heat stroke
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Introduction
A life-threatening disorder treated as a medical emergency.
Definition (operational)[2]
- core temperature of > 40.6 degrees C (> 105 degrees F)
- altered central nervous system function
- classic (exposure to hot weather) vs exertional
Etiology
(risk factors)
- environmental factors
- ambient temperature > 90 degrees F
- poorly ventilated dwelling
- lack of air conditioning
- high humidity
- age: infants, children & the elderly
- predisposing illnesses
- predisposing medications & drugs
Clinical manifestations
- manifestations common to all forms of heat injury
- headache
- weakness
- nausea & vomiting
- vertigo
- faintness
- tachycardia
- tachypnea
- hypotension
- skin may be flushed (vasodilation) or pale due to vascular collapse (pallor)
- other manifestations
- tremor
- dyspnea
- paresthesias
- confusion
- irrational behavior
- core temperature > 106 F
- hot, dry skin
- lethargy, stupor or coma
- flaccid muscle tone
- diminished deep tendon reflexes
- skin is usually dry in classic form
- profuse sweating & wet skin with exertional from
Laboratory
- complete blood count (CBC) may be normal
- serum chemistries may be normal
- disseminated intravascular coagulation panel
- plasma lactic acid
- arterial blood gas
- urinalysis
Diagnostic procedures
- tachycardia
- sinus arrhythmia
- ST segment depression
- flattened or inverted T waves
- evidence of myocardial ischemia or acute infarction
Differential diagnosis
Management
- cool patient to 101-102 degrees F; 38.0 C (100.4 F)[5]
- place patient in a cool environment
- maintain adequate ventilation
- cooling fan with spray humidifier (evaporative cooling)
- ice-water immersion (exertional heat stroke only)[2]
- a cooling rate of 1 degree C in 3-10 minutes safe[4]
- ice water immersion of elderly with non-exertional hyperthermia associated with excess mortality
- monitor core temperature
- discontinue aggressive attempts to lower temperature when core temperature reaches 101-102 degrees F
- clinical improvement tends to be rapid & sustained with reduction in temperature[2]
- massage skin to stimulate return of cooled blood to core organs & brain
- hydrate with 1/2 normal saline
- monitor for signs of congestive heart failure & pulmonary edema
- follow-up within 1 week
- ensure complete recovery
- work-up & management of pre-existing illness as indicated
- patient education
- precipitating factors
- rescources available
More general terms
More specific terms
Additional terms
References
- ↑ Saunders Manual of Medical Practice, Rakel (ed), WB Saunders, Philadelphia, 1996, pg 1178-80
- ↑ 2.0 2.1 2.2 2.3 Medical Knowledge Self Assessment Program (MKSAP) 11, 17, 18. American College of Physicians, Philadelphia 1998, 2015, 2018.
- ↑ O'Connor JP. Simple and effective method to lower body core temperatures of hyperthermic patients. Am J Emerg Med. 2017 Jun;35(6):881-884. PMID: https://www.ncbi.nlm.nih.gov/pubmed/28162872
- ↑ 4.0 4.1 NEJM Resident 360. June 19, 2019 https://resident360.nejm.org/clinical-pearls/heatstroke
- ↑ 5.0 5.1 Epstein Y, Yanovich R. Heatstroke. N Engl J Med. 2019;380(325):2449-2459 PMID: https://www.ncbi.nlm.nih.gov/pubmed/31216400 https://www.nejm.org/doi/10.1056/NEJMra1810762
- ↑ Hyperthermia-Too Hot for Your Health http://www.niapublications.org/engagepages/hyperther.asp