Heat stroke is a life-threatening condition defined as a core body temperature above 41°C with neurological dysfunction. It can be exertional, caused by strenuous physical activity in heat, or nonexertional, often affecting the elderly, chronically ill, or very young. Risk factors include impaired thermoregulation, dehydration, and medications that interfere with sweating. Complications involve multiple organ systems and can include delirium, seizures, hypotension, liver and kidney damage, and disseminated intravascular coagulation. Immediate cooling and medical care are crucial to prevent high mortality rates from heat stroke.
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
Heat-related illness and injuries are the most frequent cause of environmentally related death, occurring more often than illness or injury related to lightning, tornado, hurricane, flood, cold, and winter-related fatalities.
Such illnesses and injury range from minor conditions such as heat rash, edema, cramps and fainting to moderate conditions such as heat exhaustion. Heat stroke is a major heat emergency, representing complete breakdown of the body's ability to regulate its temperature.
Presentation prepared by John W. Lyng, MD, FACEP, NREMT-P. Dr Lyng is Medical Director or North Memorial Ambulance & Air Care and an Emergency Department Physician at North Memorial Medical Center in Minneapolis.
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
Heat-related illness and injuries are the most frequent cause of environmentally related death, occurring more often than illness or injury related to lightning, tornado, hurricane, flood, cold, and winter-related fatalities.
Such illnesses and injury range from minor conditions such as heat rash, edema, cramps and fainting to moderate conditions such as heat exhaustion. Heat stroke is a major heat emergency, representing complete breakdown of the body's ability to regulate its temperature.
Presentation prepared by John W. Lyng, MD, FACEP, NREMT-P. Dr Lyng is Medical Director or North Memorial Ambulance & Air Care and an Emergency Department Physician at North Memorial Medical Center in Minneapolis.
Heat related illnesses simply explained, spectrum of hyper and hypothermia related clinical scenarios with symptoms, diagnosis, management and prognosis.
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/.
Heat related illnesses simply explained, spectrum of hyper and hypothermia related clinical scenarios with symptoms, diagnosis, management and prognosis.
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/.
Heat related pathologies are a group of disorders, associated with impairments of thermoregulation, which occur while individuals are exposed to high temperatures. The spectrum of these clinical entities ranges from syndromes with mild/moderate clinical manifestations, like heat edema/cramps/rash to the life-threatening heat stroke.
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.
FORENSIC MEDICINE BOOKS OF
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GOUTAM BISWAS
MAGENDRAN
OTHERS
TOPICS :-
COLD INJURY
HEAT INJURY
BURN INJURY
SCALDS
ELECTROCUTION
LIGHTENING INJURY
THIS IS ONE OF MY BEST AND FAVORITE PRESENTATIONS. IT WILL SURELY HELP YOU A LOT DURING YOUR EXAMS (PROF/OTHERS). IF YOU FIND IT HELPFUL THEN LIKE IT. MY EMAIL ID IS GIVEN ON THE 2ND PAGE OF THIS PRESENTATION, IF YOU WANT PRESENTATIONS ON OTHER TOPICS (ANY MEDICAL SUBJECTS) THEN MAIL ME. I WILL WORK ON IT LOT AND WILL BE TRYING TO SHARE WITH YOU GUYS...
THANK YOU
A fever is a body temperature that is higher than normal. A normal temperature can vary from person to person, but it is usually around 98.6 F. A fever is not a disease. It is usually a sign that your body is trying to fight an illness or infection. Infections cause most fevers
Homeless people are vulnerable to the extremes of weather and exposure. Please help the homeless by donating to our #circleofwarmth campaign. https://info.miramedgs.com/CIRCLEOFWARMTHDONATETODAY
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
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Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
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These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
2. DEFINITION Elevation of the body temperature beyond 104 0 F . Most severe form of the heat-related illnesses Defined as a body temperature higher than 41.1°C (106°F) associated with neurologic dysfunction.
3.
4. FORMS Exertional heatstroke (EHS) - young,strenuous physical activity, for a prolonged period of time, in a hot environment. Classic nonexertional heatstroke (NEHS) -sedentary elderly individuals, chronically ill, and very young persons. Both associated with a high morbidity and mortality, if therapy is delayed.
5. Pathophysiology Maintainence of constant body temperature by balancing heat gain with heat loss. Excessive heat denatures proteins, destabilizes phospholipids and lipoproteins, and liquefies membrane lipids leading to cardiovascular collapse, multi organ failure, and, ultimately, death.
6. HEAT GENERATION,INTERNAL At rest, basal metabolic processes produce a 100 kcal of heat per hr . Strenuous physical activity can increase heat production more than 10-fold(>1000 kcal/h) Fever, shivering, tremors, convulsions, thyrotoxicosis,sepsis, sympathomimetic drugs increase heat production.
7. HEAT GENERATION ,EXTERNAL Acquire heat from the environment through mechanisms involved in heat dissipation, including conduction, convection, and radiation. They occur at the level of the skin and require a properly functioning skin surface, sweat glands, and ANS , but may be manipulated by behavioral responses.
8. HEAT TRANSFER Conduction -transfer of heat between 2 surfaces with differing temp that are in direct contact. Convection - between the body's surface and a gas or fluid with a differing temperature. Evaporation, which refers to the conversion of a liquid to a gaseous phase Radiation - in the form of electromagnetic waves between the body and its surroundings. The efficacy of radiation depends on the angle of the sun, season, and the presence of clouds. During summer, lying down in the sun can result in a heat gain of up to 150 kcal/h.
9. HEAT LOSS/DESSIPATION Physiologic responses to heat Increase in the blood flow to the skin, major heat-dissipating organ. Dilatation of the peripheral venous system. Stimulation of the eccrine sweat glands to produce more sweat.
10. RISK GROUP When heat gain exceeds heat loss, the body temperature rises. AT RISK INDIVIDUALS who lack the capacity to modulate the environment (eg, infants). Elderly persons and patients with diminished cardiovascular reserves . Patients with skin diseases and those taking medications that interfere with sweating .
11. Frequency USA-CDC- 8,015 deaths were attributed to excessive heat exposure from 1979-2003, 334 deaths/yr. 3,442 deaths from exposure to extreme heat in US 1999–2003. 1998, worst heat waves to strike India in 50 years resulted in > 2600 deaths in 10 wks. Unofficial reports described the number of deaths as almost double .
15. Mortality/Morbidity Duration of the temperature elevation. Delayed theraphy- mortality rate may be as high as 80%; Early diagnosis and immediate cooling -10%. Highest among the elderly population, pts with preexisting disease, those confined to a bed, and those who are socially isolated.
16. causes Increased heat production Increased metabolism Infections Sepsis Encephalitis Stimulant drugs Thyroid storm Increased muscular activity Exercise((doubles ) Convulsions Tetanus Strychnine poisoning Sympathomimetics Thyroid storm Strenuous exercise and status epilepticus can increase heat production 10-fold . Stimulant drugs, including cocaine and amphetamines, can generate excessive amounts of heat by increasing metabolism and motor activity through the stimulatory effects of dopamine. Neuroleptic agents also may elevate body temperature by increasing muscle activity, but, occasionally, these agents may cause neuroleptic malignant syndrome(NMS. Idiosyncratic reaction characterized by hyperthermia, altered mental status, muscle rigidity, and autonomic instability and appears to be due to excessive contraction of muscles. Inhaled volatile anesthetics and succinylcholine, may result in malignant hyperthermia. MH- decreased ability of the sarcoplasmic reticulum to retain calcium, resulting in sustained muscle contraction.
17. Decreased heat loss Reduced sweating Dermatologic diseases Drugs Burns Reduced CNS responses Advanced age Toddlers and infants Alcohol Barbiturates Other sedatives Reduced cardiovascular reserve Elderly persons Beta-blockers Calcium channel blockers Diuretics Drugs Anticholinergics Neuroleptics Antihistamines Exogenous factors High ambient temperatures High ambient humidity Reduced ability to acclimatize Children and toddlers Elderly persons Reduced behavioral responsiveness: Infants, patients who are bedridden, and patients who are chronically ill are at risk for heatstroke –cannot control their environment and water intake.
18. Clinical features T> 41°C , anhidrosis associated with an altered sensorium. Classic heatstroke- during environmental heat waves-very young persons ,elderly population, individuals who are chronically ill-failure of the body's heat dissipating mechanisms. EHS –young-healthy individuals who engage in strenuous physical activity-increased heat production.
19. Exertional heatstroke Hyperthermia, diaphoresis, and an altered sensorium, manifest suddenly during extreme physical exertion in a hot environment. Abdominal and muscular cramping, nausea, vomiting, diarrhea, headache, dizziness, dyspnea, weakness commonly precede the heatstroke . Syncope and LOC observed commonly before the development of EHS. Occurs in young, healthy individuals (eg, athletes, firefighters, military personnel) who, while engaging in strenuous physical activity, overwhelm their thermoregulatory system and become hyperthermic. As their ability to sweat remains intact,EHS pts are able to cool down after cessation of physical activity and may present with T<41°C. Risk factors that increase the likelihood of heat-related illnesses include a preceding viral infection, dehydration, fatigue, obesity, lack of sleep, poor physical fitness, and lack of acclimatization. May occur because of increased motor activity due to drug use, such as cocaine and amphetamines, and as a complication of status epilepticus.
20. Nonexertional heatstroke Hyperthermia, anhidrosis, and an altered sensorium, which develop suddenly after a period of prolonged elevations in ambient temperatures (ie, heat waves). Core body temperatures greater than 41°C are diagnostic. CNS symptoms, ranging from minor irritability to delusions, irrational behavior, hallucinations, and coma . Anhidrosis due to cessation of sweating is a late occurrence. Other CNS symptoms - seizures, cranial nerve abnormalities, cerebellar dysfunction, and opisthotonos. Initially may exhibit a hyperdynamic circulatory state, but, in severe cases, hypodynamic states may be noted. Affects people who are unable to control their environment and water intake (eg, infants, elderly persons, individuals who are chronically ill),. people with reduced cardiovascular reserve (eg, elderly persons, patients with chronic cardiovascular illnesses). people with impaired sweating (eg, patients with skin disease, patients ingesting anticholinergic and psychiatric drugs). Infants - immature thermoregulatory system,. Elderly persons -impaired perception of changes in body and ambient temperatures and a decreased capacity to sweat.
21.
22. Heat Stroke Col SR Mehta VSM*, Lt Col DS Jaswal+ MJAFI 2003; 59 : 140-143
23. Physical features Vital signs Temp->41°C( presence of sweating, evaporating mechanisms, and the initiation of cooling methods<41°C ). Pulse: Tachycardia to rates exceeding 130 . BP: normotensive, with a wide pulse pressure; ( hypotension due to vasodilation of the cutaneous vessels, pooling of the blood in the venous system,dehydration, myocardial damage and may signal cardiovascular collapse.)
24. Central nervous system Universal in persons with heatstroke. Range from irritability to coma. Pts may present with delirium, confusion, delusions, convulsions, hallucinations, ataxia, tremors, dysarthria, and other cerebellar findings, as well as cranial nerve abnormalities and tonic and dystonic contractions of the muscles. Pts also may exhibit decerebrate posturing, decorticate posturing, or they may be limp. Coma (electrolyte abnormalities, hypoglycemia, hepatic encephalopathy, uremic encephalopathy, and acute structural abnormalities, such as intracerebral hemorrhage due to trauma or coagulation disorders). Cerebral edema and herniation also may occur during the course of heatstroke.
25. Eyes Examination of the eyes may reveal nystagmus and oculogyric episodes due to cerebellar injury. The pupils may be fixed, dilated, pinpoint, or normal.
26. Cardiovascular Heat stress places a tremendous burden on the heart. Pts with preexisting myocardial dysfunction do not tolerate heat stress for prolonged periods. Pts commonly exhibit a hyperdynamic state, with tachycardia, low systemic vascular resistance, and a high cardiac index. A hypodynamic state, with a high systemic vascular resistance and a low cardiac index, may occur in patients with preexisting cardiovascular disease and low intravascular volume. A hypodynamic state also may signal cardiovascular collapse. High-output cardiac failure and low-output cardiac failure may occur.
27. Pulmonary Pts with heatstroke commonly exhibit tachypnea and hyperventilation caused by direct CNS stimulation, acidosis, or hypoxia. Hypoxia and cyanosis - atelectasis, pulmonary infarction, aspiration pneumonia, and pulmonary edema.
28. Hepatic Jaundice and elevated liver enzymes. Rarely, fulminant hepatic failure occurs, accompanied by encephalopathy, hypoglycemia, and disseminated intravascular coagulation (DIC) and bleeding.
29. RENAL Musculoskeletal Muscle tenderness and cramping ,rhabdomyolysis. The patient's muscles may be rigid or limp. Renal ARF - hypovolemia, low cardiac output, and myoglobinuria (due to rhabdomyolysis). Pts may exhibit oliguria and a change in the color of urine.
31. Work up Complete blood cell count Arterial blood gas analysis: res. alkalosis - direct CNS stimulation ; metabolic acidosis - lactic acidosis Glucose: Hypoglycemia electrolytes;Na,K,PO4,Ca,Mg. Hepatic function tests Muscle function tests Renal function tests CSF- nonspecific pleocytosis, and protein levels may be elevated as high as 150 mg/dL.
32. Imaging findings in heat stroke Early cerebral edema . loss of gray-white matter differentiation . Patchy high signal intensity of the white matter of cerebral hemispheres and corpus striatum . Central pontinemyelinolysis. Vascular boundary zone infarcts . later stages- diffuse cerebellar atrophy.
33. MR imaging in heat stroke;Carol T. McLaughlin etal; AJNR Am J Neuroradiol 24:1372–1375, August 2003
34. MR imaging in heat stroke;Carol T. McLaughlin etal; AJNR Am J Neuroradiol 24:1372–1375, August 2003
35. MR imaging in heat stroke;Carol T. McLaughlin etal; AJNR Am J Neuroradiol 24:1372–1375, August 2003
36. Treatment Rapid reduction of the core body temperature . Admission to the hospital for at least 48 hours . lowering the core temp to about 39°C , at least 0.2°C/min . Removal of restrictive clothing and spraying water on the body. Covering the patient with ice water–soaked sheets. Placing ice packs in the axillae and groin . Supplemental oxygen. Infusion of D50W should be considered in all patients
37. Optimal method of rapidly cooling Ice-water immersion -extremely effective method , increased thermal conductivity of ice water can reduce core body temp <39°C in 20-40 mts. Extremely uncomfortable , subcutaneous vasoconstriction, increases shivering, difficulty monitoring and resuscitating . Evaporative techniques –recent and equally effective without the practical difficulties. Intermittently spraying with warm water while a powerful fan blows across the body. Peritoneal, thoracic, rectal, and gastric lavage with ice water; cold intravenous fluids; cold humidified oxygen; cooling blankets; and wet towels.
38. TR……. Antipyretics-no role. Stop excessive production of heat -Agitation and shivering with benzodiazepines, Neuroleptics best avoided . Convulsions -Benzodiazepines and, if necessary, barbiturates ;refractory sz-paralysis and ventilation IV fluids-hypovolemia, preexisting medical conditions, and preexisting cardiovascular disease. Metabolic support and symptomatic treatment for ARF,hepatic failure and PE. Rhabdomyolysis -infusion of large amounts of intravenous fluids (fluid requirements may be as high as 10 L), alkalinization of the urine, and infusion of mannitol. Mannitol may improve renal blood flow and glomerular filtration rate, increase urine output, and prevent fluid accumulation in the interstitial compartment (through its osmotic action). Mannitol also is a free radical scavenger and, therefore, may reduce damage caused by free radicals.
39.
40. CEREBELLAR ATROPHY The physiology of neurological involvement in heat stroke Increased intracranial pressure combined with autonomic dysfunction that leads to cerebral hypoperfusion and ischaemia . Tendency towards intracranial haemorrhage because of abnormal coagulation. The cerebellum is most susceptible to hyperthermia, followed by cerebral cortex, brainstem, and spinal cord. The cerebellar findings may be a combination of these factors coupled with or solely due to the directly destructive effects of hyperthermia on the Purkinje cells. Post-Heat Stroke CerebellarAtrophy,USudhiretal, JIACM 2009; 10: 60-2 Cerebellar syndrome following neuroleptic induced heat stroke ;DAVID LEFKOWITZetal, JNNP;1983;46:183-185