ER in the Furnace

[docB]

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As some of you may have noticed vegas and Phoenix have been a tad warm of late. It was 117 yesterday. We've seen a big upsurge in the heat exhaustion/ syncope people. Today I had my first real shake and bake of this heat wave. Homeless guy, three shirts and two pair of pants, sleeping under cardboard on the sidewalk. EMS called when he began to seize. Rectal temp 108. I intubated him and started cooling him. Na was 114.

 

[Febrifuge]

This reminds me of the guy we saw a few months ago who was so septic he was 40 celsius rectal. One of our docs decided the patient needed to be cooled a lot, and right now. So we packed his armpits and groin with ice bags... plus did an ice-water gastric lavage and (the first time I'd heard of this much less seen it) did an ice-water lavage of his bladder via Foley cath.

What kind of crazy tricks do you pull out of the bag to cool somebody who's that hot?

 

[docB]

I use fans and wet towels. This works great and is not invasive (compared to cold water peritoneal lavage, bladder irrigation ect.). You have to make sure that other people don't just soak towels and drape them over the pt. That doesn't do much good. You have to use the towels to keep the skin damp but not dripping. That way the water is evaporated by the fans and that cools the pt. Ice to the groin and axilla doesn't will help too. This is much quicker than a cooling blanket especially in terms of set up.
I heard another hospital in town got an old guy from a 3rd floor walk up where the AC died. He was found down after an unknown time. The apt was supposedly around 130 degrees. Guy's temp was 109. I think he's still alive and in the unit.
My guy was waking up a few hours after I tubed him. His temp was 99 when he left for the unit.

 

[DrQuinn]

I use fans and wet towels. This works great and is not invasive (compared to cold water peritoneal lavage, bladder irrigation ect.). You have to make sure that other people don't just soak towels and drape them over the pt. That doesn't do much good. You have to use the towels to keep the skin damp but not dripping. That way the water is evaporated by the fans and that cools the pt. Ice to the groin and axilla doesn't will help too. This is much quicker than a cooling blanket especially in terms of set up.
I heard another hospital in town got an old guy from a 3rd floor walk up where the AC died. He was found down after an unknown time. The apt was supposedly around 130 degrees. Guy's temp was 109. I think he's still alive and in the unit.
My guy was waking up a few hours after I tubed him. His temp was 99 when he left for the unit.

did you RSI him? What did you use? Just curious... as sux can transiently increase core temp as well.

Q

 

[Febrifuge]

I should have said, the moist towels and fans were the first line; the docs went to the rough stuff after 10 minutes of that had done nothing to lower the poor guy's core temp.

 

[FoughtFyr]

did you RSI him? What did you use? Just curious... as sux can transiently increase core temp as well.

Q

Roc baby, it's all about the roc!

- H

 

[docB]

did you RSI him? What did you use? Just curious... as sux can transiently increase core temp as well.

Q

I used sux. I was much more concerned about the airway and aspiration than I was about a transient temp rise. Maybe roc was the way to go but the sux was redily available so in it went.

 

[DrQuinn]

I used sux. I was much more concerned about the airway and aspiration than I was about a transient temp rise. Maybe roc was the way to go but the sux was redily available so in it went.

I woudn't fault you, just curious. Got nuttin' but love for the Sux.

Q