Hyperthermia/Heatstroke

heat stroke, cooling, cold water immersion

Print Protocol

Cooling Protocol (core temperature ≥ 105°F)

Supplies Needed

• Body bag

• Water Spray Bottles

• Fans

• Ice

  • Will likely need all the ice from all ice machines in the ED
  • Additional ice can be obtained from cafeteria

• Gray plastic basins and/or clean, unused clear plastic wastebasket liners (for transporting ice)

• Cooling blanket with rectal temperature probe attachment

• 3-way foley catheter

• Bladder irrigation supplies (cooled irrigation fluids if possible)

• 2L cooled IV fluids (NS or LR)

• Towels

• 2nd ED stretcher prepared with with dry linens

Notes

Benzodiazepines can be used to treat shivering and/or agitation.

Patient may need to be intubated prior to initiation of cooling if they require airway protection.

1. Set up for ice bath:

   a. Line ED bed with chucks.

   b. Unzip body bag and place in bed.

   c. Place cooling blanket inside body bag.

2. Transfer patient to prepared bed.

3. Completely disrobe patient.

4. Place patient on cardiac monitor and obtain vital signs.

5. Obtain core temperature and place rectal temperature probe.

   a. Roll patient and obtain rectal temperature.

   b. If temperature >105°F, then immediately place rectal temperature probe and connect to cooling blanket.

6. Start spraying and fanning the patient.

7. Obtain IV access and start running cooled fluids.

8. Turn cooling blanket to 65°F.

9. Place 3-way foley and begin bladder irrigation (use cooled fluid if available).

10. Cover patient’s torso and extremities with ice.

11. Add 2-3 gray basins of water to body bag.

12. Close zipper to patient’s upper torso.

13. Closely monitor temperature and begin process of removing patient from ice bath once core temperature reaches 102°F.

Core Temp = 102°F

Remove patient from ice bath as quickly as possible to avoid overshooting temperature.

1. Stop cooled IV fluids. Continue aggressive fluid resuscitation with non-cooled fluids.

2. Stop bladder irrigation.

3. Move patient bed to decon room.

4. Place bed in reverse Trendelenburg position and cut open bottom corners of the bag to drain water.

5. Once water is drained, roll patient and tuck top flap of the body bag under them.

6. Zipper the bag completely closed (patient should now be on top of closed body bag).

7. Dry patient with towels and place in dry hospital gown.

8. Place patient on dry sheet and transfer to dry ED bed.

9. Continue monitoring patient’s core temperature to ensure they do not become hypothermic while removing them from the ice bath.