EMERGENCY MEDICINE GUIDEWIRE
  • HOME
  • The Podcasts
    • Core Concepts
    • Critical Care Topics
    • Intern Nuggets
    • Pediatric EM
    • Toxicology
    • Trauma Topics
    • Sports Medicine Corner
  • Cards for EM
    • ECG Monthly Lesson
  • CMC Imaging Mastery Project
    • Adult Chest X-Ray Cases
    • Pediatric X-Ray Cases
    • Pediatric Orthopedic X-Ray Cases
    • Abdominal Imaging Room
    • Implanted Device Radiology Room
    • Condition Specific Radiology
  • Global EM
  • Shownotes
    • Core Concepts ShowNotes
    • Cards for EM ShowNotes
    • Ped EM Morsels ReBaked Shownotes
    • Pediatric EM Shownotes
    • Sports Med Shownotes
    • Toxicology Shownotes
    • Trauma Talks Shownotes
  • Subscribe
    • iTunes
    • Google Play
    • Stitcher
  • About
  • Associated Sites
    • CMCEdMasters
    • CMCECGMasters
    • PedEMMorsels
  • HOME
  • The Podcasts
    • Core Concepts
    • Critical Care Topics
    • Intern Nuggets
    • Pediatric EM
    • Toxicology
    • Trauma Topics
    • Sports Medicine Corner
  • Cards for EM
    • ECG Monthly Lesson
  • CMC Imaging Mastery Project
    • Adult Chest X-Ray Cases
    • Pediatric X-Ray Cases
    • Pediatric Orthopedic X-Ray Cases
    • Abdominal Imaging Room
    • Implanted Device Radiology Room
    • Condition Specific Radiology
  • Global EM
  • Shownotes
    • Core Concepts ShowNotes
    • Cards for EM ShowNotes
    • Ped EM Morsels ReBaked Shownotes
    • Pediatric EM Shownotes
    • Sports Med Shownotes
    • Toxicology Shownotes
    • Trauma Talks Shownotes
  • Subscribe
    • iTunes
    • Google Play
    • Stitcher
  • About
  • Associated Sites
    • CMCEdMasters
    • CMCECGMasters
    • PedEMMorsels
Search by typing & pressing enter

YOUR CART

11/19/2018 0 Comments

Exertion Heat-related Illness


  • Results in more than 600 deaths a year in the United States!
  • Anticholinergic agents, beta-blockers, and sympathomimetic drugs can all interfere with heat removal and increase risk of heat-related illnesses
  • Patients with exertion related heat stroke are commonly young, athletes, or military personnel that present with symptoms after strenuous exercise in the heat
 
Heat Exhaustion
  • Occurs via water depletion or sodium depletion or combination
  • Water depletion occurs in elderly and persons working in hot environments
  • Salt depletion occurs when fluid losses are replaced with hypotonic solutions
 
  • Signs & Symptoms
    • Known heat exposure with temperature >37 C with:
      • Tachycardia/Palpitations
      • N/V
      • Diaphoresis
      • HA/malaise/fatigue/generalized weakness
      • Lightheadedness
      • Mentation is normal* (key distinguishing factor from heat stroke)
 
  • Evaluation
    • Labs may show:
      • Hemoconcentration
      • Entire spectrum of sodium derangements common electrolyte abnormality
 
  • Treatment
    • *NEED to remove from heat-stressed environment
    • Volume and electrolyte replacement as needed
    • Oral fluids vs. IVF 
    • Aggressive cooling (see below)
 
Heat Stroke
  • Severe end of heat-related illness spectrum with loss of thermoregulatory mechanisms
  • *TRUE EMERGENCY - focus of management should be on immediate, rapid cooling (even if can be started in pre-hospital setting!)
  • Mortality = 21-63%; can approach 30% even with treatment
  • Hallmark = Elevated temperature >41°C (106°F) + MSOF; heat exhaustion CAN have temperatures >104F
  • Occurs when endogenous heat production in combination with absorbed ambient heat exceeds the ability of the body to dissipate heat through adaptive mechanisms (i.e. sweating, hyperventilating, peripheral vasodilation)
  • The extent of neurologic injury and mortality is directly related to the peak temperature and duration of the hyperthermia

  • Symptoms
    • CNS is particularly susceptible -> AMS, coma, ataxia, confusion, seizures, hallucinations
    • Anhidrosis is frequently present; however, sweating found in up to 50% of patients
    • Shunting of perfusion to less vital organs (e.g. liver, gut) -> GI bleeds, ischemic hepatopathy
    • Compartment syndrome
    • *Hepatic injury is so common (↑AST/ALT) that if not present, consider an alternative diagnosis
  • Workup
    • ECG
    • Continuous core temp monitoring 
    • Blood glucose, CBC, CMP (including liver enzymes)
    • VBG (with lactic acid)
    • DIC labs – fibrinogen, D-dimer, PT/INR
    • CK (Rhabdomyolysis – 5x ULN) and UA (myoglobinuria)
    • Chest x-ray
    • CT brain (± LP), if indicated – BE SURE THIS IS NOT MENINGITIS
  • Management
    • As always in emergency medicine -> ABCs
    • Remove from environment
    • IVF (for renal protection and avoiding rhabdomyolysis)
      1. Goal UOP 3 mL/kg/hr
      2. Accumulation of intracellular cytoplasmic calcium which leads to myocyte cell membrane damage and ATP depletion -> Hyperphosphatemia and hypocalcemia
      3. Precise guidelines do not exist, but the goal CK should be a level less than 1000 U/L
      4. No target value for creatinine level, however may see ATN
    • Rapid cooling is mainstay of treatment
      1. Reduces morbidity/mortality, needs to be started in prehospital setting
        • Weak evidence available for target temperature; theoretical concern of overshoot hypothermia
      2. No role for antipyretics!
    • Techniques:
      1. ***Cool water immersion
        • Immersion of body to level of torso or neck in cool or ice-water
        • May not be immediately available, so consider other techniques (listed below)
        • As you can imagine, not well-tolerated
        • You will have to take them out of the water in the unfortunate event a patient has a cardiac arrest subsequently
      2. Diffuse application of ice or cold packs to entire body 
        • Benefit may be similar to ice-water immersion
      3. Evaporative/Convective Cooling
        • Set-up large fans and spray tepid water on patient’s body
        • Can perform this while getting ice bath drawn
        • Slightly higher morbidity and mortality compared to immersion
      4. Invasive
        • V V-ECMO, cold water rectal/bladder/NG lavage; bilateral chest tubes with pleural lavage… Weak data, so perform only if needed with caution
  • Consider giving antibiotics in addition to IVF hydration as it is difficult to rule out infection as a predisposing factor to the development of heatstrok
0 Comments

Your comment will be posted after it is approved.


Leave a Reply.

    Archives

    May 2019
    November 2018
    October 2018
    September 2018

    Categories

    All Sports Medicine

    RSS Feed

EMGuideWire

Picture
From the J. Lee Garvey Innovation Studio in the 
Department of Emergency Medicine
Carolinas Medical Center
Charlotte, NC

Picture
© COPYRIGHT 2015. ALL RIGHTS RESERVED.
LEGAL DISCLAIMER (to make sure that we are all clear about this):The information on this website and podcasts are the opinions of the authors solely.

For Health Care Practitioners: This website and its associated products are provided only for medical education purposes. Although the editors have made every effort to provide the most up-to-date evidence-based medical information, this writing should not necessarily be considered the standard of care and may not reflect individual practices in other geographic locations.

​For the Public
: This website and its associated products are not intended to be a substitute for professional medical advice, diagnosis, or treatment. Your physician or other qualified health care provider should be contacted with any questions you may have regarding a medical condition. Do not disregard professional medical advice or delay seeking it based on information from this writing. Relying on information provided in this website and podcast is done at your own risk. In the event of a medical emergency, contact your physician or call 9-1-1 immediately.