Febrile Interventions

inducing the shiver reflex, is counter productive

For mild to moderate fevers, I dont do ice packs...I remove extra blankets, medicate, and if its a new post-op, have them C & DB.

But when I had a malaria patient with a temp of 105.4, I used ice packs. Thats the only time I used cooling measures like that.

As an RN and a mother; one of my children had a fever of 104.2 due to a virus. The ER personnel put her in a tub of ice and water. Her fever went to 108 and she quit breathing. I will never put a child into ice and water again.

Antipyretics and tepid sponge bath are about all I do. I have only used ice packs once, when a patient's temp shot up to 40C in a matter of minutes (probable contrast reaction).

I have used ice twice under the guise of ICU nurses. One was a hepatitis case that ramped up to 105 in a few minutes. He would up on a cooling blanket the rest of the night. The second was a readmitted back surgery that went to 105.9 and was hallucinating. He wound up in the unit on Toradol and a cooling blanket as well.

I will look into the tepid water method for my work and see if that is a better option.

Tait

If they're extremely febrile, the tylenol/motrin/toradol/whatever antipyretic hasn't worked, I'll do tepid water and if they're hot will maybe put an ice pack on their head for comfort. But you hit the whole body with ice packs/ice water, the body is going to fight to warm itself up against the cold, the exact opposite of what you're wanting to do.

But this is such old school stuff, I don't know where you'd find recent research on it.

In addition to the antipyretics, I put cold washcloths under armpits, groin area and on head. Learned that from my coworker, don't know if it is correct procedure or not but it does seem to help. I had a pt. a couple weeks ago (101.4) who had liver disease so couldn't give her tyl. and the washcloths worked, as well as C&DB.

You absolutely DO NOT want to "ice" a child or infant- I cannot speak for an adult patient- however I cannot imagine that the pathophys is any different. Ice baths/ cooling the core temp rapidly will produce the "shivering" effect! What does this do? It produces body heat- increasing body temp!

Many times in the PICU we must use a cooling blanket to keep a temp down for many reasons- sepsis, hypothalmus issues d/t brain injury,, ect- we chemically paralyze the pt to prevent shivering. Then provide the abx, antipyretics.

Sometimes cool cloths under the pits, groin, and forehead of the "not paralyzed" pts- but NEVER ice baths.

incentive spirometer if they're with it enough to use it.

^^Definitely IS or get them to do some cough and deep breathing if it's an option for the patient.