Heat illness

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Its all about heat related problems
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Heat illness

  1. 1. Dr. Teena Guptadrteena30@gmail.com
  2. 2. Heat stressorHeat illness
  3. 3. Types1. Prickly heat2. Heat cramps3. Heat tetany4. Heat syncope5. Heat edema6. Heat exhaustion7. Heat stroke
  4. 4. Risk factors1. <5 / >65 yrs2. Pregnancy3. Occupation –soldiers, farmers, labors,sportsmen4. Less physical fitness5. Lack of acclimatisation6. Obesity7. High temp ,high humiditylow air velocity8. Alcohol abuse9. Skin disease-psoriasis, pyoderma etc10. Sleep deprivation11.Renal,thyroid,CVS,metabolic diseases12. Drugs-cocaineamphatemines, ACEinh,antihistaminics,etc
  5. 5. Diagnosis• R/O other causes first• Exposure high temp in immediate past• Usually pt is not acclimatised to conditions
  6. 6. Prickly heat• Lichen tropicus• Miliaria rubra• obstruction of sweat gland leakage of sweat into the deeperlayers of the epidermislocal inflammatory reaction• Maculopapular, pruritic, erythematusMay progresses to chronic dermatitis & superinfection if leftuntreated• Prevention – bath with cool water with gentle scrub, loose lightcloths• Treatment – calamine lotion , chlorhexidine lotion, oralantihistaminics• Severe – 1 % salicyic acid & antibiotics
  7. 7. Heat cramps• Spasm of muscle –shoulder,arms,adbomen,calves• Heavy muscular exercises in hot environmentwith hypotonic fluid intake electrolyteimbalance• Occurs sometime after exposure when pt isrelaxing• Oral intake of electral powder• Severe cases – iv normal saline
  8. 8. Heat tetany• Capropedal spasm & paraesthesiae• Short exposure to very hot temp• hyperventilation  resp alkalosislow co2decreased binding of calcium to albumin low ionized calcium• Management – reduce temp & reduce resprate
  9. 9. Heat syncope• Sudden loss of conciousness• High temp  peripheral vasodilation• T/t – recumbent position ,reduce bodytemp, rehydration
  10. 10. Heat edema• Pitting edema of hands & feets or anydependent part• Most common in bedridden elderly• High tempvasodilationdependent edema• T/t – reassurance, limb elevation, crepebandage , avoid high temp , adequaterehydration
  11. 11. Heat exhaustion• Excessive working in high temp with loss of fluidand salts• Normal thermoregulatory mechanism• Symptoms --Excessivesweating,fatigue,malaise,nausea, giddiness• Signs --Pale , low volume pulse, low BP , moderately hightemp < 40 degree
  12. 12. Management –• Could be precursor of heat stroke – should bemanaged promptly and adequately• rehydration, salt replacement, coolenvironment , rest
  13. 13. Heat stroke• Life threatening condition• Disturbed thermoregulatory mechanism• Exaggerated acute phase response – increasedproduction of inflammatorycytokines,endothelial derived vasoactivefactors , could be activation of coagulationprocess, alteration in expression of heat shockproteins• Dehydration very late feature
  14. 14. Symptoms and signs –• hyperpyrexia ( > 40 degree core body temp)• CNS dysfunctions – coma , stupor, delirium.• sometimes subtle symptoms– confusion, impaired judgments, abnormal behaviour.• Anhidrosis – may or may not• Other – shock, convulsions,icterus, signs ofdehydration
  15. 15. • Diagnosis –1. diagnosis of exclusion2. history of exposure to high temperature inimmediate past3. high body temperature > 40 degrees4. abnormal behaviour
  16. 16. Differential diagnosis –1. Cerebral malaria2. Encephalitis3. Meningitis4. Thyroid strom5. Pheochromocytoma6. Status epilepticus7. Cocaine &amphetamine abuse8. Delirium tremens9. CVA – pontinehemorrhage
  17. 17. TypesClassical heat stroke Exertional heat strokeElderly YoungHealth status compromised HealthySedentary Strenous activityMedications hist. present AbsentSweating absent SevereSkin dry May be moistRhabdomyolysis unusual Excessive
  18. 18. Complications• Hepatic failure• Renal failure• Cerebral edema & cerebellar demage• Arrythmias• Rhabdomyolysis• DIC
  19. 19. Investigations• CBC - ↑WBC, ↑HCT, ↓plt• ↓pro time, hypofibrinogenemia, otherfeatures of DIC• Hypoglycemia, N/↓Cl, hypokalemia, hypocalcemia, hypophophetemia• ↑CPK, ↑BUN, ↑SGOT, ↑SGPT• Urine –myoglobinuria, proteinuria, hyaline &granular cast
  20. 20. Management• To reduce body temp < 39 degree( 0.2 /m )—1. Emergency - should be managed promptly2. shift immediately to cool & shaded place3. Put cold water or wrap soaked sheet around pt4. Can immerse pt in cold water or put ice packaround neck, axilla, groin.5. Cold water gastric lavage6. Antipyretic not proven to be effective
  21. 21. • Shock, cerebral edema, adrenalinsufficiencies- iv steroids• Rhabdomyolysis & ARF – ivfluids, diuretics, mannitol, sodabicarb• Management of DIC and other complications• Supportive – iv fluids, BP, electrolyes
  22. 22. Prognosis• Mortality – 50%• Deficit in survivors - 20%• Directly proportional to temp and its duration• Coma more than 2 hrs – very poor prognosis
  23. 23. Prevention• Avoid sun during day time• Drink 1 glass of water every half hour–5-6 l / d(thirst is poor indicator of dehydration)• Light color , loose cloth• Avoid alcohol and other habit forming drugs• Immediately consult doctor if typical symmpappears
  24. 24. Thank You !!

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