Heat Illness

EMS Solutions
www.ems-safety.com
Introduction

Normal Body Temperature Regulation

Causes of Heat Illness
Clinical Pictures
Treatment
Prognosis
Prevention
Body Temperature Regulation

Heat Gain
– Metabolic
– Environmental
Heat Loss
– Radiation
– Convection
– Conduction
– Evaporation
Body Temperature Regulation

Wet-bulb globe thermometer index

– Accounts for humidity and radiant heat
– Most accurate measure of environmental heat
stress and risk of heat illness
Acclimatization
– 1-2 weeks
– Aldosterone mediated
Heat Illness

 Predisposing Factors
– Physical activity
– Extremes of age, poor physical condition, fatigue
– Excessive clothing
– Dehydration
– Cardiovascular disease
– Skin disorders
– Obesity
– Drugs
• Phenothiazines, anticholinergics, B and Ca channel blockers,
diuretics, amphetamines, LSD, cocaine, MAOIs
Drugs that Interfere with
Thermoregulation
 Increase heat production
– Thyroid hormone
– Amphetamines
– TCAs
– LSD
 Decrease thirst
– Haldol
 Decrease sweating
– Antihistamines
– Anticholinergics
– Phenothiazines
– Benztropine
Pathophysiology of Heat Illness

 Heat Cramps
 Heat tetany
 Heat Exhaustion
 Heat Stroke
– Heat stress
– Loss of ability to sweat
– Volume depletion and electrolyte imbalances not
prominent
– Pre-existing cardiovascular disease
– End-organ damage
Clinical Presentations

Heat Tetany
– Hyperventilation
– Carpalpedal spasm and tingling
Heat Cramps
– Calves, thighs, shoulders
– Intense activity, profuse sweating
– Hypotonic fluid replacement
– Normal body temperature
Clinical Presentations

Heat Exhaustion
– Fatigue, profuse sweating
– Light-headed, N/V, HA
– Increased HR, RR and decreased BP
– Normal to slightly elevated temperature
Clinical Presentation

Heat Stroke
– True emergency
– Altered LOC
– Any neurologic finding
– And elevated temperature
– May still be sweating initially
– Syncope
– History is critical
Classic vs Exertional Heatstroke
 Classic
– Elderly, chronically ill
– Sedentary
– Drug use
– Sweating absent
– Lactic acidosis usually absent
– Electrolyte abnormalities and rhabdo uncommon
– ARF <5%
– Mild DIC
– Due to poor dissipation of environmental heat
Classic vs Exertional Heatstroke
 Exertional
– Men 15-45 years, healthy
– Strenuous exercise
– No drug use
– Sweating often present
– Lactic acidosis common
– Frequent hyperkalemia, hypocalcemia, hypoglycemia
– CPK markedly elevated, severe rhabdo
– Hyperuricemia
– ARF 25-30%
– DIC marked
Differential Diagnosis of
Heatstroke
 Malignant Hyperthermia
– Halogenated anesthetics
– Depolarizing muscle relaxants
 Febrile illness, especially CNS
 CVA
 Neuroleptic malignant syndrome and seizure
 Drug OD
– Cocaine
– Amphetamines, MDMA, MDEA
Treatment

 Heat Cramps
– Oral or IV fluid and electrolyte replacement
– Rest in cool environment
 Heat Tetany
– Remove from heat
– Rebreathe expired air
– R/0 electrolyte abnormalities
 Heat Exhaustion
– Rest in cool environment
– Rapid IVF/electrolyte replacement
– CBC, SMA 7, Liver enzymes, UA
Treatment of Heatstroke
 Immediate aggressive cooling to 39 C
 High flow O2, pulse ox, intubate prn
 IV NS 250-300cc/hr
 Cardiac monitor
 Continuous core temperature monitoring
 Foley
 ABG, CBC, SMA 18, PT/PTT, UA, urine
myoglobin, UDS
 EKG, CXR
 Benzodiazepines or chlorpromazine for shivering
Prognosis of Heatstroke

90% survival with proper treatment

Morbidity directly related to duration of
hyperthermia
Poor prognosis
– Temp >41 C
– Prolonged hyperthermia
– Hyperkalemia, ARF, elevated LFTs
– Persistence of coma with normal temperature
Prevention

 Awareness
 Adaptation of behavioral and physical activity
– Clothing
– Activity
– Conditioning
– Acclimation
 Appropriate hydration
– H20 vs. sports drinks
 Education