Heat stroke: Difference between revisions
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==Diagnosis== | ==Diagnosis== | ||
*Blood | *Diagnosis is made by history and physical exam and exclusion of other diseases | ||
*Blood glucose | |||
*CBC | *CBC | ||
*Chemistry | *Chemistry | ||
* | *Arterial blood gas or Venous blood gas | ||
**PaCO2 is often <20 2/2 | **PaCO2 is often <20 2/2 hyperventilation | ||
** | *Lactate | ||
* | **Often elevated in exertional heat stroke | ||
* | *Coagulation studies | ||
* | *Creatine phosphokinase | ||
*Urinanalysis | |||
*[[ECG]] | *[[ECG]] | ||
* | *Chest x-ray | ||
* | *CT brain and/or[[LP]] as needed | ||
==Treatment== | ==Treatment== | ||
Revision as of 01:58, 26 August 2015
Background
- Universally fatal if left untreated
- Types
- Classic (nonexertional)
- Seen in children and elderly
- Exertional
- Seen in otherwise young, healthy individuals
- Classic (nonexertional)
Clinical Features
- Heat exposure + elevated temperature >40C (>104F) + neurologic abnormalities:
- Anhidrosis is frequently present; however, its absence does NOT rule out heat stroke
- Symptoms seen in Heat Exhaustion may also be present
Differential Diagnosis
Environmental
Environmental heat diagnoses
Non-Environmental
- Infectious
- Endocrine
- Neurologic
- Hypothalamic bleeding or infarct
- CVA
- Status epilepticus
- Toxicologic
- Anticholinergic toxidrome
- Sympathomimetic overdose
- Salicylate overdose
- Serotonin syndrome
- Malignant hyperthermia
- Neuroleptic Malignant Syndrome
- Withdrawal (ETOH, benzo)
Altered mental status and fever
- Infectious
- Sepsis
- Meningitis
- Encephalitis
- Cerebral malaria
- Brain abscess
- Other
Diagnosis
- Diagnosis is made by history and physical exam and exclusion of other diseases
- Blood glucose
- CBC
- Chemistry
- Arterial blood gas or Venous blood gas
- PaCO2 is often <20 2/2 hyperventilation
- Lactate
- Often elevated in exertional heat stroke
- Coagulation studies
- Creatine phosphokinase
- Urinanalysis
- ECG
- Chest x-ray
- CT brain and/orLP as needed
Treatment
General
- IVF
- Initiate at a rate that ensures adequate (start w/ NS 250cc/hr)
Cooling
- Goal is to reduce temp to 39C (102.2F) and then stop to avoid overshoot hypothermia
- Antipyretics (ASA and acetaminophen) and dantrolene have no role
- Cooling blankets work too slowly to be employed as sole treatment
- Ice packs to neck, axillae, groin are useful as adjunct only
- Cold IVF is not effective
- Techniques
- Evaporative
- Method of choice
- Spray cool water (15C (59F)) on most of pt's body surface; turn on fan
- Complications
- Shivering (occurs when skin temp is <30C (86F): tx w/ short-acting benzos
- Electrodes not sticking: place on pt's back instead
- Ice-water immersion
- Consider especially in young, healthy pts
- Complications
- Shivering
- Inability to perform defibrillation or resuscitative procedures
- Invasive
- Consider if evaporative cooling / immersion is insufficient
- Examples: cold water gastric lavage, bladder lavage, rectal lavage
- Evaporative
Complications
- Hypotension
- BP will usually respond to small fluid bolus (500cc) and body cooling
- If ineffective consider pressors (dopamine or dobutamine)
- BP will usually respond to small fluid bolus (500cc) and body cooling
- Electrolyte abnormalities
- Variable: hypokalemia and hyper or hyponatremia may be seen
- Hematologic
- DIC or abnormal bleeding
- Renal failure
- ARDS
- Seizure
- Treate with benzos