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Heat Stroke: Recognition and Treatment. Rodney S. Gonzalez, MD MAJ, MC, USA. Case 1. 25yo AD male Ranger Student (28Jul08) Arrived Ft. Drum, NY three days prior Day 0 – Fitness Test 4 mile mark noted to be fatigue and dizzy Individual sought cadre care Medic did rectal temp: 105.7

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heat stroke recognition and treatment

Heat Stroke:Recognition and Treatment

Rodney S. Gonzalez, MD

MAJ, MC, USA

case 1
Case 1
  • 25yo AD male Ranger Student (28Jul08)
    • Arrived Ft. Drum, NY three days prior
    • Day 0 – Fitness Test
    • 4 mile mark noted to be fatigue and dizzy
    • Individual sought cadre care
    • Medic did rectal temp: 105.7
    • Brought to Aid Station:
      • AAO x3
      • Rectal Temp: 106.1
case 2
Case 2
  • 23yo AD male Ranger Student (28Jul08)
    • Completed Infantry Officer training at Ft. Benning,GA
    • Day 0 – Fitness Test
    • 5 mile completed
    • Individual noted to be walking aimlessly
    • No colapse
    • Medic did rectal temp: 105.8
    • Brought to Aid Station:
      • Confused; did not know name or location
      • Rectal Temp: 106.4
heat stress is cumulative over the days preceding the injury
Heat stress is cumulative over the days preceding the injury

H – Heat Category past 2 days

E – Exertion Level past 2 days

A – Acclimatization/Individual risk factors

T – Temperature/Rest overnight

Cluster of heat injuries on prior 2 days = HIGH RISK

Note: 40% of heat injuries may occur under “green flag” conditions. This is probably due to previous days’ heat, work load and dehydration.

heat stroke
Heat Stroke
  • No temperature requirement
    • However usually (104-106 minimum)
  • Skin hot and flushed, usually dry
    • May be moist with exertional
  • Headache, dizziness
  • Nausea, diarrhea
  • Visual disturbances
  • Confusion, convulsions, coma
  • Initially respiratory alkalosis followed by a metabolic acidosis

TBMED507, 2003

Bouchama & Knochel NEJM 2002

acute cns manifestations
Acute CNS Manifestations
  • Hyperthermia-> Increased CNS metabolism
  • Increased cerebral vasoconstriction
  • Cerebellum most affected- Ataxia, Dysarthria, Dysmetria
  • AMNESIA
  • LOC, disorientated, combative
prehospital care
Prehospital Care
  • RAPID cooling is single most important intervention
  • Rest
  • Oral hydration
  • ???IV???
slide8

Soldier has suspected heat illness

(dizziness, headache, dry mouth, nausea, weakness, muscle cramps)

Are there?

Mental status changes?

OR

Vomits 2x or more?

OR

Unconsciousness > 1 minute?

OR

Rectal temperature >104º F (Medic or EMT task)?

NO

YES

TREAT: Stop, Cool

  • Loosen clothing
  • Place Soldier in shade or cool area
  • Provide fluids by mouth – 1 qt/30 Min min X 2
  • Give salty snack
  • EVACUATE: Stop, Cool, Call
  • Place Soldier flat with legs elevated in cool area
  • Strip clothing
  • Apply iced sheets, soak, & fan Soldier
  • Evaluate Soldier:
    • Too much water, urine output, vomiting? Give salty snack.
    • Poor water, urine output? Sip cool electrolyte drink. Never force water.
  • IF evacuation delayed >10 min, only one 500 cc IV Normal Saline (IV preferably chilled in ice water).
  • Stop cooling if shivering or rectal temp is 100 F. (Medic or EMT task)
  • Reconfirm core temperature when evacuation arrives (EMT or Medic task)

Soldier gets worse or does not improve

in 30 minutes?

YES

Evacuate

NO

  • Limited indoor duty for remainder of day
  • Medical evaluation within 24 hours
exertional heat stroke
Exertional Heat Stroke
  • Laboratory “Heat Panel”
    • BMP, Ca, Mg, PO4, LFTs, CK, LDH, (+/-)Uric Acid, CBC, PT/PTT, U/A, Umyoglobin
  • Admit to Hospital for monitoring
  • Follow labs every 4-8 hours
  • Heat Stroke Profile upon discharge