Passive VS Active Cooling in heat exhaustion

[HERBIE1]

I've had a lot of experience with heat related problems with heat waves and marathons. Prehospital tx, ice packs, A/C, and dousing with water are the only options we have. Bottom line is unless we get their core temp down, these people will cook themselves from the inside out. IV's- even at room temperature(as in an air conditioned rig) will also help. We don't take temps in the field, but when someone is exhibiting the classic signs, you need to work fast. Depending on how high the temp is, the hospital can do lavages, cooling blankets, etc, but as noted, there is always the danger of causing shivering, which defeats the purpose. Then again, if they become too hot, they can have a seizure, which is much worse than shivering.

I do question how much heat that a bit of shivering will generate- maybe there is data that confirms this. I'm thinking the benefit of lowering their core temp may outweigh the extra heat they may generate by shivering.

I'll never forget years ago when we had a patient in cardiogenic shock and had rales with mild to moderate SOB, and this was also before the time we had pulse oximetry. Per usual, we had a short transport time. I had a doc(our PMD at the time) suggest we give a fluid bolus to this patient, and I freaked out. I made him confirm that order several times. We complied, it didn't help nor hurt, but when we arrived, I asked for clarification. The doc explained that a couple hundred ml's of saline would have a neglible effect on the fluid overload, but could easily bring up the BP if the person was hypovolemic. If the fluid challenge didn't work, then Dopamine is an option, but setting up a drip would probably have taken too long in our case. My point is, since medicine is an art, not a science, we occasionally see grey areas that may be counterintuitive to what we are taught, and that's when medical control is vital.

Clearly, the situation, the patient's V/S, age, PMH, transport times, and protocols dictates your treatment, but someone who is severely hyperthermic is breaking down proteins and headed for renal failure, brain damage, and tons of metabolic issues. The sooner we start them cooling off, the better chance they have to recover.

[mobey]

We don't take temps in the field,

Whaa? You don't take a complete set of vital signs?

Is this due to a lack of thermometer? or just something that has never been done in your area?

[HERBIE1]

Whaa? You don't take a complete set of vital signs?

Is this due to a lack of thermometer? or just something that has never been done in your area?

Never used it.

We have a hypothermia thermometer for rectal use only- that's it. In 25+ years, not once did I ever use it, nor have I ever thought it would help me.

With a short transport time, if we know a person has a 100.3, or 97.3 temperature, tell me how this would affect our treatment?

Dealing with extremes- hypo or hyer- it's pretty obvious what needs to be done.

[speedygodzilla]

I've always understood hypothermia to be a passive treatment in prehospital. Than again I work in a city where a transport of 30 mins is a long time.

And I believe that hyperthermia treatment is dependent on pt's condition. The worse condition requiring active treatment in prehospital.

???

Replying to myself, funny

Talk to my instructor and was cleared up on what the common practice is in our area. That being active cooling, passive rewarming. So for hyperthermic cool them down with ice packs, cool to room temp water fanning it off for convection, and NS bolus. Makes sense I just won't being going crazy with something like a ice cold tub or such any time soon, but who knows what this art will change.

[mobey]

With a short transport time, if we know a person has a 100.3, or 97.3 temperature, tell me how this would affect our treatment?

Ahhh..... there it is.