Morning Report: 9/7/2012

Thanks to Dr. Semenovskaya for today’s Morning Report!

 

Heat Illness

 

Heat Illness comprises a spectrum of disorders caused by environmental heat exposure. Can be subdivided into three relative stages:

 

1) Heat Cramps: Heavy sweating; muscle cramps and spasms

2) Heat Exhaustion: Weakness; cool, pale, clammy skin; may be normotensive

3) Heat Stroke: Temperature > 105°C; Altered mental status; headache; confusion, nausea, dizziness.

 

Treatment:

 

1)   Evaporative cooling: Remove patient’s clothing and wet them with cool water or a wet sheet while directing a large fan directly at the patient

2)   Strategic ice packing: Place ice packs on patients’ groin, axillae, anterior and posterior neck

3)   Ice water immersion: Place patient in a large tub of ice water; Alternatively, place a patient on a stretcher and cover them with ice and sheet drenched in ice water

4)   Cold Water Irrigation:

  1. Cold IV fluids (NS)
  2. Gastric and Bladder lavage
  3. Chest tubes

5)   Advanced Cooling: Can consider hemodialysis, cardiopulmonary bypass, intravascular cooling.

 

Severe Side Effects: May include rhabdomyolysis, renal failure, seizures, DIC, and death; Aggressive cooling can also result in pulmonary edema, arrhythmias, shock, so cool cautiously!

 

Disposition: Patients with heat stroke may require ICU admission for intensive cooling and management of subsequent complications.

 

Reference:

“Heat Illness: How To Cool Down Hyperthermic Patients”. Semenovskaya Z, Weiner S. Medscape. http://reference.medscape.com/features/slideshow/heat-illness

The views expressed on this blog are the author's own and do not reflect the views of their employer. Please read our full disclaimer here. Any references to clinical cases refer to patients treated at a virtual hospital, Janus General Hospital.
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Jay Khadpe MD

Editor in Chief of "The Original Kings of County" Assistant Professor of Emergency Medicine Assistant Residency Director SUNY Downstate / Kings County Hospital

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