Treating Heat Stroke

Introduction

Treating heat stroke should be accomplished quickly and aggressively to improve the survival and outcome.

Before coming to the treatment aspect first let us orient ourselves a bit about this not uncommon condition especially in the summer times.

What is heat stroke?

Heat Stroke is a serious & life threatening condition secondary to dysregulation of temperature control mechanisms in the body resulting in generation of abnormal amount of heat.

Normal body-temperature as measured orally for healthy individuals is around 98.2±0.7°F and with heat stroke it is more than about 105.

The term stroke is not totally appropriate here because patient doesn’t experience the typical stroke what we think of, also there is also no blockage of circulation or bleeding in the brain which are the two common types of stroke (infarction & hemorrhagic types), nevertheless patient does generally present with various neurologic manifestations that may resemble a stroke from certain angles, if not to the fullest extent.

Hyperthermia versus fever

Heat stroke is a hyperthermia condition, and is different from fever. In our body the temperature control mainly takes place in a region of the brain called as hypothalamus. In fever the hypothalamic set-point is increased but not with hyperthermia conditions.

What triggers hyperthermia & heat stroke conditions?

It mostly results from excessive production of heat within the body or excessive heat exposure from the environment. Extremes of age like infants and old people are mainly susceptible to this condition. Impaired sweating, dehydrated conditions, excessive exposure to heat (working for long under hot sun) etc can precipitate this condition.

How does patient present?

• Body temperature above 105°F
• Confusion/disorientation
• Dry skin, mucosa
• Rapid breathing
• Blood pressure & pulse changes
• Decreased urine out put
• Seizures etc

This condition can mimic a stroke, heart attack, severe infections/sepsis etc, so a high index of suspicion is necessary. Since patient may not be able to provide history on majority of the occasions contacting family members or other people who are familiar with the patient is necessary.

Diagnosis

It is mostly a clinical diagnosis and accomplished by measuring the body temperature, obtaining a good history and doing a good clinical examination. Laboratory and radiological investigations occupy a supportive role.

Treating heat stroke

It is a medical emergency so treatment should start immediately. Patient is hospitalized and preferably admitted to ICU (intensive care unit). Body temperature should be brought down at the earliest. Patient should be placed in cool area and it can be accomplished by air conditioning, fans etc. Other general measures include undressing to let the sweating get evaporated, cold water bath, covering with cold blankets etc. Lot of intravenous fluid is given. Medications to bring down the temperature are also liberally used.

A Neurologist & Internist/family Doctors are frequently involved in the care of these patients.



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