Too Cold, Too Hot: Temperature Emergencies

• Hypothermia: handle gently and rewarm passively plus actively; keep CPR going ('not dead until warm and dead'); withhold epi until >30 °C and double the interval at 30–35 °C.
• Heat stroke: start evaporative/ice-pack cooling immediately, targeting <39 °C within 30 min; antipyretics are useless (different mechanism).
• Malignant hyperthermia: dantrolene 2.5 mg/kg repeated, stop the trigger, cool; EMHG 2024 update adds activated-charcoal circuit filters, explicit hyperkalemia management, and stopping active cooling at 38.5 °C.
• NMS: stop the dopamine blocker, give dantrolene/bromocriptine, cool, admit to ICU.

Fever/Hyperthermia Workup

• Temp ≥38.3°C (101°F)
• Consider possible causes (Table 32.1); draw two sets of sterile blood cultures
• No clear cause, clinically stable → watch closely; recurrent fever → chest x-ray, culture the possible source
• Potential infectious source: intravenous/arterial catheter · intubated · Foley catheter · surgical drain · nasogastric tube · diarrhea → chest x-ray, culture the possible source
• Immunosuppression or clinical instability → chest x-ray, culture the possible source
• Give broad empiric antibiotics directed at likely pathogens
• Improving?
• Close monitoring
• Not better after 48 hours, or worse: exchange lines/catheters · CT imaging · consider antifungal treatment · venous dopplers · noninfectious cause (Table 32.1)