63.11 Hyperthermia after a head injury

Injuries to the heat regulating centres in a patient’s brain may cause hyperthermia, especially during the first 12 hours after an injury. When he is first admitted his temperature is usually low, and any rise over 39 $\ensuremath{^\circ }$ C is a grave sign. During the first few days a temperature fluctuation of a degree or so is unimportant, but a rise after a day or two is serious, because it may indicate renewed subarachnoid bleeding, pneumonia, or meningitis. Hyperthermia can kill a patient with a head injury who might survive otherwise, so monitor his temperature carefully, and treat him promptly. It can rise very suddenly: it may be 38 $\ensuremath{^\circ }$ C one moment and 42 $\ensuremath{^\circ }$ C half an hour later.

HYPERTHERMIA Take the patient’s temperature regularly. During times of crisis take it every 10 or 25 minutes. If his temperature rises above 39 $\ensuremath{^\circ }$ C, take off his pyjamas, cover him with a wet sheet, and turn a fan on him. Bring his temperature down to 40 $\ensuremath{^\circ }$ C or below, and keep it there. If necessary give him chlorpromazine 50 mg 6 hourly, intramuscularly or by stomach tube.