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11 b Heat Stroke ....,......m...mmm.....

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Introduction Normal Body Temperature Regulation Causes of Heat Illness Clinical Pictures Treatment Prognosis Prevention
Body Temperature Regulation Heat Gain – Metabolic – Environmental Heat Loss – Radiation – Convection – Conduction – Evaporation
Heat Illness Predisposing Factors – Physical activity – Extremes of age, poor physical condition, fatigue – Excessive clothing – Dehydration – Cardiovascular disease – Skin disorders – Obesity – Drugs • Phenothiazines, anticholinergics, B and Ca channel blockers, diuretics, amphetamines, LSD, cocaine, MAOIs
Drugs that Interfere with Thermoregulation Increase heat production – Thyroid hormone – Amphetamines – TCAs – LSD Decrease thirst – Haldol Decrease sweating – Antihistamines – Anticholinergics – Phenothiazines – Benztropine
Pathophysiology of Heat Illness Heat Cramps Heat tetany Heat Exhaustion Heat Stroke – Heat stress – Loss of ability to sweat – Volume depletion and electrolyte imbalances not prominent – Pre-existing cardiovascular disease – End-organ damage
Heat Cramps Symptoms – Severe muscle cramps – General Weakness – Dizziness and fainting  Treatment – Move to a cool shady place – Electrolyte drinks – Massage the cramped area – Apply moist towels to the cramped muscle and the patient’s forehead – Transport the person to a medical care facility if symptoms worsen
Heat Exhaustion Symptoms – Rapid and shallow breathing – Weak pulse – Cold and clammy skin – Heavy perspiration – Weakness and dizziness  Treatment – Move to a cool shady place – Remove enough clothing to cool the patient – Fan the patient’s skin to promote sweat evaporation – If conscious provide electrolyte drinks – Treat for shock and transport to a medical care facility
Clinical Presentation Heat Stroke – True emergency – Altered LOC – Any neurologic finding – And elevated temperature – May still be sweating initially – Syncope – History is critical
Classic vs Exertional Heatstroke Classic – Elderly, chronically ill – Sedentary – Drug use – Sweating absent – Lactic acidosis usually absent – Electrolyte abnormalities and rhabdo uncommon – ARF <5% – Mild DIC – Due to poor dissipation of environmental heat
Classic vs Exertional Heatstroke Exertional – Men 15-45 years, healthy – Strenuous exercise – No drug use – Sweating often present – Lactic acidosis common – Frequent hyperkalemia, hypocalcemia, hypoglycemia – CPK markedly elevated, severe rhabdo – Hyperuricemia – ARF 25-30% – DIC marked
Differential Diagnosis of Heatstroke Malignant Hyperthermia – Halogenated anesthetics – Depolarizing muscle relaxants Febrile illness, especially CNS CVA Neuroleptic malignant syndrome and seizure Drug OD – Cocaine – Amphetamines, MDMA, MDEA
Heat Stroke  Symptoms – Deep breathing becoming progressively more shallow – Rapid strong pulse becoming weaker – Dry and hot skin – Unconsciousness, seizures, and muscular twitching – Dilated pupils  Treatment – Remove the person from any heat sources and remove clothing – Immerse the patient in cool water, or use cold wet towels or ice packs on the patient’s armpits, groin, under the neck, and behind the knees – Treat for shock and transport the patient to a medical care facility
Treatment of Heatstroke Immediate aggressive cooling to 39 C High flow O2, pulse ox, intubate prn IV NS 250-300cc/hr Cardiac monitor Continuous core temperature monitoring Foley ABG, CBC, SMA 18, PT/PTT, UA, urine myoglobin, UDS EKG, CXR Benzodiazepines or chlorpromazine for shivering
Heat Stress Prevention Drink plenty of water per day – 2 quarts minimum on mild days – 6 to 8 quarts on hot days or 1 quart an hour – Frequent sipping is better than guzzling Monitor the color of your urine Wear loose fitting and open clothing Do not overexert yourself Use the buddy system Don’t be afraid to stop, rest and drink
Prognosis of Heatstroke 90% survival with proper treatment Morbidity directly related to duration of hyperthermia Poor prognosis – Temp >41 C – Prolonged hyperthermia – Hyperkalemia, ARF, elevated LFTs – Persistence of coma with normal temperature

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11 b Heat Stroke ....,......m...mmm.....

  • 1. Introduction Normal Body Temperature Regulation Causes of Heat Illness Clinical Pictures Treatment Prognosis Prevention
  • 2. Body Temperature Regulation Heat Gain – Metabolic – Environmental Heat Loss – Radiation – Convection – Conduction – Evaporation
  • 3. Heat Illness Predisposing Factors – Physical activity – Extremes of age, poor physical condition, fatigue – Excessive clothing – Dehydration – Cardiovascular disease – Skin disorders – Obesity – Drugs • Phenothiazines, anticholinergics, B and Ca channel blockers, diuretics, amphetamines, LSD, cocaine, MAOIs
  • 4. Drugs that Interfere with Thermoregulation Increase heat production – Thyroid hormone – Amphetamines – TCAs – LSD Decrease thirst – Haldol Decrease sweating – Antihistamines – Anticholinergics – Phenothiazines – Benztropine
  • 5. Pathophysiology of Heat Illness Heat Cramps Heat tetany Heat Exhaustion Heat Stroke – Heat stress – Loss of ability to sweat – Volume depletion and electrolyte imbalances not prominent – Pre-existing cardiovascular disease – End-organ damage
  • 6. Heat Cramps Symptoms – Severe muscle cramps – General Weakness – Dizziness and fainting  Treatment – Move to a cool shady place – Electrolyte drinks – Massage the cramped area – Apply moist towels to the cramped muscle and the patient’s forehead – Transport the person to a medical care facility if symptoms worsen
  • 7. Heat Exhaustion Symptoms – Rapid and shallow breathing – Weak pulse – Cold and clammy skin – Heavy perspiration – Weakness and dizziness  Treatment – Move to a cool shady place – Remove enough clothing to cool the patient – Fan the patient’s skin to promote sweat evaporation – If conscious provide electrolyte drinks – Treat for shock and transport to a medical care facility
  • 8. Clinical Presentation Heat Stroke – True emergency – Altered LOC – Any neurologic finding – And elevated temperature – May still be sweating initially – Syncope – History is critical
  • 9. Classic vs Exertional Heatstroke Classic – Elderly, chronically ill – Sedentary – Drug use – Sweating absent – Lactic acidosis usually absent – Electrolyte abnormalities and rhabdo uncommon – ARF <5% – Mild DIC – Due to poor dissipation of environmental heat
  • 10. Classic vs Exertional Heatstroke Exertional – Men 15-45 years, healthy – Strenuous exercise – No drug use – Sweating often present – Lactic acidosis common – Frequent hyperkalemia, hypocalcemia, hypoglycemia – CPK markedly elevated, severe rhabdo – Hyperuricemia – ARF 25-30% – DIC marked
  • 11. Differential Diagnosis of Heatstroke Malignant Hyperthermia – Halogenated anesthetics – Depolarizing muscle relaxants Febrile illness, especially CNS CVA Neuroleptic malignant syndrome and seizure Drug OD – Cocaine – Amphetamines, MDMA, MDEA
  • 12. Heat Stroke  Symptoms – Deep breathing becoming progressively more shallow – Rapid strong pulse becoming weaker – Dry and hot skin – Unconsciousness, seizures, and muscular twitching – Dilated pupils  Treatment – Remove the person from any heat sources and remove clothing – Immerse the patient in cool water, or use cold wet towels or ice packs on the patient’s armpits, groin, under the neck, and behind the knees – Treat for shock and transport the patient to a medical care facility
  • 13. Treatment of Heatstroke Immediate aggressive cooling to 39 C High flow O2, pulse ox, intubate prn IV NS 250-300cc/hr Cardiac monitor Continuous core temperature monitoring Foley ABG, CBC, SMA 18, PT/PTT, UA, urine myoglobin, UDS EKG, CXR Benzodiazepines or chlorpromazine for shivering
  • 14. Heat Stress Prevention Drink plenty of water per day – 2 quarts minimum on mild days – 6 to 8 quarts on hot days or 1 quart an hour – Frequent sipping is better than guzzling Monitor the color of your urine Wear loose fitting and open clothing Do not overexert yourself Use the buddy system Don’t be afraid to stop, rest and drink
  • 15. Prognosis of Heatstroke 90% survival with proper treatment Morbidity directly related to duration of hyperthermia Poor prognosis – Temp >41 C – Prolonged hyperthermia – Hyperkalemia, ARF, elevated LFTs – Persistence of coma with normal temperature

Editor's Notes

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  11. There are several guides available on hydration requirements in relation to the amount of work done.
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