A 50-year-old man found outside with ambient temperature 40°F and rectal temperature 30°C who is in ventricular fibrillation should be managed how?

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In hypothermia with cardiac arrest, the priority is to preserve perfusion and actively rewarm while continuing life support. The heart is very cold, which makes defibrillation less reliable, especially early on. Therefore, defibrillate a single time if indicated, then immediately resume high-quality CPR to maintain blood flow to the heart and brain. Securing the airway with intubation ensures adequate ventilation and oxygen delivery during ongoing resuscitation. Rapid transport to a facility capable of active rewarming is essential because warming the patient improves rhythm restoration and overall outcomes. Giving IV fluids alone or starting an epinephrine infusion without addressing airway, perfusion, and rewarming does not adequately manage the core issue here, and repeatedly pausing CPR for additional shocks would deprive organs of necessary blood flow.