Can fever melt the brain?

Can a fever get so high that it causes brain damage? That question was posed to us by a listen with a recent patient whose temperature reached 106.9 Fahrenheit. Andy Sloas from the PEM ED podcast returns to ERCast to gives his take on cooling, workup, and the difference between heat exposure and infectious fever.

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  1. A.T.

    A reference to Men in Blazers?!? I feel like the two worlds of my favorite podcasts -- soccer and EM -- are colliding! Not like George Costanza…in a good way this time!
    Good stuff as always!

    1. Post
      Rob Orman

      Oh yes! Men in Blazers and The Total Soccer Show are my two favorites. And my hope for this season’s EPL is that Burnley not get relegated. Of course, that will mean Hull, Villa, or Sunderland get relegated, but that’s how it rolls.

  2. mike m

    Thanks for the review.

    I was puzzled by one comment, which was also made on the emrap episode involving medical management hyperthermia during marathons. On both podcasts the suggestion of ice bath immersion is followed by advice never to spritz cold water on the patient. Do people in ice baths not shiver?

    1. Post
      Rob Orman

      Hi Mike, Here is the response from Andy Sloas….

      If you have no other way to cool the patient, then an ice bath is the recommendation. It’s associated with a greater mortality (but the subset you’d put in an ice bath would have a greater mortality bc they’re really really hot- not sure the ice bath is causal) and it’s impossible to do cardiac monitoring or CPR. Spritzing with warm water in front of a fan (evaporative) cools extremely fast 0.3-0.5 C per minute and decreases the chance of shivering. Shivering is bad in hyperthermia care bc it increases temperature and metabolism.

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  4. Edwin Leap

    Great discussion of pediatric fever. I always need more ammunition when I conclude with ‘the baby is fine, you can go home now.’ I’m pretty sure I’ll be giving ‘the fever talk’ for about half an hour after I’m clinically dead. Well done gentlemen!

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