Transfer from M/S floor to our ICU today- emergent transfer. They gave report at the bedside. Septic, I'm sure. He was circling the drain when he came in and proceeded to go downhill. Constant seizing? (He was twitching/spastic). Hx of seizures but Tegretol levels WNL and was on Keppra IV. Has a hx of mental retardation so a baseline mental status is hard to judge. Difficult time getting pulse ox and BP to read because of movement. Finally got a BP reading in the 70s then it tanked to 50s, HR 140s, RR in 40s, put in a rectal probe and his temp read 107.4. Put cooling blanket on, gave Tylenol supp and applied Bipap. Fast forward a bit: Recheck ABGs showed pH of 6.8, too tired to remember CO2 but it wasn't pretty. Intubated, put in central line, and art line, gave Valium IV, started levo, propofol, numerous NS boluses. Had to stay until 9pm to catch up on all my paperwork. Had another patient that virtually got ignored as I couldn't leave the bedside of my other guy. When I did, I was running to get supplies, or talking to the docs. Thankfully my fellow nurses stepped up and were at the bedside to help me and also check on my other pt. I love my coworkers and charge nurse!
Fastforward: BP came up to 90s, temp was down to 100.4 R when I left. I'm tired and need to go to sleep but my brain won't shut off. I have never seen a temp that high, have you?
42.5 C (or 108.5 F). He wasn't my patient, but if my memory serves me correctly it was a street drug OD situation. His brain was cooked and he was terminally weaned the next day.
@ General E Speaking, what was the outcome of your patient with the high temp?
Sorry, been away from site for a while. I am not sure. When I returned to work after a few days off he was gone. I need to ask. I am wondering if he made it...
I had a male in his early 30s present to the ed with a cc of sudden onset headache 2 hours pta. No hx started taking his vs in triage hr 160 bp 110/68 o2 sat 96 then po temp 105. This guy then admitted he had used cocaine and heroin prior to the headache. He ended up having a rental temp of 107 f . Wbc normal diff was off chem panel normal. Bp remained stable during 3 hours in the ed. We hydrated him gave him po tylenol and put him on a cooling pad and iced him. He remained alert and oriented and didn't seem to suffer any damage to any organs at that point. Sent him to the icu with a rectal temp of 101. I don't get it. I'll find out more when I get back tomorrow but what an interesting and bizarre case.
Heard that my guy pulled thru his ordeal and was eventually able to go back to his group home. Like I said, he had a history of mental retardation so his baseline will be difficult to assess.
Specializes in Trauma, ICU, Critical Care, Recovery.
Neuro patient with a sudden (within an hour) 41.0 temp spike. It ended up being a "neuro-temp', but was treated with the cooling blanket (with rectal thermometer) , ice-packs, fan, and full cultures. He was down to 37.0 in another couple of hours.
Highest I have ever seen was a MR pt with Neuroleptic Malignant Syndrome. 107.0(yeah we use F). Second time he was admitted w/NMS, whenever they tinker with his Lithium his body revolts.
The highest I saw was on drowned patient - 43C (109.4F), but that was a good day and a half before he died, and the temp was still climbing. You could feel the heat radiating off him from the doorway :uhoh21:
Put cooling blanket on, gave Tylenol supp and applied Bipap. Fast forward a bit: Recheck ABGs showed pH of 6.8, too tired to remember CO2 but it wasn't pretty. Intubated, put in central line, and art line, gave Valium IV, started levo, propofol, numerous NS boluses. Had to stay until 9pm to catch up on all my paperwork. Had another patient that virtually got ignored as I couldn't leave the bedside of my other guy. When I did, I was running to get supplies, or talking to the docs. Thankfully my fellow nurses stepped up and were at the bedside to help me and also check on my other pt. I love my coworkers and charge nurse! 
in2ICU
71 Posts
42.5 C (or 108.5 F). He wasn't my patient, but if my memory serves me correctly it was a street drug OD situation. His brain was cooked and he was terminally weaned the next day.