Hyperthermia and heat stroke are conditions caused by the body failing to regulate its core temperature. Hyperthermia occurs when the body gains too much heat or loses too little, while fever is a regulated increase in temperature by the hypothalamus in response to infection. Heat illnesses form a spectrum from mild heat cramps to the most severe, heat stroke, defined as a core temperature over 40°C with neurological dysfunction. Heat stroke results from a failure of thermoregulation during heat exposure that leads to systemic inflammatory response and multi-organ damage.
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
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
Body temperature by Pandian M, Tutor Dept of Physiology, DYPMCKOP, this PPT f...Pandian M
BODY TEMPERATURE
HEAT BALANCE
Mechanisms of heat gain
Mechanisms of heat loss
VARIATIONS OF BODY TEMPERATURE
REGULATION OF BODY TEMPERATURE
Thermoreceptors
Hypothalamus: the thermostat
Thermoregulatory effector mechanisms
ABNORMALITIES OF BODY TEMPERATURE
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 .
Temperature practical cum theory part by Pandian M, From DYPMCKOP. This PPT f...Pandian M
INTRODUCTION
HOMEOTHERMIC ANIMALS
POIKILOTHERMIC ANIMALS
BODY TEMPERATURE
Normal Body Temperatures
VARIATIONS OF BODY TEMPERATURE
Pathological Variations
HEAT GAIN OR HEAT PRODUCTIONIN THE BODY
HEAT LOSS FROM THE BODY
Regulation of Body Temperature
Hypothalamus has two centers which regulate the body temperature:
Applied
We have described the pathophysiology of sleep in its simplest form before jumping into the disorders, there are many queries related to normal/abnormal sleep pattern by the parents in routine opds, then common sleep problems like sleep walking, terrors, night mares and Obstructive sleep apneas discussed in the presentation. Management guidelines for obstructive sleep apneas added.
The topic is very different from the adult ILDs, majority of childhood ILDs are developmental disorders of the Lungs. We have described the common ILDs in this ppt, also discussed how to approach and management in the end.
Various types of Pulmonary function tests, physiology , how to do spirometry, how to interpret, precautions while doing it, newer pfts : described in this ppt.
This ppt presents the schematic way to read chest X-rays in pediatric and adult patients. Very useful for Clinicians in daily practice and for students who are appearing in practical exams.
We will discuss briefly common tropical diseases found in INDIA. The presentation is basic for undergraduate students. we are covering dengue, malaria, chikungunya, and rickettsia in this presentation.
CHAPTER 1 SEMESTER V - ROLE OF PEADIATRIC NURSE.pdfSachin Sharma
Pediatric nurses play a vital role in the health and well-being of children. Their responsibilities are wide-ranging, and their objectives can be categorized into several key areas:
1. Direct Patient Care:
Objective: Provide comprehensive and compassionate care to infants, children, and adolescents in various healthcare settings (hospitals, clinics, etc.).
This includes tasks like:
Monitoring vital signs and physical condition.
Administering medications and treatments.
Performing procedures as directed by doctors.
Assisting with daily living activities (bathing, feeding).
Providing emotional support and pain management.
2. Health Promotion and Education:
Objective: Promote healthy behaviors and educate children, families, and communities about preventive healthcare.
This includes tasks like:
Administering vaccinations.
Providing education on nutrition, hygiene, and development.
Offering breastfeeding and childbirth support.
Counseling families on safety and injury prevention.
3. Collaboration and Advocacy:
Objective: Collaborate effectively with doctors, social workers, therapists, and other healthcare professionals to ensure coordinated care for children.
Objective: Advocate for the rights and best interests of their patients, especially when children cannot speak for themselves.
This includes tasks like:
Communicating effectively with healthcare teams.
Identifying and addressing potential risks to child welfare.
Educating families about their child's condition and treatment options.
4. Professional Development and Research:
Objective: Stay up-to-date on the latest advancements in pediatric healthcare through continuing education and research.
Objective: Contribute to improving the quality of care for children by participating in research initiatives.
This includes tasks like:
Attending workshops and conferences on pediatric nursing.
Participating in clinical trials related to child health.
Implementing evidence-based practices into their daily routines.
By fulfilling these objectives, pediatric nurses play a crucial role in ensuring the optimal health and well-being of children throughout all stages of their development.
Antibiotic Stewardship by Anushri Srivastava.pptxAnushriSrivastav
Stewardship is the act of taking good care of something.
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
WHO launched the Global Antimicrobial Resistance and Use Surveillance System (GLASS) in 2015 to fill knowledge gaps and inform strategies at all levels.
ACCORDING TO apic.org,
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
ACCORDING TO pewtrusts.org,
Antibiotic stewardship refers to efforts in doctors’ offices, hospitals, long term care facilities, and other health care settings to ensure that antibiotics are used only when necessary and appropriate
According to WHO,
Antimicrobial stewardship is a systematic approach to educate and support health care professionals to follow evidence-based guidelines for prescribing and administering antimicrobials
In 1996, John McGowan and Dale Gerding first applied the term antimicrobial stewardship, where they suggested a causal association between antimicrobial agent use and resistance. They also focused on the urgency of large-scale controlled trials of antimicrobial-use regulation employing sophisticated epidemiologic methods, molecular typing, and precise resistance mechanism analysis.
Antimicrobial Stewardship(AMS) refers to the optimal selection, dosing, and duration of antimicrobial treatment resulting in the best clinical outcome with minimal side effects to the patients and minimal impact on subsequent resistance.
According to the 2019 report, in the US, more than 2.8 million antibiotic-resistant infections occur each year, and more than 35000 people die. In addition to this, it also mentioned that 223,900 cases of Clostridoides difficile occurred in 2017, of which 12800 people died. The report did not include viruses or parasites
VISION
Being proactive
Supporting optimal animal and human health
Exploring ways to reduce overall use of antimicrobials
Using the drugs that prevent and treat disease by killing microscopic organisms in a responsible way
GOAL
to prevent the generation and spread of antimicrobial resistance (AMR). Doing so will preserve the effectiveness of these drugs in animals and humans for years to come.
being to preserve human and animal health and the effectiveness of antimicrobial medications.
to implement a multidisciplinary approach in assembling a stewardship team to include an infectious disease physician, a clinical pharmacist with infectious diseases training, infection preventionist, and a close collaboration with the staff in the clinical microbiology laboratory
to prevent antimicrobial overuse, misuse and abuse.
to minimize the developme
Global launch of the Healthy Ageing and Prevention Index 2nd wave – alongside...ILC- UK
The Healthy Ageing and Prevention Index is an online tool created by ILC that ranks countries on six metrics including, life span, health span, work span, income, environmental performance, and happiness. The Index helps us understand how well countries have adapted to longevity and inform decision makers on what must be done to maximise the economic benefits that comes with living well for longer.
Alongside the 77th World Health Assembly in Geneva on 28 May 2024, we launched the second version of our Index, allowing us to track progress and give new insights into what needs to be done to keep populations healthier for longer.
The speakers included:
Professor Orazio Schillaci, Minister of Health, Italy
Dr Hans Groth, Chairman of the Board, World Demographic & Ageing Forum
Professor Ilona Kickbusch, Founder and Chair, Global Health Centre, Geneva Graduate Institute and co-chair, World Health Summit Council
Dr Natasha Azzopardi Muscat, Director, Country Health Policies and Systems Division, World Health Organisation EURO
Dr Marta Lomazzi, Executive Manager, World Federation of Public Health Associations
Dr Shyam Bishen, Head, Centre for Health and Healthcare and Member of the Executive Committee, World Economic Forum
Dr Karin Tegmark Wisell, Director General, Public Health Agency of Sweden
Defecation
Normal defecation begins with movement in the left colon, moving stool toward the anus. When stool reaches the rectum, the distention causes relaxation of the internal sphincter and an awareness of the need to defecate. At the time of defecation, the external sphincter relaxes, and abdominal muscles contract, increasing intrarectal pressure and forcing the stool out
The Valsalva maneuver exerts pressure to expel faeces through a voluntary contraction of the abdominal muscles while maintaining forced expiration against a closed airway. Patients with cardiovascular disease, glaucoma, increased intracranial pressure, or a new surgical wound are at greater risk for cardiac dysrhythmias and elevated blood pressure with the Valsalva maneuver and need to avoid straining to pass the stool.
Normal defecation is painless, resulting in passage of soft, formed stool
CONSTIPATION
Constipation is a symptom, not a disease. Improper diet, reduced fluid intake, lack of exercise, and certain medications can cause constipation. For example, patients receiving opiates for pain after surgery often require a stool softener or laxative to prevent constipation. The signs of constipation include infrequent bowel movements (less than every 3 days), difficulty passing stools, excessive straining, inability to defecate at will, and hard feaces
IMPACTION
Fecal impaction results from unrelieved constipation. It is a collection of hardened feces wedged in the rectum that a person cannot expel. In cases of severe impaction the mass extends up into the sigmoid colon.
DIARRHEA
Diarrhea is an increase in the number of stools and the passage of liquid, unformed feces. It is associated with disorders affecting digestion, absorption, and secretion in the GI tract. Intestinal contents pass through the small and large intestine too quickly to allow for the usual absorption of fluid and nutrients. Irritation within the colon results in increased mucus secretion. As a result, feces become watery, and the patient is unable to control the urge to defecate. Normally an anal bag is safe and effective in long-term treatment of patients with fecal incontinence at home, in hospice, or in the hospital. Fecal incontinence is expensive and a potentially dangerous condition in terms of contamination and risk of skin ulceration
HEMORRHOIDS
Hemorrhoids are dilated, engorged veins in the lining of the rectum. They are either external or internal.
FLATULENCE
As gas accumulates in the lumen of the intestines, the bowel wall stretches and distends (flatulence). It is a common cause of abdominal fullness, pain, and cramping. Normally intestinal gas escapes through the mouth (belching) or the anus (passing of flatus)
FECAL INCONTINENCE
Fecal incontinence is the inability to control passage of feces and gas from the anus. Incontinence harms a patient’s body image
PREPARATION AND GIVING OF LAXATIVESACCORDING TO POTTER AND PERRY,
An enema is the instillation of a solution into the rectum and sig
Empowering ACOs: Leveraging Quality Management Tools for MIPS and BeyondHealth Catalyst
Join us as we delve into the crucial realm of quality reporting for MSSP (Medicare Shared Savings Program) Accountable Care Organizations (ACOs).
In this session, we will explore how a robust quality management solution can empower your organization to meet regulatory requirements and improve processes for MIPS reporting and internal quality programs. Learn how our MeasureAble application enables compliance and fosters continuous improvement.
One of the most developed cities of India, the city of Chennai is the capital of Tamilnadu and many people from different parts of India come here to earn their bread and butter. Being a metropolitan, the city is filled with towering building and beaches but the sad part as with almost every Indian city
How many patients does case series should have In comparison to case reports.pdfpubrica101
Pubrica’s team of researchers and writers create scientific and medical research articles, which may be important resources for authors and practitioners. Pubrica medical writers assist you in creating and revising the introduction by alerting the reader to gaps in the chosen study subject. Our professionals understand the order in which the hypothesis topic is followed by the broad subject, the issue, and the backdrop.
https://pubrica.com/academy/case-study-or-series/how-many-patients-does-case-series-should-have-in-comparison-to-case-reports/
1. HYPERTHERMIA AND
HEAT STROKE
DR DEEPAK KUMAR
ASSISTANT PROFESSOR
MAULANA AZAD MEDICAL COLLEGE
NEW DELHI, INDIA
Images used in this PPT are freely available on Google to download, for any copyright
issues please contact- deepakk70@gmail.com, we will immediately remove it.
2. HYPERTHERMIA
• Rise in body temp. beyond the hypothalamic set point
• Due to inadequate loss and/or excessive heat gain.
• Failed Thermoregulation.
3. • What is Fever?
• How it is different from Hyperthermia?
To Differentiate, Lets first understand the Patho-
physiology of both.
5. • THERMORECEPTORS IN
CORTEX
/HYPOTHALAMUS/MID
BRAIN/MEDULLA/SC/D
EEP ABDOMINAL
ORGANS
CORE TEMP.
• THERMORECEP
TORS IN SKIN
SHELL
TEMP.
LAT.
SPINOTH
ALAMIC
TRACT
TEMP.
CHANGE
SENSED
TEMP DIFF.
FROM SET
POINT
PREOPTIC
/ANTERIOR
HYPOTHAL
AMOUS
THERMOREG
ULATION
Thermoregulatory center
McAllen RM. Preoptic thermoregulatory mechanisms in detail. Am J Physiol Regul Integr Comp Physiol 2004;287(2):R272-3
6.
7. FEVER
• Body’s defensive response
• Hypothalamic set point is raised
• Thermo-regulated elevation of body temp.
• Unfavourable environment for pathogens to grow
• High grade >40 C can be seen but remains briefly
followed by sweating
9. HEAT LOSS HEAT GAIN
PHYSICAL ACTIVITY
BASAL METABOLISM
EMOTIONAL/HORMONAL
PASSIVE HEAT
CONDUCTION(3%)
CONVECTION (12-15%)
EVAPORATION(25%)
RADIATION(55-65%)
HYPER
THERMIA
Lee-Chiong TL Jr, Stitt JT. Disorders of temperature regulation. Compr Ther 1995;21(12):697-704
10. HYPERTHERMIA VS FEVER
HYPERTHERMIA FEVER
Setting Environmental
exposure/increased
production/decreased
dissipation
Infection
Temperature (>40 deg C/104 deg F)
common
(>40 deg C/104 deg F)
rare
Hypothalamic set point Not raised raised
Sweating Usually absent or minimal
but may be present
continuously
Profuse
Skin Dry /flushed Moist
Shivering Absent Present
Response to antipyretics Absent Marked
14. CHILDREN
MORE PRONE TO
HYPERTHERMIA
GREATER BSA/MASS
RATIO
MORE HEAT
PRODUCED PER KG
BWT
SLOWER SWEATING
RATE
SWEATING STARTS
AT HIGHER TEMP
LOWER CARDIAC
OUTPUT
Bytomski, Jeffrey R., and Deborah L. Squire. “Heat illness in children..” Current Sports Medicine Reports 2, no. 6
(December 2003)
27. 1. HEAT CRAMPS
• Intermittent ,painful, spasmodic contraction
of skeletal muscles (Calf & hamstring)
• During / after vigorous exercise
• Hypotonic fluid + insuff. Na intake hyponatremia prevent
Na gradient from being strong enough to power the Ca
pumps Ca ions remain in the myofibrils muscle stays
contracted
• Oral rehydration and electrolyte replenishment
28. 2. PRICKLY HEAT ( MILIRIA RUBRA/SWEAT RASH/HEAT RASH)
• Macular /popular/vesicular, erythematous, pruritic rash
• Common @ clothed areas
• Blockage of sweat gland openings by stratum corneum debris
causing inflammation of sweat glands
• Ducts rupture vesicles risk of other major heat illness
increase(if large surface of the body involved) due to anhidrosis
in the affected region
• Loose & clean clothes + Antihistaminics
29. 3. HEAT TETANY
• Heat hyperventilation respi alkalosis parsthesias
(extremities & circumoral) & carpopedal spasm
• High pH causes enhanced binding of calcium with proteins
iCa
• Can be differentiated from heat cramps as there is very little to
no pain
• Cooling
30. 4. HEAT EXHAUTION
• Illness with nonspecific symptoms.
• Common- General irritability, fatigue, weakness, light-headedness,
headache, nausea ,vomiting, and muscle cramps.
• accompanied by poor judgment, irritability, dizziness, making
differentiation from heat stroke difficult.
• Core temp. < 40 deg C
31. • 2 types -
• water depletion type
- lack of fluid intake + exertion in hot environment
-signs of hypovolemia predominate
• salt depletion type
- consumption of hypotonic fluids hyponatremia neurological
features seizures & coma
Most cases – mixed salt and water depletion
32. MANAGEMENT
Initial management – on site
• Discontinue motor activity
• Remove source of heat exposure
• Reduce clothing or equipment.
• Shift to a cool or air-conditioned space
• Place in Supine position Raise lower extremities slightly
Venous return
• Oral rehydration therapy
33. Redrawn from Glazer JL: Management of heatstroke and heat exhaustion, American Family Physician
34. WHEN TO CONSIDER HOSPITALISATION?
• The symptoms of heat exhaustion mostly resolve
within 2–3 hours.
• If- Patient’s symptoms have not improved within the
first 20–30 minutes of the initial on site management.
36. Measuring rectal temp.
• Put petroleum jelly on the bulb end.
• Lay the child face down and spread the
buttocks apart.
• Insert the bulb end approx. 3 cm past the anal
margin.
• Held for at least 1 minute, or until the temp.
stopped rising.
Morley CJ. Axillary and rectal temperature measurements in infants. Arch Dis
Child. 1992 Jan;67(1):122-5.
38. • Laboratory evaluation
Eletrolyte imbalances
Features of dehydration- elevated hematocrit and serum urea.
LFT, KFT, VBG- ?? Heat Stroke progression.
• Intravenous fluid and electrolyte replacement therapy is
employed.
• More aggressive cooling measures not warranted
39. Seen commonly in elderly patients
5. HEAT EDEMA
• Dependent extremities
• Due to cutaneous vasodilation + pooling of interstitial fluid
• Resolves within few days
• Diuretics NOT to be given volume depletion
6. HEAT SYNCOPE
• prolonged stationary standing / sudden standing after prolonged heat
exposure
• Volume depletion + peripheral vasodilation + decreased vasomotor tone
venous return causing cerebral hypoperfusion
• Elderly
• Fluids + cooling+ supine position
41. MALIGNANT HYPERTHERMIA
• Genetic syndrome (50% AD & 50% point mutation) - gene encoding
RYR1 ryanodine receptor
• The incidence of MH reactions ranges from 1:5,000 to 1:50,000.
• Neuromuscular disorders (muscular dystrophy, myotonia) high risk
• First signs- masseter spasm during ET intubation/ increase ETCO2
• Imp. in OT/intensive setting
Rosenberg, Henry et al. “Malignant hyperthermia.” Orphanet journal of rare diseases )
42. Management
• Immediate discontinuation of the possible trigger agent.
• The inspired gas is converted to 100% oxygen at a high flow rate to
wash out residual anaesthetic as rapidly as possible.
• The dantrolene, 2.5 mg/kg IV, is given as rapidly as possible.
• Cold normal saline, 15 mL/kg, is administered rapidly if the
temperature is >39°C
• Hyperkalemia
45. SEROTONIN SYNDROME
Triad – abnormalities of-
1. mental status (agitation / hypervigilance/ delirium)
2. neuromuscular function (clonus/ hyperreflexia)
3. autonomic function (hyperthermia/ tachycardia/ HTN/
diaphoresis/vomiting diarrhoea)
Develops within 24 hrs of drug admin
Overstimulation of 5-HT1A and 5-HT2A
46. Management
• Antidote- Cyproheptadine, a H1 receptor antagonist with
nonspecific serotonergic (5-HT1A and 5-HT2A) antagonistic
properties.
• Cyproheptadine (tablet or syrup).
• Total daily dose of 0.25 mg/kg divided every 6 hours.
• The maximum daily dose is 12 mg for children 2-6 years and 16 mg
for children 7-14 years old.
48. Definition
• No universally accepted definition exists
• Bouchama’s definition (commonly used)
Core body temp. above 40 °C, accompanied by hot dry
skin and CNS abnormalities (delirium, convulsions &
coma)
Form of hyperthermia associated with SIR that leads
multi-organ dysfunction, predominantly
encephalopathy.
Bouchama A, Knochel JP. Heat stroke. N Engl J Med. 2002;346:1978–88
49. Features Bauchama Misset Pease JAAM Modified JAAM
Tempera
ture
> 40˚C >40.5°
C
>40.6 °C High environmental
temperature
High
environmental
temperature
CNS Encephalop
athy
delirium,
convulsions
& coma
Alteration
of mental
status
(coma,
delirium,
disorientati
on or
seizures)
Impaired
consciousness, Japan
Coma Scale score of
≥2 , cerebellar
symptoms,
convulsions, or
seizures)
Glasgow Coma
Scale (GCS) score
of ≤14
Sytemic SIR with
MOD
Hepatic/renal
dysfunction
Coagulation disorder
Creatinine or
total bilirubin
levels of ≥1.2
mg/dL
Skin Hot, dry
skin
Hot, dry, or
flushed skin
51. Features Classic heat stroke Exertional heat stroke
Age group Prepubertal, elderly Post-pubertal and active
Occurrence Epidemic (heat waves) Sporadic (any time of year)
Activity Sedentary Strenuous
Health status Chronically ill Generally healthy
Medications Prescribed for chronic illness None/ illicit drugs
Mechanism Absorption of environmental heat
and poor heat dissipation
Excessie heat production,
which overwhelms heat-loss
Sweating Maybe absent (dry skin) Usually present (wet skin)
52. Epidemiology
• “Silent disaster” - develops slowly and kills humans
and animals nationwide.
• > 22,000 fatalities in India (1992-2015).
• In 2015, the country witnessed the fifth deadliest
heat wave in history.
2300 deaths – in Andhra pradesh., Telangana,
Punjab, Odisha, Bihar
• June 2019- 53.96% population exposed to heat
waves
National Disaster Management Authority. GOI. 2017
55. Heat Wave
• Condition that leads to physiological stress and can
cause death due to rise in atmospheric temp.
• World Meteorological Organization
Daily max. temp. exceeds the avg. max. temp. of
the area by 5° C for 5 consecutive days.
Or if the max temp. of any place continues to >45°
C consecutively for 2 days. (Costal >40)
56.
57. Heat index / Apparent temperature
• What the temp. feels like to the body when the
humidity is combined with the air temp.
• When the humidity is high, rate of perspiration
decreases and the body feels warmer.
• Ex- if air temp. is 34°C and relative humidity is 75%,
the heat index--how hot it feels--is 49°C.
The same effect is reached at just 31°C when the
relative humidity is 100 %.
58.
59. • Mortality from heat stroke has been reported to
increase due to climate change
• By the 2050s, heat stroke-related deaths are
expected to rise by nearly 2.5 times
• 25-50% mortality even with aggressive care
65. Laboratory evaluation
Test Findings Interpretation
Blood Leukocytosis Systemic inflammation from
(heat-related illness or
sepsis)
Elevated hematocrit Dehydration
Thrombocytopenia,
elevation in hyper-
segmented neutrophils, and
atypical lymphocytes
heat injury
Electrolytes Hyponatremia
Hypernatremia
hyperkalemia
hyperphosphatemia, and
hypocalcemia
Loss in sweat
Dehydration
Muscle damage
Glucose Hypoglycemia Fulminant hepatic failure
66. LFT Elevation in AST and ALT Liver dysfunction
KFT Deranged KFT AKI
Urine Proteins Rhabdomyolysis
Myoglobulin Rhabdomyolysis
Increased sp. gravity Hypovolemia
CSF Nonspecific pleocytosis
CSF protein elevated
Given in National GUIDE
Animal model studies.
ABG Metabolic acidosis
Respiratory alkalosis
Lactic acidosis
CNS stimulation-
hyperventilaton
67. Coagulation studies Elevated PT-INR, APTT (DIC)
Creatinine kinase Raised (Muscle injury)
Chest X ray ARDS
Neuroimaging Cerebral infarction, hemorrhage, or
edema
ECG Arrhythmias
68. ECG Changes
• Seen in 85% of HS patients in one study.
• sinus tachycardia (43-79%)
• QT prolongation (61%)
• Both non-specific and specific ST changes associated
with coronary artery territories
• conduction defects- incomplete and complete RBBB
Mimish L. Electrocardiographic findings in heat stroke and exhaustion: A study on Makkah pilgrims.
Journal of the Saudi Heart Association. 2012; 24(1): 35-9 12.
Akhtar MJ, al-Nozha M, al-Harthi S & Nouh MS. Electrocardiographic abnormalities in patients with
heat stroke. Chest. 1993; 104(2): 411-4
69. Neuroimaging
MRI-
• selective vulnerability of cerebellar Purkinje cells to
heat-induced injury
• Ischemia/Hemmorhage in dentate nuclei, cerebellar
hemispheres, cerebellar peduncles, midbrain,
thalami, hippocampi, basal ganglia, the splenium,
temporo-occipital lobes
• Cerebral Edema
• Cerebral atrophy ( Late – after 2 weeks, Progressive)
Albukrek D, Bakon M, Moran DS, Faibel M, Epstein Y (1997) Heat-strokeinduced cerebellar atrophy: clinical
course, CT and MRI findings. Neuroradiology 39: 195–197
Sudhakar PJ, Al-Hashimi H (2007) Bilateral hippocampal hyperintensities: a new finding in MR imaging of heat
stroke. Pediatr Radiol 37: 1289–1291
71. PRINCIPLES
• FIRST COOL THEN SHIFT
• RAPID COOLING METHOD HAS TO BE USED
• INTENSIVE CARE UNIT
• MOD MONITORING AND ORGAN SPECIFIC
TREATMENT
72. • Deaths has been seen as early as within 30 minutes
of heat stroke onset.
• start effective cooling method with min. rate of
0.20 C/ min.
• End point used in large series is 39 C (proven safe)
73. COOLING METHODS
COOL WATER IMMERSION
EXTERNAL COOLING
METHODS
INTERNAL COOLING
METHODS
CONDUCTION METHOD
EVAPORATION AND
FANNING
COOL IV SALINE
GASTRIC LAVAGE
BLADDER/BOWEL
IRRIGATION
BODY COOLING UNIT
75. Whole body cold water immersion
• Most effective method of cooling
• Rapid rate of cooling
Ice used in water (1 C) – 0.35 C/min
Cold Water (5 C)- 0.15 C/min
• Immersion of only torso and legs- 0.25 C/min
level of neck- 0.35 C/min
hands and legs- 0.15 C/min
recommended - National Athletic Trainers’ Association and American College of Sports Medicine
77. ?? Peripheral vasoconstriction
• Thought previously – immersion of body to cold water
– per vasoconstriction and shivering ( heat
production)
• Recent studies shown
a) Thermogenesis via shivering occurs in
normothermic not hyperthermia. (1)
b) if +, do not impede the cooling process (2)
1. Proulx CI, Ducharme MB, Kenny GP. Effect of water temperature on cooling efficiency during
hyperthermia in humans. J Appl Physiol. 2003;94(4):1317–1323
2. Casa DJ, McDermott BP, Lee E, Yeargin SW, Armstrong LE, Maresh CM. Cold-water immersion: the
gold standard for exertional heat stroke treatment. Exerc Sport Sci Rev. 2007;35(3):141–149
78. Disadvantages
• Whole setup is cumbersome
• More man power required
• Difficult to maintain IV access/vitals monitoring
• CPR if needed, cant be performed
• Patient can vomit, pass stool/urine
79. Evaporation and fanning
• Less efficient c/w cold water immersion
• Rate of cooling- o.15 C/min
• Body exposed- mist sprayer filled with cold water is
sprayed all over the body- continued with air fan @
min 0.5 m/s.
• If sprayer is not available, cold towels can be used.
Brendon P. McDermott et al. Acute Whole-Body Cooling for Exercise-Induced Hyperthermia: A
Systematic Review. Journal of Athletic Training 2009;44(1):84–93
80. Cooling by ice packs
• Conductive cooling by the application of crushed ice
or ice packs to the body
• strategic application of ice packs to the axilla, neck,
and groin
• Rate of cooling- 0.028 C/m
• When applied to whole body- 0.034 C/m
• Ineffective method- takes 110 minutes to cool a
patient from 42.2C (108F) to 38.9C (102F)
Brendon P. McDermott et al. Acute Whole-Body Cooling for Exercise-Induced Hyperthermia: A
Systematic Review. Journal of Athletic Training 2009;44(1):84–93
84. Body-cooling unit (BCU),
• Specially constructed device, produces a superior
cooling rate of 0.31 ˚ C/min
• Directing air currents while simultaneously spraying
water on patients
• Cost- 18,000 USD!!!
Brendon P. McDermott et al. Acute Whole-Body Cooling for Exercise-Induced Hyperthermia: A
Systematic Review. Journal of Athletic Training 2009;44(1):84–93
86. Cold External Environment
• Bring the patient away from the exposure
• Preferably to the cool area (ac units)
• Rate of cooling – 21 C/ 20% humidity- 0.06
32 C/ 20% humidity-0.02
• management in an ICU without ac were
independently associated with an increased risk of
hospital death
Misset B et al. Mortality of patients with heatstroke admitted to intensive care units during the
2003 heat wave in France: a national multiple-center risk factor study. Crit Care Med. 2006;34:
1087–92.
87. Internal cooling method
Include gastric, peritoneal, and bladder lavage with
cold water.
• Rate of cooling- 0.018 C/min
• Role not been fully established
• Can be used along with other methods
Brendon P. McDermott et al. Acute Whole-Body Cooling for Exercise-Induced
Hyperthermia: A Systematic Review. Journal of Athletic Training 2009;44(1):84–
93
88. Other cooling methods
• Intravascular balloon catheter cooling
• Rate of cooling - 0.12 C/min
• Inbuilt thermistor for sensing core body temp and
fluid infused
• change in temp. as small as 0.1°C sensed
Hamaya H1 et al. Successful management of heat stroke associated with multiple-organ dysfunction
by active intravascular cooling. Am J Emerg Med. 2015 Jan;33(1):124.
91. Medications
Dantrolene: Impairs calcium release from the
sarcoplasmic reticulum
• Reduces muscle excitation and contraction
• Studies show no difference in cooling rate, outcome,
mortality
Antithrombin III, rsThrombomodulin α:
• To treat coagulopathy??
• No proven studies
Eran Hadad et al. Clinical review: Treatment of heat stroke: should dantrolene be
considered? Crit Care. 2005; 9(1): 86–91
Hagiwara S et al. Highdose antithrombin III prevents heat stroke by attenuating
systemic inflammation in rats. Inflamm Res. 2010;59:511–8.
92. Poor prognostic factors
• Core temp > 40 C- bad, > 42 C - worst
• Duration of illness, > 60 min- bad, >90 min – worst
• Age - > 80 yrs, no pediatric data.
• Associated Heart disease or Malignancy
• Anuria, Coma
• On Diuretic therapy
• Use of Ionotropes within first 24 hours in ICU
• Management without Ac in ICU
• Increased PT, Raised ALT > 1000
Hausfater et al. Prognostic factors in non-exertional heatstroke. Intensive Care Med. 2010;36: 272–80.
Misset B et al. Mortality of patients with heatstroke admitted to intensive care units during the 2003
heat wave in France: a national multiple-center risk factor study. Crit Care Med. 2006;34: 1087–92
93.
94. At site other than health center
• Remove clothing, cool water& fan skin.
• Place ice packs.
• Offer cool fluids if alert and able to drink
• Immediately transfer to nearest health care facility
• While transferring, cooling has to be contd.
• Start intravenous fluids.
95. AT HEALTH CENTRE
STEP 1
• Clinical assessment for CVS, Resp & CNS func.
• Exclude other D/D.
• Assess airway and ensure good resp. efforts.
• Put oxygen, IV lines take samples.
• Check body core temp. - rectal or esophageal.
• Send ICU call, start and continue treatment
96.
97. STEP-2. Initiate cooling process
• Removal of body clothing
• Use mist fan / air conditioned room / Stand fans
• Ice packs at groins, neck and axilla, spray cool water
• Ongoing tepid sponging
• Lavage with cold saline via NG tube or urinary
catheter
98.
99. STEP 3.
• Cooling can be stopped – 39 C
• Use Benzodiazepines for seizures.
• DO NOT use PCM or other NSAIDS.
• Close monitor- Core temp, BP, 4 hourly Dx, Hourly
Urine output, ECG, half hourly GCS
100. Step 4
• Seek and trace investigation results
• Look for signs of coagulopathies, AKI and liver
dysfunction
• ABG regularly – look for metabolic acidosis
• Most important!!!!