Rapid reduction of core temperature to 40°C (104°F) is the primary goal of treatment and is accomplished by physical cooling techniques. Antipyretics are not effective. The fastest cooling techniques reported in the literature are usually implemented in a structured research laboratory environment, using animal models and equipment and techniques that are not universally available. In clinical practice, a technique that allows easy patient access and is readily available is preferable to a technique that may be faster but is difficult to perform or does not permit easy access to the patient ( Table. 18Zz4). Many of the techniques may be used in combination. Although effective and reported to be widely used, immersion cooling is relatively contraindicated if the patient may require cardiac monitoring and defibrillation. Also, the efficiency of immersion has been primarily documented in young, healthy patients without comorbid diseases. The safety and efficacy of immersion in classic heatstroke victims has not been established. Special considerations should be taken for invasive cooling techniques. Iced gastric lavage should not be used unless the airway is protected. Iced peritoneal lavage is relatively contraindicated if the patient is pregnant or has had previous abdominal surgery.
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