Warm and dead...

[psu_213]

Not long after I started in the ED, I took care of my first cardiac arrest pt who did not survive. I was told by my preceptor "always get a temp, because they are not dead until they are warm and dead." Now if arrests come in, and they are DOA, the time of death is called by the MD shortly, and there is no temp taken (or at least not charted, if I am looking at it retrospectively). Just curious as to what the standard is. What have others been taught about this?

[Here.I.Stand, BSN, RN]

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.

[Guest219794]

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?

My only attempt to warm a dead person also worked poorly.

The warming process was complicated by the fact that they were dead.

I am not sure the best practice for warming dead people, but in my very limited experience, heat packs on the periphery in the hopes that CPR provides circulation adequate to warm the core, is futile.

What is the best practice for warming dead people? Does a Bair hugger actually work? With or without compressions?

[Guest219794]

"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.

While not relevant in hospital, there are instances in wilderness medicine, where compressions are not indicated for pulselessness, as a manually palpated pulse may be a poor indicator of perfusion in hypothermia.

" Starting chest compressions

might precipitate ventricular fibrillation in a patient who actually has a weak pulse

which is difficult to detect, but which might be providing adequate perfusion. If

chest compressions cause ventricular fibrillation, this perfusion will be lost."

Alaska protocol.

[rnhopeful82, ASN, RN]

I am re watching Greys (I am a masochist) and last nights was the episode where Meredith's everything stopped because of being in the cold water for so long. They said she wasn't dead until she was warm and dead, too. So, like the pps stated, I am assuming it is for those who's body temp is dangerously below normal and likely/possibly masking life.

[Guest374845]

What is the best practice for warming dead people? Does a Bair hugger actually work? With or without compressions?

Warm IV crystalloid, OG or bladder lavage with warm water, bilateral chest tubes with warm saline instillation, conductive warming via room temp and towels soaked in warmed fluids.

[Guest219794]

Warm IV crystalloid, OG or bladder lavage with warm water, bilateral chest tubes with warm saline instillation, conductive warming via room temp and towels soaked in warmed fluids.

Sounds about right.

In my one experience, the doc was kind of committed to the principle, but not the application.

Heat packs and warmed fluids was definitely not cutting it.

The guy was really quite dead on arrival, and I was very sure that regardless of any interventions, there would be no change of status.