As the patient is profoundly hypothermic (temp <32 C), passive external rewarming should be augmented by active core rewarming. Active core rewarming should include:

a) Rewarming of airways via administration of heated, humidified air or oxygen by a mask or endotracheal tube.

b) Infusion of warmed intravenous fluids.

c) Peritoneal lavage with heated crystalloid dialysate.

d) GI lavage.

e) Pleural irrigation using a thoracostomy tube.

f) Extracorporeal rewarming using cardiopulmonary bypass is sometimes suggested in an appropriate setting.