Morning Report: 9/7/2012

Thanks to Dr. Semenovskaya for today’s Morning Report!

Heat Illness

Heat Illness comprises a spectrum of disorders caused by environmental heat exposure. Can be subdivided into three relative stages:

1) Heat Cramps: Heavy sweating; muscle cramps and spasms

2) Heat Exhaustion: Weakness; cool, pale, clammy skin; may be normotensive

3) Heat Stroke: Temperature > 105°C; Altered mental status; headache; confusion, nausea, dizziness.

Treatment:

1) Evaporative cooling: Remove patient’s clothing and wet them with cool water or a wet sheet while directing a large fan directly at the patient

2) Strategic ice packing: Place ice packs on patients’ groin, axillae, anterior and posterior neck

3) Ice water immersion: Place patient in a large tub of ice water; Alternatively, place a patient on a stretcher and cover them with ice and sheet drenched in ice water

4) Cold Water Irrigation:

Cold IV fluids (NS)
Gastric and Bladder lavage
Chest tubes

5) Advanced Cooling: Can consider hemodialysis, cardiopulmonary bypass, intravascular cooling.

Severe Side Effects: May include rhabdomyolysis, renal failure, seizures, DIC, and death; Aggressive cooling can also result in pulmonary edema, arrhythmias, shock, so cool cautiously!

Disposition: Patients with heat stroke may require ICU admission for intensive cooling and management of subsequent complications.

Reference:

“Heat Illness: How To Cool Down Hyperthermic Patients”. Semenovskaya Z, Weiner S. Medscape. http://reference.medscape.com/features/slideshow/heat-illness