Heat stroke medical therapy

Heat stroke Microchapters
Home
Patient Information
Overview
Historical Perspective
Classification
Pathophysiology
Causes
Differentiating Heat Stroke from other Diseases
Epidemiology and Demographics
Risk Factors
Screening
Natural History, Complications and Prognosis
Diagnosis
History and Symptoms
Physical Examination
Laboratory Findings
X-rays
Ultrasound
CT Scan
MRI
Other Imaging Studies
Other Diagnostic Studies
Treatment
Medical Therapy
Surgery
Primary Prevention
Secondary Prevention
Cost-Effectiveness of Therapy
Future or Investigational Therapies
Case Studies
Case #1
Heat stroke medical therapy On the Web
Most recent articles
Most cited articles
Review articles
CME Programs
Powerpoint slides
Images
American Roentgen Ray Society Images of Heat stroke medical therapy All Images X-rays Echo & Ultrasound CT Images MRI
Ongoing Trials at Clinical Trials.gov
US National Guidelines Clearinghouse
NICE Guidance
FDA on Heat stroke medical therapy
CDC on Heat stroke medical therapy
Heat stroke medical therapy in the news
Blogs on Heat stroke medical therapy
Directions to Hospitals Treating Breast cancer
Risk calculators and risk factors for Heat stroke medical therapy

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Usama Talib, BSc, MD [2]

Overview

The heat stroke is primarily managed by removing the patient from the environment to minimize heat exposure and to ionitiate rapid cooling protocols.

Medical Therapy

The heat stroke is primarily managed by:

• Removing the patient from the environment to minimize heat exposure
• Initiating cooling protocols as soon as possible
• Providing support to the effected organs

align="center" style="background:#4479BA; color: #FFFFFF;" |Condition align="center" style="background:#4479BA; color: #FFFFFF;" |Intervention align="center" style="background:#4479BA; color: #FFFFFF;" |Goal

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)	Measure the patient’s core temperature (with a rectal probe) If the core temperature is >40°C, move the patient to a cooler place, remove his or her clothing, and initiate external cooling: Cold packs on the neck, axillae, and groin; Continuous fanning (or opening of the ambulance windows) Spraying of the skin with water at 25°C to 30°C Position an unconscious patient on his or her side and clear the airway Administer oxygen at 4 liters/min Give isotonic crystalloid (normal saline) Rapidly transfer the patient to an emergency department	Diagnose heat stroke† Lower the core temperature to <39.4°C, promote cooling by conduction, and promote cooling by evaporation Minimize the risk of aspiration Increase arterial oxygen saturation to >90% Provide volume expansion
In Hospital
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 temperature 30°C–33°C
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 of urine
	Monitor serum potassium and calcium levels and treat hyperkalemia	Prevent life-threatening cardiac arrhythmia
After cooling
Multiorgan dysfunction	Supportive therapy	Recovery of organ function

Cooling

The cooling is done on the following principles:

• 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
  • Fanning

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:

• Vasoconstriction and
• Shivering

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

Use of Pharmacological Agents

Pharmocological agents have not proven to be of benefit in case of hyprethermia or heat stroke. The agents that have been considered include:

• Dantrolene sodium
• Antipyretics

Recovery

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.