Heat stroke medical therapy
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Usama Talib, BSc, MD [2]
Overview
The heat stroke is primarily managed by removing the patient from the environment to minimize heat exposure and to ionitiate rapid cooling protocols.[1]
Medical Therapy
The heat stroke is primarily managed by:[1][2][3][4][5]
- Removing the patient from the environment to minimize heat exposure
- Initiating cooling protocols as soon as possible
- Providing support to the effected organs
Cooling
The cooling is done on the following principles:[4][6]
- The heat is transferred from the body core to the skin and then dissipated into the air.
- Vasodilatation of the vessels in the skin occurs as a compensatory mechanism to help dissipate the heat
- Cooling therapies focus on increasing and facilitating the transfer of heat from the body to the surroundings while keeping the vasodilatory cooling mechanism intact. They can utilize:
- Increasing the gradient of temperature between the body and the surroundings (cooling by the help of conduction)
- Increasing the water vapor pressure gradient between the body and the surroundings (cooling by the help of evaporation)
- Accelerating the flow of air closer to the skin (cooling by the help of convection)
- These can be achieved by:
- Application of water
- Application of ice
- Fanning
Avoidance of Excessive cooling
Most of the techniques used for cooling can decrease the temperature of the skin excessively. Temperature can fall up to 30°C or lower resulting in compensatory mechanisms like:[3]
- Vasoconstriction and
- Shivering
These responses are not desired and can result in inappropriate management of hyperthermia. This can be avoided by an alternate or combined application of the following along with the cooling techniques:[7][8]
- Massaging of the body
- Spraying lukewarm water of 40°C
- Exposing to moving air which is hot i.e around 45°C
Use of Pharmacological Agents
Pharmocological agents have not proven to be of benefit in case of hyprethermia or heat stroke. The agents that have been considered include:
- Dantrolene sodium
- Antipyretics
Recovery
The revival of the functioning of the central nervous system is a positive prognostic sign. It is usually seen following aggressive therapy. 20% patients face residual damage of the brain and a higher mortality is associated with this.[9][5]
References
- ↑ 1.0 1.1 Leon LR, Bouchama A (2015). "Heat stroke". Compr Physiol. 5 (2): 611–47. doi:10.1002/cphy.c140017. PMID 25880507.
- ↑ Bouchama A, Dehbi M, Mohamed G, Matthies F, Shoukri M, Menne B (2007). "Prognostic factors in heat wave related deaths: a meta-analysis". Arch Intern Med. 167 (20): 2170–6. doi:10.1001/archinte.167.20.ira70009. PMID 17698676.
- ↑ 3.0 3.1 Bouchama A, Knochel JP (2002). "Heat stroke". N Engl J Med. 346 (25): 1978–88. doi:10.1056/NEJMra011089. PMID 12075060.
- ↑ 4.0 4.1 Graham BS, Lichtenstein MJ, Hinson JM, Theil GB (1986). "Nonexertional heatstroke. Physiologic management and cooling in 14 patients". Arch Intern Med. 146 (1): 87–90. PMID 3942468.
- ↑ 5.0 5.1 Dematte JE, O'Mara K, Buescher J, Whitney CG, Forsythe S, McNamee T; et al. (1998). "Near-fatal heat stroke during the 1995 heat wave in Chicago". Ann Intern Med. 129 (3): 173–81. PMID 9696724.
- ↑ Rowell LB (1983). "Cardiovascular aspects of human thermoregulation". Circ Res. 52 (4): 367–79. PMID 6339107.
- ↑ WYNDHAM CH, STRYDOM NB, COOKE HM, MARITZ JS, MORRISON JF, FLEMING PW; et al. (1959). "Methods of cooling subjects with hyperpyrexia". J Appl Physiol. 14: 771–6. PMID 13846292.
- ↑ Al-Aska AK, Abu-Aisha H, Yaqub B, Al-Harthi SS, Sallam A (1987). "Simplified cooling bed for heatstroke". Lancet. 1 (8529): 381. PMID 2880179.
- ↑ Hart GR, Anderson RJ, Crumpler CP, Shulkin A, Reed G, Knochel JP (1982). "Epidemic classical heat stroke: clinical characteristics and course of 28 patients". Medicine (Baltimore). 61 (3): 189–97. PMID 7078400.