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Episode Info: Take Home Points Heat stroke is a life-threatening disorder characterized by elevated core temperature, compromise to neurologic function and multi-system organ dysfunction The keystone of treatment is rapid cooling within 30 minutes of presentation preferably with ice water immersion Patients with heat stroke should be investigated for rhabdomyolysis, AKI, liver failure and concomitant infection REBEL Core Cast 35.0 – Environmental Hyperthermia Click here for Direct Download of Podcast Heatstroke Definition: A life-threatening emergency in which there is a failure of the body’s thermoregulatory mechanisms to handle extrinsic and intrinsic heat. The failure of thermoregulation leads to multi-system organ dysfunction characterized by alteration of neurologic function. Unlike fever, hyperthermia is not caused by endogenous pyrogens that change the thermoregulation set point in the brain. Hyperthermia results from excessive heat production and/or inadequate heat dissipation Categories of Heat Illness Minor Heat Illness Heat Cramps: Intermittent muscle cramps likely related to salt deficiency Heat Edema: Swelling of the feet and ankles typically in non-acclimatized people Heat Syncope: Caused by peripheral vasodilation of decrease venous return Prickly Heat: Vesicular rash caused by obstruction of the sweat gland pores Heat Exhaustion Moderate temperature elevation (typically < 40oC) Caused by volume depletion secondary to heat stress Variant forms: water depletion, salt depletion Symptoms + Signs Nonspecific symptoms: Weakness, fatigue, headache, nausea/vomiting, muscle cramps Syncope Orthostatic hypotension Continued sweating Intact neurologic function Management Serum electrolyte measurement to help guide fluid management Symptomatic management Heat Stroke Physiologic Changes in Heat Stroke Cardiovascular Hypodynamic states seen in elderly (or those with compromised cardiac function at baseline) Hyperdynamic states in young patients Mild volume depletion Edema and hemorrhage in the GI tract occur (likely due to regional ischemia) Acute kidney injury (AKI) Contributors: volume depletion, hypotension, myoglobinuria Coagulopathy Electrolyte disturbances: hypernatremia, hyperkalemia, hypophasphatemia, hypocalcemia Clinical Manifestations Vital Sign Abnormalities Hyperthermia (typically > 41oC) Tachypnea Tachycardia Hypotension Hot, dry skin with absence of sweating CNS dysfunction: altered mental status, seizures, coma Differential Diagnosis Sepsis Sympathomimetic intoxication (sweating usually present) Anticholinergic intoxication (sweating absent) Sedative-hypnotic withdrawal Serotonin toxicity Malignant hyperthermia Neuroleptic malignant syndrome Severe decompensated hyperthyroidism (i.e. thyroid storm) Management Basic Interventions Large bore IV access X 2, supplemental oxygen (pre-oxygenation for possible RSI), cardiac monitor Consider early airway management for altered mental status or seizure activity Continuous core te...
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