Warm and dead...

What was the situation of the cardiac arrest? The saying that someone is not dead until they are warm and dead refers to someone who suffers a cardiac arrest secondary to a cold exposure -- especially cold water drowning. At normal temperatures a body is going to cool down to room temperature after death and start to feel cool to the touch.

It was several years ago, so I don't remember the specifics of my first arrest pt that I mentioned. One of the cases I am thinking of, man found down while he was out jogging on a fairly cold day. As best I could tell reviewing the chart, it was witnessed with unknown down time.

I'm wondering if your preceptor misappropriated the phrase from the treatment of cold-injured patients. I'm guessing you know that the concept comes from the "diving reflex" seen in cold water drownings but has been expanded to include severely cold-exposed patients who are profoundly hypothermic. I really don't think it applies to every code that comes in.

I read about a case of a young, otherwise healthy person who passed out drunk in a snowbank. Her "friends" left her there. Found much later in full arrest; warmed up in the ED, and made a recovery. Only had minimal neurological deficits. And, hopefully, hangs with a different set of friends.

The correct saying is, "if they come in cold and dead, they aren't dead until they're warm and dead." Meaning if they come in from a cold exposure arrest, the snow bank example is a prime one. If someone walks out into the snow and has a witnessed arrest five steps out, it doesn't apply. Also if they've simply been down so long that their body is cool, then that doesn't "count" either.

I read about a case of a young, otherwise healthy person who passed out drunk in a snowbank. Her "friends" left her there. Found much later in full arrest; warmed up in the ED, and made a recovery. Only had minimal neurological deficits. And, hopefully, hangs with a different set of friends.

Concur with those above. This ^ is one of the fewer cases where the saying applies.

While as a paramedic, I was instructed by a new ER doc via radio, to begin CPR on a frozen, older person, who had died while shoveling snow, outside at least 4 hours ago. I delivered this popsicle to the MD in the ER and 1.5 hours later the staff there was still doing CPR while trying to warm the corpse. ( I had left soon after delivering the "pt") Maybe they were a new doc?

"That's the kind of situation where it makes sense. Profoundly hypothermic people may feel pulseless but they really aren't. Their rate/strength has just decreased to the point of being un-assessable (not sure that's actually a word). But it's not a sustainable state"

This situation is, by definition, pulseless and chest compressions are indicated. If you can't feel a pulse, the patient is pulseless.

If the patient's death is thought to be caused by hypothermia, then yes they need to be warmed before they are pronounced. If it's just your typical cardiac arrest there is no reason to do a temp (unless you get ROSC back).

Annie

In my world we use the phrase in brain death exams too -- we don't want hypothermia to mask underlying brain function. We have had pts who were mildly hypothermic (35°-ish); we put the Bair hugger on and notify the physician when the temp hits.... 36° or 36.5° (it escapes me at the moment).

So from the brain death perspective, they are not BRAIN dead until they are warm and brain dead.