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Heat Stroke

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Heat Stroke Diagnosis and Management.

Published in: Health & Medicine
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Heat Stroke

  1. 1. Heat Strokehttp://crisbertcualteros.page.tl
  2. 2. Occurs with high core temperature  direct thermaltissue injury2ndary effect: acute renal failure fromrhabdomyolysis
  3. 3. 1. Classic Heat Stroke Occurs after several days of heat exposure Individual at risk:1. Chronically ill2. Dehydrated3. Elderly4. Obese5. With Chronic CardioVascular Disease6. Alcohol abuse7. Those who use sedative, hypnotics, a-adrenergic antagonist, diuretics, cholinergics, or antipsychotics
  4. 4. Classic Heat Stroke Risk factors:1. High humidity2. Lack of air-conditioning> 50% have infectionHave core temp > 40.5 CUsually comatose and anhidrotic
  5. 5. 2. Exertional Heat StrokeOccurs rapidly in unacclaimatized & unfit person whoexrcised in high ambient temperature & humidityAt risk: (if they lack access to water)AthletesSoldiersLaborersCongenital diseases that impair sweating maycontributeCore temp may < 40.5 C
  6. 6. DIAGNOSIS:1. Hx of exposure and exercise2. Core temp 40 C or more3. Changes in mental status (confusion  delirium  coma)
  7. 7. DDX:1. Malignant hyperthermia2. Neuroleptic Malignant Syndrome3. Anticholinergic Poisoning4. Sympathomimetic Toxicity (inc. Cocaine)5. Severe Hyperthyroidism6. Sepsis7. Meningitis8. Cerebral Malaria9. Encephalitis10. Hypothalamic Dysfunction due to hemorrhage or stroke11. Brain Abscess
  8. 8. Treatment:Immediate Cooling with Ice Application and TepidSprayIf severely elevated core temp  Gastric lavage withice waterMonitor core temp continuously by rectal probeDiscontinue cooling measures when the core tempreaches 39 C ideally achieved within 30 minutesA temperature rebound may occur in 3-6 hours andshould be retreatedHypotension: crystalloid  or vassopressors
  9. 9. MonitoringCbc, PT, PTT, Fibrin degradationProducts, electrolytes, BUN, Creatinine, Glucose, Ca, CK, Liver Function test, ABG, U/A, ECG
  10. 10. Complications Rhabdomyolysis or urine output of less than 30ml/min1. Adequate fluid replacement2. Mannitol-12.5 to 25 grams IV3. Bicarbonate 44 -100 meq/LTo promote osmotic diuresis and urine alkalinizationHypoxemia and ARDSSeizures

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