A brief yet comprehensive description of a very common problem faced in KSA especially during hajj season. It is meant to enhance the awareness among ER and ICU physicians.
This document discusses heat stroke, including its causes, symptoms, diagnosis, treatment, nursing care, and prevention. Heat stroke is a life-threatening condition where the body's core temperature rises above 104°F due to prolonged exposure to high temperatures. It can lead to organ damage or death if not promptly treated. Treatment involves rapidly cooling the body through methods like cold baths and cooling blankets. Nursing care focuses on continuous cooling and monitoring of vital signs. Prevention emphasizes staying hydrated, wearing loose clothing, and limiting time outdoors in extreme heat.
This document discusses the management of burn patients. It notes that in Australia from 1997-2005, the rate of burn-related deaths was 0.5 per 100,000 people and hospitalization rates for fire, burn, and scald injuries was 31.9 per 100,000 per year. During 2001-02, burns and scalds accounted for over 6,000 hospitalizations costing $132 million. The document then covers classifications of burns, first aid, fluid resuscitation protocols, monitoring burn patients, determining burn depth and wound management, as well as scar management. It emphasizes the importance of a multidisciplinary team approach in treating burn patients.
Frostbite occurs when body tissues freeze due to prolonged exposure to cold temperatures, most commonly affecting the extremities. Superficial frostbite involves freezing of the skin and subcutaneous tissues, appearing waxy white and numb, while deep frostbite extends to muscles, tendons and bones. Risk factors include alcohol use, age, medical conditions, weather, injury and constrictive clothing. Symptoms may include pins and needles sensation, numbness, hard and pale skin, blisters and blackened skin. Treatment focuses on slowly rewarming the affected areas and preventing refreezing, along with pain medications, antibiotics and tetanus shots as needed. Surgery may be required for severe cases involving tissue death or
This document discusses heat exhaustion, including its causes, symptoms, treatment, and how to prevent it. It defines heat exhaustion as when the body is unable to cool itself and if left untreated can lead to heat stroke. The document outlines the key symptoms of heat exhaustion as headache, dizziness, sweating, nausea and cramps. It provides steps for treatment, which include rehydration, cooling the person, and monitoring their condition. Prevention tips emphasize hydration, rest, and avoiding overexertion in hot weather.
This document provides an overview of burns, including their anatomy, physiology, incidence, causes, classifications, stages of treatment, complications, and nursing management. It begins with definitions of burns and classifications according to depth and extent. It then discusses the pathophysiology and presents the three phases of burn care - emergent/resuscitative, acute/intermediate, and rehabilitation. Nursing priorities and treatments are outlined for each phase, including wound care, pain management, and psychological support. Surgical procedures and potential complications are also reviewed.
Dr. Ruhul Amin discusses heat stroke, which is a life-threatening illness caused by the body overheating. It is associated with a systemic inflammatory response and multi-organ dysfunction, predominantly affecting the central nervous system. Heat stroke is defined clinically as a core body temperature over 40°C accompanied by hot, dry skin and neurological issues. Treatment involves rapidly cooling the body to under 39°C and treating complications which can include multi-organ failure. Prevention emphasizes acclimatization to heat, scheduling activities for cooler times, drinking fluids, and avoiding overexertion in hot conditions.
This document provides guidance on snake bites in India. It discusses that snake bites are a major public health issue, killing over 11,000 people annually. The most common venomous snakes in India are Russell's viper, hump-nosed viper, cobra, and krait. It outlines the clinical presentation of envenomings from different snakes, including neuroparalytic effects from cobras and kraits, bleeding disorders from vipers, and muscle damage from sea snakes. The document emphasizes rapid assessment, resuscitation, detailed examination to identify the snake species, laboratory tests, and antivenom treatment for snake bites in India.
Advanced cardiac life support (ACLS) refers to interventions for urgent treatment of cardiac arrest and other life-threatening emergencies, as well as the knowledge and skills to deploy those interventions. ACLS protocols from the American Heart Association are considered the gold standard and get reviewed every 5 years. BLS with high-quality CPR forms the critical foundation for ACLS. For shockable rhythms like ventricular fibrillation, the ACLS treatment involves defibrillation, CPR, and administration of drugs like epinephrine and amiodarone. For non-shockable rhythms like asystole, ACLS focuses on identifying and treating reversible causes through CPR and medications while preparing for transport to a hospital.
This document discusses heat stroke, including its causes, symptoms, diagnosis, treatment, nursing care, and prevention. Heat stroke is a life-threatening condition where the body's core temperature rises above 104°F due to prolonged exposure to high temperatures. It can lead to organ damage or death if not promptly treated. Treatment involves rapidly cooling the body through methods like cold baths and cooling blankets. Nursing care focuses on continuous cooling and monitoring of vital signs. Prevention emphasizes staying hydrated, wearing loose clothing, and limiting time outdoors in extreme heat.
This document discusses the management of burn patients. It notes that in Australia from 1997-2005, the rate of burn-related deaths was 0.5 per 100,000 people and hospitalization rates for fire, burn, and scald injuries was 31.9 per 100,000 per year. During 2001-02, burns and scalds accounted for over 6,000 hospitalizations costing $132 million. The document then covers classifications of burns, first aid, fluid resuscitation protocols, monitoring burn patients, determining burn depth and wound management, as well as scar management. It emphasizes the importance of a multidisciplinary team approach in treating burn patients.
Frostbite occurs when body tissues freeze due to prolonged exposure to cold temperatures, most commonly affecting the extremities. Superficial frostbite involves freezing of the skin and subcutaneous tissues, appearing waxy white and numb, while deep frostbite extends to muscles, tendons and bones. Risk factors include alcohol use, age, medical conditions, weather, injury and constrictive clothing. Symptoms may include pins and needles sensation, numbness, hard and pale skin, blisters and blackened skin. Treatment focuses on slowly rewarming the affected areas and preventing refreezing, along with pain medications, antibiotics and tetanus shots as needed. Surgery may be required for severe cases involving tissue death or
This document discusses heat exhaustion, including its causes, symptoms, treatment, and how to prevent it. It defines heat exhaustion as when the body is unable to cool itself and if left untreated can lead to heat stroke. The document outlines the key symptoms of heat exhaustion as headache, dizziness, sweating, nausea and cramps. It provides steps for treatment, which include rehydration, cooling the person, and monitoring their condition. Prevention tips emphasize hydration, rest, and avoiding overexertion in hot weather.
This document provides an overview of burns, including their anatomy, physiology, incidence, causes, classifications, stages of treatment, complications, and nursing management. It begins with definitions of burns and classifications according to depth and extent. It then discusses the pathophysiology and presents the three phases of burn care - emergent/resuscitative, acute/intermediate, and rehabilitation. Nursing priorities and treatments are outlined for each phase, including wound care, pain management, and psychological support. Surgical procedures and potential complications are also reviewed.
Dr. Ruhul Amin discusses heat stroke, which is a life-threatening illness caused by the body overheating. It is associated with a systemic inflammatory response and multi-organ dysfunction, predominantly affecting the central nervous system. Heat stroke is defined clinically as a core body temperature over 40°C accompanied by hot, dry skin and neurological issues. Treatment involves rapidly cooling the body to under 39°C and treating complications which can include multi-organ failure. Prevention emphasizes acclimatization to heat, scheduling activities for cooler times, drinking fluids, and avoiding overexertion in hot conditions.
This document provides guidance on snake bites in India. It discusses that snake bites are a major public health issue, killing over 11,000 people annually. The most common venomous snakes in India are Russell's viper, hump-nosed viper, cobra, and krait. It outlines the clinical presentation of envenomings from different snakes, including neuroparalytic effects from cobras and kraits, bleeding disorders from vipers, and muscle damage from sea snakes. The document emphasizes rapid assessment, resuscitation, detailed examination to identify the snake species, laboratory tests, and antivenom treatment for snake bites in India.
Advanced cardiac life support (ACLS) refers to interventions for urgent treatment of cardiac arrest and other life-threatening emergencies, as well as the knowledge and skills to deploy those interventions. ACLS protocols from the American Heart Association are considered the gold standard and get reviewed every 5 years. BLS with high-quality CPR forms the critical foundation for ACLS. For shockable rhythms like ventricular fibrillation, the ACLS treatment involves defibrillation, CPR, and administration of drugs like epinephrine and amiodarone. For non-shockable rhythms like asystole, ACLS focuses on identifying and treating reversible causes through CPR and medications while preparing for transport to a hospital.
Dr. Sachin Verma is a young, diligent and dynamic physician. He did his graduation from IGMC Shimla and MD in Internal Medicine from GSVM Medical College Kanpur. Then he did his Fellowship in Intensive Care Medicine (FICM) from Apollo Hospital Delhi. He has done fellowship in infectious diseases by Infectious Disease Society of America (IDSA). He has also done FCCS course and is certified Advance Cardiac Life support (ACLS) and Basic Life Support (BLS) provider by American Heart Association. He has also done a course in Cardiology by American College of Cardiology and a course in Diabetology by International Diabetes Centre. He specializes in the management of Infections, Multiorgan Dysfunctions and Critically ill patients and has many publications and presentations in various national conferences under his belt. He is currently working in NABH Approved Ivy super-specialty Hospital Mohali as Consultant Intensivists and Physician.
Burns are wounds caused by heat, chemicals, electricity or radiation that damage the skin. They are classified based on depth and percentage of total body surface area affected. First degree burns involve only the outer layer of skin while deeper burns affect underlying tissues. Symptoms depend on depth but may include pain, blistering, and loss of sensation. Systemic effects can include increased metabolic demands and risk of infection. Treatment involves cooling the burn, fluid resuscitation, wound care, antibiotics and surgery. Complications may include scarring, contractures and infections if not properly managed.
Pulmonary edema is the accumulation of fluid in the lungs, which makes breathing difficult. It occurs when fluid leaks into the tiny air sacs in the lungs called alveoli. This fluid buildup is usually due to heart failure or conditions that increase blood pressure in the lungs. Common symptoms include shortness of breath, cough, and wheezing. Diagnosis involves listening to the chest, chest x-rays, and echocardiograms. Treatment focuses on reducing fluid buildup through diuretics, oxygen therapy, and treating the underlying cause.
Injury to the skin caused by exposure to extreme cold is called frostbite. This happens when you are exposed to temperatures below the freezing point of your skin.
https://www.icliniq.com/articles/diseases-and-disorders-common-medical-conditions/frostbite
This document provides information on burns, including causes, assessment, treatment and prevention. Burns are injuries caused by heat, chemicals, electricity or radiation. Assessment involves checking the airway, breathing, circulation, disability and exposure. Treatment depends on the severity and depth of the burn, and may include cleaning, dressing and fluid replacement. Deeper burns require specialist care. Prevention strategies include smoke alarms, fire safety education, and safe cooking and electrical practices.
CARDIAC TAMPONADE ( Cardiac emergency) • Cardiac Tamponade is a life threatening complication caused by excessive accumulation of fluid in the pericardium. Or • Compression of all cardiac chambers due to excessive accumulation of pericardial fluid leading to compromised cardiac out put.
This document discusses diabetic ketoacidosis (DKA), providing definitions, symptoms, pathophysiology, diagnosis, treatment, and complications. DKA results from a lack of insulin and causes the body to burn fat and produce acidic ketones. It is defined by hyperglycemia, ketosis, and acidemia. Treatment involves fluid replacement, insulin therapy to lower blood glucose levels, and monitoring for complications like shock, thrombosis, pulmonary edema, and cerebral edema. The goal is to resolve the DKA and transition the patient to their usual insulin regimen and diet to prevent future occurrences.
An electrical injury occurs when an electric current passes through the body, interfering with organ function or burning tissue. The type and severity of damage depends on factors like current type (AC vs DC), voltage, resistance, duration, and pathway. AC current is generally more dangerous than DC as it can cause cardiac arrhythmias. Electrical injuries require aggressive fluid resuscitation to prevent complications like renal failure. Management involves stabilizing vital functions and treating burns based on their depth and extent. Prognosis depends on the severity and site of injury.
This document discusses the management of hyperpyrexia or high fever. It defines hyperpyrexia as an elevated core body temperature regulated by the hypothalamus. Common causes include infection, drugs, and inflammatory or neoplastic diseases. Signs and symptoms include chills, fatigue, and fever patterns. Treatment involves monitoring, IV fluids, antipyretics like acetaminophen, and antibiotics for unstable or immunocompromised patients. More aggressive cooling is rarely needed.
Burns can cause significant injury and require careful management. The document discusses:
1) The classification of burns as first, second, third, or fourth degree based on depth of tissue damage. Deep burns involving muscle and bone carry the worst prognosis.
2) Burn extent is evaluated using methods like the Rule of Nines to determine percentage of total body surface area affected to guide fluid resuscitation.
3) Initial priorities are airway protection, stopping the burning process, and preventing hypothermia. Fluid resuscitation based on formulas like Parkland is critical to avoid hypovolemic shock.
4) Long term concerns include wound care, risk of infection, contractures, and psychological impacts
This document provides an overview of the management of head injuries. It defines different types of head injuries from scalp lacerations to traumatic brain injuries. It describes the most common causes of head injuries and explains the layers of the head. It then details different types of head injuries including concussions, skull fractures, and intracranial hemorrhages. It outlines the clinical presentation, diagnostic tools, and management approaches for various head injuries.
This document discusses arterial blood gas (ABG) analysis. ABG analysis is used to monitor acid-base imbalances and assess respiratory and lung conditions. Blood is obtained via arterial puncture, usually from the radial or femoral artery. The document outlines the purposes, indications, types of acid-base imbalances, causes, clinical manifestations, and management of various respiratory and metabolic conditions that can be identified through ABG analysis. It also provides details on the procedure, equipment, preparation, sample collection, follow-up, complications, and contraindications of ABG analysis.
A burn is a type of injury to skin, or other tissues, caused by heat, cold, electricity, chemicals, friction, or radiation. Most burns are due to heat from hot liquids, solids, or fire. While rates are similar for males and females the underlying causes often differ.
This document discusses the classification, assessment, and management of burns. It begins by classifying burns based on their depth, percentage of total body surface area affected, and severity. Assessment involves determining the depth, size, and extent of burns. Management consists of prehospital care like cooling burns and giving oxygen, as well as hospital care including airway control, fluid resuscitation, and dressing burns. The goal of treatment is to control the airway, provide breathing support, resuscitate fluid losses, and care for the burn wound.
A fracture is a break or disruption in the continuity of bone caused by trauma or disease. Fractures are classified based on type, communication with the external environment, and anatomic location. Treatment involves emergency care like splinting, definitive care like closed or open reduction and immobilization with casting or internal fixation, and rehabilitation. Complications can be systemic like shock or local like injury to surrounding tissues or joints. Proper management of fractures aims to restore function and alignment of the injured bone.
Basic data about heat stroke uncluding: Definition, forms, exertional and non exertional, epidemiology, risk factors, characteristics, ettiology, pathophysiology, clinical presentation in all body systems, management, cooling tools, assisting procedures, complications, prevention, and patient education
This document discusses body temperature regulation and fevers. It defines key terms like core temperature, surface temperature, and fever. Fever is caused by the hypothalamus setting a higher temperature set point in response to infections or other stimuli. Types of fevers include intermittent, remittent, sustained, and relapsing. Treatment involves antipyretics and addressing the underlying cause. Hyperthermia is an unintentional elevated temperature while hypothermia is a subnormal temperature. Frostbite results from freezing of tissues, especially the extremities. Proper first aid involves slowly rewarming while avoiding further injury.
Guillain-Barre syndrome is a rare disorder where the immune system attacks the peripheral nervous system, damaging nerves and causing muscle weakness and paralysis. It has several forms but commonly results in ascending paralysis beginning in the lower extremities. It is often triggered by a bacterial or viral infection and works by demyelinating peripheral nerves. Diagnosis involves spinal fluid analysis and nerve conduction tests. Treatment focuses on supportive care like ventilation and plasma exchange or IV immunoglobulin to stop antibody damage. Nursing care monitors for complications and manages symptoms like respiratory issues, mobility, nutrition, and autonomic dysfunction.
Dehydration occurs when fluid loss exceeds fluid intake. It can be caused by excessive fluid loss through vomiting, diarrhea, or reduced fluid intake. As dehydration worsens, complications include hypotension, decreased cardiac output, renal failure, and potentially death from hypovolemic shock if untreated. Treatment involves oral or IV fluid replacement administered gradually over 48 hours to restore fluid balance and prevent edema. Nursing care focuses on monitoring fluid intake and output, administering replacement fluids, and educating patients and families on prevention.
Clinical management of heat related illness, mohLee Oi Wah
Heat-related illnesses range from mild to life-threatening. Heat stroke is the most severe form and occurs when the core body temperature rises above 40.5°C. It can cause damage to the central nervous system and other organs. Immediate cooling through methods like ice packs and cold water is critical for survival, as mortality from heat stroke can be as high as 70% without prompt treatment. Factors like extreme heat, strenuous physical activity, age, and medical conditions increase the risk of developing heat stroke.
Dr. Sachin Verma is a young, diligent and dynamic physician. He did his graduation from IGMC Shimla and MD in Internal Medicine from GSVM Medical College Kanpur. Then he did his Fellowship in Intensive Care Medicine (FICM) from Apollo Hospital Delhi. He has done fellowship in infectious diseases by Infectious Disease Society of America (IDSA). He has also done FCCS course and is certified Advance Cardiac Life support (ACLS) and Basic Life Support (BLS) provider by American Heart Association. He has also done a course in Cardiology by American College of Cardiology and a course in Diabetology by International Diabetes Centre. He specializes in the management of Infections, Multiorgan Dysfunctions and Critically ill patients and has many publications and presentations in various national conferences under his belt. He is currently working in NABH Approved Ivy super-specialty Hospital Mohali as Consultant Intensivists and Physician.
Burns are wounds caused by heat, chemicals, electricity or radiation that damage the skin. They are classified based on depth and percentage of total body surface area affected. First degree burns involve only the outer layer of skin while deeper burns affect underlying tissues. Symptoms depend on depth but may include pain, blistering, and loss of sensation. Systemic effects can include increased metabolic demands and risk of infection. Treatment involves cooling the burn, fluid resuscitation, wound care, antibiotics and surgery. Complications may include scarring, contractures and infections if not properly managed.
Pulmonary edema is the accumulation of fluid in the lungs, which makes breathing difficult. It occurs when fluid leaks into the tiny air sacs in the lungs called alveoli. This fluid buildup is usually due to heart failure or conditions that increase blood pressure in the lungs. Common symptoms include shortness of breath, cough, and wheezing. Diagnosis involves listening to the chest, chest x-rays, and echocardiograms. Treatment focuses on reducing fluid buildup through diuretics, oxygen therapy, and treating the underlying cause.
Injury to the skin caused by exposure to extreme cold is called frostbite. This happens when you are exposed to temperatures below the freezing point of your skin.
https://www.icliniq.com/articles/diseases-and-disorders-common-medical-conditions/frostbite
This document provides information on burns, including causes, assessment, treatment and prevention. Burns are injuries caused by heat, chemicals, electricity or radiation. Assessment involves checking the airway, breathing, circulation, disability and exposure. Treatment depends on the severity and depth of the burn, and may include cleaning, dressing and fluid replacement. Deeper burns require specialist care. Prevention strategies include smoke alarms, fire safety education, and safe cooking and electrical practices.
CARDIAC TAMPONADE ( Cardiac emergency) • Cardiac Tamponade is a life threatening complication caused by excessive accumulation of fluid in the pericardium. Or • Compression of all cardiac chambers due to excessive accumulation of pericardial fluid leading to compromised cardiac out put.
This document discusses diabetic ketoacidosis (DKA), providing definitions, symptoms, pathophysiology, diagnosis, treatment, and complications. DKA results from a lack of insulin and causes the body to burn fat and produce acidic ketones. It is defined by hyperglycemia, ketosis, and acidemia. Treatment involves fluid replacement, insulin therapy to lower blood glucose levels, and monitoring for complications like shock, thrombosis, pulmonary edema, and cerebral edema. The goal is to resolve the DKA and transition the patient to their usual insulin regimen and diet to prevent future occurrences.
An electrical injury occurs when an electric current passes through the body, interfering with organ function or burning tissue. The type and severity of damage depends on factors like current type (AC vs DC), voltage, resistance, duration, and pathway. AC current is generally more dangerous than DC as it can cause cardiac arrhythmias. Electrical injuries require aggressive fluid resuscitation to prevent complications like renal failure. Management involves stabilizing vital functions and treating burns based on their depth and extent. Prognosis depends on the severity and site of injury.
This document discusses the management of hyperpyrexia or high fever. It defines hyperpyrexia as an elevated core body temperature regulated by the hypothalamus. Common causes include infection, drugs, and inflammatory or neoplastic diseases. Signs and symptoms include chills, fatigue, and fever patterns. Treatment involves monitoring, IV fluids, antipyretics like acetaminophen, and antibiotics for unstable or immunocompromised patients. More aggressive cooling is rarely needed.
Burns can cause significant injury and require careful management. The document discusses:
1) The classification of burns as first, second, third, or fourth degree based on depth of tissue damage. Deep burns involving muscle and bone carry the worst prognosis.
2) Burn extent is evaluated using methods like the Rule of Nines to determine percentage of total body surface area affected to guide fluid resuscitation.
3) Initial priorities are airway protection, stopping the burning process, and preventing hypothermia. Fluid resuscitation based on formulas like Parkland is critical to avoid hypovolemic shock.
4) Long term concerns include wound care, risk of infection, contractures, and psychological impacts
This document provides an overview of the management of head injuries. It defines different types of head injuries from scalp lacerations to traumatic brain injuries. It describes the most common causes of head injuries and explains the layers of the head. It then details different types of head injuries including concussions, skull fractures, and intracranial hemorrhages. It outlines the clinical presentation, diagnostic tools, and management approaches for various head injuries.
This document discusses arterial blood gas (ABG) analysis. ABG analysis is used to monitor acid-base imbalances and assess respiratory and lung conditions. Blood is obtained via arterial puncture, usually from the radial or femoral artery. The document outlines the purposes, indications, types of acid-base imbalances, causes, clinical manifestations, and management of various respiratory and metabolic conditions that can be identified through ABG analysis. It also provides details on the procedure, equipment, preparation, sample collection, follow-up, complications, and contraindications of ABG analysis.
A burn is a type of injury to skin, or other tissues, caused by heat, cold, electricity, chemicals, friction, or radiation. Most burns are due to heat from hot liquids, solids, or fire. While rates are similar for males and females the underlying causes often differ.
This document discusses the classification, assessment, and management of burns. It begins by classifying burns based on their depth, percentage of total body surface area affected, and severity. Assessment involves determining the depth, size, and extent of burns. Management consists of prehospital care like cooling burns and giving oxygen, as well as hospital care including airway control, fluid resuscitation, and dressing burns. The goal of treatment is to control the airway, provide breathing support, resuscitate fluid losses, and care for the burn wound.
A fracture is a break or disruption in the continuity of bone caused by trauma or disease. Fractures are classified based on type, communication with the external environment, and anatomic location. Treatment involves emergency care like splinting, definitive care like closed or open reduction and immobilization with casting or internal fixation, and rehabilitation. Complications can be systemic like shock or local like injury to surrounding tissues or joints. Proper management of fractures aims to restore function and alignment of the injured bone.
Basic data about heat stroke uncluding: Definition, forms, exertional and non exertional, epidemiology, risk factors, characteristics, ettiology, pathophysiology, clinical presentation in all body systems, management, cooling tools, assisting procedures, complications, prevention, and patient education
This document discusses body temperature regulation and fevers. It defines key terms like core temperature, surface temperature, and fever. Fever is caused by the hypothalamus setting a higher temperature set point in response to infections or other stimuli. Types of fevers include intermittent, remittent, sustained, and relapsing. Treatment involves antipyretics and addressing the underlying cause. Hyperthermia is an unintentional elevated temperature while hypothermia is a subnormal temperature. Frostbite results from freezing of tissues, especially the extremities. Proper first aid involves slowly rewarming while avoiding further injury.
Guillain-Barre syndrome is a rare disorder where the immune system attacks the peripheral nervous system, damaging nerves and causing muscle weakness and paralysis. It has several forms but commonly results in ascending paralysis beginning in the lower extremities. It is often triggered by a bacterial or viral infection and works by demyelinating peripheral nerves. Diagnosis involves spinal fluid analysis and nerve conduction tests. Treatment focuses on supportive care like ventilation and plasma exchange or IV immunoglobulin to stop antibody damage. Nursing care monitors for complications and manages symptoms like respiratory issues, mobility, nutrition, and autonomic dysfunction.
Dehydration occurs when fluid loss exceeds fluid intake. It can be caused by excessive fluid loss through vomiting, diarrhea, or reduced fluid intake. As dehydration worsens, complications include hypotension, decreased cardiac output, renal failure, and potentially death from hypovolemic shock if untreated. Treatment involves oral or IV fluid replacement administered gradually over 48 hours to restore fluid balance and prevent edema. Nursing care focuses on monitoring fluid intake and output, administering replacement fluids, and educating patients and families on prevention.
Clinical management of heat related illness, mohLee Oi Wah
Heat-related illnesses range from mild to life-threatening. Heat stroke is the most severe form and occurs when the core body temperature rises above 40.5°C. It can cause damage to the central nervous system and other organs. Immediate cooling through methods like ice packs and cold water is critical for survival, as mortality from heat stroke can be as high as 70% without prompt treatment. Factors like extreme heat, strenuous physical activity, age, and medical conditions increase the risk of developing heat stroke.
Myxoedema coma is an extreme state of hypo metabolism
resulting from low levels of thyroid hormone and caused
by a severe and long-standing depletion of thyroid
hormone. lt is characterized by hypothermia, an altered
mental status ranging from slow mentation to coma, and an
identifiable precipitating event.
This document provides information about heat stroke, including its causes, symptoms, risk factors, diagnosis, treatment, and nursing care. Heat stroke is a life-threatening condition caused by the body overheating, usually from prolonged exposure to high temperatures. It is characterized by a core body temperature above 104°F and altered mental state. Rapid cooling through methods like cold baths is crucial to treatment. Those at highest risk include the elderly, young children, athletes, and those with chronic conditions.
Heat, Cold and High Altitude Related illnessUsama Ragab
Heat, Cold and High Altitude Related illness
By Dr Usama Ragab
Lecturer of Medicine
Topics are heat and cold related illness and high altitude medical disorders
This document discusses heat emergencies ranging from minor issues like heat cramps and heat rash to life-threatening heat stroke. The body cools itself through sweating and blood flow changes but may become overwhelmed in extreme heat. Heat stroke is a medical emergency defined by a core temperature over 104°F and altered mental status. Treatment involves rapid cooling through methods like evaporative cooling, immersion, or ice packs while providing IV fluids and monitoring for complications like hypotension, hypokalemia, or renal failure. High risk groups include the elderly, young, chronically ill, and those engaged in strenuous activity in hot conditions.
Hypothermia is common in trauma patients and those exposed to cold environments. It can be accidental, primary, secondary, or therapeutic. Mild hypothermia between 32-35 degrees Celsius is used for neuroprotection, while moderate (28-32 degrees) is used for cardiopulmonary bypass. Physiologic changes associated with hypothermia include coagulopathies, metabolic effects, hypokalemia, hyperglycemia, and effects on the cardiovascular, immune, and coagulation systems. Treatment follows the ABCDE approach - ensuring a patent airway, warming humidified oxygen, warm IV fluids, monitoring for hypoglycemia, and passive or active external rewarming depending on severity. Core rewarm
This document discusses environmental injuries from a critical care perspective, focusing on accidental hypothermia and heat stroke. It defines hypothermia and heat stroke, describes classifications, thermoregulation, diagnosis, and management approaches. For hypothermia, it covers stages, predisposing factors, effects on organs, and recommendations for passive rewarming or active core rewarming. For heat stroke, it discusses classifications, pathophysiology, effects on body systems, incidence/mortality, diagnosis based on temperature and neurological status, and cooling methods such as evaporation or conduction.
This document discusses cardiac arrest in special situations. It covers cardiac arrest associated with conditions like asthma, anaphylaxis, hypothermia, avalanches, drowning, and more. For each situation, it provides an introduction, discusses modifications that may be needed for basic and advanced life support, and outlines initial care and treatment considerations. The overall aim is to guide resuscitation efforts for cardiac arrests occurring in these unique contexts.
Disorders related to environmental factors can cause hypothermia or hyperthermia. Hypothermia occurs when the body fails to produce enough heat in cold environments, lowering the core temperature below 35°C and impacting various bodily functions. It is common in infants, elderly people, and those with certain medical conditions. Treatment involves slowly rewarming the body and addressing complications. Extremities can also be affected by cold injuries like frostnip, trench foot or frostbite. High altitudes can cause illnesses due to reduced oxygen levels like acute mountain sickness, high altitude cerebral edema, or high altitude pulmonary edema. Radiation exposure depends on various factors and can cause early effects like nausea or long term effects like cancer depending
Drowning is a leading cause of accidental death in children worldwide. It occurs most commonly in males ages 1-5 years due to inadequate supervision near bodies of water. Drowning causes hypoxemia which quickly leads to respiratory and cardiac arrest. Survivors can have long-term pulmonary, neurological, cardiovascular and other injuries. Prompt rescue and resuscitation efforts on scene improve outcomes. In the hospital, management focuses on rewarming, correcting hypothermia, hypoxemia and other physiological derangements to prevent secondary neurological injury.
The Effects of Temperature and its dysregulation on health and in disease. Includes Heat stroke, Malignant Hyperthermia, Neuroleptic malignant syndrome as well as Hypothermia and Frost bite
This document discusses hyperpyrexia (extreme fever over 104°F), hypothermia, and their ECG findings. Hyperpyrexia is a medical emergency caused by conditions like neuroleptic malignant syndrome. Symptoms include fatigue and altered mental status. Treatment focuses on antipyretics, antibiotics for unstable patients, and external cooling if needed. Hypothermia occurs when the body loses heat faster than it can produce heat, with a temperature below 95°F. It presents with CNS depression and arrhythmias. First aid involves removing wet clothes and using external heat sources. Management treats for further heat loss and warms the body core through heated IVs and blankets while avoiding arrhythmias.
Pathophysiology of shock and its managementBipulBorthakur
This document discusses different types of shock including distributive, cardiogenic, obstructive, hypovolemic, and stages of shock. It provides details on sepsis and septic shock including pathogenesis, diagnostic criteria, and elements of care. Specific types of shock like neurogenic shock, anaphylactic shock, and cardiogenic shock are also summarized. The document emphasizes early recognition and treatment of shock.
Heatstroke, also known as sun stroke, is a life-threatening condition caused by the body overheating, usually as a result of prolonged exposure to or physical exertion in high temperatures. It occurs when the body fails to regulate its temperature and the body's temperature rises rapidly. If not treated immediately, heatstroke can cause damage to internal organs and potentially lead to death. First aid involves cooling the body by removing clothing, immersing in cool water if possible or using cold compresses, and seeking immediate medical help. In the hospital, treatment focuses on lowering the body temperature and addressing any organ damage through IV fluids, ventilation if needed, and monitoring vital signs.
this slide contain inteoduction, definition, causes, risk factor, clinical manifestaion, types , treatment, medical management, nursing management, nursing care given in the intial stage, in case of emergency .
This document discusses therapeutic hypothermia for post-cardiac arrest patients. It describes the pathophysiology of post-cardiac arrest syndrome and how hypothermia can help by reducing oxidative stress and inflammation. The goals and physiologic effects of hypothermia are outlined, along with indications, contraindications, and the process for inducing and maintaining cooling and rewarming. Research shows hypothermia improves outcomes for comatose cardiac arrest survivors when initiated quickly.
Environmental Emergencies Board Review 2013 Tim O'KelleyTroy Pennington
This document discusses various environmental emergencies including submersion, hypothermia, hyperthermia, frostbite, and thermal burns. It provides details on the pathophysiology, risk factors, signs and symptoms, diagnosis, and management of each condition. For submersion it notes that drowning is caused by asphyxiation from liquid inhalation and discusses epidemiology, pathophysiology involving wet or dry drowning, risk factors, and management including rescue breathing and airway support. For hypothermia and hyperthermia it outlines mechanisms of heat conservation and loss, degrees of each condition based on temperature, etiologies, associated signs and symptoms, potential complications, diagnostic tests, and rewarming
A brief yet comprehensive coverage of ICU role in ECMO cases. Presentation has been prepared in order to help ICU fellows and registrars to understand the importance of their role and to know necessary actions they have to take in case of need.
A simplified description of basal ganglia stroke to help understand the clinical scenarios where patients present with neurological symptoms not clearly pointing towards possibility of stroke.
Vertebral artery pseudo-aneurysms and dissections are known to occur as a result of mechanical
manipulations of the cervical region, traumatic injury, spontaneously and iatrogenic injury because of central
venous catheterization. Central venous lines have become an integral part of patient care, but they are
not without complications. Vertebral artery injury (leading to pseudo-aneurysm and dissection) is one of
the rarer complications of central venous catheter placement. We report a case of inadvertent vertebral
artery catheterization during a dialysis catheter placement which subsequently demonstrated arterial
blood. Duplex ultrasound and computed tomographic (CT) scan confirmed vertebral artery catheterization.
It was successfully treated with open surgical technique by the vascular surgeon because of the size of
catheter and subsequent requirement of artery repair. There were no neurological sequelae. Open surgical
repair remains the gold standard of treatment. Endovascular repair of vertebral artery pseudo-aneurysms
has been described with promising outcomes, but long-term results are lacking. This case report describes
the rare iatrogenic event of vertebral artery injury and reviews its etiology, diagnosis, complications, and management.
From eye drops to icu, a case report of three side effects of ophthalmic timo...Muhammad Asim Rana
Timolol Maleate (also called Timolol) is a nonselective beta-adrenergic blocker and a class II antiarrhythmic drug, which is used
to treat intraocular hypertension. It has been reported to cause systemic side effects especially in elderly patients with other
comorbidities.These side effects are due to systemic absorption of the drug and it is known that Timolol is measurable in the serum
following ophthalmic use. Chances of life threatening side effects increase if these are coprescribed with other cardiodepressant
drugs like calcium channel or systemic beta blockers. We report a case where an elderly patient was admitted with three side
effects of Timolol and his condition required ICU admission with mechanical ventilation and temporary transvenous pacing.The
case emphasizes the need of raising awareness among physicians of such medications about the potential side effects and drug
interactions. A close liaison among patient’s physicians is suggested.
Congenitally absent Inferior Vena Cava: A rare cause of recurrent DVT and non...Muhammad Asim Rana
In search of a cause for the so-called idiopathic Deep Vein Thrombosis (DVT), researchers have
pointed towards association between recurrent DVT and absent IVC
The best use of systemic corticosteroids in the intensive care units, reviewMuhammad Asim Rana
Corticosteroids are one of the most common medications that are used in the intensive care units (ICUs);
corticosteroids are used for a variety of indications, including septic shock, acute respiratory distress syndrome
(ARDS), bacterial meningitis, tuberculous meningitis, lupus nephritis, severe chronic obstructive pulmonary disease
(COPD) exacerbations and many others.
Corticosteroids are associated with many severe side effects that affect morbidity and mortality of the patients like
increased risk of infections, glucose intolerance, hypokalemia, sodium retention, edema, hypertension, myopathy
etc. In order to make the best use of these medications and to minimize the unwanted side effects we should follow
some particular protocol. Please keep in our mind that there is controversy about dosing and tapering of steroids, so
effort has been made to include the best available evidence.
This review discusses mainly the most common indications of corticosteroids in ICU, dosing of corticosteroids in
those indications and how to taper corticosteroids according to the best evidence that recommends their use.
Literature search was done using Medline, BMJ, Uptodate, Chochrane database, Google scholar and the best
evidence based guidelines in which steroids are recommended to treat ICU related disorders. Sex hormones are not
discussed in this review since its use is rare in the intensive care units.
A very effective, precise and focused presentation for Calcium abnormalities and approach towards management. Targeted to teach the to the point diagnosis and treatment.
It is requested to download the presentation to run the animation as it is a very interactive presentation
A detailed discussion and description on fungal diseases and management. The focus is kept on those facts which frequently come across an intensivist but it is also important for the Internist.
A simple presentation on hypokalemia. The most common electrolyte disorder in the Critical Care practice.The presentation is based on a mortality and morbidity case report and discussion. It covers all the basic aspects of understanding the causes of hypokalemia in ICU and its management. Target audience are residents ICU and ER but all health care workers can benefit.
Plasmapheresis is a medical procedure that involves the separation and removal of plasma from whole blood. The document summarizes guidelines from the American Academy of Neurology (AAN), American Society for Apheresis (ASFA), and American Association of Blood Banks (AABB) on the use of plasmapheresis to treat various medical conditions. The guidelines categorize conditions into four categories based on the evidence for the efficacy of plasmapheresis as a treatment. Category I conditions have the strongest evidence that plasmapheresis is an effective first-line therapy. This includes Guillain-Barré syndrome, chronic inflammatory demyelinating polyneuropathy, and thrombotic thrombocytopenic purp
Transorbital stab injury with retained knife. A narrow escapeMuhammad Asim Rana
An interesting case report about a patient who was admitted with a 13 cm long knife stabbed in his eye and has gone across the mid line. The interesting thing to note is that patient did not develop any neurological deficit.
Multi drug resistant bacteria are a big problem in ICUs now a days. This is a successful case report where we treated an pleural infection b directly instilling the drug colistin in the pleura.
A simple description of a less understood topic in Intensive Care Medicine. Aim to make understanding and management easy for the residents and prevention steps for all ICU workers.
Iron toxicity can cause multi-organ failure and death if not properly treated. There are typically 5 stages of iron poisoning: 1) gastrointestinal symptoms within 6 hours; 2) a latent period with no symptoms but ongoing toxicity; 3) shock and multi-organ failure 2-24 hours later; 4) hepatotoxicity 12-24 hours later; and 5) gastrointestinal obstruction 1-7 weeks later. Treatment involves gastric lavage for ingestions within 2 hours, chelation therapy with deferoxamine for serum iron levels over 90 umol/L, and supportive care including IV fluids, ventilation, and dialysis as needed. Proper management of iron toxicity can prevent serious complications and death.
This study aimed to measure compliance with ventilator-associated pneumonia (VAP) bundle components in an intensive care unit (ICU) in Saudi Arabia. An audit of 88 mechanically ventilated patients found high compliance (87.5-100%) with hand hygiene, mouth care, and avoiding routine ventilator tubing changes. Compliance was lower for head-of-bed elevation (95.2%) and daily sedation vacations (65.5%). No patients received endotracheal tubes with subglottic suction ports due to unavailability. The authors recommend increasing education, minimizing provider workload, improving equipment maintenance, and ensuring access to recommended ventilation equipment.
1) The document provides guidance on evaluating and treating acute kidney injury in intensive care unit patients, including initial steps like taking a history, examining medications, and checking urine and blood tests.
2) It describes assessing the patient's volume status and ruling out potential obstructions before determining if the cause is pre-renal such as hypovolemia, or renal such as glomerulonephritis or acute tubular necrosis.
3) The guidance advises optimizing cardiac output if heart failure is a factor, giving volume replacements if needed for pre-renal causes, and involving nephrology if the cause appears to be within the kidneys.
How to Control Your Asthma Tips by gokuldas hospital.Gokuldas Hospital
Respiratory issues like asthma are the most sensitive issue that is affecting millions worldwide. It hampers the daily activities leaving the body tired and breathless.
The key to a good grip on asthma is proper knowledge and management strategies. Understanding the patient-specific symptoms and carving out an effective treatment likewise is the best way to keep asthma under control.
Summer is a time for fun in the sun, but the heat and humidity can also wreak havoc on your skin. From itchy rashes to unwanted pigmentation, several skin conditions become more prevalent during these warmer months.
Osvaldo Bernardo Muchanga-GASTROINTESTINAL INFECTIONS AND GASTRITIS-2024.pdfOsvaldo Bernardo Muchanga
GASTROINTESTINAL INFECTIONS AND GASTRITIS
Osvaldo Bernardo Muchanga
Gastrointestinal Infections
GASTROINTESTINAL INFECTIONS result from the ingestion of pathogens that cause infections at the level of this tract, generally being transmitted by food, water and hands contaminated by microorganisms such as E. coli, Salmonella, Shigella, Vibrio cholerae, Campylobacter, Staphylococcus, Rotavirus among others that are generally contained in feces, thus configuring a FECAL-ORAL type of transmission.
Among the factors that lead to the occurrence of gastrointestinal infections are the hygienic and sanitary deficiencies that characterize our markets and other places where raw or cooked food is sold, poor environmental sanitation in communities, deficiencies in water treatment (or in the process of its plumbing), risky hygienic-sanitary habits (not washing hands after major and/or minor needs), among others.
These are generally consequences (signs and symptoms) resulting from gastrointestinal infections: diarrhea, vomiting, fever and malaise, among others.
The treatment consists of replacing lost liquids and electrolytes (drinking drinking water and other recommended liquids, including consumption of juicy fruits such as papayas, apples, pears, among others that contain water in their composition).
To prevent this, it is necessary to promote health education, improve the hygienic-sanitary conditions of markets and communities in general as a way of promoting, preserving and prolonging PUBLIC HEALTH.
Gastritis and Gastric Health
Gastric Health is one of the most relevant concerns in human health, with gastrointestinal infections being among the main illnesses that affect humans.
Among gastric problems, we have GASTRITIS AND GASTRIC ULCERS as the main public health problems. Gastritis and gastric ulcers normally result from inflammation and corrosion of the walls of the stomach (gastric mucosa) and are generally associated (caused) by the bacterium Helicobacter pylor, which, according to the literature, this bacterium settles on these walls (of the stomach) and starts to release urease that ends up altering the normal pH of the stomach (acid), which leads to inflammation and corrosion of the mucous membranes and consequent gastritis or ulcers, respectively.
In addition to bacterial infections, gastritis and gastric ulcers are associated with several factors, with emphasis on prolonged fasting, chemical substances including drugs, alcohol, foods with strong seasonings including chilli, which ends up causing inflammation of the stomach walls and/or corrosion. of the same, resulting in the appearance of wounds and consequent gastritis or ulcers, respectively.
Among patients with gastritis and/or ulcers, one of the dilemmas is associated with the foods to consume in order to minimize the sensation of pain and discomfort.
These lecture slides, by Dr Sidra Arshad, offer a simplified look into the mechanisms involved in the regulation of respiration:
Learning objectives:
1. Describe the organisation of respiratory center
2. Describe the nervous control of inspiration and respiratory rhythm
3. Describe the functions of the dorsal and respiratory groups of neurons
4. Describe the influences of the Pneumotaxic and Apneustic centers
5. Explain the role of Hering-Breur inflation reflex in regulation of inspiration
6. Explain the role of central chemoreceptors in regulation of respiration
7. Explain the role of peripheral chemoreceptors in regulation of respiration
8. Explain the regulation of respiration during exercise
9. Integrate the respiratory regulatory mechanisms
10. Describe the Cheyne-Stokes breathing
Study Resources:
1. Chapter 42, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 36, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 13, Human Physiology by Lauralee Sherwood, 9th edition
Travel vaccination in Manchester offers comprehensive immunization services for individuals planning international trips. Expert healthcare providers administer vaccines tailored to your destination, ensuring you stay protected against various diseases. Conveniently located clinics and flexible appointment options make it easy to get the necessary shots before your journey. Stay healthy and travel with confidence by getting vaccinated in Manchester. Visit us: www.nxhealthcare.co.uk
Computer in pharmaceutical research and development-Mpharm(Pharmaceutics)MuskanShingari
Statistics- Statistics is the science of collecting, organizing, presenting, analyzing and interpreting numerical data to assist in making more effective decisions.
A statistics is a measure which is used to estimate the population parameter
Parameters-It is used to describe the properties of an entire population.
Examples-Measures of central tendency Dispersion, Variance, Standard Deviation (SD), Absolute Error, Mean Absolute Error (MAE), Eigen Value
Nano-gold for Cancer Therapy chemistry investigatory projectSIVAVINAYAKPK
chemistry investigatory project
The development of nanogold-based cancer therapy could revolutionize oncology by providing a more targeted, less invasive treatment option. This project contributes to the growing body of research aimed at harnessing nanotechnology for medical applications, paving the way for future clinical trials and potential commercial applications.
Cancer remains one of the leading causes of death worldwide, prompting the need for innovative treatment methods. Nanotechnology offers promising new approaches, including the use of gold nanoparticles (nanogold) for targeted cancer therapy. Nanogold particles possess unique physical and chemical properties that make them suitable for drug delivery, imaging, and photothermal therapy.
PGx Analysis in VarSeq: A User’s PerspectiveGolden Helix
Since our release of the PGx capabilities in VarSeq, we’ve had a few months to gather some insights from various use cases. Some users approach PGx workflows by means of array genotyping or what seems to be a growing trend of adding the star allele calling to the existing NGS pipeline for whole genome data. Luckily, both approaches are supported with the VarSeq software platform. The genotyping method being used will also dictate what the scope of the tertiary analysis will be. For example, are your PGx reports a standalone pipeline or would your lab’s goal be to handle a dual-purpose workflow and report on PGx + Diagnostic findings.
The purpose of this webcast is to:
Discuss and demonstrate the approaches with array and NGS genotyping methods for star allele calling to prep for downstream analysis.
Following genotyping, explore alternative tertiary workflow concepts in VarSeq to handle PGx reporting.
Moreover, we will include insights users will need to consider when validating their PGx workflow for all possible star alleles and options you have for automating your PGx analysis for large number of samples. Please join us for a session dedicated to the application of star allele genotyping and subsequent PGx workflows in our VarSeq software.
Know the difference between Endodontics and Orthodontics.Gokuldas Hospital
Your smile is beautiful.
Let’s be honest. Maintaining that beautiful smile is not an easy task. It is more than brushing and flossing. Sometimes, you might encounter dental issues that need special dental care. These issues can range anywhere from misalignment of the jaw to pain in the root of teeth.
STUDIES IN SUPPORT OF SPECIAL POPULATIONS: GERIATRICS E7shruti jagirdar
Unit 4: MRA 103T Regulatory affairs
This guideline is directed principally toward new Molecular Entities that are
likely to have significant use in the elderly, either because the disease intended
to be treated is characteristically a disease of aging ( e.g., Alzheimer's disease) or
because the population to be treated is known to include substantial numbers of
geriatric patients (e.g., hypertension).
5-hydroxytryptamine or 5-HT or Serotonin is a neurotransmitter that serves a range of roles in the human body. It is sometimes referred to as the happy chemical since it promotes overall well-being and happiness.
It is mostly found in the brain, intestines, and blood platelets.
5-HT is utilised to transport messages between nerve cells, is known to be involved in smooth muscle contraction, and adds to overall well-being and pleasure, among other benefits. 5-HT regulates the body's sleep-wake cycles and internal clock by acting as a precursor to melatonin.
It is hypothesised to regulate hunger, emotions, motor, cognitive, and autonomic processes.
2. • Heat rash
• Sunburn
• Heat cramps
• Heat exhaustion
• Heat stroke
Heat Illnesses (Hyperthermia)Severity
American Meteorological Society
Central North Carolina Chapter
April 21, 2005
3. DEFINITION
• A core temperature ≥40°C accompanied by CNS
dysfunction in patients with environmental heat
exposure. This condition represents a failure of the
body's ability to maintain thermoregulatory
homeostasis.
4. Classification
• Classic (nonexertional) heat stroke : more
common in younger children who are unable to
escape from hot environments and those with
underlying chronic medical conditions that impair
thermoregulation.
• Exertional heat stroke : generally occurs in
healthy individuals who engage in heavy exercise
during periods of high temperature and humidity.
Typical patients are athletes and military recruits
in basic training.
6. CLINICAL FEATURES
• The diagnostic criteria are elevated core
temperature (≥40°C) and (CNS)
abnormalities following environmental
heat exposure.
• Children with elevated body temperature
and CNS abnormalities should be treated
as victims of heat stroke.
7. CNS Manifestations
• CNS symptoms can be manifested as
– Impaired judgment
– inappropriate behavior
• Children commonly present with more significant
neurologic symptoms such as
– seizures
– delirium
– hallucinations
– ataxia
– coma
8. Other Clinical Manifestations
• Tachycardia
• Tachypnea
• The skin may be flushed and warm or diaphoretic.
• Vomiting and diarrhea are also common.
• Those patients with coagulopathy may
demonstrate
– purpura,
– hemoptysis,
– hematemesis,
– melena,
– hematochezia.
9.
10. DIAGNOSTIC EVALUATION
• Clinical assessment:
• The diagnosis of heat stroke is based
upon a careful history and physical
examination.
11. Core temperature measurement
• Should be determined in all patients and
continuously monitored.
• Rectal temperature is the most commonly
obtained core temperature measurement,
although esophageal, central venous, pulmonary
artery, or bladder probe temperature are potential
alternatives.
• Oral, axillary, or tympanic membrane
temperatures are unreliable in treating heat
illness.
12. Laboratory findings
●Rapid blood glucose to identify hypoglycemia
●Blood gas (venous or arterial) to evaluate for the presence and
severity of metabolic acidosis
●CBC,(PT), (PTT), INR and Serum electrolytes .
●Liver enzymes to assess for liver injury
●Urea and creatinine to identify prerenal azotemia or renal
failure resulting from myoglobinuria
●Serum (CK), ionized or total calcium, and phosphate to detect
rhabdomyolysis , hypocalcemia and hyperphosphatemia
●Urine rapid dipstick and urinalysis to diagnose myoglobinuria
●Toxicologic screening for drugs of abuse or prescribed
medications
13. Chest radiograph:
Helps identify pulmonary edema and is useful in
patients for whom pulmonary aspiration is a
concern.
Electrocardiogram:
Should be obtained in patients with electrolyte
abnormalities (eg, hyperkalemia, hypokalemia,
hypocalcemia) and/or rhabdomyolysis.
Computed tomography:
CT-Brain should be obtained if a child has persistently
altered mental status despite cooling or shows signs
of increased intracranial pressure suggestive of
cerebral edema or intracranial hemorrhage.
14. ECG of a patient with a core temperature of 40°C
Dysrhythmias
14
16. DIFFERENTIAL DIAGNOSIS
• Sepsis
• Central nervous system conditions
• Status epilepticus
• Toxic overdose
• Serotonin syndrome
• Hemorrhagic shock and encephalopathy
syndrome
• Neuroleptic malignant syndrome
• Thyroid storm
• Malignant hyperthermia
17.
18. PREHOSPITAL CARE
• Cooling might have occurred prior to the
arrival of the hospital.
• Removal from the source of heat stress
and rapid initiation of cooling, as the risk of
morbidity and mortality for patients with
heat-related illness is associated with the
duration of hyperthermia.
19. • Patients with heat stroke should be treated
with either ice water immersion or
evaporative external cooling in the field.
• Pre-hospital cooling measure should be
initiated prior to / or simultaneously with
activation of emergency medical services.
20. • Evaporative cooling may be accomplished
in the field by spraying patients with water or
saline and fanning these patients, either
manually or with ambulance fans or air-
conditioners. Application of ice packs to the
neck, axillae, and groin.
• The institution of pre-hospital cooling should
not delay timely transportation to definitive
care.
22. HOSPITAL MANAGEMENT
• Stabilization: In addition to the careful assessment and
support of airway, breathing, and circulation, the
clinician should anticipate and aggressively manage
hyperthermia, dehydration, rhabdomyolysis, DIC, high
output cardiac insufficiency, renal and hepatic failure.
• Altered mental status typically resolves once
oxygenation, adequate tissue perfusion, and
normothermia are achieved.
• Seizures should be treated with benzodiazepines
(lorazepam 0.1mg/kg,IV)
23. Rapid cooling
•Evaporative cooling:
is achieved by spraying patients with tepid water (to
minimize shivering) while fanning with high-flow
fans to maximize air circulation. Cooling rates
approaching 0.15ºC per minute have been achieved
in adults. Alternatively, the patient may be placed on
a cooling blanket. If tolerated, selective application
of ice packs to the neck, axillae, and groin during
evaporative cooling may be of additional benefit.
24. Rapid cooling
Cold water immersion:
Cold water immersion is another adjunctive
cooling modality when evaporative cooling
with or without selective ice application is not
possible.
25. Internal cooling
The most effective method of lowering the
core body temperature quickly is the use of
cardiopulmonary bypass; however, this
highly specialized intervention is not
rapidly available at most institutions.
Newer, less invasive devices such as
intravascular cooling catheters have been
utilized to rapidly induce therapeutic
hypothermia .
26. • Gastric, rectal, and/or bladder lavage with
cold isotonic fluids (eg, normal saline that
has been iced) have been proposed as
additional means of invasive cooling.
However, it is not clear that these methods
are any more effective than evaporative
cooling or cold water immersion alone.
Thus, these methods are not routinely
employed.
27. Duration of cooling
• Decreases in core body temperature as
measured by rectal temperature generally
lag behind the actual drop in core
temperature at the hypothalamus. For this
reason, cooling measures are generally
stopped in pediatric heat stroke victims once
the core temperature reaches approximately
38ºC to prevent overshoot hypothermia.
28. Pharmacologic therapy
Medications have a limited role in the management
of heat stroke. However, pharmacologic measures
taken to prevent shivering.
• We suggest that patients with heat stroke receive
benzodiazepines (eg, midazolam 0.05 to 0.1 mg/kg
iv ) to prevent shivering during cooling measures.
• Although antipsychotic agents (chlorpromazine)
have been used in adults to prevent shivering,it
may exacerbate hypotension in heat stroke victims.
They also have a greater propensity to cause
dystonia in children. Thus, they should be avoided.
29. • Dantrolene Although initial evidence suggested
that dantrolene shortened cooling times in adults
with heat stroke, additional small trials have not
identified a consistent benefit. Thus, dantrolene is
not routinely used.
• Antipyretic medications (acetaminophen,
ibuprofen) are ineffective for the treatment of
hyperthermia in heat stroke victims and should
not be used because they may exacerbate liver
injury (acetaminophen) or compound coagulation
disorders (nonsteroidal antiinflammatory agents,
ibuprofen).
30. Treatment of end-organ dysfunction
After stabilization and rapid cooling, the victim with
heat stroke remains at high risk for multiple organ
failure, metabolic abnormalities, and disorders of
coagulation.
31. • Rhabdomyolysis with hyperkalemia,
hypocalcemia, and hyperphosphatemia
• DIC
• Acute kidney injury
• Hyponatremic dehydration
• Cardiogenic shock with low systemic vascular
resistance
• Cardiogenic and noncardiogenic pulmonary
(ARDS)
• Liver failure : Treatment is supportive. Rarely,
liver transplantation has been necessary in
teenagers with heat stroke-associated liver
failure.
• Cerebral edema
32. Complications
• Respiratory dysfunction:
– Tracheal intubation and mechanical ventilation are often
necessary. In a review of 28 patients admitted with heat
stroke, 24 (86 percent) developed respiratory failure with
most requiring mechanical ventilation.
33. Arrhythmia and cardiac dysfunction :
• Potential cardiac complications include
acute decompensated heart failure and
myocardial injury .ECG abnormalities
include sinus tachycardia , conduction
abnormalities, prolonged QT interval,
transient Brugada pattern, and nonspecific
ST-T changes. Rapid cooling is essential;
cardiac dysfunction and tachyarrhythmias
generally resolve with cooling.
34. Hypotension :
• Hypotension associated with heat stroke results
from peripheral vasodilation, cardiac dysfunction,
and volume depletion. Treatment consists primarily
of discrete intravenous (IV) boluses of isotonic
crystalloid (eg, isotonic saline 250 to 500 mL).
Given the risk of pulmonary edema, excessive fluid
administration should be avoided.
35. • Seizures:
• Seizures are common. Initial treatment consists of short-
acting benzodiazepines, while cooling measures are
initiated. Midazolam 0.1 to 0.2 mg/kg IV, to a maximum
dose of 4 mg, has an onset of action one to five minutes
and duration of action of 1 to 6 hours. Lorazepam 0.1
mg/kg IV, to maximum dose of 4 mg, is a second-line
option, as the duration of action may be prolonged from
12 to 24 hours. Barbiturates should be avoided. Rapid
cooling is essential to treatment.
36. • Acute kidney injury & Rhabdomyolysis:
• Renal function studies and serum electrolyte
should be followed closely over the first few
days of illness; renal replacement therapy
may be needed.
37. • Hepatic injury:
• Generally self-limited but in some
cases may progress to acute liver
failure, with a subset of patients
requiring liver transplantation.
38. • DIC
• can develop during the first 3 days of illness
and coagulation studies should be
monitored during this period. Replacement
of clotting factors with FFP and platelets
may be necessary.
39. OUTCOMES
Morbidity or mortality are directly related to duration
and degree of hyperthermia.
Thus, heat stroke must be treated aggressively. In
addition, prognosis depends on the patient
population and type of heat stroke.
40. Mortality
• Mortality of up to 63 % has been reported in
elderly adults with classic heat stroke. In contrast,
mortality is much lower (1 to 15 %) in
adolescents and young adults with exertional heat
stroke. Additional poor prognostic indicators for
mortality include the height of the initial core body
temperature and the number of organ systems
affected during the course of treatment.
41. Neurologic abnormalities:
• Permanent neurologic damage is more commonly
seen in patients with core temperatures >42ºC
(107.6ºF) and consist of
– spasticity,
– ataxia,
– dysarthria,
– poor coordination,
– impaired memory, and
– behavioral changes.
• Patients recovering from rapidly treated exertional or classic
heat stroke with core body temperatures below this level may
manifest some of these neurologic findings but typically
recover fully.
42. Preventing heat-related illness
• Dress for the heat : Wear lightweight, light-coloured
clothing. It is also a good idea to wear hats or to use an
umbrella.
• Drink water : Carry water or juice with you and drink
continuously even if you do not feel thirsty. Avoid
alcohol and caffeine, which dehydrate the body.
• Avoid foods that are high in protein, which increase
metabolic heat.
• Stay indoors when possible.
• Take regular breaks when engaged in physical activity
on warm days.
• Take time out to find a cool place.
42
43. Take Home Message
• Children with elevated body temperature and CNS
abnormalities should be treated as victims of heat stroke.
• Rectal temperature is the most commonly obtained core
temperature measurement.
• Morbidity or mortality are directly related to duration and
degree of hyperthermia.
• The institution of prehospital cooling should not delay
timely transportation to definitive care.
• The most effective method of lowering the core body
temperature quickly is the use of cardiopulmonary bypass.