day 5 - kuliah heat stroke

8/13/2019 Day 5 - Kuliah Heat Stroke

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HE T STROKEI Made Susila Utama

Tropical & Infectious Disease DivisionInternal Medicine Dept, Medical Faculty

Sanglah Hospital, Udayana Univ. Bali


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Severe form of heat illness

Heat Stroke is A MEDICAL EMERGENCY!

life-threatening illness commonly fatal

preventable


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DEFINITION

Heat strokeis defined clinically as a core

body temperature that rises above 40C

and that is accompanied by hot, dry skin

and central nervous system abnormalities

such as delirium, convulsions, or coma.


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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


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HEAT EXHAUSTION: Mild-to-moderate

illness due to water or salt depletion thatresults from exposure to high

environmental heat or strenuous physical

exercise; signs and symptoms includeintense thirst, weakness, discomfort,

anxiety, dizziness, fainting, and headache;

core temperature may be normal, belownormal, or slightly elevated (>37C but


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Classi f icat ion

exertional: typically seen in healthy youngadults 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 underlyingdisease. Result of impaired thermoregulation

combined with high ambient temperatures.

Often due to impaired sweating6


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Mortality related to high temperature

Centers for DiseaseControl (CDC)

1999 to 20033442

Heat-Related Fatalities

in USA.

approximately 690

deaths per year

The fatalities

males

elderly


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Predispos ing 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 heatstroke, barbiturate poisoning

- cystic fibrosis

- healed thermal burn salt and water depletion

- diuretic induced

Hypokalemia 9


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Impaired voluntary mechanisms

coma

physical disabilitymental illness

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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

Heat Balance equation

Body Heat = Metabolism

+ [+conduction + radiation]

+ convectionevaporation

Body Heat = M + [+ K + R + C E]

Copyright Texas Parks & Wildlife Department


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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


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Clinical Manifestation

Heatstroke

Trias

Temp > 40.50 C (104.90)

Disfungsi CNS Anhidrosis

Hyperpyrexia: possibility heatstroke after

exclusion the other cause.

Many neurological disturbance


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Clinical manifestation (cont.)

Heatstroke Effect to system organ

CNS

Iritabilitas,

Combativeness

Cerebellum

Sensitif thd panas

Ataxia

Cerebral edema

Anhidrosis

total failure of thermoregulation


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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


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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

strokeAbnormality CNS


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Invest igat ions

temperature- electrolytes, urea, creatinine, calcium

- LFTs

- CPK

- ABG: note that Paco2 and Pao2 will be falsely lowand 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 myoglobin22


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treatment

Heatstroke

Treatment

Initial ABCs, O2high dose

pulse oximetry

EKG, IV access, volume replacement

Temperature


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treatment (cont.)

Heatstroke

Cooling

Techniques

Evaporative

Immersion

Ice packing

Strategic ice packs

Gastric lavage

Peritoneal lavage

Cardiac bypass

H t t k T t t


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Heatstroke Treatment:

Cool Quickly!

External cooling

-Cold ice packs

-Water spraying

-Fans

-Cooling blankets

-Ice bath

Internal cooling

-Intravenous fluids

-Peritoneal lavage

Antipyretics have no role in the acute treatment of heatstroke


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Prevention

AC

non alkohol

non caffein

urine output monitoring


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Prevention is the BestTreatment


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Underestimate the seriousness of heat

illness

Give the victim medications to reducefever

Give the victim liquids that contain alcohol

or caffeine Give anything by mouth if HEAT STROKE

is suspected


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day 5 - kuliah heat stroke

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