hyperperfusion

[onecrazykid108]

What treatments would you do for someone with a fever? just cool off their skin?

 

[usafmedic45]

First things first: If you're looking for medical advice, this is not the place to go. Following any advice here without consulting a physician is a bad idea and you do so at your own risk.

OK, now that the disclaimer is out of the way, as an EMS provider you are not going to do much for someone with a fever unless they are showing signs of neurologic problems due to it (seizures, coma, etc). Even then, the best treatment in those cases is transport and general supportive care. Only in extreme cases (heat stroke, drug induced hyperthermia, etc) would aggressive cooling such as ice packs, dousing the patient in cold water, etc in the field be indicated. If the patient is dehydrated, starting an IV and using judicious amounts of IV fluids to begin to correct it is indicated.

The only thing worse than a high fever is letting the temperature rebound after bringing it down initially. Follow your local protocols, but like I said, the best bet for your average fever patient is keep them in a cool ambulance, remove as much clothing as you can (stripping them naked is not necessary in most cases) and transporting the patient to the hospital.

 

[CAOX3]

Bring them to the hospital. The origin of the fever needs to be addressed.

We used to give tylenol, not any more and we are not allowed external cooling.

And why is this titled hyperperfusion? Like in Cerebral hyperperfusion syndrome?

 

[usafmedic45]

we are not allowed external cooling

Not even in heat stroke and other circumstances where you need to bring the temperature down ASAP?

 

[CAOX3]

Not even in heat stroke and other circumstances where you need to bring the temperature down ASAP?

Sorry, I meant in fever of uknown origin.

In heat emergencies and such we can.

 

[usafmedic45]

Sorry, I meant in fever of uknown origin.

In heat emergencies and such we can.

Ah...ok. That makes more sense.

 

[onecrazykid108]

When someone is in hypoperfusion (shock) their skin gets cool thats why you keep them warm with blankets. I named it hyperperfusion because if somoene is getting too much perfusion they get warm and turn red ect.

and i'm not seeking medical advice just curious.

 

[usafmedic45]

I named it hyperperfusion because if somoene is getting too much perfusion they get warm and turn red ect

That ("too much perfusion") is not an accurate description of what is going on in fever though. It's a poor choice for the title of this thread. Perhaps going back and brushing up on your physiology and pathophysiology is in order?

 

[Smash]

When someone is in hypoperfusion (shock) their skin gets cool thats why you keep them warm with blankets. I named it hyperperfusion because if somoene is getting too much perfusion they get warm and turn red ect.

and i'm not seeking medical advice just curious.

Someone can be in shock and have warm, flushed skin, good systolic blood pressure and bounding pulses.

 

[MrBrown]

Someone can be in shock and have warm, flushed skin, good systolic blood pressure and bounding pulses.

It is how most of my patients feel when I turn up

 

[LondonMedic]

Someone can be in shock and have warm, flushed skin, good systolic blood pressure and bounding pulses.

Remind me please? :blush:

 

[Smash]

Remind me please? :blush:

Sorry, should have said adequate rather than good. Hyperdynamic shock states like warm septic shock where inadequate perfusion occurs at a tissue level despite elevated cardiac index; due to massively increased metabolic demand it is essentially a supply/demand mismatch. Systolic bp often appears 'normal' but a fall in diastolic (widened pulse pressure) indicates loss of vascular tone. This is normally compensated for by a rise in heart rate, but this is limited in some patients with poor sympathetic tone like the elderly.

But you knew that!

 

[MrBrown]

Sorry, should have said adequate rather than good. Hyperdynamic shock states like warm septic shock where inadequate perfusion occurs at a tissue level despite elevated cardiac index; due to massively increased metabolic demand it is essentially a supply/demand mismatch. Systolic bp often appears 'normal' but a fall in diastolic (widened pulse pressure) indicates loss of vascular tone. This is normally compensated for by a rise in heart rate, but this is limited in some patients with poor sympathetic tone like the elderly.

But you knew that!

I can honestly said I had never heard of "hyperdynamic shock" so at the mo I am doing some lookey-loo'ing online.

This is very interesting, sounds like this fellow needs fluids, ceftriaxone, inotropes, IV acetamyophen and some sort of pro-coagulation support; maybe a unit or two of FFP.

Brown is over his head here ... LM, be a dear, ring up Red Base for me, tell them its a go

 

[LondonMedic]

Sorry, should have said adequate rather than good. Hyperdynamic shock states like warm septic shock where inadequate perfusion occurs at a tissue level despite elevated cardiac index; due to massively increased metabolic demand it is essentially a supply/demand mismatch. Systolic bp often appears 'normal' but a fall in diastolic (widened pulse pressure) indicates loss of vascular tone. This is normally compensated for by a rise in heart rate, but this is limited in some patients with poor sympathetic tone like the elderly.

But you knew that!

That's sepsis, as per Surviving Sepsis, it's not actually shock until there's refractory hypotension.

 

[Smash]

That's sepsis, as per Surviving Sepsis, it's not actually shock until there's refractory hypotension.

So a state of global inadequate tissue perfusion is not shock unless hypotension is present?

 

[LondonMedic]

So a state of global inadequate tissue perfusion is not shock unless hypotension is present?

Apparently so.

http://www.ccmtutorials.com/infection/sepsis/page3.htm
http://www.survivingsepsis.org/

The 'warm' and 'cold' definitions are out.

 

[Smash]

Well I guess that show how out of date I am!

So how do we refer to someone in whom there is high cardiac output but inadequate organ perfusion?

 

[LondonMedic]

Well I guess that show how out of date I am!

So how do we refer to someone in whom there is high cardiac output but inadequate organ perfusion?

Well, as per the guidance, they have Sepsis (or SIRS).

Anyway, how would you measure and diagnose organ underperfusion? Lactate? StO2? UOP? I would argue, strongly, that anyone who is underperfused enough to have diagnosable end organ dysfunction is going to be hypotensive, certainly by MAP. And if they're not, they soon will be.

 

[MrBrown]

Well, as per the guidance, they have Sepsis (or SIRS).

Anyway, how would you measure and diagnose organ underperfusion? Lactate? StO2? UOP? I would argue, strongly, that anyone who is underperfused enough to have diagnosable end organ dysfunction is going to be hypotensive, certainly by MAP. And if they're not, they soon will be.

I agree but bloody hell I don't know, what am I, a doctor?

 

[lightsandsirens5]

It is how most of my patients feel when I turn up

Brown, that orange jumpsuit would send even a perfectly healthy person into shock.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

So someone with good cardiac output but low organ perfusion has sepsis? I's confoosed.:unsure: It would seem that there would be more causes than that. Isn't saying that a person with said problem has sepsis like saying the because an animal is covered in black fur that it is a dog?

I'm just a lowly ambulance riding Int. here, but this seems strange.