HEAT STROKE
It is defined as the combination, of hyperpyrexia (108.6°C]) and neurologic symptoms. It is a medical emergency.
Causes
It is caused by a shutdown or failure of the heat-regulating mechanisms of the body.
Assessment
1. Assess airway, breathing, circulation and LOC.
2. Obtain a history.
3. Neurologic assessment.
4. Assess vital signs (temperature > 105F, hypotension, rapid pulse may be bounding or weak, rapid respiration).
5. ABG-metabolic acidosis.
Clinical Manifestations
Skin may appear flushed and hot; in early stroke, the skin may be moist, but, as the heatstroke progresses, the skin will become dry as the body loses its ability to sweat.
Patient may exhibit bizarre behaviour or irritability. This may progress to confusion, combativeness, deliriousness and coma. CNS disturbances seizures, fixed and dilated pupils and decerebrate or decorticate posturing. Tremors.
General interventions
1. Provide cooling measures.
a. Spray tepid H₂O on the skin while electric fans are used to blow continuously over the patient to augment heat dissipation.
b. Apply ice-packs to neck, groin, axillae and scalp.
c. Soak sheets/towels in ice H₂O and place on patient using fans to accelerate evaporation/cooling rate.
d. Immerse patient in cold H₂) [(controversial because it may result in peripheral vasoconstriction and may decrease the body's heat loss)]
e. If temperature fails to decrease (initiate core cooling): Iced saline lavage of stomach, cool fluid peritoneal dialysis, cool fluid bladder irrigation or cool fluid chest irrigation.
f. Place the patient on a hypothermia blanket.
g. Discontinue active cooling when the temperature reaches 102°F. 2.
2. Oxygenate patient to supply tissue needs exaggerated by the hypermetabolic condition.
3. Monitor vital signs continuously, including ECG, CVP, BP, pulse and RR and neurologic assessment.
4. Replace fluids.
Start IVF as directed to replace fluid losses and maintain adequate circulation (eg RL).
5. Supportive care.
- Dialysis for renal failure.
- Diuretics (mannitol) to promote diuresis.
- Anticonvulsants to control seizures.
- Potassium for hypokalemia and Sodium Bi Carbonate to correct metabolic acidosis.
- Intensive shivering may be controlled by diazepam.
- Intensive shivering may be controlled by diazepam. Shivering will generate heat and increase the metabolic rate.
- Patients with depleted clotting factors may be treated with platelets or fresh frozen plasma.
6. Measure urinary output; acute tubular necrosis is a complication.
7. Continue to monitor ECG for possible ischemia or infarction, dysrhythmias.
8. Perform serial laboratory testing (clotting parameters, electrolytes, glucose and serum enzymes).
9. Admit the patient to the ICU; permanent liver, cardiac and CNS damage may occur.
10. Monitor patient for development of seizures and provide a safe environment in case of seizures.
