This is a lecture by Dr. Jim Holliman from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
This document discusses the physiological effects of training and racing in heat and humidity. It notes that exercise in hot and humid environments increases core temperature and sweat rate. Performance is impaired due to factors like hyperthermia and reduced muscle blood flow. However, heat acclimatization through repeated exercise in hot conditions promotes adaptations like increased plasma volume and sweat rate that improve heat tolerance and performance. Maintaining proper hydration is important to prevent dehydration, which can significantly reduce exercise capacity.
The document discusses physiological responses and health risks associated with exercise in cold environments. It covers topics like peripheral vasoconstriction, nonshivering thermogenesis, metabolic heat production, hypothermia, frostbite, and how factors like body size, wind chill, and cold water immersion impact heat loss. The key points are that the body's first response to cold is vasoconstriction to reduce heat loss, prolonged exercise in cold conditions can lead to declining core temperature and hypothermia if metabolic heat production is insufficient, and immersion in cold water greatly increases risk due to very rapid heat loss through conduction.
Then there are factors such as the temperature, allergens, pollution and altitude that cannot be controlled and can have serious effects on human performance. Environmental factors such as temperature during competition can hinder performance if not taken seriously. The average body temperature is 37°C
The document discusses the physiological effects of exercising in the heat and strategies for athletes to reduce the impact of heat. It covers acute responses like increased sweating and core temperature. It also discusses performance implications of dehydration and strategies for acclimation like improved sweating and cardiovascular function over 7-14 days. Drinking guidelines are provided to hydrate before, during and after competition with water and electrolytes in hot conditions.
Body adaptations during exercise in extreme cold environment 1 1(1)Simone Marello
Body adaptations during exercise in extreme cold environments can include habituation, metabolic, and insulative cold adaptations. During aerobic exercise, shivering can increase metabolism and oxygen consumption up to 40% of VO2 max. Maximal intensity exercises like jumping and sprinting have been shown to decrease in performance by 4.2-5.1% per 1 degree Celsius as muscular temperatures decrease. The intensity of exercise, environmental temperatures, and duration of exposure should be considered for cold weather exercise.
This document defines various types of heat injury including heat edema, heat rash, sunburn, heat tetany, heat syncope, heat cramps, heat exhaustion, and heat stroke. It identifies factors that influence heat injury such as acclimatization, physical fitness level, fatigue, food and alcohol consumption, and medications. Prevention of heat injuries requires monitoring the wet bulb globe temperature index and ensuring soldiers are properly acclimatized, hydrated, and rested.
Ice rescue and immersion hypothermia slide shareRommie Duckworth
In cases of environmental hypothermia, the common sense approach of “Warm them up!” may be the worst thing that you can do for your patient. In this presentation we learn the deadly effects of immersion, after-drop and cold induced vasodilation and how to properly differentiate between mild, moderate and severe hypothermia. We will discuss wilderness EMT and extreme environment treatment algorithms and how they apply to your service area.
The document discusses sports food and nutrition requirements for athletes. It covers the basics of sports nutrition including macronutrients, micronutrients, hydration, and classifications of sports foods such as sports drinks, energy drinks, and milk products. Recommendations are provided on food intake before, during, and after exercise for optimal performance and recovery.
This document discusses the physiological effects of training and racing in heat and humidity. It notes that exercise in hot and humid environments increases core temperature and sweat rate. Performance is impaired due to factors like hyperthermia and reduced muscle blood flow. However, heat acclimatization through repeated exercise in hot conditions promotes adaptations like increased plasma volume and sweat rate that improve heat tolerance and performance. Maintaining proper hydration is important to prevent dehydration, which can significantly reduce exercise capacity.
The document discusses physiological responses and health risks associated with exercise in cold environments. It covers topics like peripheral vasoconstriction, nonshivering thermogenesis, metabolic heat production, hypothermia, frostbite, and how factors like body size, wind chill, and cold water immersion impact heat loss. The key points are that the body's first response to cold is vasoconstriction to reduce heat loss, prolonged exercise in cold conditions can lead to declining core temperature and hypothermia if metabolic heat production is insufficient, and immersion in cold water greatly increases risk due to very rapid heat loss through conduction.
Then there are factors such as the temperature, allergens, pollution and altitude that cannot be controlled and can have serious effects on human performance. Environmental factors such as temperature during competition can hinder performance if not taken seriously. The average body temperature is 37°C
The document discusses the physiological effects of exercising in the heat and strategies for athletes to reduce the impact of heat. It covers acute responses like increased sweating and core temperature. It also discusses performance implications of dehydration and strategies for acclimation like improved sweating and cardiovascular function over 7-14 days. Drinking guidelines are provided to hydrate before, during and after competition with water and electrolytes in hot conditions.
Body adaptations during exercise in extreme cold environment 1 1(1)Simone Marello
Body adaptations during exercise in extreme cold environments can include habituation, metabolic, and insulative cold adaptations. During aerobic exercise, shivering can increase metabolism and oxygen consumption up to 40% of VO2 max. Maximal intensity exercises like jumping and sprinting have been shown to decrease in performance by 4.2-5.1% per 1 degree Celsius as muscular temperatures decrease. The intensity of exercise, environmental temperatures, and duration of exposure should be considered for cold weather exercise.
This document defines various types of heat injury including heat edema, heat rash, sunburn, heat tetany, heat syncope, heat cramps, heat exhaustion, and heat stroke. It identifies factors that influence heat injury such as acclimatization, physical fitness level, fatigue, food and alcohol consumption, and medications. Prevention of heat injuries requires monitoring the wet bulb globe temperature index and ensuring soldiers are properly acclimatized, hydrated, and rested.
Ice rescue and immersion hypothermia slide shareRommie Duckworth
In cases of environmental hypothermia, the common sense approach of “Warm them up!” may be the worst thing that you can do for your patient. In this presentation we learn the deadly effects of immersion, after-drop and cold induced vasodilation and how to properly differentiate between mild, moderate and severe hypothermia. We will discuss wilderness EMT and extreme environment treatment algorithms and how they apply to your service area.
The document discusses sports food and nutrition requirements for athletes. It covers the basics of sports nutrition including macronutrients, micronutrients, hydration, and classifications of sports foods such as sports drinks, energy drinks, and milk products. Recommendations are provided on food intake before, during, and after exercise for optimal performance and recovery.
The document discusses Dietary Reference Intakes (DRIs), which provide target intake levels like the Recommended Dietary Allowance (RDA) and Adequate Intake (AI) as well as upper intake limits (UL) for essential nutrients. It outlines the background and timeline of DRIs, defines key terms, and discusses their uses for assessing diets and planning nutrition on individual and group levels. Specific antioxidants like vitamins C and E, selenium, and carotenoids are also summarized with their functions, intake values, sources, and recommendations.
The document provides information on national dietary recommendations including the Recommended Dietary Allowance (RDA) and Dietary Reference Intake (DRI) which specify nutrient needs. It also discusses the Dietary Guidelines for Americans which provide recommendations on food choices, physical activity, and limiting sugars, salt and saturated fat. Key macronutrients like carbohydrates, fats, proteins, vitamins and minerals are explained along with dietary recommendations and guidelines for intake of each.
Endodontics for the aged and Geriateric. What should one look for, and what changes do we need to deal with in our clinics. A comprehensive review presentation- Dr. Abhishek John Samuel, MDS (Endodontics).
8 measurement of energy expenditure in athletesSiham Gritly
The document discusses various methods for measuring energy expenditure in athletes, including basal metabolic rate (BMR), maximal oxygen consumption (VO2 max), and respiratory quotient (RQ). It describes how BMR is the minimum energy needed at rest and accounts for 65-75% of total daily energy expenditure. VO2 max measures aerobic capacity while RQ indicates the ratio of oxygen used to carbon dioxide expelled. Total energy expenditure includes BMR, physical activity, and the thermic effect of food.
RDA is the new cataloging standard that replaces AACR2. It is based on FRBR and focuses on user tasks like finding, identifying, selecting, and obtaining resources. RDA uses FRBR entities and relationships to organize descriptive information and focuses on online resources. It differs from AACR2 in areas like elements, vocabularies, transcription, and levels of description. While RDA supports metadata sharing and digital environments, concerns include costs of implementation and difficulty adapting the new standard. The future of RDA remains unclear as it is still being developed.
This document discusses nutritional requirements and how nutrient needs are determined. It explains the Dietary Reference Intakes (DRIs) which include Adequate Intake (AI), Estimated Average Requirement (EAR), Recommended Dietary Allowance (RDA), and Tolerable Upper Intake Level (UL). The EAR is the daily intake level to meet needs of half the population. The RDA meets the needs of 97-98% of people. The AI is used when an RDA is not available. The UL is the highest daily intake unlikely to cause adverse health effects. Nutrient standards help determine Daily Values and Acceptable Macronutrient Distribution Ranges.
RDA is a new cataloging standard designed to replace AACR2 and provide guidelines for describing digital resources. It is based on FRBR and FRAD which are models that organize information by user tasks and relationships between entities like works, expressions, manifestations and items. RDA aims to be more intuitive for users by providing more detailed descriptions of resources and is being tested by various libraries and organizations before its full implementation. However, some questions remain regarding its costs and benefits compared to AACR2.
Lecture 3 Dietary requirements and guidelineswajihahwafa
1. Define the Dietary Reference Intakes (DRIs)
2. Present four (4) levels that represent five (5) food group in Malaysian Food Guide Pyramid
3. Read and understand a nutrition facts label.
4. Present the 14 key Messages of Malaysian Dietary Guidelines and 15 Key Messages Malaysian Dietary Guidelines for Children and Adolescents
This is a lecture from the Ghana Emergency Medicine Collaborative (GEMC). To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
GEMC- Alterations in Body Temperature: The Adult Patient with a Fever- Reside...Open.Michigan
This is a lecture by Joe Lex, MD from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
GMEC - Fluid and Electrolyte Imbalances in Emergency NursingOpen.Michigan
This document provides an overview of fluid and electrolyte imbalances in emergency nursing, focusing on sodium imbalances. It defines electrolytes and explains their importance in bodily functions. Reasons for electrolyte imbalances include kidney dysfunction, dehydration, diarrhea, and medication side effects. The document discusses sodium in detail, including its normal levels, foods high in sodium, and causes and signs of hyponatremia (low sodium). It explains that hyponatremia can be hypovolemic, euvolemic, or hypervolemic, and provides examples of signs and symptoms for hypovolemic and hypervolemic hyponatremia.
GEMC- Heat Related Illnesses- Resident TrainingOpen.Michigan
This is a lecture by Randall Ellis, MD MPH from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
The drawbacks of climate change are so overt. The Disturbance of Great Ocean Conveyor currents led to the extreme changes in temperature around the globe in the form of a cooler northern, warmer tropical and cooler snowy winter, warmer summer. Many deaths from hypothermia were reported especially in refugee camps as it is not well equipped. Hypothermia is a medical emergency that occurs when the body loses heat faster than it can produce heat, causing a dangerously low body temperature. Normal body temperature is around 98.6 F (37 C). Hypothermia occurs as the body temperature falls below 95 F (35 C). When body temperature drops, heart, nervous system and other organs can't work normally. Left untreated, hypothermia can eventually lead to complete failure of heart and respiratory system and eventually to death.
This is a lecture by Dr. John Martel from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
Heat and cold applications are used for local and systemic effects. Heat promotes healing, reduces swelling and pain by increasing blood flow. It can increase inflammation and risk of burns. Cold decreases temperature, constricts blood vessels, reduces inflammation and acts as a local anesthetic but can cause pain, burns or cyanosis. Various methods deliver heat or cold including hot packs, electrical pads, ice, compresses and baths. Care must be taken with certain patients and conditions.
This document provides information about exercising in cold conditions and discusses hypothermia. It covers topics like how the body generates and loses heat, factors that influence heat loss, signs and symptoms of hypothermia, and treatment approaches for mild, moderate, and severe hypothermia. Guidelines are provided for exercising safely in cold weather, such as dressing in layers, keeping extremities warm, and monitoring for signs of cold stress. The effects of cold on exercise performance are outlined, noting that activities like swimming are higher risk due to increased heat loss through water conduction and convection.
This document discusses the pathophysiology and management of burn patients. It covers:
1) Major burns cause massive tissue destruction and inflammatory response, leading to burn shock from fluid shifts and systemic effects if >20% TBSA.
2) Burns trigger a hypermetabolic response for weeks, with increased cardiac work and protein catabolism impairing healing.
3) Resuscitation follows the Parkland formula to replace fluid losses. Fluid management aims to maintain urine output and prevent organ dysfunction.
Temperature and heat hazard by mzgin m. ayoobMzgin Mohammed
This document discusses heat and temperature hazards. It defines heat and temperature, explains how the body is affected by heat, and identifies heat-related illnesses like heat stroke, heat exhaustion, and heat cramps. It also discusses the risks of extreme cold temperatures and ways to monitor and prevent heat stress, such as designating oversight of water, rest, shade, and modified work schedules. The goal is to educate about temperature hazards and suppress risks through awareness and precautions.
This is a lecture by Dr. Jennifer Thompson from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
This is a lecture by Dr. JIm Holliman from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
The document discusses Dietary Reference Intakes (DRIs), which provide target intake levels like the Recommended Dietary Allowance (RDA) and Adequate Intake (AI) as well as upper intake limits (UL) for essential nutrients. It outlines the background and timeline of DRIs, defines key terms, and discusses their uses for assessing diets and planning nutrition on individual and group levels. Specific antioxidants like vitamins C and E, selenium, and carotenoids are also summarized with their functions, intake values, sources, and recommendations.
The document provides information on national dietary recommendations including the Recommended Dietary Allowance (RDA) and Dietary Reference Intake (DRI) which specify nutrient needs. It also discusses the Dietary Guidelines for Americans which provide recommendations on food choices, physical activity, and limiting sugars, salt and saturated fat. Key macronutrients like carbohydrates, fats, proteins, vitamins and minerals are explained along with dietary recommendations and guidelines for intake of each.
Endodontics for the aged and Geriateric. What should one look for, and what changes do we need to deal with in our clinics. A comprehensive review presentation- Dr. Abhishek John Samuel, MDS (Endodontics).
8 measurement of energy expenditure in athletesSiham Gritly
The document discusses various methods for measuring energy expenditure in athletes, including basal metabolic rate (BMR), maximal oxygen consumption (VO2 max), and respiratory quotient (RQ). It describes how BMR is the minimum energy needed at rest and accounts for 65-75% of total daily energy expenditure. VO2 max measures aerobic capacity while RQ indicates the ratio of oxygen used to carbon dioxide expelled. Total energy expenditure includes BMR, physical activity, and the thermic effect of food.
RDA is the new cataloging standard that replaces AACR2. It is based on FRBR and focuses on user tasks like finding, identifying, selecting, and obtaining resources. RDA uses FRBR entities and relationships to organize descriptive information and focuses on online resources. It differs from AACR2 in areas like elements, vocabularies, transcription, and levels of description. While RDA supports metadata sharing and digital environments, concerns include costs of implementation and difficulty adapting the new standard. The future of RDA remains unclear as it is still being developed.
This document discusses nutritional requirements and how nutrient needs are determined. It explains the Dietary Reference Intakes (DRIs) which include Adequate Intake (AI), Estimated Average Requirement (EAR), Recommended Dietary Allowance (RDA), and Tolerable Upper Intake Level (UL). The EAR is the daily intake level to meet needs of half the population. The RDA meets the needs of 97-98% of people. The AI is used when an RDA is not available. The UL is the highest daily intake unlikely to cause adverse health effects. Nutrient standards help determine Daily Values and Acceptable Macronutrient Distribution Ranges.
RDA is a new cataloging standard designed to replace AACR2 and provide guidelines for describing digital resources. It is based on FRBR and FRAD which are models that organize information by user tasks and relationships between entities like works, expressions, manifestations and items. RDA aims to be more intuitive for users by providing more detailed descriptions of resources and is being tested by various libraries and organizations before its full implementation. However, some questions remain regarding its costs and benefits compared to AACR2.
Lecture 3 Dietary requirements and guidelineswajihahwafa
1. Define the Dietary Reference Intakes (DRIs)
2. Present four (4) levels that represent five (5) food group in Malaysian Food Guide Pyramid
3. Read and understand a nutrition facts label.
4. Present the 14 key Messages of Malaysian Dietary Guidelines and 15 Key Messages Malaysian Dietary Guidelines for Children and Adolescents
This is a lecture from the Ghana Emergency Medicine Collaborative (GEMC). To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
GEMC- Alterations in Body Temperature: The Adult Patient with a Fever- Reside...Open.Michigan
This is a lecture by Joe Lex, MD from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
GMEC - Fluid and Electrolyte Imbalances in Emergency NursingOpen.Michigan
This document provides an overview of fluid and electrolyte imbalances in emergency nursing, focusing on sodium imbalances. It defines electrolytes and explains their importance in bodily functions. Reasons for electrolyte imbalances include kidney dysfunction, dehydration, diarrhea, and medication side effects. The document discusses sodium in detail, including its normal levels, foods high in sodium, and causes and signs of hyponatremia (low sodium). It explains that hyponatremia can be hypovolemic, euvolemic, or hypervolemic, and provides examples of signs and symptoms for hypovolemic and hypervolemic hyponatremia.
GEMC- Heat Related Illnesses- Resident TrainingOpen.Michigan
This is a lecture by Randall Ellis, MD MPH from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
The drawbacks of climate change are so overt. The Disturbance of Great Ocean Conveyor currents led to the extreme changes in temperature around the globe in the form of a cooler northern, warmer tropical and cooler snowy winter, warmer summer. Many deaths from hypothermia were reported especially in refugee camps as it is not well equipped. Hypothermia is a medical emergency that occurs when the body loses heat faster than it can produce heat, causing a dangerously low body temperature. Normal body temperature is around 98.6 F (37 C). Hypothermia occurs as the body temperature falls below 95 F (35 C). When body temperature drops, heart, nervous system and other organs can't work normally. Left untreated, hypothermia can eventually lead to complete failure of heart and respiratory system and eventually to death.
This is a lecture by Dr. John Martel from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
Heat and cold applications are used for local and systemic effects. Heat promotes healing, reduces swelling and pain by increasing blood flow. It can increase inflammation and risk of burns. Cold decreases temperature, constricts blood vessels, reduces inflammation and acts as a local anesthetic but can cause pain, burns or cyanosis. Various methods deliver heat or cold including hot packs, electrical pads, ice, compresses and baths. Care must be taken with certain patients and conditions.
This document provides information about exercising in cold conditions and discusses hypothermia. It covers topics like how the body generates and loses heat, factors that influence heat loss, signs and symptoms of hypothermia, and treatment approaches for mild, moderate, and severe hypothermia. Guidelines are provided for exercising safely in cold weather, such as dressing in layers, keeping extremities warm, and monitoring for signs of cold stress. The effects of cold on exercise performance are outlined, noting that activities like swimming are higher risk due to increased heat loss through water conduction and convection.
This document discusses the pathophysiology and management of burn patients. It covers:
1) Major burns cause massive tissue destruction and inflammatory response, leading to burn shock from fluid shifts and systemic effects if >20% TBSA.
2) Burns trigger a hypermetabolic response for weeks, with increased cardiac work and protein catabolism impairing healing.
3) Resuscitation follows the Parkland formula to replace fluid losses. Fluid management aims to maintain urine output and prevent organ dysfunction.
Temperature and heat hazard by mzgin m. ayoobMzgin Mohammed
This document discusses heat and temperature hazards. It defines heat and temperature, explains how the body is affected by heat, and identifies heat-related illnesses like heat stroke, heat exhaustion, and heat cramps. It also discusses the risks of extreme cold temperatures and ways to monitor and prevent heat stress, such as designating oversight of water, rest, shade, and modified work schedules. The goal is to educate about temperature hazards and suppress risks through awareness and precautions.
This is a lecture by Dr. Jennifer Thompson from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
This is a lecture by Dr. JIm Holliman from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
GEMC: Introduction to Burns: Resident TrainingOpen.Michigan
This is a lecture by Dr. Robert Preston from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
5.exercise in different environment.pptxEshetuGirma1
The document discusses various environmental conditions that can affect exercise performance, including heat, cold, altitude, and pollution. It describes the physiological impacts of exercising in different temperatures and altitudes, such as hyperthermia, hypothermia, frostbite, and altitude sickness. Prevention and treatment strategies are provided for related illnesses like heat cramps, heat exhaustion, and heat stroke. The key is to properly warm or cool the body as needed and rehydrate in hot conditions.
This document discusses various environmental health issues including heat-related illnesses like heat stroke and heat exhaustion, cold-related illnesses like hypothermia, and issues related to altitude changes, lightning strikes, sun exposure, and air pollution. It provides details on the physiology of temperature regulation, mechanisms of heat exchange, signs and symptoms of different heat-related illnesses, and recommendations for prevention and treatment.
Heat stroke is a severe heat-related illness that occurs when the body becomes unable to regulate its core temperature, causing it to rise rapidly. There are two main types - exertional heat stroke, which affects young active individuals, and classic nonexertional heat stroke, which more commonly affects elderly or ill people. Heat stroke is life-threatening and can cause damage to organs and death if not promptly treated. Factors that contribute to heat stroke include increased heat production from physical exertion or medical conditions, reduced ability to dissipate heat through sweating or blood flow, and an inability to acclimate to hot environments.
09.30.08(b): Approach to the Patient with Disorders of OsmoregulationOpen.Michigan
This document discusses disorders of osmoregulation and provides guidance on evaluating and managing patients with abnormalities in sodium balance and water homeostasis. It reviews key concepts such as calculating plasma osmolality, distinguishing types of polyuric states like diabetes insipidus, and developing a systematic approach to hyponatremia. Clinical cases are presented to demonstrate how to identify the etiology and determine appropriate treatment for conditions that cause hypo- and hypernatremia.
This document discusses temperature and humidity. It begins by defining temperature and explaining different methods of temperature measurement, including mercury thermometers, resistance thermometers, and thermistors. It then discusses measuring body temperature, factors that influence body temperature, and methods of heat transfer from the body. The document also covers thermoregulation, causes of hyperthermia, temperature changes during surgery, effects of hypothermia, and methods for preventing hypothermia, including through the use of humidity.
1. Burns can be classified based on the type of injury, percentage of total body surface area burned, and depth of burn into the skin.
2. Fluid resuscitation is essential to correct burn shock and hypovolemia. Formulas like Parkland and Brooke are used to calculate fluid needs.
3. Wound management includes initial silver dressings, then foams, hydrocolloids, or hydrogels depending on wound characteristics. Nutrition, infection control, and rehabilitation are also important.
This is a lecture by Joe Lex, MD from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
Similar to GEMC- Environmental Hypothermia- Resident Training (20)
This is a lecture by Joe Lex, MD from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
This is a lecture by Jim Holliman, MD from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
This is a lecture by Joe Lex, MD from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
GEMC- Rapid Sequence Intubation & Emergency Airway Support in the Pediatric E...Open.Michigan
This is a lecture by Michele Nypaver, MD from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
This document provides an overview of ocular emergencies. It begins with an introduction to the Project: Ghana Emergency Medicine Collaborative and author information. The bulk of the document consists of slides reviewing various eye conditions and emergencies, including styes, chalazions, conjunctivitis, iritis, orbital cellulitis, subconjunctival hemorrhages, and scleritis. Treatment approaches are provided for many of the conditions. The document concludes with a discussion of the eye examination approach and areas to be reviewed.
GEMC- Disorders of the Pleura, Mediastinum, and Chest Wall- Resident TrainingOpen.Michigan
This document provides an overview of disorders of the pleura, mediastinum, and chest wall. It discusses several topics in 1-3 sentences each, including costochondritis (inflammation of the costal cartilages), mediastinitis (infection of the mediastinum), mediastinal masses, pneumothorax (air in the pleural space), and catamenial pneumothorax (recurrent pneumothorax associated with menstruation). The document aims to enhance understanding of the major clinical disorders commonly encountered in emergency medicine involving the pleura, mediastinum, and chest wall.
GEMC- Dental Emergencies and Common Dental Blocks- Resident TrainingOpen.Michigan
This is a lecture by Joe Lex, MD from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
This is a lecture by Joe Lex, MD from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
GEMC- Arthritis and Arthrocentesis- Resident TrainingOpen.Michigan
This is a lecture by Joe Lex, MD from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
GEMC- Bursitis, Tendonitis, Fibromyalgia, and RSD- Resident TrainingOpen.Michigan
This is a lecture by Joe Lex, MD from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
GEMC- Right Upper Quadrant Ultrasound- Resident TrainingOpen.Michigan
This is a lecture by Jeff Holmes from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
The document summarizes cardiovascular topics including pericardial tamponade, pericarditis, infective endocarditis, hypertension, tumors, and valvular disorders. It provides details on the causes, signs and symptoms, diagnostic studies, and management of these conditions. The document also includes bonus sections on cardiac transplant patients, pacemakers and ICDs, and EKG morphology.
This is a lecture by Joe Lex, MD from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
GEMC: Nursing Process and Linkage between Theory and PracticeOpen.Michigan
This is a lecture by Jeremy Lapham from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
2014 gemc-nursing-lapham-general survey and patient care managementOpen.Michigan
This is a lecture by Dr. Jeremy Lapham from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
This document discusses the evaluation and management of patients with kidney failure presenting to the emergency department. It covers causes of acute kidney injury including pre-renal, intra-renal and post-renal failure. It also discusses evaluation of kidney function, risks of intravenous contrast, dialysis indications and complications in chronic kidney disease patients including infection, cardiovascular issues and electrolyte abnormalities. Special considerations are outlined for resuscitating, evaluating and treating kidney failure patients in the emergency setting.
GEMC: The Role of Radiography in the Initial Evaluation of C-Spine TraumaOpen.Michigan
This is a lecture by Dr. Stephen Hartsell from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
This is a lecture by Dr. Jim Holliman from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
GEMC- Sickle Cell Disease: Special Considerations in Pediatrics- Resident Tra...Open.Michigan
This is a lecture by Hannah Smith, MD from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
GEMC- Ghana Grab Bag Pediatric Quiz- Resident TrainingOpen.Michigan
This is a lecture by Hannah Smith, MD and Ruth S. Hwu, MD from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
LAND USE LAND COVER AND NDVI OF MIRZAPUR DISTRICT, UPRAHUL
This Dissertation explores the particular circumstances of Mirzapur, a region located in the
core of India. Mirzapur, with its varied terrains and abundant biodiversity, offers an optimal
environment for investigating the changes in vegetation cover dynamics. Our study utilizes
advanced technologies such as GIS (Geographic Information Systems) and Remote sensing to
analyze the transformations that have taken place over the course of a decade.
The complex relationship between human activities and the environment has been the focus
of extensive research and worry. As the global community grapples with swift urbanization,
population expansion, and economic progress, the effects on natural ecosystems are becoming
more evident. A crucial element of this impact is the alteration of vegetation cover, which plays a
significant role in maintaining the ecological equilibrium of our planet.Land serves as the foundation for all human activities and provides the necessary materials for
these activities. As the most crucial natural resource, its utilization by humans results in different
'Land uses,' which are determined by both human activities and the physical characteristics of the
land.
The utilization of land is impacted by human needs and environmental factors. In countries
like India, rapid population growth and the emphasis on extensive resource exploitation can lead
to significant land degradation, adversely affecting the region's land cover.
Therefore, human intervention has significantly influenced land use patterns over many
centuries, evolving its structure over time and space. In the present era, these changes have
accelerated due to factors such as agriculture and urbanization. Information regarding land use and
cover is essential for various planning and management tasks related to the Earth's surface,
providing crucial environmental data for scientific, resource management, policy purposes, and
diverse human activities.
Accurate understanding of land use and cover is imperative for the development planning
of any area. Consequently, a wide range of professionals, including earth system scientists, land
and water managers, and urban planners, are interested in obtaining data on land use and cover
changes, conversion trends, and other related patterns. The spatial dimensions of land use and
cover support policymakers and scientists in making well-informed decisions, as alterations in
these patterns indicate shifts in economic and social conditions. Monitoring such changes with the
help of Advanced technologies like Remote Sensing and Geographic Information Systems is
crucial for coordinated efforts across different administrative levels. Advanced technologies like
Remote Sensing and Geographic Information Systems
9
Changes in vegetation cover refer to variations in the distribution, composition, and overall
structure of plant communities across different temporal and spatial scales. These changes can
occur natural.
Philippine Edukasyong Pantahanan at Pangkabuhayan (EPP) CurriculumMJDuyan
(𝐓𝐋𝐄 𝟏𝟎𝟎) (𝐋𝐞𝐬𝐬𝐨𝐧 𝟏)-𝐏𝐫𝐞𝐥𝐢𝐦𝐬
𝐃𝐢𝐬𝐜𝐮𝐬𝐬 𝐭𝐡𝐞 𝐄𝐏𝐏 𝐂𝐮𝐫𝐫𝐢𝐜𝐮𝐥𝐮𝐦 𝐢𝐧 𝐭𝐡𝐞 𝐏𝐡𝐢𝐥𝐢𝐩𝐩𝐢𝐧𝐞𝐬:
- Understand the goals and objectives of the Edukasyong Pantahanan at Pangkabuhayan (EPP) curriculum, recognizing its importance in fostering practical life skills and values among students. Students will also be able to identify the key components and subjects covered, such as agriculture, home economics, industrial arts, and information and communication technology.
𝐄𝐱𝐩𝐥𝐚𝐢𝐧 𝐭𝐡𝐞 𝐍𝐚𝐭𝐮𝐫𝐞 𝐚𝐧𝐝 𝐒𝐜𝐨𝐩𝐞 𝐨𝐟 𝐚𝐧 𝐄𝐧𝐭𝐫𝐞𝐩𝐫𝐞𝐧𝐞𝐮𝐫:
-Define entrepreneurship, distinguishing it from general business activities by emphasizing its focus on innovation, risk-taking, and value creation. Students will describe the characteristics and traits of successful entrepreneurs, including their roles and responsibilities, and discuss the broader economic and social impacts of entrepreneurial activities on both local and global scales.
বাংলাদেশের অর্থনৈতিক সমীক্ষা ২০২৪ [Bangladesh Economic Review 2024 Bangla.pdf] কম্পিউটার , ট্যাব ও স্মার্ট ফোন ভার্সন সহ সম্পূর্ণ বাংলা ই-বুক বা pdf বই " সুচিপত্র ...বুকমার্ক মেনু 🔖 ও হাইপার লিংক মেনু 📝👆 যুক্ত ..
আমাদের সবার জন্য খুব খুব গুরুত্বপূর্ণ একটি বই ..বিসিএস, ব্যাংক, ইউনিভার্সিটি ভর্তি ও যে কোন প্রতিযোগিতা মূলক পরীক্ষার জন্য এর খুব ইম্পরট্যান্ট একটি বিষয় ...তাছাড়া বাংলাদেশের সাম্প্রতিক যে কোন ডাটা বা তথ্য এই বইতে পাবেন ...
তাই একজন নাগরিক হিসাবে এই তথ্য গুলো আপনার জানা প্রয়োজন ...।
বিসিএস ও ব্যাংক এর লিখিত পরীক্ষা ...+এছাড়া মাধ্যমিক ও উচ্চমাধ্যমিকের স্টুডেন্টদের জন্য অনেক কাজে আসবে ...
Temple of Asclepius in Thrace. Excavation resultsKrassimira Luka
The temple and the sanctuary around were dedicated to Asklepios Zmidrenus. This name has been known since 1875 when an inscription dedicated to him was discovered in Rome. The inscription is dated in 227 AD and was left by soldiers originating from the city of Philippopolis (modern Plovdiv).
Walmart Business+ and Spark Good for Nonprofits.pdfTechSoup
"Learn about all the ways Walmart supports nonprofit organizations.
You will hear from Liz Willett, the Head of Nonprofits, and hear about what Walmart is doing to help nonprofits, including Walmart Business and Spark Good. Walmart Business+ is a new offer for nonprofits that offers discounts and also streamlines nonprofits order and expense tracking, saving time and money.
The webinar may also give some examples on how nonprofits can best leverage Walmart Business+.
The event will cover the following::
Walmart Business + (https://business.walmart.com/plus) is a new shopping experience for nonprofits, schools, and local business customers that connects an exclusive online shopping experience to stores. Benefits include free delivery and shipping, a 'Spend Analytics” feature, special discounts, deals and tax-exempt shopping.
Special TechSoup offer for a free 180 days membership, and up to $150 in discounts on eligible orders.
Spark Good (walmart.com/sparkgood) is a charitable platform that enables nonprofits to receive donations directly from customers and associates.
Answers about how you can do more with Walmart!"
GEMC- Environmental Hypothermia- Resident Training
1. Project: Ghana Emergency Medicine Collaborative
Document Title: Environmental Hyperthermia
Author(s): Jim Holliman (Uniformed Services University of the Health
Sciences), MD 2012
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speak to your physician if you have questions about your medical condition.
Viewer discretion is advised: Some medical content is graphic and may not be suitable for all viewers.
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3. Environmental Hyperthermia
Jim Holliman, M.D., F.A.C.E.P.
Professor of Military and Emergency Medicine
Uniformed Services University of the Health Sciences
Clinical Professor of Emergency Medicine
George Washington University
Bethesda, Maryland, U.S.A.
3
4. Heat-Related Illnesses : History
•
•
•
•
•
•
•
•
•
Death reported from field labor : (Old Testament, II Kings 4:18-20)
Roman Army in Arabia decimated by heat : 24 B.C.
King Edward & Crusaders lost battle against Arabs : 3rd Crusade
Heat wave in Peking, China : 11,000 deaths : 1743
123 British troops died in Black Hole of Calcutta : 1856
U.S. Army : 125 reported deaths in basic training : 1941-44
820 U.S. reported deaths / "heat wave year" (1952-55, 1966)
Several thousand deaths in heat wave in Greece / Italy : 1987
? > 10,000 deaths in France in 2003
4
5. Heat-Related Illness : Incidence
• ? About 4000 deaths / year in U.S.A.
• Second leading cause of death in
amateur athletes (head trauma is first)
• Can cause mass numbers of deaths
during "heat wave"
• Some cases mistakenly attributed to
heart disease
5
6. Controversies or Unclear Points
• Environmental Hyperthermia
• What is the most effective central cooling method ?
• What is the best method to limit shivering ?
• Are any medications helpful as adjunct therapy ?
6
8. Mechanisms of Heat Transfer
• Conduction (2 %)
• Transfer of heat by direct physical contact
• Convection (1 to 40 %, depends on wind velocity)
• Transfer of heat to air / water vapor circulating
around body
• Radiation (30 to 65 %)
• Heat transfer by infrared waves
• Evaporation (10 to 80 %)
• Conversion of liquid sweat to vapor (0.58 Kcal / cc
of H2O evaporated)
8
11. Sources of Exogenous Heat Gain
•
•
•
•
•
Closed spaces (locked cars, etc.)
Bright sunshine (150 Kcal / hr)
Hot tubs
Lack of air conditioning
Hot soil (can transmit heat thru shoes)
11
12. Sources of Endogenous Heat Gain
•
•
•
•
Exercise (300 to 900 Kcal / hr)
Agitation / restraint
Fever / infection
Hypermetabolism / hyperthyroidism
12
13. Baseline Energy Metabolism
• Basal metabolism (adult male)
• 65 to 85 Kcal/hr or 50 to 60 Kcal/hr/m2
body surface area
• For every 100 calories produced :
• O2 consumption is 20 liters
• CO2 production is 20 liters
• 100 ml water is needed (for sweat and
respiratory loss)
13
14. Energy Expenditure During
Different Activities
Activity
LABOR
Shoveling
Hand sawing
Pushing wheelbarrow
Carrying bricks
Light assembly work
Typing
Kcal / hr
570
450
300
216
108
84
14
15. Energy Expenditure During
Different Activities (cont.)
Activity
SPORTS & RECREATION*
Football
Wrestling
Hockey
5-mile run
Walking (4 mph)
Basketball
Swimming
Kcal / hr
102
114
173
360
340
344
660
• *Calorie expenditure per event given as increment above basal
requirement
15
16. Causes of Impaired Heat
Dissipation
•
•
•
•
•
•
•
High environmental temperature
High environmental humidity
Lack of acclimatization
Excessive clothing
Obesity
Diabetes / autonomic neuropathy
Sweat gland dysfunction (dehydration, cystic
fibrosis, ectodermal dysplasia, scleroderma,
extensive scars)
• Previous heatstroke
16
17. Hyperthermia : Types of
Causative Drug Reactions or Effects
•
•
•
•
•
Hypersensitivity
Hypermetabolism
Impaired thermoregulation
Impaired heat dissipation
Impaired cardiovascular
compensation
• Direct pyrogens
17
19. Children at Greater Risk of
Heat Stress
•
•
•
•
•
•
•
•
•
•
•
•
Obesity
Febrile state
Cystic fibrosis
Diabetes mellitus
Diabetes insipidus
Ectodermal dysplasia
GI infection
Chronic heart failure
Caloric malnutrition
Anorexia nervosa
Mental deficiency
Peripheral vascular disease
19
20. Environmental Causes of
Hyperthermia
• Mild forms of heat illness :
• Heat edema
• Heat cramps
• Heat syncope
• Prickly heat
• Heat Exhaustion :
• Sodium depletion type
• Water depletion type
• Heatstroke :
• Classic
• Exertional
20
21. Treatment of Mild Forms of
Heat Illness
• Heat edema (usually only hands, feet, ankles)
• Elevation, support hose (do not use diuretics)
• Heat cramps (due to Na depletion)
• Cooling, PO fluids containing some salt
• Heat syncope (usually due to mild fluid depletion)
• Rest, PO fluids
• Prickly heat
• Skin cleansing, loose clothing, antibiotics if
pustular
21
22. Acclimatization to Heat Exposure
• Improved metabolic efficiency (increased aerobic
metabolism, decreased heat wasted in making ATP)
• Sweating promoted at lower core temperature
• Rate of sweating increases from 1.5 to 3 liters / hr
• Stroke volume increases, cardiac output increases,
heart rate decreases
• Aldosterone secretion increases (Na in sweat
decreases from 30 to 5 meq / liter)
• Potassium retention
22
23. Acclimatization to Heat Exposure
• Gradual : takes 10 to 20 days
• Full tolerance may take 2 months
23
24. Heat Exhaustion :
Sodium Depletion Type
• Etiology
•
•
•
•
Usually in unacclimatized
Usually young age
Exercise in hot environment
Mildly inadequate fluid intake &
moderate inadequate Na intake
24
25. Heat Exhaustion :
Sodium Depletion Type
• Sx : + febrile, headache, weakness, fatigue,
nausea, diarrhea, cramps, + hypotension /
tachycardia
• Rx : Rest, cooling, fluids (PO or IV) with
sodium
25
26. Heat Exhaustion :
Water Depletion Type
• Etiology : Usually elderly with
inadequate free water intake ; can
lead to heatstroke
• Sx : Febrile, thirst, weakness,
confusion
• Rx : Cooling, rest, hypotonic fluids ; if
elderly, may need hospital admission
26
27. Heatstroke :
Items Required for Diagnosis
• Exposure to heat stress : internal or
external
o
• Elevated body temperature (usually > 40 C)
• Major CNS dysfunction (bizarre behavior,
seizures, coma, etc.)
• Usually tachypneic, tachycardic,
hypotensive
• Usually anhydrotic
27
28. Heatstroke
• A true emergency
• Rapid dx and Rx essential
• Two types :
• Classic
• Exertional
28
29. Classic Heatstroke
• Usually elderly
• Occurs after exposure to heat for > 1 week
• Mortality 70 % untreated, 10 to 20 %
treated
29
30. Exertional Heatstroke
•
•
•
•
Usually younger age
Usually after heavy exertion
May still have sweating
May have rhabdomyolysis / renal
failure
• Mortality 30 % untreated, < 10 %
treated
30
31. Table 3 : Comparison of Classic and
Exertional Heatstroke
Age of patients
Epidemiology
Predisposing diseases
Sweating
Classic
Elderly
Epidemic (heat waves)
Present
Absent
Exertional
Younger
Sporadic
Absent
Often present
Acid/base disturbance
Resp. alkalosis
Renal failure
Rhabdomyolysis
Uncommon
Uncommon
Uncommon
Common
Common
Common
Mild
Marked
Disseminated intravascular coagulation
Hyperuricemia
Metabolic acidosis
31
32. Heatstroke :
Differential Diagnosis
•
•
•
•
•
•
•
Meningitis / encephalitis : do LP if not sure
Cerebral falciparum malaria
CVA / traumatic intracranial bleed
DKA with infection
Thyroid storm
Neuroleptic malignant syndrome*
Malignant hyperthermia*
*These should show muscle rigidity
32
33. Heatstroke :
Emergency Treatment Protocol
• Airway management : intubate if comatose ; High
flow O2 for all
• Large bore IV and rapid bolus 500 to 1000 cc NS
• Draw blood (CBC, lytes, BUN, glucose, creatinine,
PT, PTT, platelets, lactate, calcium, LFT's, CPK,
ABG)
• Rapid external cooling : fully undress patient : ice
bath with skin massage (Hubbard tank) or cool
skin soaks and fans
• Foley and NG tube insertion : iced NG lavage
33
34. Heatstroke :
Emergency Treatment Protocol (cont.)
• Monitor core temp. (high rectal probe or
esophageal) ; stop external cooling when core
temp. < 102o F
• Monitor for hypotension, hypocalcemia,
arrhythmias, seizures, acidosis, ARF
• Admit to ICU
• Acetaminophen (do not use aspirin)
• Consider low dose phenothiazine
(chlorpromazine 25 mg IV) or diazepam IV to
promote heat loss and lessen shivering
34
35. Heatstroke :
Early Complications & Treatment
• Shivering : generates heat so should be
suppressed with chlorpromazine or thiopental
• Hypotension : usually Rx with increased IV fluids
• Rhabdomyolysis / renal failure : usually only need
Rx with fluids but may need bicarb + mannitol
• Acidosis
• Hypocalcemia
• Hypoglycemia : Rx with IV glucose
• Seizures : standard Rx with diazepam or lorazepam,
phenytoin
35
36. Heatstroke : Late Complications
•
•
•
•
•
•
•
DIC
Hepatic necrosis / failure
Renal failure with hyperkalemia
Acute MI ; reported but uncommon
Muscle compartment syndrome
CNS damage
Permanently impaired thermoregulatory
control : susceptible to heatstroke again
under even milder conditions
36
37. Heatstroke : Mortality Reports
Setting
Type
3 military series
exertional
Heat wave (U.S.)
classic
Mecca pilgrimage
mixed
(1979)
Mecca pilgrimage
mixed
(1986)
1986 U.S.A. series
classic
1967 series,
exertional
younger patients
1977-1983 Louisville,
classic
KY
Treatment
ice bath
ice bath
BCU
Mortality
0 / 66
14%
11%
KSU bed
0 / 25
fan, ice packs
ice packs only
7%
24%
ice packs, sheets
21%
37
38. Heatstroke : Rate of Cooling
Effect on Mortality
Author
Vicario
Yaqub
Mortality Reported
33% if 1 hr. temp. > 38.9 o
15% if 1 hr. temp. < 38.9 o
18% if > 1 hr. to 38.5 o
5% if < 1 hr. to 38.5 o
38
39. Heatstroke :
Rapid Body Cooling Techniques
Technique
Ice water immersion
BCU (net / spray)
Iced gastric lavage
High freq. jet ventilation
Dantrolene treatment
Spontaneous (no
treatment)
Reported Cooling Rate
( C / min)
0.21 to 0.23
0.11 to 0.17
0.08 to 0.11
0.06
0.04
0.03 to 0.06
39
40. Khogali's Objections to Ice Water
Immersion (Favoring Use of BCU)
• Peripheral vasoconstriction shunting
blood from skin ( ? rise in core temp.)
• Induction of shivering : raises heat
production
• Extreme discomfort to patient
• Difficulty performing CPR
• Difficulty monitoring VS
• "Unpleasant and unhygienic" conditions if
emesis or diarrhea occur
40
41. Other Cooling Methods
• Groin, neck, axillae, or scalp ice packs
• Limited effectiveness
• Iced peritoneal lavage
• Only a few case reports
• Cold O2 / Cold IV fluids
• Minimal heat exchange
• Iced enemas
• Minimal heat exchange
• Cardiopulmonary bypass
• Effective but time consuming to set up
41
42. Probably the best cooling method is water spray and fans with
the patient on an open stretcher
Source undetermined
42
43. Heatstroke : Prognosis (Px)
•
•
•
•
•
If coma < 3 to 4 hrs. : px good
If coma > 10 hrs. : likely fatal
SGOT < 1000 in first 24 hr. : px good
SGOT > 1000 in first 24 hr. : likely fatal
Temperature > 42.2 oC on admission : worse
px but can have complete recovery
43
44. Heat Illness : Prevention
• Time exertion to avoid sunlight exposure and the hottest
daytime hours (10:00 am to 3:00 pm)
• Light loose clothing permitting airflow over body surface
• Consume 400 to 500 cc fluid before exertion and 200 to
300 cc at 20 min. intervals during exertion
• Check body weight before practice : if wt. down 3 % ,
increase PO fluids ; if wt. down 5 %, cancel participation
that day ; if wt. down 7 %, immediate fluids & consider
medical attention
• Use only low osmolal fluids (< 2.5 g glucose and < 0.2 g
NaCl per 100 cc)
• Extra NaCl and potassium intake during acclimatization
o
44
• Cancel event if WBGT > 30 C
45. Potential Problems with Salt
Tablet Use
•
•
•
•
•
•
Delayed gastric emptying
Osmotic fluid shift into gut
Gastric mucosal damage
Hypernatremic dehydration
May impair acclimatization
May exacerbate potassium depletion
45
46. Hyperthermia : WBGT
• Wet bulb globe temperature = Heat Index
• WBGT = 0.7 X wet bulb temperature
+
0.2 X black globe temperature
+
0.1 X dry thermometer temperature
46
47. Wet-Bulb Globe Temperature (WBGT)
and Recommended Activity Levels
C
15
19-21
22-24
24
27
28
30
31.5
F
60
66-70
Activity
No precautions
No precautions as long as H2O, salt & food
easily available
71-75 Postpone sports practice, avoid hiking
76
Lighter practice, work only with rest breaks
80
No hiking or sports
82
Only necessary heavy exertion with caution
85
Cancel all exertion for unacclimatized;
Avoid sun exposure even at rest
88
Limited brief activity for acclimatized, fit
personnel only
47
49. Neuroleptic Malignant Syndrome
(NMS)
• Definition :
– Idiosyncratic reaction to neuroleptic agents
(phenothiazines, etc.) that consists of fever, mental status
changes, muscle rigidity, autonomic dysfunction,
respiratory distress and possible rhabdomyolysis; May
cause as many as 4000 deaths / year
– Occurs with therapeutic doses of neuroleptics and is not
related to duration of therapy
– Occurs with phenothiazines, butyrophenones,
thioxanthines, metaclopromide (Reglan) and withdrawal
from amantadine or levodopa
49
51. NMS
• Occurs with therapeutic doses of
neuroleptics
• Not related to duration of therapy
• Subsequent exposure does not always
cause recurrence
• Most reported cases in young males
51
52. NMS : Incidence
• First described 1968
• Affects < 1 % of patients on
neuroleptics
• 9 to 30 % mortality in reported cases
• ? 4000 deaths / year
52
53. NMS Symptom Complex
• I : Hyperpyrexia (may reach 41 o C)
• II : Generalized Rigidity; Akinesia
• III : Altered Consciousness
• Dazed mutism
• Stupor
• Coma
• IV : Autonomic Dysfunction
• Diaphoresis
• Dyspnea
• Urinary incontinence
• Labile blood pressure
• Tachycardia
53
54. NMS : Causative Agents
• Haloperidol / fluphenazine : 1/2 of
reported cases
• Chlorpromazine / other phenothiazines
• Thioxanthines
• Metaclopromide
• Withdrawal from amantadine or levodopa
• ? more severe if neuroleptic plus lithium
54
55. NMS Onset and Duration
• Usually gradual onset : over 1 to 3
days
• Lasts 1 to 2 weeks after stopping oral
neuroleptics
• May last several weeks after stopping
IM neuroleptic ("depot" preparations)
55
56. NMS : Treatment
• Basic Rx same as for heatstroke
• O2, cooling, IV fluids, cardiac monitoring, ICU admission
• Stop the neuroleptic !
• Consider use of adjunctive drugs : (To restore CNS
dopamine levels)
• Bromocriptine 2.5 to 20 mg PO tid
• or Amantadine 100 mg PO tid
• or Levodopa 100 to 230 mg PO tid
• or Dantrolene 1 to 10 mg / Kg / day IV or PO
• Consider ECT (for Rx of the original condition) if the
neuroleptic cannot be restarted
56
57. Malignant Hyperthermia
• Definition :
• Inherited condition (autosomal dominant with
variable penetrance) causing fever, acidosis
and muscle ridigity in response to halogenated
general anesthetics and depolarizing
neuromuscular blockers (succinylcholine)
• Probably due to excessive release of
intracellular calcium in muscle ; Can rarely
occur in predisposed patient from stress alone
57
58. Malignant Hyperthermia :
Incidence
• 1 per 200,000 patients exposed to
general anesthesia
• Has occurred in response to stress
with only local anesthesia
• Untreated mortality 70 %
58
60. Malignant Hyperthermia
•
•
•
•
Usually occurs early introperatively
Can rarely present postoperatively
Can rarely present from stress alone
Can occur in patient who has had
uneventful prior surgery & anesthesia
60
61. Malignant Hyperthermia :
Patients at Risk
•
•
•
•
•
•
•
Positive family history
Family history of neuromuscular diseases
Increased muscle bulk
Frequent muscle cramps
Excessive anxiety
Twitches / fasciculations at rest
Diagnostic muscle biopsy / contracture test
available at some centers
61
62. Malignant Hyperthermia :
Family History
• Always specifically ask about family
history of problems with general
anesthesia (and also pseudocholinesterase
deficiency) prior to anesthetic
administration
• If any question of malignant hyperthermia,
use narcotic / benzodiazepine / N2O but not
halogenated anesthetics or succinylcholine
62
63. Malignant Hyperthermia :
Diagnosis
•
•
•
•
•
•
•
•
Fever : sudden rise : often 41 C
Tachycardia / tachypnea
Muscle rigidity (may first note masseter spasm)
DIC (may first note capillary bleeding in the
surgical wound)
Ventricular arrhythmias (may first note PVC's)
Acidosis
Hypotension
Rhabdomyolysis / myoglobinuria
63
64. Malignant Hyperthermia :
Treatment
• Discontinue the anesthetic immediately (use new tubing
or new anesthesia machine)
• Ventilate with 100 % O2
• Discontinue the surgery and close the wound quickly
• Call for help
• Start external cooling : Ice packs to scalp, groin, axillae :
hypothermic blanket : uncover patient
• Insert NG and foley : start iced NG lavage
• Draw blood (SMA6, CBC, LFT's, PT, PTT, CPK, Ca, ABG)
• IV fluid bolus + bicarb + mannitol
• Give dantrolene 1 mg / Kg IV every 3 to 5 min. (until
symptoms subside or dose of 10 mg / Kg reached)
64
66. Prevention of Malignant
Hyperthermia
• Choose other anesthetics (local, regional, spinal,
N2O + narcotics + pancuronium)
• Pretreat with 1 mg / Kg dantrolene PO q8h X 4
doses prior to surgery or 2.5 mg / Kg IV 30 min.
before surgery
• Have cooling materials and adequate dantrolene
in OR prior to inducing anesthesia
• 24 hour malignant hyperthermia hotline : (209) 634-4917
66
67. The Only 2 Things of Important Relevance
to Ask About in the Family History
• Malignant hyperthermia
• Pseudocholinesterase deficiency
67
68. Factors that Help Differentiate Neuroleptic
Malignant Syndrome (NMS) from Malignant
Hyperthermia (MH)
Precipitating factors
Onset
Cardinal signs
Genetic
predisposition
NMS
Neuroleptics
MH
Inhaled anesthetics,
depolarizing muscle
blockers, stress of
surgery
Minutes to hours
90% within 14 days;
up to years
Temp. as high as
Temp. as high as
105.8 F(41 C), auto- 111.2 F (44 C), rigid
nomic nervous
jaw muscles
system dysfunction
No
Yes
68
69. Factors that Help Differentiate Neuroleptic
Malignant Syndrome from Malignant
Hyperthermia (cont.)
Elevated creatine
kinase levels when
asymptomatic
Localization of
thermoregulatory
deficit
Treatment
Mortality
NMS ______
Rare
Hypothalamus
Supportive care,
dopaminergics,
dantrolene
Up to 20 %
MH _______
Often
Muscle (sarcoplasmic reticulum)
Supportive care,
dantrolene
Up to 60 %
69