-
Oxygen provided.
Hospital:
·
ABCDE's...intubate if needed
·
IV access: studies show average volume given 1- 1.3 liters
·
Measure core temperature
·
Foley...measure I / O's
·
Immediate Cooling !!!!!!! Accurate diagnosis and duration of
hyperthermia is main determinant of outcome. Studies seem to
show that rapid cooling to below 39C within 30 minutes of
presentation improves survival.
Mist method or Evaporative Cooling: Mecca Body Cooling Unit in which a fine
mist of warm water [around 32*C] is blown over the patient suspended on a
netting stretcher. Alternatively, sponge the naked patient with lukewarm water
while fanning with room air. Reported cooling rates of 0.31*C/minute. Alternative
approaches have mist temps of 59*F and constant draft of air at 45*C [113*F].
"WET and WINDY Approach.
VS
Immersion Method: has worked in some studies with cooling rates reported of
0.15*C/minute. Difficult to manage patients. In studies with heatstroke, ice
water cooling was twice as rapid in reducing core temperature as the evaporative
spray method (0.20C/min compared to 0.11C/minute). In more than 200
patients with extertional heatstroke, immersion reduced temps to < 39C in 10-40
minutes-no patients died.
i
Peritoneal Lavage: reported to rapidly reduce temperature using 6*C lavage
fluid.
Continue cooling until ~ 102*F
Give IV fluids: NS or D5WNS/1/2 NS
Try to minimize shivering (which will only serve to raise the temp)
Valium
commonly
used to minimize
If DIC: supportive care until clotting factors return to normal
DO NOT GIVE ANTIPYRETICS....
Complications:
-
Worsening of underlying disease process, e.g. CAD
-
Liver injury
-
Acute renal failure [severe rhabdo seen]
-
ARDS
-
Blood coag problems---DIC
-
Neuro injury
