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Sunrise over Gulf of Mexico

Sunrise over Gulf of Mexico. Heat Illness and Heat Stroke. Heat Illness Inability to maintain normal body temp due to excess heat production or decreased heat transfer to environment. 3 Forms of Heat Illness. Heat Stress Feeling of discomfort, decreased Performance Normal body temp

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Sunrise over Gulf of Mexico

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  1. Sunrise over Gulf of Mexico

  2. Heat Illness and Heat Stroke • Heat Illness • Inability to maintain normal body temp due to excess heat production or decreased heat transfer to environment

  3. 3 Forms of Heat Illness • Heat Stress • Feeling of discomfort, decreased Performance • Normal body temp • Heat Exhaustion • Mild dehydration • Temp 100.4 – 104 • Intense discomfort, thirst, N/V • Transient confusion (No other neuro symptoms) • Heat Stroke • Body temp >104 • Neuro dysfunction

  4. Heat Stroke • Classic (nonexertional) • Environmental exposure to heat • Young children, elderly, disabled • Exertional • Young, healthy individuals • Athletes, military recruits • Heavy exercise in high temps and humidity

  5. Heat Stroke • Among high school athletes, heat stroke is 3rd leading cause of mortality • May ignore symptoms until they collapse • Risk factors: prolonged exercise in warm, humid environment

  6. Physiologic Cooling Mechanisms • Evaporation (of sweat) • Ineffective relative humidity >75% • Convection, conduction, and radiation • Ineffective >95F

  7. Much more than little adults • Children are at increased risk for heat illness • Higher metabolic rate- higher heat production • Increased surface area to mass ratio- increased absorption of heat • Smaller absolute blood volume and lower cardiac output- limits transfer of heat from core to surface • Lower sweat rate per gland and start at higher temps • Inadequate fluid replenishment • Longer to acclimate to hot environments (10-14days)

  8. Critical Thermal Maximum (CTM) • Degree of elevated body temp and duration that can be tolerated b/f cell damage occurs • Core body temp 107.6 for 45min

  9. DDx • Sepsis/Encephalitis • CNS Conditions (Dysregulation) • Congenital anomalies or traumatic brain injury • Status Epilepticus • Toxidromes • Anticholinergics, Salicylate, Stimulants • Serotonin Syndrome • Neuroleptic Malignant Syndrome • Malignant Hyperthermia • Thyroid Storm • Hemorrhagic Shock and Encephalopathy Syndrome

  10. Stabilization • ABCDE • Continuous temp monitoring (rectal probe) • Rapid Cooling • Evaporative cooling of greatest benefit • Spray with water while using high-flow fans • Can decrease temp by 0.27F/min • Ice packs to neck, axillae, groin as adjunct • Cooling blankets not as beneficial • Cold water immersion is effective but not practical • Chilled IV saline (little data)

  11. Cooling • Bring temp down to <104F as rapidly as possible • Stop cooling measures at 100.4F • Use benzos to stop shivering

  12. Treatment of End Organ Dysfunction • Rhabdomyolysis • hyperkalemia, hypocalcemia, hyperphosphatemia • DIC • Acute Renal Failure • Hyponatremic dehydration/ Hypovolemic shock • Cardiogenic shock • Pulmonary edema • Liver failure • Cerebral Edema

  13. Outcome • Mortality • Up to 15% in adolescents • Up to 63% in elderly • Permanent neurologic damage t>107.6 • Heat Intolerance

  14. Prevention • Infants: avoid excessive bundling or bedding • If sweating at night- dangerous sign • Lightly colored vehicle with window cracked: • 145F in 40minutes • Keep parked cars locked • Increased awareness to high risk groups

  15. Sporting Events • Light colored clothing • Never wear material that restricts sweat loss • 500ml within 2hrs prior to event • 250ml q 20 minutes while exercising

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