hot packs to sternum for post partum shaking?

  1. Hi all. came across something new last night at work. The L&D nurse brought over my post C-sect patient and the patient had the shakes pretty bad. The L&D nurse put a hot pack on her chest, near the sternum, and it seemed to help.
    I am trying to figure out the physiology behind it. My thoughts run to dilating arteries/veins and the SNS. Am I close?
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  2. 16 Comments

  3. by   rpbear
    We just use warm blankets, or demerol in small doses for the shakes. I am not sure of the physiology behind the warm pack to the sternum maybe someone else can chime in. We are no longer able to make hot packs on our unit for our pt's because we had an bad burn to a pt from a hot pack.
  4. by   MIA-RN1
    Quote from rpbear
    We just use warm blankets, or demerol in small doses for the shakes. I am not sure of the physiology behind the warm pack to the sternum maybe someone else can chime in. We are no longer able to make hot packs on our unit for our pt's because we had an bad burn to a pt from a hot pack.
    We use the disposable ones that you squeeze to activate. Was the burn from that kind or from one your staff made?
  5. by   rpbear
    I think it was one of those rice ones you put in the microwave that the pt asked the RN to heat up for her. I wish we had the disposable ones.
  6. by   Selke
    Were her shakes from decrease in body temperature, in which case warm blankets or warm pack or Bair Hugger would bring her temp back up to normal and stop the shakes? Or were they a response to regional anesthetic and the fluctuation in hormones after delivery? In that case demerol 12mg IVP does the trick (not sure of the exact mechanism of action). This latter cause is the most common cause of post op and post partum shakes I'm familiar with; warming the patient doesn't do anything as they're already warm.
  7. by   MIA-RN1
    Quote from Anon Nurse
    Were her shakes from decrease in body temperature, in which case warm blankets or warm pack or Bair Hugger would bring her temp back up to normal and stop the shakes? Or were they a response to regional anesthetic and the fluctuation in hormones after delivery? In that case demerol 12mg IVP does the trick (not sure of the exact mechanism of action). This latter cause is the most common cause of post op and post partum shakes I'm familiar with; warming the patient doesn't do anything as they're already warm.
    yeah I am not sure why she was shaking. She had started w/ a spinal but then it wasn't taking for some reason and they went to general anesthesia. I've seen that type of shaking in PACU but this patient was awake and had been for a while in PACU before I got her so I don't think she was cold. We never seem to use demerol in our hospital. they get duramorph and then we treat them on our side w/ percocet, vicoden, or tylenol 3, and ibuprofen. They can get morphine IVP if its bad. We don't even use PCA pumps!
  8. by   ragingmomster
    We are not allowed to get to the demerol fast enough to help for p c/s shakes (pyxis and pharmacy overrides issues)

    I will give the hot pack a try, we can load pt's with 5-6 + hot blankets and sometimes still have issues with the shakes.
  9. by   Selke
    Quote from ragingmomster
    We are not allowed to get to the demerol fast enough to help for p c/s shakes (pyxis and pharmacy overrides issues)

    I will give the hot pack a try, we can load pt's with 5-6 + hot blankets and sometimes still have issues with the shakes.
    Because the shakes aren't caused by the pt's being cold -- their temps will be normal and they will tell you they aren't cold and the blankets don't work. I don't have reference materials with me right now to look up the physiology, but I was told it had to do with aftereffects of regional anesthesia that some women are more susceptible to (you know how some will shake after getting a labor epidural? but it goes away), and the dramatic changes in hormones post delivery. Some s/p vag del pts get horrible shakes, too.

    At the hospital I worked where we gave this post op it was a part of standing post c-section orders (unless the pt had a demerol allergy). Demerol was in the pyxis, but only used for this, unless someone had a morphine allergy. I don't have references handy for this as to why it helps. You could ask the anesthesiolgists about it.
  10. by   CMCRN
    We use Demerol post op also. Re: the heat, anesthesia said sometimes it is successful as it "fools the body" because its only previous experience with shaking was when cold. I have also found that I have very good luck if I can get the pt to Yawn! Shakes and Yawns are on the same nerve pathway and both can't happen at once. Hard to yawn on command though so usually everyone in the room has to yawn.
  11. by   SmilingBluEyes
    I have used warm blankets to the chest and 25 mg Demerol both. I find the Demerol works MUCH better in almost all cases.
  12. by   33-weeker
    i got the shakes after daughter was born drug-free. it caught me off-guard. i remember commenting to my midwife that i thought only women who got epidurals shook like that. she chuckled and said many women shake after giving birth.

    i would speculate that it is all the heat leaving with the baby, the placenta and fluid, combined with all the tremendous changes the body is going through at that point. i don't remember being particularly cold, just shaking.
  13. by   htrn
    OK folks, I have used this 3 or 4 times since I originally saw this post - IT WORKS

    The moms were NSVD, some with and some without epidurals. I see the shakes in most deliveries no matter how the kiddos come. Was told it had to do with hormones and the adrenaline.

    I have been taking receiving blankets out of the warmer and folding them so that they are about 6 inches wide and 12 inches long, then shove it down the front of her chest, under her gown, right btwn the two God given lunch boxes - and they either stop or greatly decrease their shaking.

    Would love to know the physiology behind it tho.
  14. by   Selke
    Quote from obrnheather
    OK folks, I have used this 3 or 4 times since I originally saw this post - IT WORKS
    .... I have been taking receiving blankets out of the warmer and folding them so that they are about 6 inches wide and 12 inches long, then shove it down the front of her chest, under her gown, right btwn the two God given lunch boxes - and they either stop or greatly decrease their shaking.

    Would love to know the physiology behind it tho.
    "The two god given lunchboxes" ... you've given me quite a laugh and a silly visual with that one! I may use this in the future with your permission. I've told a few pts before that "god didn't give women breasts for men to play with but for little babies to nurse from!"

    I'll try this technique in the future.
    Last edit by Selke on Oct 28, '06

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