Which finding is most concerning in a confused patient exposed to high temperatures?

Hot and dry skin is the most concerning finding in a confused patient who has been exposed to high temperatures, as it is a classic sign of heat stroke. In this condition, the body's thermoregulation fails, and the skin no longer sweats due to dehydration or overwhelming heat. This lack of perspiration prevents cooling, leading to a dangerous increase in core body temperature, which can result in serious complications including organ failure or death.

Conversely, cold and clammy skin indicates that the body might be experiencing heat exhaustion or shock, where the person is still able to sweat but may be hypovolemic. Warm and sweaty skin suggests that the individual is still effectively thermoregulating, and pale and cool skin often points to shock or hypothermia rather than heat-related illness. Thus, the absence of sweating alongside confusion and a hot state indicates a critical medical emergency that requires immediate intervention.