II. Indications
- Heat Illness (esp. Heat Stroke)
III. Precautions
- Confirm indication for rapid cooling before starting
- Consider continuous Temperature monitoring
-
Rectal Temperature lags core Temperature (avoid over-cooling)
- Stop cooling before reaching normothermia
- Shivering may circumvent cooling measures
- Consider Benzodiazepines to prevent shivering
- Consider paralytics in intubated patients
IV. Target
- Rapid cooling to Temperature under 101 F (38.3 C)
V. Technique: Evaporative Cooling
- Undress patient completely
- Consider switching telemtry leads to back
- Use a large fan near patient to circulate warm or room Temperature air (allows evaporation)
- Wet and re-wet the patient with cool water (preferably 15 C), constantly keeping the skin dampl
- Efficacy
- Reduces Body Temperature up to 0.1 C per minute
VI. Types: Other External Cooling Measures
- Ice water immersion (preferred, most effective measure)
- Uses Decontamination tub or impermeable sheets
- Ensure head remain above water surface
- Certain monitoring equipment must be disconnected
- Associated with nearly 100% survival rate when used immediately in exertional Heat Stroke
- Extremity ice water immersion
- Alternative when not able to completely immerse body
- Evaporative Cooling with fans and misting
- Cool saline bags applied to groin and axilla
VII. Types: Internal Cooling measures
- Ice water rectal enemas
- Bladder lavage
- Nasogastric lavage (cold Gastric Lavage)
- Peritoneal Lavage
- Thoracic cavity lavage
VIII. References
- Warrington (2017) Crit Dec Emerg Med 31(6): 12