A 78-year-old male is unresponsive with cold hands and a warm core. What is your next step?

In this scenario, the patient is unresponsive and displays a discrepancy in temperature, characterized by cold hands and a warm core. This presentation can be indicative of a significant circulatory issue, such as cardiac arrest. When a patient is unresponsive, especially in the context of potentially severe hypothermia or other life-threatening conditions, immediate intervention is critical.

Beginning chest compressions is essential because it establishes artificial circulation, which is vital for delivering oxygenated blood to the vital organs, especially the brain and heart. Additionally, in cases of suspected cardiac arrest, performing chest compressions is a key component of the resuscitation protocol.

While recognizing the potential for hypothermia is important, the immediate focus should be on initiating chest compressions since the unresponsive state combined with the patient's symptoms suggests a critical cardiopulmonary condition. Rather than just assessing or attaching an AED without first providing compressions, performing chest compressions promptly addresses the urgent need for blood circulation, which is crucial in improving the patient's chances for survival.

In summary, starting chest compressions is the most appropriate initial action in this situation, as it directly responds to the immediate life-threatening condition presented by the unresponsive patient.