Heat stroke

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

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 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

General

1) 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

   -may 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)

Specific Co-Symptom

1) Shivering

    -Treat with chlorpromazine, benzodiazepines, or thiopental

2) Seizure

    -Treated with diazepam or thiopental (dilantin is ineffective)

- cns recovery is a favorable sign- but 20% will have resid damage

Mistry, KajiQuestions, Donaldson

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