A 40 year old man presents via ambulance after he was found stumbling around a park on a hot summer day. He is mumbling, not responding to questions appropriately, and very disoriented. His skin is dry and hot to touch. Rectal temperature is 106.1 F. IV access has been obtained and normal saline has been started. What is next most effective immediate treatment for cooling?
A. Rectal Acetaminophen
B. Cooling with fans and skin wetting from a spray bottle.
C. Bladder lavage.
D. Ice packs placed on axillae and groin.
E. Cardiopulmonary bypass/ ECMO.