Internal Medicine

0521779407-09 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:13

Hyperthermia 769

■Move patient to cool environment and promptly initiate treatment;

outcome related to time of hyperthermia; improved survival if tem-

perature <38.9◦C within 30 min

General Measures

■Intubate if comatose or depressed protective airway reflexes

■Rapidly cool patient until <38.9◦C, then slow cooling to prevent iatro-

genic hypothermia

■Obtain IV access and place urinary catheter to monitor urine output

■Volume resuscitation: most patients significantly volume depleted;

adequate intravascular volume needed for good peripheral perfu-

sion and success of convective or evaporative cooling

■Identify predisposing conditions and determine duration and sever-

ity of exposure

specific therapy

Indications

■Core body temperature >38.5◦C, esp in patients with neurologic

deficits

Treatment Options

■Fluid resuscitation:

➣Oral salt-containing solutions for mild hyperthermia only

➣IV fluids for moderate to severe hyperthermia

➣Urine alkalinization for rhabdomyolysis

Cooling Methods

■Electric fan cooling: for mild hyperthermia only

■Maximal evaporative cooling: for moderate to severe hyperthermia;

mist patient with tepid (helps prevent shivering) water; use electric

fan to blow warm air across patient

■Ice packs at points of major heat transfer (groin, axilla, chest): may

speed cooling when combined with maximal evaporative cooling

■Ice water lavage (gastric and rectal) and cold peritoneal lavage: for

severely elevated core temperature; may speed cooling when com-

bined with maximal evaporative cooling

■Correct hemodynamic and metabolic derangements: oxygen for

hypoxemia; mechanical ventilation and PEEP for ARDS; crystalloids

and vasopressors for hypotension (focus on fluid resuscitation since

alpha-adrenergic agents may slow cooling by exacerbating periph-

eral vasoconstriction).

■Diazepam and phenytoin for seizures