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Exposure to high temperatures with out good heat loss may
lead to heat cramps, heat stroke, or heat exhaustion. Many
times in the outdoors, if one is not properly equipped with
hydration or proper clothing, heat stroke may develop. The
higher the humidity, the less efficiently heat is lost from
the body. Other factors that contribute to this are age, being
overweight, and also alcohol consumption. Another contributing
factor may be drug use, as many different types of drugs,
antihistamines for example, can also increase the susceptibility
to heat stroke.
Heat or sunstroke is of abrupt onset, usually preceded by
headache and fatigue. The ability to sweat decreases, and
the skin becomes hot, flushed and very dry. Pulse is usually
very rapid, and can reach anywhere from 100-160 beats per
minute. Begin disoriented is not uncommon prior to loss of
consciousness. Fever can rise to 106 degrees Fahrenheit, and
brain damage is not uncommon.
If while in a very hot environment you or your partner experiences
sudden onset of hot, dry skin and rapid pulse, this may be
a life-threatening situation, and emergency treatment should
immediately be sought.
Heat Stroke Treatment
Heat stroke treatment should include rapid cooling, e.g.
immersion in cool water or ice, removal and immersion of clothing
in water, redressing the victim and fanning repeatedly. If
the patient starts to shiver, the cooling process should be
slowed, as shivering will increase the core temperature of
the body. If possible, the temperature should be taken approximately
every 10 minutes to avoid a continued temperature drop, which
could result in hypothermia. The victim should be transported
immediately to a hospital setting as again, this is a medical
emergency.
Healthcare Provider - Medical Treatment
Heat stroke is a medical emergency.
The mortality does range anywhere from 40-80%. If an individual
has any type of altered mental status, we are most likely
dealing with heat stroke. We see elevated liver enzymes, and
be monitored for Rhabdomyolysis. According to research, the
only organ that is not directly damaged from heat stroke is
the pancreas. When these individuals come to your ER or urgent
care center, as per Eric A. Weiss, M.D., Associate Professor
of Emergency Medicine at Stanford University School of Medicine,
he prefers evaporative techniques for cooling. The patient
is completely undressed. He either take sheets and wets them
down, or sprays warm water on the skin and fans the individual.
Ice packs can be used at the same time under the armpits,
neck and groin. It is the evaporation process that begins
the cooling, not the water itself. It is important to note
that we do not want the individual to shiver, since this will
increase core body temperature. Most of these patients can
be cooled down to 101-102 degrees Fahrenheit in less than
30 minutes. Cooling should be discontinued when temperature
falls below 100 degrees Fahrenheit, administer IV fluids consisting
of D5-1/2 normal saline or lactated ringers. Monitor urine
output, as well as vitals every 10-15 minutes. It is important
to draw blood gases, CBC, electrolytes, CPK, and platelet
count. Again, to reiterate, individual do not have to have
dry skin to make a diagnosis of heat stroke. In one particular
study of military recruits, 50% of these patients who were
diagnoses with heat stroke still had the ability to sweat.
This may be one of the reasons that we see so many professional
athletes getting misdiagnosed, since they are most likely
still diaphoretic and are diagnosed with heat exhaustion,
as opposed to heat stroke. |
