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Heat Stroke

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Appendix C: Common Problems/Conditions
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Appendix E: Decontamination Procedures
Appendix F: Glossary

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.

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