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Johndoeone

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i recently had a call where there was an obvious death with lividity fixed pupils. pt was found in bed covered up, last known well time was approx 4 hours prior. The only issue was patient was warm to the touch, very warm. There was very little rigor. Has anyone had a warm obvious death in the past? By protocol we (senior medic with me) decided not to work it. I'm guessing the patient had a fever or sepsis. Just a little uneasy about the whole process.
 
Johndoeone said:
i recently had a call where there was an obvious death with lividity fixed pupils. pt was found in bed covered up, last known well time was approx 4 hours prior. The only issue was patient was warm to the touch, very warm. There was very little rigor. Has anyone had a warm obvious death in the past? By protocol we (senior medic with me) decided not to work it. I'm guessing the patient had a fever or sepsis. Just a little uneasy about the whole process.
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You answered your own question. Patient was found in bed covered up so ther is part of it. Second, doesnt sound like this guy had been dead very long.

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Johndoeone said:
i recently had a call where there was an obvious death with lividity fixed pupils. pt was found in bed covered up, last known well time was approx 4 hours prior. The only issue was patient was warm to the touch, very warm. There was very little rigor. Has anyone had a warm obvious death in the past? By protocol we (senior medic with me) decided not to work it. I'm guessing the patient had a fever or sepsis. Just a little uneasy about the whole process.
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I have to say I am a bit perplexed by this question in the sense that you say "obvious" followed by "uneasy". I am not questioning your judgement as much as trying to point out your own.. I think most people would agree (and am sure I will hear other wise if not) that when you say obvious you have seen it enough and clinically know the signs enough to use that term. Dependent Lividity and Rigor are pretty concrete findings. Any rigor is enough, you don't need to quantify the amount. I don't think that the Temp. of the pt should weigh that heavily on you in the face of other obvious signs.
 
FLMedic311 said:
I have to say I am a bit perplexed by this question in the sense that you say "obvious" followed by "uneasy". I am not questioning your judgement as much as trying to point out your own.. I think most people would agree (and am sure I will hear other wise if not) that when you say obvious you have seen it enough and clinically know the signs enough to use that term. Dependent Lividity and Rigor are pretty concrete findings. Any rigor is enough, you don't need to quantify the amount. I don't think that the Temp. of the pt should weigh that heavily on you in the face of other obvious signs.
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I work in a pretty busy area and have seen a good quantity of deceased people; however I am still fairly green with 2 years 911 experience and only 18 months as a medic. I've never seen someone remain so warm with Lividity so I guess I just found it odd. My partner seemed more comfortable, something that will come with experience I suppose. I do appreciate the insight.
 
I have.... we were dispatched for a fall victim found an elderly lady down in a senior apartment... she looked really dead, but she was really warm and no rigor. I called for ALS, and worked her for about 10 minutes before ALS and the on duty supervisor arrived, and they pronounced her almost immediately it was also 80 degrees in the room, which was why she was quite warm

I'd rather work a dead body than not work a viable one, especially one that was still warm.

However, If they have lividity, there is a very good chance they are beyond your help.
 
Lividity and rigor is an obvious death. Lividity starts becoming apparent approx 2+ hours after cardiac arrest. If the person is well insulated (in bed) and in a heated room, its going to take them a little while to cool down.
 
Once cardiac arrest occurs, the body only loses about 1-2 degrees F per hour. The actual rate of cooling depends partly on ambient temperature of course, and being covered with a blanket would probably slow it a little.

So at a normal room temperature of, say, 70 degrees, it would take quite a while before a corpse didn't feel warm as compared to the ambient environment.
 
I work in investigations for a major metropolitan medical examiner's office, and it's not at all uncommon to find a body where livor and rigor are fixed, but the body is still warm to the touch.
 
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This patient, as you have described, had obviously expired. Are you worried about what an outsider might think or if you did the right thing?
 
I worked as a removal technician for a very busy mortuary service last year. Have handled more than my fair share of deceased people so I feel I can help with these types of questions. It is very common to find warm decedents if they have been covered up (care facilities/nursing homes, AFH's, covered up in bed at home) . Many times I have showed up hours after passing and there was no apparent rigor. many decedents were still warm. So, as you answered your own question, don't worry that really is an deceased person. Unfortunately. You didn't do anything wrong if you saw lividity and fixed pupils, even with absence of rigor.
 
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