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Chills and rigors

  • 1.  Chills and rigors

    Posted 05-22-2019 13:36
    Hi All,

    I am currently working in a research setting where our patients are receiving chemo, immunotherapy and monoclonal antibodies.  My patients are experiencing increased chills and rigors.  I would like to get your input on what your facilities are using to manage theses side effects.  Does anyone have any data on the use of Demerol vs Dilaudid?  or any other medications.  Please advise.  Thanks

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    Karen Fayssoux-Bautista RN
    Infusion
    Torrance CA
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  • 2.  RE: Chills and rigors

    Posted 05-23-2019 20:08
    Hi Karen
    in our research setting, the typical meds we use for this are meperidine, dex and diphenhydramine.

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    Julie O'Connor RN MSN OCN
    Clinical Research Nurse
    Dallas TX
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  • 3.  RE: Chills and rigors

    Posted 30 days ago
    Thanks for your input

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    Karen Fayssoux-Bautista RN
    Infusion
    Torrance CA
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  • 4.  RE: Chills and rigors

    Posted 05-24-2019 18:32
    We always used 12.5mg of  IV demerol for chills and rigors.  It is probably the only way demerol is being used now.  It works well and fast.  Rigors and chills are exhausting.  the patients feel great relief and I have had some marriage proposals after giving this for rigors.

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    Diane Linn MSN RN OCN
    Nurse Educator
    Sitka AK
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  • 5.  RE: Chills and rigors

    Posted 30 days ago
    Thanks for your input

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    Karen Fayssoux-Bautista RN
    Infusion
    Torrance CA
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  • 6.  RE: Chills and rigors

    Posted 30 days ago
    Diane--I lol'd at your message. Truth! In 15 years, I've seen it be an infallible solution. Trouble is, I don't know how you would clinically test it against other things. I've never tried to use Dilaudid for rigors--they aren't having pain, they are shaking. I forgot the mechanism behind it. I once had an AML pt that was a family medicine doc. He developed rigors with a neutropenic fever overnight and I talked him and the hospitalist into trying it (he had already been worked up for sepsis). The patient was amazed at how well and how fast it worked. Very trust-building, that we could take care of it so quickly. He found the rigors extremely unpleasant. And it only takes a 'whiff,' compared to the doses that used to be used for sedation/pain control. I understand about the long-term difficulties with neurotoxic metabolities (early on in my career, I did have a patient dependent on it for pain control, who ended up falling), but for rigors, it works.

    I apologize if it's a double-post. Thought I did this yesterday but don't see it.

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    Carol Siewert RN
    Madison WI
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  • 7.  RE: Chills and rigors

    Posted 18 days ago
    Hot blankets do seem to help as do hotpacks. The first hospital I worked at we did Demerol, and morphine was inferior IMO - but keep a patient in hospital for over a month with fevers and rigors, and patients did seem to quickly develop more toxicity with Demerol. IHI has campaigned to remove Demerol as a first line option. We did not use dilaudid for this anywhere that I worked. Other premedications to prevent reaction might help.

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    John Hillson RN
    Hillsborough NC
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