, falls) — treat exposure and cause simultaneously.
Aged patients exhibit blunted shivering; rewarming is therefore predominantly endogenous-metabolic and requires active core measures.
Hypothermia-induced atrial fibrillation is rate-responsive and resolves with rewarming; do not cardiovert.
Osborn (J) waves on ECG are pathognomonic at <32°C and indicate high risk of ventricular fibrillation.
Myxedema coma requires IV levothyroxine plus empiric IV hydrocortisone to prevent adrenal crisis.
Rewarming rate should not exceed 0.5–1°C/hour in elderly/cardiac patients to prevent afterdrop and arrhythmia.
Avoid nitroprusside, dobutamine bolus, and aggressive vasodilation in cold, bradycardic, elderly patients.
Test Your Clinical Reasoning in Real Time
Step into the active clinician role for this case. Order diagnostic tests, analyze live laboratory panels, and navigate branching clinical decisions with real-time feedback.