MANAGEMENT OF HEAT RELATED EMERGENCIES IN HOSPITAL

MANAGEMENT OF HEAT RELATED EMERGENCIES

1. MANAGEMENT OF HEAT RELATED EMERGENCIES DR. ASIF IQBAL

2. Heat stroke Heat stroke  or  heatstroke , also known as  sun-stroke , is a severe  heat illness  that results in a  body temperature  greater than 40.0 °C (104.0 °F), along with red skin, headache,  dizziness , and  confusion . Sweating  is generally present in exertional heatstroke, but not in classic heatstroke. The start of heat stroke can be sudden or gradual.  Heatstroke is a life-threatening condition due to the potential for multi-organ dysfunction, with typical complications including  seizures ,  rhabdomyolysis , or  kidney failure .

3. Heat exhaustion Heat exhaustion  is a heat-related illness characterized by the body's inability to effectively cool itself, typically occurring in high ambient temperatures or during intense physical exertion. In heat exhaustion, core body temperature ranges from 37 °C to 40 °C (98.6 °F to 104 °F). Symptoms include profuse sweating, weakness, dizziness, headache, nausea, and lowered blood pressure, resulting from dehydration and serum electrolyte depletion.

4. Heat cramps Heat cramps , a type of  heat illness , are muscle spasms that result from loss of large amount of salt and water through exercise.  Heat cramps are associated with  cramping  in the  abdomen ,  arms  and  calves . This can be caused by inadequate consumption of fluids or  electrolytes .  Heavy sweating causes heat cramps, especially when the water is replaced without also replacing salt or  potassium .

5. Heat syncope Heat syncope  is  fainting  or dizziness as a result of overheating ( syncope  is the medical term for fainting). It is a type of  heat illness . The basic symptom of heat syncope is fainting, with or without  mental confusion .  Heat syncope is caused by peripheral vessel dilation, resulting in diminished blood flow to the brain and  dehydration .

6. pathophysiology of heat stroke

7. DIFFERENTIAL DIAGNOSIS Other conditions which may present similarly to heat stroke include  meningitis ,  encephalitis ,  epilepsy , drug toxicity, severe dehydration, and certain metabolic syndromes such as  serotonin syndrome ,  neuroleptic malignant syndrome ,  malignant hyperthermia  and  thyroid storm Take a detail history including drug history and do good physical examination to r/o differential diagnoses.

8. Treatment ,cont..  During cooling, the body temperature should be lowered to less than 39 degrees Celsius, ideally less than 38-38.5 degrees Celsius. In hospital mechanical cooling methods include ice water immersion, infusion of cold intravenous fluids, placing ice packs or wet gauze around the person, and fanning. Aggressive ice-water immersion remains the  gold standard  for exertional heat stroke and may also be used for classic heat stroke.  person's heart rate and breathing should be monitored. IV fluid resuscitation is usually needed for circulatory failure and organ dysfunction and is also indicated if  rhabdomyolysis  is present. In severe cases  hemodialysis  and ventilator support may be needed.

9. Treatment ,cont.. In the field, the person should be moved to a cool area, such as indoors or to a shaded area. Clothing should be removed to promote heat loss through passive cooling. Conductive cooling methods such as  ice-water immersion  should also be used  if possible. Evaporative and convective cooling by a combination of cool water spray or cold compresses with constant air flow over the body, such as with a fan or air-conditioning unit, is also an effective alternative

10. LAB TESTS TO R/O COMPLICATION

11. AVOID.. Dantrolene , a muscle relaxant used to treat other forms of hyperthermia, is not an effective treatment for heat stroke. Antipyretics  such as  aspirin  and  acetaminophen  are also not recommended as a means to lower body temperature in the treatment of heat stroke and their use may lead to worsening liver damage

12. Untreated heat exhaustion Untreated heat exhaustion can progress to heatstroke, a much more serious illness involving central nervous system dysfunction such as delirium and coma.  Other systemic effects, including rhabdomyolysis, hepatic failure, arrhythmias, disseminated intravascular coagulation, and even death, are not uncommon

13. CAUTION When the outside temperature is 21 °C (70 °F), the temperature inside a car parked in direct sunlight can quickly exceed 49 °C (120 °F). Young children or elderly adults left alone in a vehicle are at particular risk of succumbing to heat stroke. "Heat stroke in children and in the elderly can occur within minutes, even if a car window is opened slightly." As these groups of individuals may not be able to open car doors or to express discomfort verbally (or audibly, inside a closed car)

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