HEAT STROKE

I Made Susila Utama

Tropical & Infectious Disease Division
Internal Medicine Dept, Medical Faculty
Sanglah Hospital, Udayana Univ. Bali
• Severe form of heat illness
• Heat Stroke is A MEDICAL EMERGENCY!
• life-threatening illness
• commonly fatal
• preventable
 DEFINITION
• Heat stroke is defined clinically as a core
body temperature that rises above 40°C
and that is accompanied by hot, dry skin
and central nervous system abnormalities
such as delirium, convulsions, or coma.
• HYPERTHERMIA: A rise in body
temperature above the hypothalamic set
point when heat-dissipating mechanisms
are impaired (by drugs or disease) or
overwhelmed by external (environmental
or induced) or internal (metabolic) heat
• HEAT EXHAUSTION: Mild-to-moderate
illness due to water or salt depletion that
results from exposure to high
environmental heat or strenuous physical
exercise; signs and symptoms include
intense thirst, weakness, discomfort,
anxiety, dizziness, fainting, and headache;
core temperature may be normal, below
normal, or slightly elevated (>37°C but
<40°C)
 Classification
• exertional: typically seen in healthy young
adults who overexert themselves in high
ambient (Surrounding) temperatures or in a hot
environment to which they are not acclimatized
(To adapt).
• non-exertional (classic): usually affects elderly
and debilitated patients with chronic underlying
disease. Result of impaired thermoregulation
combined with high ambient temperatures.
Often due to impaired sweating
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 Mortality related to high temperature
• Centers for Disease
Control (CDC)
– 1999 to 2003 – 3442
Heat-Related Fatalities
in USA.
– approximately 690
deaths per year
– The fatalities
• males
• elderly
 Predisposing factors

• Increased heat production

- hyperthyroidism
- exercise
- sepsis

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 Impaired heat loss -Impaired sweating
• Drugs
- anticholinergics, anti-Parkinsonian drugs,
anti-histamines, butyrophenones,
phenothiazines, tricyclics
• Abnormal sweat glands
- sweat gland injury following acute heat
stroke, barbiturate poisoning
- cystic fibrosis
- healed thermal burn
• salt and water depletion
- diuretic induced
• Hypokalemia 9
• Impaired voluntary mechanisms
coma
physical disability
mental illness

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• Impaired delivery of blood to
peripheral circulation
- cardiovascular disease
- hypokalemia (decreased muscle blood
flow)
- dehydration

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• Others
- elderly
- high ambient temperature and
humidity, poor ventilation
- lack of acclimatization
- obesity
- fatigue
- DM
- malnutrition
- alcoholism
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 Pathophysiology
• Balance
– conduction
– convection
– radiation
– Evaporation
© Copyright Texas Parks & Wildlife Department

Heat Balance equation

Body Heat = Metabolism
+ [+conduction + radiation]
+ convection – evaporation
Body Heat = M + [+ K + R + C – E]
 Pathophysiology (cont.)
• Physiologic response to heat

– Anterior hypothalamus
– CNS stimulation vasomotor tone, cutaneous blood flow.
Increased heart rate and cardiac out put.

– Parasimpatis stimulation
• sweathing
Dehydration

- Adaptation
 Clinical Manifestation
• Heatstroke
– Trias
• Temp > 40.50 C (104.90)
• Disfungsi CNS
• Anhidrosis
– Hyperpyrexia: possibility heatstroke after
exclusion the other cause.
– Many neurological disturbance
 Clinical manifestation (cont.)

• Heatstroke
– Effect to system organ
• CNS
– Iritabilitas,
– Combativeness
• Cerebellum
– Sensitif thd panas
– Ataxia
• Cerebral edema
• Anhidrosis
– total failure of thermoregulation
Symptoms of heat stroke include
the following:
• absence of sweating
• red or flushed skin
• shortness of breath
• rapid pulse
• hallucinations
• confusion
• agitation
• disorientation
• seizure
• coma
Angkor Wat
 Investigations
• temperature
- electrolytes, urea, creatinine, calcium
- LFTs
- CPK
- ABG: note that Paco2 and Pao2 will be falsely low
and pH falsely elevated if results are not corrected
for temperature
- ECG and ECG monitoring
- urine output
- FBC, clotting, fibrinogen, FDP, D-dimer. Anaemia
frequent. Platelets low/normal. Lymphocytosis
- test urine for myoglobin
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 Core Body Temperature
• Use rectal thermometer
• Heat exhaustion
temp < 104
• Heat Stroke
temp >= 104
• T > 104 by itself is NOT diagnostic of heat
stroke
– Abnormality CNS
 treatment

• Heatstroke
– Treatment
• Initial ABC’s, O2 high dose
• pulse oximetry
• EKG, IV access, volume replacement
• Temperature
 treatment (cont.)
• Heatstroke
– Cooling
Techniques
• Evaporative
• Immersion
• Ice packing
• Strategic ice packs
• Gastric lavage
• Peritoneal lavage
• Cardiac bypass
 Heatstroke Treatment:
Cool Quickly!

External cooling Internal cooling

-Cold ice packs -Intravenous fluids
-Water spraying -Peritoneal lavage
-Fans

-Cooling blankets
-Ice bath

Antipyretics have no role in the acute treatment of heatstroke

 Complication

– Heart failure, lung edema, cardiovaskulercollaps

– Hepatic injury (thermal)
– Renal injury
• 20 rhabdomyolysis, myoglobinuria, and renal failure
– Hematological insult
• Micro-hemorrhages
• Thrombocytopenia
• increased thrombocyte agregation(thermal)
– Fluid and electrolite imbalance
 Prevention
• AC
• non alkohol
• non caffein
• urine output monitoring

Prevention is the Best Treatment

• Underestimate the seriousness of heat
illness
• Give the victim medications to reduce
fever
• Give the victim liquids that contain alcohol
or caffeine
• Give anything by mouth if HEAT STROKE
is suspected
Angkor Wat