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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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heat illness and heat stroke
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
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
heat stroke
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
heat stroke1
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
physiologic cooling mechanisms
Physiologic Cooling Mechanisms
  • Evaporation (of sweat)
    • Ineffective relative humidity >75%
  • Convection, conduction, and radiation
    • Ineffective >95F
much more than little adults
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)
critical thermal maximum ctm
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
slide11
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
stabilization
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)
cooling
Cooling
  • Bring temp down to <104F as rapidly as possible
  • Stop cooling measures at 100.4F
  • Use benzos to stop shivering
treatment of end organ dysfunction
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
outcome
Outcome
  • Mortality
    • Up to 15% in adolescents
    • Up to 63% in elderly
  • Permanent neurologic damage t>107.6
  • Heat Intolerance
prevention
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
sporting events
Sporting Events
  • Light colored clothing
  • Never wear material that restricts sweat loss
  • 500ml within 2hrs prior to event
  • 250ml q 20 minutes while exercising