II. Indications

III. Precautions

  1. Confirm indication for rapid cooling before starting
  2. Consider continuous Temperature monitoring
  3. Rectal Temperature lags core Temperature (avoid over-cooling)
    1. Stop cooling before reaching normothermia
  4. Shivering may circumvent cooling measures
    1. Consider Benzodiazepines to prevent shivering
    2. Consider paralytics in intubated patients

IV. Target

  1. Rapid cooling to Temperature under 101 F (38.3 C)

V. Technique: Evaporative Cooling

  1. Undress patient completely
  2. Consider switching telemtry leads to back
  3. Use a large fan near patient to circulate warm or room Temperature air (allows evaporation)
  4. Wet and re-wet the patient with cool water (preferably 15 C), constantly keeping the skin dampl
  5. Efficacy
    1. Reduces Body Temperature up to 0.1 C per minute

VI. Types: Other External Cooling Measures

  1. Ice water immersion (preferred, most effective measure)
    1. Uses Decontamination tub or impermeable sheets
    2. Ensure head remain above water surface
    3. Certain monitoring equipment must be disconnected
    4. Associated with nearly 100% survival rate when used immediately in exertional Heat Stroke
      1. Casa (2007) Exerc Sport Sci Rev 35(3): 141-9 [PubMed]
  2. Extremity ice water immersion
    1. Alternative when not able to completely immerse body
  3. Evaporative Cooling with fans and misting
  4. Cool saline bags applied to groin and axilla

VII. Types: Internal Cooling measures

  1. Ice water rectal enemas
  2. Bladder lavage
  3. Nasogastric lavage (cold Gastric Lavage)
  4. Peritoneal Lavage
  5. Thoracic cavity lavage

VIII. References

  1. Warrington (2017) Crit Dec Emerg Med 31(6): 12

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