Passive VS Active Cooling in heat exhaustion

[LittleMissEMT]

Ok, i am new so i feel like i need to ask and get some more opinions because i have heard many different ones so far and they contradict with each other and with what i have learned in school.

When is it better to apply active cooling to a person suffering from heat exhaustion than be passive and let them cool off?

Shoud you give cold fluids orally? I ve heard some people strongly recomend it (even doctors) and others - not.

[emti2008]

I have been taught to get the pt. into a cool environment first. If the pt. is a&o x4 then they can sit up and sip up to a liter of water if nausea does not develope, other wise lay them supine, if nausea is present they can lay in recovery position. If decreased LOC then lay them back, do not give water try to get a line if it's in your protocols and transport.

I hope that helps some, I had heat exaustion a month and a half ago. I can tell you that they used ice to cool me down which was not a good idea. It threw me into convulsions, i had been unconcious and they were trying to talk to me but I couldn't respond, even though I could hear some of what they were saying, I was considered a load and go, and they stuck me 5 times to get an IV in me, so I say this to say that if anyone has said use ice it's really not that good, it can cool the body down too rapidly during heat exaustion. You should also look for signs that they may be going into heat stroke because it's a different protocol where I'm at... Hope it helps some.

[jwraider]

Had a pt with a temp of 106.9 this weekend (taken in the ED). He was ALOC, hypotensive and tachycardic. I used the AC, fluids and cold packs with no changes. At the ED they got a 2nd bag of NS, more cool packs fanned him and other similair things. Several hours later his temp was 96.X (they over shot!)

I think rapid changes would be bad yet you can't leave someone at 106 for very long. Watching this patient makes me think it is a more delicate science than forcing a temperature quickly.

[EMS Solutions]

Depending on the heat emergency some protocols say to give cool fluids by mouth if the patient has a patent airway. Others say nothing by mouth. I have put cold packs to arm pits, groin, neck to cool patient off. IV fluids are also an option. I would check with your local treatment guidelines and follow those established by your medical director.

I actually just did a hyperthermia overview podcast with Greg Friese from EMS1 and Everyday EMS Tips. There's some good points to listen to:

http://ems-safety.com/blog/?p=67

Plus a free online CE on Hyperthermia.

[tniuqs]

Ah one of my pet peaves:

Heat exhaustion vs heat stroke vs heat prostration these are almost "lay terms" these days.

Hyperthermia like Hypothermia should be taught as to varying degrees not different entities, hell it just confuses me anyway ... fluid resuscitation with attention to electrolyte replacement and blood glucose levels are of key importance in understanding the pathophysiology and treatment.

As for immersing in ICE CUBEs ... YIKES ... SO not a good idea as the body will respond as in the Hypothermia ie "after drop phenomenon" I would expect the same response to overshoot in Tx of Hyperthermia (although were I work its not a common call)

Passive external cooling with chemical cold packs is a good field treatment but fluids are definitive care either PO (as tolerated) IV or IO ... but crummy in cooling ones beer ( I have done field research in this area with only fair results)

cheers

Edited July 22, 2009 by tniuqs

[AnthonyM83]

Ok, i am new so i feel like i need to ask and get some more opinions because i have heard many different ones so far and they contradict with each other and with what i have learned in school.

When is it better to apply active cooling to a person suffering from heat exhaustion than be passive and let them cool off?

Shoud you give cold fluids orally? I ve heard some people strongly recomend it (even doctors) and others - not.

It is generally taught that you can orally rehydrate and passively cool a heat exhaustion patient. Water or electrolyte solutions are preferred (Gatorade, Pedialyte, even Normal Saline), as they will replace their electrolyte imbalances. They should be conscious, oriented, and able to drink it themselves, generally. Cooling may include loosening/removing clothes as appropriate and even fanning.

Heat stroke patients (as determined primarily by ALOC) should not receive oral fluids. Cooling is generally more aggressive and can include active cooling with cold packs (not in direct contact with skin) and even luke warm wet towels (recool towels as they warm up). Contact ALS. Of course, O2.

Remember, local protocols may describe exactly what to do or may not address it at all.

You may have to go with what you learned in class and from your textbook.

Also remember that a patient can easily start shivering if you are too aggressive. During ER clinicals, we had patient with temp of 108.6 Nurses started dumping crushed ice all over him. I voiced my opinion, but it wasn't my place. He very quickly started shivering, which creates a lot of heat and worsened his condition. In addition, his skin was now very cold, so capillaries vasoconstricted, which further impeded heat loss.

[Spock]

Active cooling is much better than passive. The University of Pittsburgh Center for Emergency Medicine is doing a lot of research on this and they just did a big study using firefighters at a live burn. Data should be published soon.

When I worked as an athletic trainer in the NFL back in the 80's the most effective way to cool a player post practice was cold immersion. I kept a whirlpool bath filled with cold water and the players would dunk themselves for a few minutes and they loved it. Incidence of heat illness dropped dramatically.

Live long and prosper.

Spock

[tniuqs]

UNIT 632

Respond to a F/F with Chest Pain.

To find o/a cold (to the touch) pale, diaphoretic, 55 y/o patient male .... with more stinky smoky firemen than you can swing a cat at, good idea for a exam scenario there.

Do you pack bath tub of ice around in your rig ?

I think symptomatic treatment for the different demographic group(s) i.e. adolescent to blue hair .. and "tepid" for febrile seizures (most likely the biggest group % wise) please and thank you.

cheers

[Richard B the EMT]

Do you pack bath tub of ice around in your rig ?

THAT line takes me back to around 1974, when an instructor told me that an ER doctor couldn't understand that an ambulance crew IN THE FIELD was unable to put a burned extremity into an ice bath, even after being told, both by the instructor and numerous students, that ambulances don't carry ice making machines. Everyone at that class agreed, however, if such was available, that it was the best course of action.

[speedygodzilla]

I've always understood hypothermia to be a passive treatment in prehospital. Than again I work in a city where a transport of 30 mins is a long time.

And I believe that hyperthermia treatment is dependent on pt's condition. The worse condition requiring active treatment in prehospital.

???