How many paramedics dump ice on hyperthemic patients in the field?

Peak

ED/Prehospital Registered Nurse
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How do you suggest that gets done 45 minutes from the hospital? Also we are more than able to give fent and/or versed to assist in limiting shivering, much like what is done for TTM patients elsewhere.
I think historically temperature monitoring and management has been an area of opportunity within EMS. Still most patients come in without a temperature being taken in the field and I would bet a good number if not a majority of EMS agencies do not have thermometers.

Ideally you should have a rectal or esophageal probe and we have the ability to monitor core temps on our lifepaks and propaqs, but I recognize that most EMS systems to not purchase the models that have the ability to monitor invasive pressures and temps.

I know that this is a big ask for some prehospital clinicians, but a rectal temp checked frequently is probably going to be the best compromise in the field. Rectal thermometers are cheap, you can get single patient ones for about two bucks each
 

Peak

ED/Prehospital Registered Nurse
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@Tigger I realized that I may have completely skipped the actual clinical treatment portion of your question.

The patient needs to be as close to naked as reasonable. Clothing traps heat so it needs to go. I would think one can easily find water or you could probably just use some NS to wet a washcloth or gauze and brush the patient. Crank up the fan on the AC in the back of the bus.

If your service has chemical cold packs I would put a couple wrapped in a towel, pillow case, et cetera in the groin, armpits, and neck. There is some literature that shows the bottom of the feet and face may actually be better temperature conductors as they don’t vasoconstrict as much to the cold but I’m not comfortable enough with the data to make that recommendation.
 

GMCmedic

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Some local high schools have protocols in place for rectal temp monitoring and ice baths. EMS is called for airway monitoring/management and transport only after the core temp reaches a certain number (I dont remember what it is), or if patient presents with other life threats. EMS is free to use versed for shivering, or paralytics if intubated.

Beyond that, most local services use chemical cold packs or sterile water.
 

Tigger

Dodges Pucks
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I think historically temperature monitoring and management has been an area of opportunity within EMS. Still most patients come in without a temperature being taken in the field and I would bet a good number if not a majority of EMS agencies do not have thermometers.

Ideally you should have a rectal or esophageal probe and we have the ability to monitor core temps on our lifepaks and propaqs, but I recognize that most EMS systems to not purchase the models that have the ability to monitor invasive pressures and temps.

I know that this is a big ask for some prehospital clinicians, but a rectal temp checked frequently is probably going to be the best compromise in the field. Rectal thermometers are cheap, you can get single patient ones for about two bucks each
We do have thermometers capable of getting a rectal temp, just as every ambulance in the county is required to have.
 

Tigger

Dodges Pucks
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Can we use our thermoscans rectally? :D
That would be...exciting.

For real though, getting people to stop dumping the single use thermometers "now that we carry these fancy scanners" has been a continued struggle.
 

FiremanMike

EMS Coordinator
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That would be...exciting.

For real though, getting people to stop dumping the single use thermometers "now that we carry these fancy scanners" has been a continued struggle.
If this goes on much longer, I won't have a choice - I can't find thermoscan covers :/
 

mrhunt

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during summertime Its regularly 110 to 113 degree's here and our units are outside in direct sunlight all day, no temp control.
I carry a personal small cooler with a 10 drop and 500 bag that's chilled. Our non-chilled saline in the units is hot to the touch and some get so hot that it can actually melt the bags theyre in.

If any hyperthermic pt's i'll use that, ice packs and dump saline solution bottles on them if necessary as well as removing all clothing.
 

Tigger

Dodges Pucks
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during summertime Its regularly 110 to 113 degree's here and our units are outside in direct sunlight all day, no temp control.
I carry a personal small cooler with a 10 drop and 500 bag that's chilled. Our non-chilled saline in the units is hot to the touch and some get so hot that it can actually melt the bags theyre in.

If any hyperthermic pt's i'll use that, ice packs and dump saline solution bottles on them if necessary as well as removing all clothing.
Be careful administering chilled saline of an unknown temperature even for hyperthermic patients. "Room temp" is fine.
 

mrhunt

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I appreciate that advice. What do you think is more harmful though? Saline that is easily 110 to 120 Degree's, Or saline that is approx 70 to 80 degree's to a hyperthermic pt? I honestly dont know...

Typically even in a cooler The ice packs melt extremely fast and by the time i touch it Its just slightly cool v.s. the other bags that are actually hot to the touch. I should probally do more research on the subject.
 

Tigger

Dodges Pucks
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I appreciate that advice. What do you think is more harmful though? Saline that is easily 110 to 120 Degree's, Or saline that is approx 70 to 80 degree's to a hyperthermic pt? I honestly dont know...

Typically even in a cooler The ice packs melt extremely fast and by the time i touch it Its just slightly cool v.s. the other bags that are actually hot to the touch. I should probally do more research on the subject.
I have no idea. If you were set and determined I would put a thermometer in there so I knew that it was around room temperature.
 

mrhunt

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Thaaaats an excellent idea. Almost a "why didn't I think of that" moment. Lol.

Anyways, I know just to watch em to make sure shivering doesn't start as that raises temps again but aside from that or putting someone accidentally into HYPOthermia I'm not sure of any other negative outcomes.... However I definitely would like to learn more and research better.
 

Tigger

Dodges Pucks
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Thaaaats an excellent idea. Almost a "why didn't I think of that" moment. Lol.

Anyways, I know just to watch em to make sure shivering doesn't start as that raises temps again but aside from that or putting someone accidentally into HYPOthermia I'm not sure of any other negative outcomes.... However I definitely would like to learn more and research better.
My understanding is that chilled saline can cause significant vasoconstriction.
 

FiremanMike

EMS Coordinator
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My understanding is that chilled saline can cause significant vasoconstriction.
Makes sense..

Also not sure if it's mentioned here, but it's my understanding that the only way to do appropriate hypothermic therapy involves constant rectal temperature monitoring..
 

mrhunt

Forum Lieutenant
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Totally agree and makes sense with both.

However, in a field stabilization scenario which were all basically in, thatd something thats not likely to happen....
 

luke_31

Forum Asst. Chief
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Makes sense..

Also not sure if it's mentioned here, but it's my understanding that the only way to do appropriate hypothermic therapy involves constant rectal temperature monitoring..
You are correct sir. Constant rectal monitoring is needed for hypothermic therapy.
 

dutemplar

Forum Captain
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We sometimes do fairly aggressive cooling... but from rural areas (and beach) to hospital can be 1.5 hours or better. by road. People out in 130-140F weather don't always do so good... The hard part would be finding ice, although there are tons of small shops, "restaurants" and all have always been super responsive if we pop our head in the door and say we need a bucket of water, ice, or whatnot.

The original FB post was such a bleepshow... oh my.
 

MedicFF

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This is a great thread. Rich in knowledge as well as humor.

In the ED, getting a rectal temp is easy on an altered Pt...most times. In the field, I’ve found it less simple. For a host of reasons.

Great points on the cold fluids. We’ve given them in the ED per doctor’s orders with no issue. Got to circle back with colleagues to refresh my memory on the specifics of those cases to ensure we were doing it right.

As for the 130-140F climate, dayumm! We talking Mojave FD in the dead of summer? Hope hazard pay applies there.
 

dutemplar

Forum Captain
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As for the 130-140F climate, dayumm! We talking Mojave FD in the dead of summer? Hope hazard pay applies there.
Qatar. More sand, less rattlers... unless you could the Land Cruisers rattling sideways up and down the dunes.
 

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