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

1. heat stroke- hot and altered
2. tachy and hyperventilation
3. may have hypotn
4. nonexertional heat stroke- have resp alk
5. exertional- resp alk and lactic acidosis, also rhabdo and electrolyte abnormalities
6. may have muscular rigidity
7. hypoglycemia rare
8. can progress to multiorgan faillure

Treatment

General

Rapid Cooling

1. by conduction, evaporaton, convection
2. continue only until the temperature drops to 38.5 or 39 C to avoid overshoot hypothermia
3. evaporative cooling and iced gastric lavage recommended
   1. e.g. luke-warm water or wet towels + blowing air with a fan
   2. ay consider peritoneal and thoracic lavage
4. cooling blankets may be effective for mild heatstroke
5. 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

1. Shivering: Treat with chlorpromazine, benzodiazepines, or thiopental
2. Seizure: Treated with diazepam or thiopental (dilantin is ineffective)

Prognosis

• cns recovery is a favorable sign- but 20% will have resid damage

See Also

Heat Exhaustion

Source

Mistry, KajiQuestions, Donaldson