​Kembara Xtra - Medicine - Heat Strokes

​Kembara Xtra - Medicine - Heat Strokes 
Introduction 
When exposed to high external temperatures, the body's thermoregulatory processes can fail due to dehydration, electrolyte losses, and a continuum of illnesses that get progressively worse.
Heat exhaustion is a mild to moderate form of heat disease that manifests symptoms similar to those of dehydration and has a normal to increased body temperature (1).
– A serious medical emergency, heat stroke is defined by an increased core temperature >104°F and disorders of the central nervous system (CNS).

Exertional or nonexertional Affected systems include the endocrine/metabolic, nervous, hepatic, and hematopoietic
Synonyms include heat exhaustion, heat stroke, hyperthermia, heat prostration, and heat disease.
Aspects of Geriatrics
The elderly are more vulnerable.
Child Safety Considerations
Kids are more vulnerable.
pregnant women's issues
Women who are expecting may be especially vulnerable to volume depletion caused by heat stress.

Epidemiology: More common in younger or older people; more common in men than in women.
Estimated incidence is 20/100,000 per season; it depends on how hot it is. There is concern that the incidence will rise as environmental temperatures rise.
Prevalence Depends on environmental factors combined with predisposing conditions Around 600 deaths occur in the US every year.

Pathophysiology and Etiology 
Overheating causes immediate cellular toxicity. Asymmetry between pro- and anti-inflammatory cytokines, vascular endothelial damage, and end-organ malfunction are other effects of excessive heat.

Failure of heat-dissipating systems, extreme heat stress, and an increased acutephase inflammatory response interact.

Risk factors include alcohol and other substance abuse, poor physical conditioning, salt or water depletion, obesity, acute febrile or gastrointestinal illnesses, uncontrolled diabetes mellitus, hypertension, and cardiac disease, high temperatures and humidity, and poor air circulation. Other risk factors include ephedra, nutritional supplements, heavy clothing, and medications (adrenergics, anticholinergics, antihistamines, and antipsyc).

Prevention 
Preventative measures are crucial in avoiding heat illness. Key preventive strategies include activity modification and appropriate fluid replacement.
Through appropriate fitness and activity modification, permit acclimatization.
Never leave children (or dogs) unsupervised in cars during hot weather. Dress correctly with loose-fitting, open-weaved, light-colored clothing. Consume a proper volume of fluids, especially during strenuous exertion in hot conditions.
Try to enter air-conditioned spaces while it's sweltering outside.


The symptoms of heat exhaustion are milder than those of heat stroke, and there are no CNS abnormalities.
- Excessive sweating, tachycardia, hypotension, thirst, weakness, lethargy, nausea, vomiting, headaches, myalgias, and hyperventilation.
- Core temperature is typically high but varies; if increased, it should not exceed 104°F (40°C)
Heat stroke is characterized by altered mental status and a rise in body temperature.
Classic (nonexertional): environmental exposure is the primary cause, which tends to affect older or chronically ill individuals. Delirium, confusion, and coma are the most common symptoms, and a core temperature of more than 104°F (>40°C) may occur.
 Dry, hot, and flushed skin
Exhaustion; confusion, disorientation; delirium; coma; hot, flushed skin, usually accompanied by sweating; Exertional: mainly younger, active people; quick onset
 Core temperature more than 104°F (>40°C)

Heat exhaustion is characterized by sweating, weariness, lightheadedness or dizziness, cramping, nausea, vomiting, and headaches. Heat cramps cause muscle spasms and cramping.
Heat stroke: altered state of consciousness


clinical assessment 
Rectal temperature (Avoid using oral temperature as a gauge.)
Heat stroke symptoms include rectal (core temperature) elevation (>103), hot/dry skin, and hindered compensatory sweating. Heat exhaustion symptoms include tachycardia and cool/clammy skin.


Differential diagnoses include febrile illnesses, sepsis, drug-induced fluid loss, cardiac arrhythmia or infarction, acute cocaine intoxication, neuroleptic malignant syndrome, and malignant hyperthermia (a genetic disorder of the skeletal and cardiac muscles characterized by abnormal muscle metabolism in response to halothane or skeletal muscle reactants).

Laboratory Results 

Identify end-organ injury
Initial examinations (lab, imaging)
Liver enzymes, muscle enzymes (creatine phosphokinase), electrolytes (especially sodium), creatinine, BUN, and CBC—hemoconcentration Urinalysis: increased urine specific gravity Drugs that may affect test results: diuretics

Management 
To treat heat stroke, immediately submerge the body in ice water to lower core body temperature. the state of the airways and hemodynamics.

 Use normal saline sparingly when replacing fluids and electrolytes; stay away from hypotonic fluids. adhere to serum sodium.

Think about CVP monitoring.
● Consider the following treatments for heat exhaustion: - Evaporative cooling: misting the patient with water and employing fans to promote convective and evaporative heat loss- Submerge your hands and arms in ice water.
- Applying cold or ice packs to the axillae, groin, and neck
There isn't a glaring advantage to any one treatment for heat exhaustion. 

First Line of Medicine
In the early phase of therapy, no drugs are needed.
To rehydrate, use isotonic saline solution.

Antipyretics should not be used to reduce core temperature in cases of heat illness.

Next Line
Consider immunomodulators like corticosteroids for patients who are critically unwell (ICU patients).
Iced peritoneal, bladder, or gastric lavage
If you have DIC, you should think about getting the right replacement therapy.

Admission 

 Cool the patient as soon as possible (even before transfer) if heat stroke is suspected or has been confirmed.
For quick cooling, take off your clothes, soak the sufferer, and use ice packs.
Emergency care is best provided in a hospital environment.


Follow-Up Rest with the legs raised.
patient observation
Rectal temperature monitoring: If the core temperature falls to 102°F (38.9°C) and stabilizes, cooling may be stopped.
Patients with heat stroke may need careful hydration and electrolyte management, hemodynamic monitoring, and airway treatment.
Think about CVP monitoring.

Diet 
Avoid caffeine and drink only cool or cold, clear drinks (noncarbonated).
No sodium restrictions

The secret to prevention is adequate hydration.
Proper acclimation and conditioning
• Fatigue and headache are two indicators of heat exhaustion; • Skin exposure promotes heat loss in hot, humid weather; • Use appropriate sun protection.

The prognosis is good and recovery usually takes between 24 and 48 hours if serum chemistries are normal and mental function is not affected.
The priority in heat-related disease is early recognition and intervention because the mortality rate for heat stroke (10-80%) is strongly correlated with the length and severity of hyperthermia as well as the speed and efficacy of diagnosis and treatment. Patient mortality decreases as the patient is cooled to below 40oC more quickly.

Acute renal failure, rhabdomyolysis, DIC, pulmonary edema, acute respiratory distress syndrome, coma, convulsions, hepatitis cell necrosis and failure of any major organ system are all possible complications.