Heat stroke: Difference between revisions
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==Background== | ==Background== | ||
*often fatal, if survive probable brain damage | *often fatal, if survive probable brain damage | ||
*usually v young or elderly, poor or socially isolated, no access to air conditioning | *usually v young or elderly, poor or socially isolated, no access to air conditioning | ||
*heat stroke has microvasc thrombosis and endothelial cell damage- like DIC | *heat stroke has microvasc thrombosis and endothelial cell damage- like DIC | ||
==Diagnosis== | ==Diagnosis== | ||
*Heat Stroke- temp >40 and CNS dz | *Heat Stroke- temp >40 and CNS dz | ||
*Heat Exhaustion- thirst, weakness, anxiety, dizzy, HA due to temp and water and salt depletion. Temp can be low, high or normal. (>37 but <40) | *Heat Exhaustion- thirst, weakness, anxiety, dizzy, HA due to temp and water and salt depletion. Temp can be low, high or normal. (>37 but <40) | ||
==Signs & Symptoms== | ==Signs & Symptoms== | ||
#heat stroke- hot and altered | |||
#tachy and hyperventilation | |||
#may have hypotn | |||
#nonexertional heat stroke- have resp alk | |||
#exertional- resp alk and lactic acidosis, also rhabdo and electrolyte abnormalities | |||
#may have muscular rigidity | |||
#hypoglycemia rare | |||
#can progress to multiorgan faillure | |||
==Treatment== | ==Treatment== | ||
===General=== | |||
Rapid Cooling | |||
#by conduction, evaporaton, convection | |||
#continue only until the temperature drops to 38.5 or 39 C to avoid overshoot hypothermia | |||
#evaporative cooling and iced gastric lavage recommended | |||
##e.g. luke-warm water or wet towels + blowing air with a fan | |||
##ay consider peritoneal and thoracic lavage | |||
#cooling blankets may be effective for mild heatstroke | |||
#immersing or covering the patient in ice NOT recommended (causes vasoconstriction and shivering) | |||
^no drugs helpful (dantrolene not effective; antipyretics not studied) | |||
===Specific Co-Symptom=== | |||
Specific Co-Symptom | |||
# Shivering: Treat with chlorpromazine, benzodiazepines, or thiopental | # Shivering: Treat with chlorpromazine, benzodiazepines, or thiopental | ||
# Seizure: Treated with diazepam or thiopental (dilantin is ineffective) | # Seizure: Treated with diazepam or thiopental (dilantin is ineffective) | ||
==Prognosis== | ==Prognosis== | ||
*cns recovery is a favorable sign- but 20% will have resid damage | *cns recovery is a favorable sign- but 20% will have resid damage | ||
==See Also== | ==See Also== | ||
Environ: [[Heat Exhaustion]] | Environ: [[Heat Exhaustion]] | ||
==Source == | ==Source == | ||
Mistry, KajiQuestions, Donaldson | Mistry, KajiQuestions, Donaldson | ||
[[Category:Environ]] | [[Category:Environ]] | ||
Revision as of 19:43, 13 March 2011
Background
- often fatal, if survive probable brain damage
- usually v young or elderly, poor or socially isolated, no access to air conditioning
- heat stroke has microvasc thrombosis and endothelial cell damage- like DIC
Diagnosis
- Heat Stroke- temp >40 and CNS dz
- Heat Exhaustion- thirst, weakness, anxiety, dizzy, HA due to temp and water and salt depletion. Temp can be low, high or normal. (>37 but <40)
Signs & Symptoms
- heat stroke- hot and altered
- tachy and hyperventilation
- may have hypotn
- nonexertional heat stroke- have resp alk
- exertional- resp alk and lactic acidosis, also rhabdo and electrolyte abnormalities
- may have muscular rigidity
- hypoglycemia rare
- can progress to multiorgan faillure
Treatment
General
Rapid Cooling
- by conduction, evaporaton, convection
- continue only until the temperature drops to 38.5 or 39 C to avoid overshoot hypothermia
- evaporative cooling and iced gastric lavage recommended
- e.g. luke-warm water or wet towels + blowing air with a fan
- ay consider peritoneal and thoracic lavage
- cooling blankets may be effective for mild heatstroke
- immersing or covering the patient in ice NOT recommended (causes vasoconstriction and shivering)
^no drugs helpful (dantrolene not effective; antipyretics not studied)
Specific Co-Symptom
- Shivering: Treat with chlorpromazine, benzodiazepines, or thiopental
- Seizure: Treated with diazepam or thiopental (dilantin is ineffective)
Prognosis
- cns recovery is a favorable sign- but 20% will have resid damage
See Also
Environ: Heat Exhaustion
Source
Mistry, KajiQuestions, Donaldson