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  • Amy Gutman MDPrehospitalmd@gmail.com / www.TEAEMS.com

    Bledsoe et al., Paramedic Care Principles & Practice Volume 3: Medical 2006 by Pearson Education, Inc. Upper Saddle River, NJ

  • OVERVIEWHeat Related Illnesses

    High Altitude Illnesses

    Lightening Injuries

    Bledsoe et al., Paramedic Care Principles & Practice Volume 3: Medical 2006 by Pearson Education, Inc. Upper Saddle River, NJ

  • DEFINITIONSNormal temperature98.6oF (37oC)

    HypothermiaCore temp 105oF (45oC)

    Bledsoe et al., Paramedic Care Principles & Practice Volume 3: Medical 2006 by Pearson Education, Inc. Upper Saddle River, NJ

  • HOMEOSTASIS: THERMOREGULATIONBodys desire to maintain a steady internal environment

    Maintain enzyme / cell activities & organ functions

    Body temp maintained by multiple interconnected mechanismsPrimarily set by hypothalamus acting as a thermostatPeripheral & central thermoreceptors shunt blood to core to maintain homeostasis

    Bledsoe et al., Paramedic Care Principles & Practice Volume 3: Medical 2006 by Pearson Education, Inc. Upper Saddle River, NJ

  • THERMOREGULATION METHODSBody TemperatureCore & Peripheral

    Hypothalamus

    Heat DissipationSweating, vasodilatation

    Heat ConservationShivering, vasoconstrictionThermoreceptorsCentral Peripheral

    Metabolic RateBasic metabolic rateExertional metabolic rateCore temperature

    Bledsoe et al., Paramedic Care Principles & Practice Volume 3: Medical 2006 by Pearson Education, Inc. Upper Saddle River, NJ

  • HOMEOSTASIS: THERMOLYSISConductionDirect loss of heat from one object to another

    ConvectionDirect heat loss to air currents

    RadiationHeat loss to nearby objects without direct contact

    EvaporationHeat loss secondary to water evaporation from skin

    RespirationConvection, radiation & evaporation

    Bledsoe et al., Paramedic Care Principles & Practice Volume 3: Medical 2006 by Pearson Education, Inc. Upper Saddle River, NJ

  • HOMEOSTASIS: THERMOREGULATIONBody generates cellullar level heat via mitochondrial metabolismBasal metabolic rateExertion metabolic rate

    Shivering is an autonomic / automatic heat forming mechanism via muscle contraction

    Bledsoe et al., Paramedic Care Principles & Practice Volume 3: Medical 2006 by Pearson Education, Inc. Upper Saddle River, NJ

  • THERMAL REGULATION

    Heat flows from area of high to low temperature

    A body in warm environment gains heat, a body in a cool environment gives off heat

    Other factors:WindRelative humidity

    Bledsoe et al., Paramedic Care Principles & Practice Volume 3: Medical 2006 by Pearson Education, Inc. Upper Saddle River, NJ

  • Humidity Index

    Bledsoe et al., Paramedic Care Principles & Practice Volume 3: Medical 2006 by Pearson Education, Inc. Upper Saddle River, NJ

  • RISK FACTORSAgeAge extremes less able to tolerate temp shifts

    Poor Health & Predisposing PMHIDDM: autonomic dysfunction reduces ability to vasodilate & sweatCardiac: fluid shifts not tolerated well

    MedicationsBeta blockers, Diuretics, Antipsychotics

    Environmental FactorsAcclimitization, exposure time, ambient temperature, Humidity, Wind

    Bledsoe et al., Paramedic Care Principles & Practice Volume 3: Medical 2006 by Pearson Education, Inc. Upper Saddle River, NJ

  • PREVENTATIVE MEASURESAdequate fluid intakeDehydration prevents thermolysis

    Recognizing SSX Early:N / V / abd pain, vision disturbances, decreased urine output, poor skin turgor, hypovolemic shock

    TreatmentHydrationGradual acclimatizationLimited exposure to hostile environments

    Bledsoe et al., Paramedic Care Principles & Practice Volume 3: Medical 2006 by Pearson Education, Inc. Upper Saddle River, NJ

  • HEAT EMERGENCIES SPECTRUMHeat Cramps:Muscle cramps relieved by salt & hydration

    Heat Edema:Swollen ankles relieved by leg elevation

    Heat Syncope:LOC from vasodilation; must r/o serious etiologies

    Heat Exhaustion:Volume depletion with vague, non-specific SSX

    Heat Stroke:CNS dysfunction is hallmark

    Bledsoe et al., Paramedic Care Principles & Practice Volume 3: Medical 2006 by Pearson Education, Inc. Upper Saddle River, NJ

  • HYPERTHERMIAAbnormal elevation of core temperature typically caused by elevated external temperatures

    Must differentiate from fever (pyrexia)Fever: normal response to infection caused by pyrogens which reset hypothalamic thermostat & increase BMR

    Fever makes body environment less hospitable to infectious organisms

    Fever treatable with anti-pyretics, hyperthermia is not

    Bledsoe et al., Paramedic Care Principles & Practice Volume 3: Medical 2006 by Pearson Education, Inc. Upper Saddle River, NJ

  • HEAT CRAMPSPainful non-emergency that must be differentiated from other disorders

    Hyperthermia causes sweatingSweat consists of water & salt Sodium loss causes muscle cramping

    Symptoms:Extremity muscle crampingA & O, though weak, faint or dizzySkin is warm & moistTemp normal to mildly elevatedVitals reasonably normal, often with tachycardia

    Bledsoe et al., Paramedic Care Principles & Practice Volume 3: Medical 2006 by Pearson Education, Inc. Upper Saddle River, NJ

  • HEAT EXHAUSTIONMost common heat illness seen by EMS

    Etiology:Sweat & sodium loss creates loss of blood volumeVasodilation worsens problem ultimately causing a drop in cardiac output /BP with a rise in heart rate to compensate

    SSX:Body temp >100F (37.8)Cool & clammy skinTachypnea, tachycardia, hypotensionMuscle cramping & generalized weaknessCNS: Headache, Anxiety, Impaired judgment

    Progresses to Heat Stroke if not treated

    Bledsoe et al., Paramedic Care Principles & Practice Volume 3: Medical 2006 by Pearson Education, Inc. Upper Saddle River, NJ

  • DEVELOPMENT OF HEAT EXHAUSTIONHeatExcessive SweatingHypovolemiaSkin Arteriolar DilationDecreased Cardiac OutputDecreased Mean Arterial PressureCirculatory Collapse

    Bledsoe et al., Paramedic Care Principles & Practice Volume 3: Medical 2006 by Pearson Education, Inc. Upper Saddle River, NJ

  • HEAT EXHAUSTION TREATMENTRemove from environment

    Remove clothing, active & passive cooling

    Oral electrolytes or IV crystalloids

    Resolves with hydration, rest & supine

    If symptoms do not resolve consider other causes

    Bledsoe et al., Paramedic Care Principles & Practice Volume 3: Medical 2006 by Pearson Education, Inc. Upper Saddle River, NJ

  • HEAT STROKEEnvironmental emergency with 80% mortality if late or inadequate treatment

    Hallmark: hot dry skin without sweat plus AMS

    Lack of hypothalamic thermoregulation causes uncontrolled hyperthermia

    Core temp often >105 FCellular death, protein denaturationDamage to brain, kidney & liver causes multi-system failureRectal temperature is necessary to provide accurate reading

    Bledsoe et al., Paramedic Care Principles & Practice Volume 3: Medical 2006 by Pearson Education, Inc. Upper Saddle River, NJ

  • HEAT STROKE CATEGORIESClassic Secondary to altered thermoregulationElderly, chronically ill, patients with AMS

    ExertionalHealthy individuals with significant heat stressSkin initially moist due to exertional sweating

    Bledsoe et al., Paramedic Care Principles & Practice Volume 3: Medical 2006 by Pearson Education, Inc. Upper Saddle River, NJ

  • HEAT STROKE SSXCore temp >105F (40.5C)

    Mental status changes / anxiety / Confusion

    Hypotension

    TachypneaRenal failure

    DIC

    Hypotension with bounding or thready tachycardia

    Possible seizures

    Bledsoe et al., Paramedic Care Principles & Practice Volume 3: Medical 2006 by Pearson Education, Inc. Upper Saddle River, NJ

  • DEVELOPMENT OF HEAT STROKEStrenuous ExerciseHot, Humid EnvironmentInadequate Temperature RegulationCore Temperature ElevatesImpaired CNS FunctionOrgan & Tissue DamageComa & Death

    Bledsoe et al., Paramedic Care Principles & Practice Volume 3: Medical 2006 by Pearson Education, Inc. Upper Saddle River, NJ

  • HEATSTROKE TREATMENTTransfer to cool environment

    Remove clothing, start rapid active coolingCover with moist sheets Mist with cool water

    Target temperature 102FOvercooling may cause reflex hypothermiaAdminister O2 prn

    IV rehydration

    Cardiac monitor

    AVOID vasopressors or anticholinergic drugs

    Reassess vitals frequently

    Bledsoe et al., Paramedic Care Principles & Practice Volume 3: Medical 2006 by Pearson Education, Inc. Upper Saddle River, NJ

  • OEMS 2.3 HYPERTHERMIA /HEAT EMERGENCIESPriorities: Rapid Recognition & Cooling!Scene safety, BSIAirway management, O2 as neededContinually assess & record LOC, ABCs, vitalsSAMPLE historyLoosen / remove clothing, move to cool environmentIf A&Ox3, give water or oral rehydration solutionRapid transport w/wo ALS in position of comfortDo not allow patient to exert themselves

    Bledsoe et al., Paramedic Care Principles & Practice Volume 3: Medical 2006 by Pearson Education, Inc. Upper Saddle River, NJ

  • OEMS 2.3 MANAGEMENTRapid but not over cooling; If shivering occurs, discontinue active coolingCool packs to armpits, neck, groin and evaporation techniques (fans, windows)Keep skin wet with towels or spongesElevate legs if supineALS intercept if necessary & available; Rapid transport w/wo ALSNotify rec