Heat stroke medical therapy
Heat stroke Microchapters
Heat stroke medical therapy On the Web
American Roentgen Ray Society Images of Heat stroke medical therapy
The heat stroke is primarily managed by removing the patient from the environment to minimize heat exposure and to ionitiate rapid cooling protocols.
- Removing the patient from the environment to minimize heat exposure
- Initiating cooling protocols as soon as possible
- Providing support to the effected organs
|The Management of Heat Stroke*|
|Out of Hospital|
|Heat stress (due to heat wave, summer
heat, or strenuous exercise), with
changes in mental status (anxiety,
delirium, seizures, or coma)
|Cooling period||Confirm diagnosis with thermometer calibrated to measure high temperatures (40°C to 47°C).|
|Hyperthermia||Monitor the rectal and skin temperatures; continue cooling||Keep rectal temperature <39.4°C§ and skin
|Seizures||Give benzodiazepines||Control seizures|
|Respiratory failure||Consider elective intubation (for impaired gag and cough reflexes or deterioration of respiratory function)||Protect airway and augment oxygenation (arterial
oxygen saturation >90%)
|Hypotension||Administer fluids for volume expansion, consider vasopressors, and consider monitoring central venous pressure||Increase mean arterial pressure to >60 mm Hg
and restore organ perfusion and tissue oxygenation
|Rhabdomyolysis||Expand volume with normal saline and administer intravenous
furosemide, mannitol, and sodium bicarbonate
|Prevent myoglobin-induced renal injury: promote
renal blood flow, diuresis, and alkalization
|Monitor serum potassium and calcium levels and treat hyperkalemia||Prevent life-threatening cardiac arrhythmia|
|Multiorgan dysfunction||Supportive therapy||Recovery of organ function|
*Adopted from Heat Stroke.
- The heat is transferred from the body core to the skin and then dissipated into the air.
- Vasodilatation of the vessels in the skin occurs as a compensatory mechanism to help dissipate the heat
- Cooling therapies focus on increasing and facilitating the transfer of heat from the body to the surroundings while keeping the vasodilatory cooling mechanism intact. They can utilize:
- Increasing the gradient of temperature between the body and the surroundings (cooling by the help of conduction)
- Increasing the water vapor pressure gradient between the body and the surroundings (cooling by the help of evaporation)
- Accelerating the flow of air closer to the skin (cooling by the help of convection)
- These can be achieved by:
- Application of water
- Application of ice
Methods of Cooling
|Methods of Cooling*|
|Techniques based on Conductive cooling|
|Techniques based on Evaporative or Convective cooling|
*Adopted from Heat Stroke.
Avoidance of Excessive cooling
Most of the techniques used for cooling can decrease the temperature of the skin excessively. Temperature can fall up to 30°C or lower resulting in compensatory mechanisms like:
These responses are not desired and can result in inappropriate management of hyperthermia. This can be avoided by an alternate or combined application of the following along with the cooling techniques:
- Massaging of the body
- Spraying lukewarm water of 40°C
- Exposing to moving air which is hot i.e around 45°C
- A decrease in temperature at the rate of 0.15°C or 0.27°F per minute has been successfully tested.
Use of Pharmacological Agents
- Dantrolene sodium
- It is used for malignant hyperthermia
- Its use is no more recommended for heat stroke
The revival of the functioning of the central nervous system is a positive prognostic sign. It is usually seen following aggressive therapy. 20% patients face residual damage of the brain and a higher mortality is associated with this.
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