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
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
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
- 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