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Heat stroke is hyperthermia (>41.6 Celsius / 106 Fahrenheit) plus neurologic findings (e.g., altered mental status, seizures, coma, etc.); it also causes systemic inflammation response syndrome (i.e., cytokine release), coagulation disorders (e.g., thrombosis in end organs) and tissue abnormalities (e.g., acute kidney injury and rhabdomyolysis)
Two classifications exist:
- Exertional heatstroke (young people engaged in strenuous physical activities in hot climates)
- Non-exertional heatstroke occurring in sedentary people (elderly, debilitated, or chronically-ill patients) who are unprotected from the elements (e.g., trapped in apartments during heat waves)
Treatment includes:
- Insertion of a continuous core thermometer
- Supporting ABC’s
- Cooling by at least to 0.2 degrees celsius per minute to 39 degrees (to avoid overshoot)
- Benzodiazepines for sedation, shivering, and seizures
- Antipyretics and phenytoin have not been shown beneficial
- Support and protect end-organs with particular attention to kidneys; increased risk of kidney injury from rhabdomyolysis, ischemia and systemic inflammation.
Despite the most aggressive therapy, up to 30% survivors may have permanent neurologic or multi-organ system dysfunction months to years after recovery
References
Leon, L. Heat stroke: role of the systemic inflammatory response. Journal of Applied Physiology 2010 Dec;109(6):1980-8
http://emedicine.medscape.com/article/166320-overview
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