Emergency Medicine Book

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Heat Stroke

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  1. See Also
    1. Heat Illness
  2. Risk Factors
    1. See Heat Illness Risk Factors
    2. See Medications Predisposing to Heat Illness
  3. Types
    1. Classic Heatstroke
      1. Gradual environmental exposure
      2. Usually seen in elderly and debilitated patients
    2. Exertional Heatstroke
      1. Rapid onset over hours
      2. Usually seen in young patients and in athletes
  4. Signs
    1. Heat Exhaustion symptoms and signs
    2. Hyperpyrexia (Use rectal probe)
      1. Core Temperature exceeds 40 C (104 F)
      2. Core temps may range as high as 44 C (111 F)
      3. Reports of temperatures up to 47 C (116.6 F)
    3. Altered Level of Consciousness (Delirium or coma)
    4. Anhidrosis
    5. Tachycardia
    6. Hypotension
    7. Tachypnea
  5. Labs
    1. Complete Blood Count (CBC)
    2. Chemistry Panel (Chem7)
    3. ProTime (PT)
    4. Partial Thromboplastin Time (PTT)
    5. Arterial Blood Gas (ABG)
    6. Creatine Phosphokinase (CPK)
    7. Urinalysis
  6. Differential Diagnosis (hyperthermia with ALOC)
    1. Sepsis
    2. Meningitis
    3. Cerebrovascular Accident
    4. Brain Tumor
    5. Head Injury
    6. Withdrawal from abused substances
    7. Neuroleptic Malignant Syndrome
    8. Hyperthyroidism (Hyperthyroid storm)
    9. Pheochromocytoma
    10. Anticholinergic Poisoning
  7. Management
    1. Rapid cooling to temperature under 101 F (38.3 C)
      1. Evaporative cooling with fans and misting
      2. Cool saline bags applied to groin and axilla
      3. Ice water rectal enemas
      4. Ice water immersion
      5. Nasogastric lavage
      6. Peritoneal lavage
    2. Same IV hydration as for Heat Exhaustion
      1. Observe closely for pulmonary edema
    3. ABC Management
      1. Intubation may be needed to protect airway
    4. Altered Level of Consciousness
      1. Treat as Delirium
      2. Check bedside glucose
      3. Consider banana bag containing Thiamine
      4. Consider Naloxone
    5. Myoglobinuria
      1. Maintain urine output at 50 to 100 ml per hour
      2. Alkalinize urine and force diuresis with mannitol
    6. Disseminated Intravascular Coagulation (DIC)
      1. Fresh frozen plasma and platelets as needed
    7. Shivering with rapid cooling
      1. Consider Neuroleptics (e.g. Chlorpromazine)
      2. Dantrolene is not effective in lowering core temp
        1. Bouchama (2002) N Engl J Med 346:1978
  8. Complications
    1. Disseminated Intravascular Coagulation (DIC)
    2. Rhabdomyolysis
    3. Acute Renal Failure
    4. Adult Respiratory Distress Syndrome (ARDS)
    5. Hepatocellular necrosis
  9. Prognosis: Short-Term
    1. Mortality: <10% (if treated appropriately)
      1. Mortality higher in some groups (e.g. firefighters)
    2. Indicators of Poor Prognosis
      1. Core Temperature exceeds 42 degrees Celsius
      2. Aspartate Aminotransferase (AST) >1000 in first day
      3. Prolonged coma exceeds 2 hours
  10. Prognosis: Long-Term outcomes for survivors
    1. Increased risk of Heat stroke under same conditions
      1. Test heat tolerance 8-12 weeks post-episode
      2. Assess for residual injury in Thermoregulation
    2. Long-term neurologic or behavioral deficits
      1. Neurologic injury is permanent in 20% of cases
      2. Dematte (1998) Ann Intern Med 129:173
  11. Prevention
    1. See Heat Illness Prevention
  12. References
    1. Czerkawski (1996) Your Patient Fitness 10(4): 13-20
    2. Sandor (1997) Physician SportsMed, 25(6):35-40
    3. Barrow (1998) Am Fam Physician 58(3):749
    4. Hett (1998) J Postgrad Med 103(6):107
    5. Epstein (1990) Med Sci Sports Exerc 22(1):29
    6. Grafe (1997) Clin Sports Med 16(4):569
    7. Wexler (2002) Am Fam Physician 65(11):2307
    8. Yaqub (1998) J Neurol Sci 156(2):144

Heat Stroke (C0018843)

Definition (MSH)A condition caused by the failure of body to dissipate heat in an excessively hot environment or during exertion in a hot environment. Contrast to HEAT EXHAUSTION, the body temperature in heat stroke patient is dangerously high with red, hot skin accompanied by DELUSIONS; CONVULSIONS; or COMA. It can be a life-threatening emergency and is most common in infants and the elderly.
ConceptsInjury or Poisoning (T037)
ICD9992.0
MSHD018883
EnglishHeat apoplexy, heat apoplexy or hyperpyrexia, Heat hyperpyrexia, Heat Stroke, Heat Strokes, heatstroke, Heatstrokes, Thermoplegia
Spanishapopejia por calor, golpe de calor, termoplejia
Parent Conceptsenvironmental temperature-related disorder (C0679357), Physical findings (C0311392), Disorders, General, Functional and NEC (C0549512), Heat Stress Disorders (C0282507), Heat Stroke (C0018843), Effects of heat (C0221500)
SourcesAOD, COSTAR, CST, DXP, MSH, MTH, MTHICD9, NDFRT, QMR, SCTSPA, SNOMEDCT
Derived from the NIH UMLS (Unified Medical Language System)



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