Assessment of a Patient's Shivering

Abstract

Therapeutic temperature management (TTM) is also known as therapeutic hypothermia or therapeutic temperature modulation. This therapy has become a standard of care for patients who are comatose after cardiac arrest. It is also used for comatose patients with acute liver failure and brain injury patients with persistent elevated intracranial pressure.1Patients receiving TTM therapy must be monitored for a variety of side effects including fluid and electrolyte alterations, hemodynamic instability, respiratory insufficiency, and shivering. Shivering is an involuntary response designed to generate heat and increase body temperature. It is difficult to identify but can have devastating effects in these already critically ill patients. An assessment tool, such as the Bedside Shivering Assessment Scale (BSAS), will help quickly identify patients who are shivering, and alllow for early intervention to limit the consequences of the shivering response.2