Lecture 1 Heat Related Illness

HEAT RELATED ILLNESS
Common Medical Emergencies

LECTURE OUTLINE
• Introduction to heat related illness
• Physiology of temperature regulation
• Risk factors for heat related illness
• Spectrum of heat related illness
• Assessment of heat related illness
• Cooling mechanisms
LECTURE OBJECTIVES
• Understand mechanisms of body heat
regulation
• Know various presentation of heat related
illness
• Able to perform rapid cooling techniques
INTRODUCTION
• Continuum of disorders
– Minor syndromes – heat cramps, heat syncope,
and heat exhaustion
– Severely life-threatening disorder – heat stroke.
• Heat exhaustion most common
PHYSIOLOGY
TEMPERATURE REGULATION
• Body temperature regulation – balance of
heat creation and heat dissipation
• Hyperthermia
– Normal hypothalamic set point but abnormal heat
production or inadequate dissipation
• Fever:
– Elevated hypothalamic set point
HEAT PRODUCTION
• Cellular metabolism
• Mechanical work of skeletal muscle
• Absorption
– Radiation from the sun
– Direct contact with hot objects
– Higher ambient temperature
HEAT DISSIPATION
• Methods:
1.Conduction – energy transferred from one solid
object to another as a result of direct contact and
a difference in temperature
2.Convection – gas or liquid absorbs heat and moves
it away from the body
3.Radiation – heat transfer between the body and its
surroundings by electromagnetic waves.
4.Evaporation – sweat into ambient air.
HEAT DISSIPATION
• Convection and evaporation – most important
– Regulated to control temperature.
• Sweating increases heat dissipation –
evaporation cooling
• High ambient temperature
– Decreased gradient between the skin surface and
periphery – less efficient convective heat loss
• High humidity or low wind
– Sweat evaporation – less efficient
Distribution of temperatures within the
human body into core and shell during
exposure to cold and warm environments.
Human Physiology, 3rd ed. Philadelphia

RISK FACTORS
• Chronic medical conditions
• Mental illness
• Occupational exposure to high temperatures
• Insufficient acclimatization
• Elderly
• Children < 4 years of age
HEAT CRAMPS
• Brief, intermittent and severe muscle cramps
– Muscle fatigued by heavy work or exercise
– Related to loss of salt and water
• Onset: several hours after vigorous exertion
• Presentation:
– Painful muscle spasms – calves, thighs, and
shoulders during rest or showering.
– Core body temperature – normal or elevated.
– Symptoms and signs of heat exhaustion
HEAT EXHAUSTION
• Changes in mental status associated with
increased in body temperature
– Inappropriate treatment  heat stroke.
• Causes:
– Volume depletion in conditions of heat stress
– Water depletion heat exhaustion – hot
environment with inadequate water replacement
– Salt depletion heat exhaustion. – hot environments
with heavy sweating + hypotonic fluid replacement
HEAT EXHAUSTION
PRESENTATION
• Symptoms
– Fatigue, weakness, dizziness, headache, nausea,
vomiting, and muscle cramps.
• Signs
– Profuse sweating
– Evidence of dehydration
– Orthostatic syncope.
HEAT EXHAUSTION
MANAGEMENT
• Cooling treatment
• Rehydration
– Oral fluid in alert patients
HEAT STROKE
• Commonly seen in high ambient temperature and
humidity environment
• Usually involve high risk populations
• Symptoms
– Altered mental status
– Nausea and vomiting
• Signs
– Tachycardia and hypotension
– Hyperventilation
– Anhidrosis
FOCUS HISTORY
• Allergies
• Medications
– Enquire medications that can increase fluid loss –
diuretics
• Past illness
– Hypertension, diabetes, heart disease
• Last meal
• Events surrounding chief complaint
PRIMARY SURVEY
• Assess consciousness level
• Airway and breathing assessment especially in
unconscious patients
• Circulation
– Look for signs of inadequate perfusion
HEAT STROKE
INTERVENTION
• Remove patient to cool, shaded area.
• Clothing removed and cooling treatment
instituted.
• Administer supplemental oxygen
• All victims assessed for and continuously
monitored for development of heat stroke.
• Rapid transport to medical facility if suspect
heat stroke
HEAT STROKE INTERVENTION
COOLING METHODS
• Cooling should not be delayed.
• Cold water or ice water cooling
– Immersion
– Dousing patient
– Spraying water over the patient’s skin
• Fanning the patient
• Ice packs application over large vessel – neck,
axillae, and groin
COOLING METHODS
IMMERSION DISADVANTAGES
• Induced peripheral vasoconstriction
• Shivering – lead to paradoxical increase in core
temperature and discomfort
• Difficulty to monitor and performing
cardiopulmonary resuscitation,
• Unsanitary conditions – vomiting and diarrhea
HEAT STROKE MANGEMENT
MONITORING AND COMMUNICATIONS
• Patients must be frequently monitored to
detect development of heat stroke
– Level of consciousness
– Respiratory rate
– Pulse rate
• Communication with base
– Patient condition
– Intervention provided
SUMMARY
• Continuum of disorders from minor syndromes
to Severely life-threatening disorder – heat
stroke.
• Body temperature regulation – balance of heat
creation and heat dissipation
• Patients should be moved to shaded area and
cooling techniques instituted
• All patients must be monitored for heat stroke
development

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HEAT RELATED ILLNESS

Common Medical Emergencies

Human Physiology, 3rd ed. Philadelphia

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