HEAT STROKE

CASE 2
Astillero, Shayne Hope
Belitor, Jazhel Keren
Cardino, Cherrylou
Case No. 2
You have been called to a 23 year old male with no previous
medical history in the process of running a half marathon and
has collapsed with dizziness. On arrival, the person is
confused and combative with bystanders in attendance. On
examination he is found to be conscious, but very confused.
Pupils dilated and slow to react. Pulse rate 120, weak, thready.
Blood Pressure: 87/45. Skin, pale, warm to touch and dry.
Temperature 42.1 (tympanic).
Heat Stroke

Heat Stroke can be defined as an extreme hyperthermia

with thermoregulatory failure, characterized by serious end
stage organ damage with universal involvement of the
central nervous system. Although there is no specific vital
sign parameters that define heat stroke, a core body
temperature greater than 41 degrees C or 40.5 degrees C
with anhydrases and an altered mental state is generally
accepted as heat stroke.
PATHOPHYSIOLOGY
Prescribed Medications
● Benzodiazepines
● Alkalinizing agents
● Diuretics (osmosis)
● Adrenergic agonist agents
Benzodiazepines- safe and effective in controlling agitation, convulsions, and shivering.
● Lorazepam (Ativan) - drug of choice Contraindications:

Side Effects: ● Hypersensitivity

● Severe respiratory depression
● Drowsiness ● Sleep apnea
● Dizziness ● Acute narrow angle glaucoma
● Loss of coordination
● Headache
● Nausea
● Blurred vision
● Constipation
● Heartburn
● Change in appetite
Benzodiazepines
● Midazolam (Versed) Contraindications:

Side Effects: ● Hypersensitivity

● Acute alcohol intoxication
● Pain/redness at injection site
● Acute narrow angle glaucoma
● Dizziness
● Intrathecal/epidural use (formulations containing
● Drowsiness
preservatives, such as, benzyl alcohol)
● Nausea
● Vomiting
Alkalinizing Agents - for severe acidosis and rhabdomyolysis
● Sodium bicarbonate Contraindications:

Side Effects: ● Hypersensitivity

● metabolic/respiratory alkalosis
● Nausea
● Pts at risk of developing diuretic-induced
● vomiting
hypochloremic alkalosis
● Bloating
● Increased thirst
● Stomach cramps
Diuretics (Osmotic)
● Mannitol (Osmitrol) Contraindications:

Side Effects: ● Hypersensitivity

● Anuria
● Dry mouth
● Severe Hypovolemia
● Excessive thirst
● Pre-existing severe pulmonary vascular congestion
● Headache
or pulmonary edema
● Nausea
● Vomiting
● Excess urination
Adrenergic Agonist Agents- produce vasodilation and increase the inotropic state
● Dobutamine (Dobutrex) Contraindications:

Side Effects: ● Hypersensitivity to drug or components

● Acute myocardial infarction
● Increased heart rate
● Severe hypertension
● Increased blood pressure
● Headache
● Nausea
● Vomiting
● Palpitations
● Swelling at injection site
Medical Procedures
Non-surgical Procedure
Nursing Diagnosis
1. Hyperthermia related to prolonged exposure to hot weather as evidenced by
core body temperature of 42.1 degree Celsius (tympanic)
2. Fluid volume deficit related to dehydration due to heat stroke as evidenced by temperature
of 42.1 degree Celsius, blood pressure: 87/45, Pale skin, warm to touch and dry and weak and
thready pulse
3. Altered mental status related to metabolic imbalance secondary
to heat stroke as evidenced by confusion and dizziness
Emergency Nursing Interventions/Management
- Treatment focuses on stabilizing the patient’s ABCs, rapidly reducing the core
temperature, and monitoring for dysrhythmias.
● Give 100% O2 to compensate for the patient’s hypermetabolic state.
● Ventilation with a BVM or intubation and mechanical ventilation is needed.
Emergency Nursing Interventions/Management
● Place the patient on continuous ECG monitoring and pulse oximetry.
● Establish IV access and begin fluid replacement.
● Obtain blood for electrolytes and CBC. Correcting electrolyte imbalances
and coagulation abnormalities is critical.
● Place the patient in a cool environment. Promote evaporative cooling by
removing clothing and spraying the patient with lukewarm water in front of a
large fan.
Emergency Nursing Interventions/Management
● Other cooling methods include conductive cooling (e.g., immersing the
patient in a cool water bath); applying ice packs to the groins and axillae;
and, in refractory cases, peritoneal or rectal lavage with iced fluids.
Emergency Nursing Interventions/Management
● Closely monitor the patient’s temperature and control shivering. Shivering
increases core temperature due to the heat generated by muscle activity.
This complicates cooling efforts.
● Carefully monitor the urine for color, amount, pH, and myoglobin. Heat
stroke places the patient at risk for kidney injury due to rhabdomyolysis. It is a
serious syndrome caused by the breakdown of skeletal muscle.
Rhabdomyolysis
Discharge Plan
● Medication/s - No discharge medication/s.
● Exercise - Advise pt to avoid prolong exposure to heat or sun. There are
no specific exercises that are recommended to patients who experienced
heatstroke. However, the patient is advised to avoid exercise for 1 week after
the incident.
● Therapy - Not applicable
● Health Teaching
- Teaching patient and SO about the importance of proper hydration during
hot weather and physical exercise.
- Teach patient and SO the early signs of and interventions for heat-related
stress.
Discharge Plan
● OPD Visit - Consult physician when symptoms are felt again or if it worsens.
● Diet - There are no dietary changes. However, stress out the importance of
adequate fluid intake especially while doing strenuous physical activity.
● Spiritual - If the patient identifies herself as a religious person, support him
by telling that he can proceed with her usual religious activities.
● Lifestyle - There are no specific lifestyle changes. He could still participate in
a marathon. However, the patient must be taught on the importance of
proper hydration.