heat illness
| Bouchama's definition: temp>40C, hot+dry skin and neurological s/s (coma, delirium, seizures) Exertional: syndrome associated with a raised core temperature and disordered thermoregulation which occurs on a spectrum of severity, ranging from mild to life threatening during or immediately after physical activity |
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| Etiology | 'Classic' heatstroke = non-exertional. Heat exhaustion - systemic disorder; sweating++ Heat stroke - associated with SIRS → multiorgan problems including encephalopathy |
| Epidemiology | Risk factors: - medications - cholinergic; SSRIs, etc. - extremes of age |
| Clinical presentation | C: hypovolaemic shock, dry skin D: focal neurology E: Rhabdomyolysis, ATN, low phosphate, high CK |
| Pathogenesis | Direct cell damage likely due to protein denaturation → ↑ vascular permeability Activation of pro-inflammatory pathways Dehydration → renal failure Translocation of gut flora → inflammatory response |
| Diagnostic investigations | FBC, U+E, LFT, CK... looking for end organ damage and other exertional badness eg hyponatraemia |
| Management | FPHC: "S3F" - shade, strip, spray, fan Cool before transporting/before core temp Cold water immersion most effective for EHI - target core temp 38.5C - risk of rebound hyperthermia - contraindicated with arrhythmia, cardiogenic shock - should be done with core temp monitoring "Immediately active cool using whole body (from neck down) water immersion technique (1-26 °C) until core temperature < 39°C. Where water immersion is not available, use any technique that provides the most rapid rate of cooling." - Resus Council Fluid resuscitation - no evidence for cool IV fluids prehospital |
sources/links
FPHC exertional heat illness guidance 2024
https://litfl.com/heat-stroke/
https://www.rcemlearning.co.uk/reference/heat-related-illness/#1569490445555-1adc4f8a-b673