A young male patient who was angry with friends wandered away from a party and spent the night outside uncovered in 40-50°F temperatures. He is confused, has decreased but adequate breathing, and has a weak radial pulse. His skin is cool and capillary refill delayed. You note that he is not shivering. Based on this presentation, what can you safely conclude?

Environmental emergencies can include a variety of patient presentations, such as heat and cold exposure, toxic envenomation, exposure to allergens, and noxious plants.  Here are some symptoms of environmental emergencies: Hyperthermia: Elevated core temperature, muscle cramps, altered mental status, weakness, headache, nausea or vomiting, rapid, strong pulse at first, which deteriorates into thready pulse, deep, rapid breathing at first, which deteriorates into shallow and weak breathing, skin that is cool and moist during early stages, skin that is hot at late stages,... Show more

Environmental emergencies can include a variety of patient presentations, such as heat and cold exposure, toxic envenomation, exposure to allergens, and noxious plants. 

Here are some symptoms of environmental emergencies:
Hyperthermia: Elevated core temperature, muscle cramps, altered mental status, weakness, headache, nausea or vomiting, rapid, strong pulse at first, which deteriorates into thready pulse, deep, rapid breathing at first, which deteriorates into shallow and weak breathing, skin that is cool and moist during early stages, skin that is hot at late stages, seizures
Convection: The loss of heat through contact with a cooler gas or fluid, symptoms include sweaty skin, flushing, lightheadedness, dry skin, weakness, nausea/vomiting, muscle cramping, gradually increasing heart rate
Conduction: The transfer of heat from a part of the body to a colder object or substance by direct contact, such as when a warm hand touches cold metal or ice, or is immersed in water with a temperature of less than 98°F (36.7°C) 

Here are some steps for providing first aid in environmental emergencies:
Ensure the scene is safe and wear personal protective equipment
Get the first aid kit and the AED
Tell the dispatcher the chemicals involved if possible
Remove the person from the toxin or poison and seek a well-ventilated area if possible 

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