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PeterC

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A few weeks ago I had to work in a Level I trauma center for my EMT class. We had a traumatic arrest come in, stab wound to the aorta. After a thoracotomy, packed RBC induction, attempts to stop the bleeding, and 13 minutes the doctor made the most interesting request. He wanted hot water.

The nurse handed him warm saline @100 degrees Fahrenheit, but yet he still demanded hotter water. The nurse got water that was hot enough to make a nice cup of coffee with and the doctor poured it into the chest cavity causing steam to rise and then pronounced him.

Why did he do this? I have asked other doctors and they were confused about this.
 

danzman

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A few weeks ago I had to work in a Level I trauma center for my EMT class. We had a traumatic arrest come in, stab wound to the aorta. After a thoracotomy, packed RBC induction, attempts to stop the bleeding, and 13 minutes the doctor made the most interesting request. He wanted hot water.

The nurse handed him warm saline @100 degrees Fahrenheit, but yet he still demanded hotter water. The nurse got water that was hot enough to make a nice cup of coffee with and the doctor poured it into the chest cavity causing steam to rise and then pronounced him.

Why did he do this? I have asked other doctors and they were confused about this.


I guess because the steam coming out of a cracked chest would look pretty sweet.
 
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loveoforganic

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docB

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Maybe he was planning to make coffee and spilled it in the chest?

Seriously though, was the patient placed on a hypothermia protocol prior to arrival? If he started getting cold saline and then coded again maybe this guy felt he need to do this to ensure the patient was warm and dead before he called it.
 

PeterC

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From my understanding therapeutic hypothermia therapy was initiated en-route to this hospital, but would "superheating" have had any benefit for making him "warm and dead"? He defiantly lost 3L of blood in the hospital alone and had been asystolic for 20+ minutes.
 

Rendar5

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I guess he simply wasn't able to call the code with the patient's temperature at the time. weird though.
 

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The rationale I've seen for this in prolonged thoracotomy resuscitations has been that the myocardium is essentially locally hypothermic and thus irritable and refractory to interventions. I saw it work once--visibly fibrillating heart that was reheated with hot saline and then shockable and went sinus... until it went asystolic due to his massive blood loss from his multiple GSWs. Waste of time in that case, but neat to see.
 
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