Severe hyperthermia? Its in the bag.
While your friends at home are shivering in the Camden, NJ winter, you are on an elective retrieval medicine rotation in New South Wales, Australia. A 32 year old patient arrives in a rural emergency department obtunded. His friends state he was out hiking and may have used some cocaine as well. His initial vital signs are notable for hypotension and a core temperature of 41.5C (106.7). There are no fans available for evaporative cooling and no gel adhesive body temperature controlling devices (such as those used following cadiac arrest). The patient requires intubation which is done uneventfully, the staff asks what tools you might use to reduce the body temperature.
A recent case report was published noting that body bags are mostly waterproof, durable devices which can hold ice water to allow for cold water immersion in cases of severe, life threatening hyperthermia. In the two reported cases, the patients were placed in the body bags with an ice water slurry and kept in reverse Trendelenberg position. Their upper torsos were kept exposed to allow cardiac monitoring and access to peripheral IVs. A piece of water resistant tape was placed along the zipper to reduce leaking and a bucket at the start of the zipper collected any excess water. The body bag technique was found to be effective in reducing body temperature and more readily accessible than other methods of ice water immersion.
Wang AZ, Lupov IP, Sloan BK. A Novel Technique for Ice Water Immersion in Severe Drug-Induced Hyperthermia in the Emergency Department. Journal of Emergency Medicine. 2019;57(5):713-715. doi:10.1016/j.jemermed.2019.08.041.