Management of hyperthermia in neuro patients

nrsang97, BSN, RN · Jan 26, 2007

I usually use Tylenol and Ice packs to the groin and armpits. Also a cooling blanket if temp is 38.5 or above. If able we can give ibuprofen. Sometimes sandwich pt with one cooling blanked on top and one under. These are the things we typically use. Also Ice water baths. These things usually help.

harrn · Jan 27, 2007

I usually use Tylenol and Ice packs to the groin and armpits. Also a cooling blanket if temp is 38.5 or above. If able we can give ibuprofen. Sometimes sandwich pt with one cooling blanked on top and one under. These are the things we typically use. Also Ice water baths. These things usually help.

Thanks nrsang for reply.

In our ICU we used to put fan of that unit on along with other measures .But now recently we were told not to switch fan on as it increases the chances of shivering in patient .

on contrary is`nt it important to have ventilation of air around the hyperthermic patient

i am really confused plz help me to sort it out!!!

gwenith, BSN, RN · Jan 27, 2007

if they shiver you have to stop the fan/cooling measures as shivering will increase the icp. in severe cases i have paralysed a patient who is shivering, just to get the temp down but it is not often done,

the other issue with fans is infection control of course, some units will not use them because of this.

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&list_uids=12386509&dopt=abstract

http://www.co-criticalcare.com/pt/re/cocritcare/abstract.00075198-200204000-00003.htm;jsessionid=f7lljddf40msqdhhplpyjs0vytwy7gzqhgrx6kn21fgsplnphwpn!1416047858!-949856144!8091!-1

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&list_uids=12742737&dopt=abstract

from uptodate (which you probably will not be able to access) talking of the treatment of hyperthermia for adults

fever — elevated metabolic demand in the brain results in increased cerebral blood flow (cbf), and can elevate icp by increasing the volume of blood in the cranial vault. conversely, decreasing metabolic demand can lower icp by reducing blood flow.
fever increases brain metabolism, and has been demonstrated to increase brain injury in animal models [78]. therefore, aggressive treatment of fever, including acetaminophen and mechanical cooling, is recommended in patients with increased icp. intracranial hypertension is a recognized indication for neuromuscular paralysis in selected patients [79]. (see "use of neuromuscular blocking medications in critically ill patients").

and for children

hyperthermia — hyperthermia (>38.5 degrees c) can contribute to brain damage in cases of ischemia. fever also increases cerebral metabolism and blood flow, thereby contributing to elevated icp [17]. fever should be lowered with antipyretics and/or cooling blankets immediately. shivering, which can contribute to elevated icp, should be avoided.

http://www.utdol.com/utd/content/topic.do?topickey=ped_neur/15543&type=p&selectedtitle=37~37

harrn · Jan 29, 2007

Thanks gwenith for helping me out:biggringi

If they shiver you have to stop the fan/cooling measures as shivering will increase the ICP. In severe cases I have paralysed a patient who is shivering, just to get the temp down but it is not often done,
The other issue with fans is infection control of course, some units will not use them because of this.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12386509&dopt=Abstract
http://www.co-criticalcare.com/pt/re/cocritcare/abstract.00075198-200204000-00003.htm;jsessionid=F7LLJdDF40msqdHhplpyJS0vyTwy7GzqHGRX6kN21fGsPLNphwPN!1416047858!-949856144!8091!-1
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12742737&dopt=Abstract
From UptoDate (which you probably will not be able to access) Talking of the treatment of hyperthermia for adults
and for children
http://www.utdol.com/utd/content/topic.do?topicKey=ped_neur/15543&type=P&selectedTitle=37~37

burn out · Jan 29, 2007

Fans are a JACHO violation and we are not even allowed to have them in our hospital..infection control issue., Tylenol, cooling blankets, ice to the groins and arm pits usually take care of regular fever. However if the fever is neruo in origin you can freeze the body in a block of ice (just kidding)and it will stay elevated..it is truly a challenge. Sometimes when my patient is running a difficult temp I will ask RT to lower the temp on the heater on the vent. Other things I have wondered about but not done...iced lavage to cool core temp if ng tube is present. of course if the pateint is awke and able to swallow ...force fluids po

GrnHonu99, RN · Apr 9, 2007

We don't use fans on my unit. I use Tylenol, two doses usually does it...I have also used ice baths, icepacks in various places, cooling blankets....

RoxanRN · Apr 10, 2007

Fans are a JACHO violation.......

Can you provide the citiation from JCAHC as I'm unable to find anything about it on their site.

gasmaster · Apr 11, 2007

There are some great products out there, like the Artic Sun, that specialize in hyperthermia devices. The patient is wrapped in the AC blanket around the torso,and there's separate wraps for the extremities. All can be controlled independently so you can cool to different temps. It attaches to the pt's foley and is programmable so say you want to cool to 95, just set it and it maintains. It allows you to have precise, constant temp control. I agree with someone else who mentioned paralyzing the patient to prevent shivering if necessary.

GrnHonu99, RN · Apr 19, 2007

I found an article at work that talks about using fans...ill look for it and try to post that piece.