Heat illness
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Heat illness
- 3. Types 1. Prickly heat 2. Heat cramps 3. Heat tetany 4. Heat syncope 5. Heat edema 6. Heat exhaustion 7. Heat stroke
- 4. Risk factors 1. <5 / >65 yrs 2. Pregnancy 3. Occupation – soldiers, farmers , labors,sportsmen 4. Less physical fitness 5. Lack of acclimatisation 6. Obesity 7. High temp ,high humidity low air velocity 8. Alcohol abuse 9. Skin disease- psoriasis, pyoderma etc 10. Sleep deprivation 11.Renal,thyroid,CVS,metaboli c diseases 12. Drugs-cocaine amphatemines, ACE inh,antihistaminics,etc
- 5. Diagnosis • R/O other causes first • Exposure high temp in immediate past • Usually pt is not acclimatised to conditions
- 6. Prickly heat • Lichen tropicus • Miliaria rubra • obstruction of sweat gland leakage of sweat into the deeper layers of the epidermislocal inflammatory reaction • Maculopapular, pruritic, erythematus May progresses to chronic dermatitis & superinfection if left untreated • Prevention – bath with cool water with gentle scrub, loose light cloths • Treatment – calamine lotion , chlorhexidine lotion, oral antihistaminics • Severe – 1 % salicyic acid & antibiotics
- 7. Heat cramps • Spasm of muscle – shoulder,arms,adbomen,calves • Heavy muscular exercises in hot environment with hypotonic fluid intake electrolyte imbalance • Occurs sometime after exposure when pt is relaxing • Oral intake of electral powder • Severe cases – iv normal saline
- 8. Heat tetany • Capropedal spasm & paraesthesiae • Short exposure to very hot temp • hyperventilation resp alkalosislow co2 decreased binding of calcium to albumin low ionized calcium • Management – reduce temp & reduce resp rate
- 9. Heat syncope • Sudden loss of conciousness • High temp peripheral vasodilation • T/t – recumbent position ,reduce body temp, rehydration
- 10. Heat edema • Pitting edema of hands & feets or any dependent part • Most common in bedridden elderly • High tempvasodilationdependent edema • T/t – reassurance, limb elevation, crepe bandage , avoid high temp , adequate rehydration
- 11. Heat exhaustion • Excessive working in high temp with loss of fluid and salts • Normal thermoregulatory mechanism • Symptoms -- Excessive sweating,fatigue,malaise,nausea, giddiness • Signs -- Pale , low volume pulse, low BP , moderately high temp < 40 degree
- 12. Management – • Could be precursor of heat stroke – should be managed promptly and adequately • rehydration, salt replacement, cool environment , rest
- 13. Heat stroke • Life threatening condition • Disturbed thermoregulatory mechanism • Exaggerated acute phase response – increased production of inflammatory cytokines,endothelial derived vasoactive factors , could be activation of coagulation process, alteration in expression of heat shock proteins • Dehydration very late feature
- 14. Symptoms and signs – • hyperpyrexia ( > 40 degree core body temp) • CNS dysfunctions – coma , stupor, delirium. • sometimes subtle symptoms– confusion , impaired judgments, abnormal behaviour. • Anhidrosis – may or may not • Other – shock, convulsions,icterus, signs of dehydration
- 15. • Diagnosis – 1. diagnosis of exclusion 2. history of exposure to high temperature in immediate past 3. high body temperature > 40 degrees 4. abnormal behaviour
- 16. Differential diagnosis – 1. Cerebral malaria 2. Encephalitis 3. Meningitis 4. Thyroid strom 5. Pheochromocytoma 6. Status epilepticus 7. Cocaine & amphetamine abuse 8. Delirium tremens 9. CVA – pontine hemorrhage
- 17. Types Classical heat stroke Exertional heat stroke Elderly Young Health status compromised Healthy Sedentary Strenous activity Medications hist. present Absent Sweating absent Severe Skin dry May be moist Rhabdomyolysis unusual Excessive
- 18. Complications • Hepatic failure • Renal failure • Cerebral edema & cerebellar demage • Arrythmias • Rhabdomyolysis • DIC
- 19. Investigations • CBC - ↑WBC, ↑HCT, ↓plt • ↓pro time, hypofibrinogenemia, other features of DIC • Hypoglycemia, N/↓Cl, hypokalemia, hypocalc emia, hypophophetemia • ↑CPK, ↑BUN, ↑SGOT, ↑SGPT • Urine –myoglobinuria, proteinuria, hyaline & granular cast
- 20. Management • To reduce body temp < 39 degree( 0.2 /m )— 1. Emergency - should be managed promptly 2. shift immediately to cool & shaded place 3. Put cold water or wrap soaked sheet around pt 4. Can immerse pt in cold water or put ice pack around neck, axilla, groin. 5. Cold water gastric lavage 6. Antipyretic not proven to be effective
- 21. • Shock, cerebral edema, adrenal insufficiencies- iv steroids • Rhabdomyolysis & ARF – iv fluids, diuretics, mannitol, sodabicarb • Management of DIC and other complications • Supportive – iv fluids, BP, electrolyes
- 22. Prognosis • Mortality – 50% • Deficit in survivors - 20% • Directly proportional to temp and its duration • Coma more than 2 hrs – very poor prognosis
- 23. Prevention • Avoid sun during day time • Drink 1 glass of water every half hour–5-6 l / d (thirst is poor indicator of dehydration) • Light color , loose cloth • Avoid alcohol and other habit forming drugs • Immediately consult doctor if typical symmp appears
- 24. Thank You !!