Heat Illnesses - PowerPoint PPT Presentation

Loading...

PPT – Heat Illnesses PowerPoint presentation | free to download - id: 3f344e-NTViY



Loading


The Adobe Flash plugin is needed to view this content

Get the plugin now

View by Category
About This Presentation
Title:

Heat Illnesses

Description:

Heat Illnesses – PowerPoint PPT presentation

Number of Views:430
Avg rating:3.0/5.0
Slides: 25
Provided by: wilderness3
Learn more at: http://wildernessmedicine.wikispaces.com
Category:
Tags: heat | illnesses

less

Write a Comment
User Comments (0)
Transcript and Presenter's Notes

Title: Heat Illnesses


1
Heat Illnesses
2
Scenario
  • You are one of the doctors on duty at the Great
    North Run. It is an unusually hot, humid and
    still day (temp 18 degrees) for the time of year.
  • A participant collapses after nearly 8 miles. He
    is brought to your facility which is only 20
    yards away.

3
  • He looks and feels hot.
  • How do you determine if he has a heat illness?
  • If so why might this have occurred?
  • If so how will you further assess and manage him?

4
Heat illnesses
  • Heat exhaustion
  • Heat stroke

5
Factors affecting heat stress
  • Temperature
  • Humidity
  • Movement of air or lack of air movement
  • Clothing
  • Physical activity

6
(No Transcript)
7
(No Transcript)
8
Remember
  • One case of a heat illness means
  • Other cases may be heading your way
  • You may become affected if youre in the same
    environment
  • You need to review what you/others are doing
  • Prevention better than cure keep drinking
  • Sodium concentration should be 50mmol/litre
  • Thirst signifies dehydration
  • Lack of thirst does not signify hydration

9
Heat Exhaustion Time Running Out
  • Most commonly encountered form of heat illness
  • May result from physical exertion in hot
    environments cardiovascular system cannot meet
    combined requirements of muscular, visceral and
    thermoregulatory blood flow.
  • Increased demand for cardiac output
  • Reduced ECF volume
  • Usually both salt and water deplete
  • The skin is cool and clammy with sweat.
  • Body temperature may be normal lt39 even if
    collapse
  • No organ damage (though may be dysfunction
    through underperfusion)

10
Heat Exhaustion- Treatment
  • Check orientation if casualty disorientated
    treat as heat stroke
  • Rest in the shade or cool place
  • Monitor temp and treat as heat stroke if keeps
    rising
  • Drink plenty of salt solution or electrolyte
    fluids
  • Parenteral fluids only if vomiting
  • Remove/loosen clothing to allow body to cool
  • Wetting skin aids cooling (if let water
    evaporate)
  • If unsure if heat exhaustion or heat stroke
    manage as if heat stroke

11
Heat Stroke Out of time
  • This is an emergency!!
  • If you suspect someone is suffering from heat
    stroke act immediately
  • Their condition will rapidly deteriorate without
    treatment
  • Brain damage and death are possible

12
Heat Stroke
  • Serious medical condition that requires emergency
    medical attention (without prompt and effective
    treatment, mortality nearly 80)
  • Sweating is often diminished or absent
    (anhidrosis more likely in classic than in
    exertional heat stroke), which makes the skin hot
    and dry
  • Body temperature is very high (41C and rising)
  • There is organ damage in heat stroke
  • In right environment
  • If core temp gt 40 and CNS dysfunction causing
    delirium or convulsion, the casualty has heat
    stroke
  • If core temp gt 39 and patient unconscious, the
    casualty has heat stroke

13
Phases of heat stroke
  • Hyperthermic
  • Haematological and enzymatic
  • Renal and hepatic

14
1. Hyperthermic phase
  • CNS disturbance
  • GI disturbance (DV)
  • Hyperventilation and respiratory alkalosis

15
2. Haematological and enzymatic phase
  • Leukocytosis
  • Clinical evidence of bleeding diathesis
  • Abnormal clotting
  • High CK and myoglobinuria

16
3. Renal and hepatic phase
  • Renal impairment and failure
  • Hypokalaemia early, hyperkalaemia late
  • Casts in urine
  • Elevated liver enzymes

17
Organs damaged
  • Brain
  • Coagulation/haemostatic
  • Muscle
  • Liver (and therefore hypoglycaemia)
  • Kidneys

18
Heat Stroke Signs and Symptoms
  • Mental confusion
  • Delirium
  • Chills
  • Dizziness
  • Loss of consciousness
  • Convulsions or coma
  • A body temperature of 41C or more
  • Hot, dry skin that may be red, mottled or bluish
  • Tachycardia

19
Differential diagnosis
  • Infection (esp. meningococcal sepsis, falciparum
    malaria)
  • Pontine bleed
  • Drug intoxication (cocaine, MDMA)
  • Thyroid storm

20
Heat Stroke - Treatment
  • ABCDE
  • Airway protection often needed
  • Go easy on the fluids 1 1.5 litres enough
    initially give more based on urine output (or
    lack of)
  • D stands for degrees
  • Cool cool cool can start this on scene
  • Outcome relates to magnitude and duration of high
    temp
  • Evaporative methods usually best
  • Treat fits aggressively (they raise temp further)
  • Suppress shivering (chlorpromazine)
  • Avoid antipyretic

21
  • Parris Island Protocol For Treating Suspected
    Exertional Heatstroke
  • In field, ice packed around the groin and
    axillary areas, and patient immediately
    transported to clinic on stretcher.
  • Stretcher placed above water and ice, with
    carrying handles sticking out at both ends.
  • Sheets are dipped into icy water and used to
    cover and drench patient frequently rewetted.
  • Copious ice added to top of sheet, and skin
    massaged to improve blood flow.
  • Head constantly irrigated with ice water and fan
    directed at patient.
  • GCS other vital signs assessed, blood taken for
    laboratory analyses.
  • One litre of normal saline administered
    intravenously, as a bolus.
  • Potassium not administered until electrolytes
    determined.
  • If temperature not lowered sufficiently, patient
    immersed into ice and water. Temperature usually
    falls to 39.5C within 15 to 20 minutes.

22
Heat stroke
  • After ABC and rapid cooling intensive care may be
    needed for the multisystem problems that can
    develop
  • Work up needs to assess haemostasis, liver, renal
    function and CK
  • CNS dysfunction common ALWAYS look for and
    treat hypoglycaemia

23
Scenario
  • You are one of the doctors on duty at the Great
    North Run. It is an unusually hot, humid and
    still day (temp 18 degrees) for the time of year.
  • A participant collapses after nearly 8 miles. He
    is brought to your facility which is only 20
    yards away.

24
  • He looks and feels hot.
  • How do you determine if he has a heat illness?
  • If so why might this have occurred?
  • If so how will you further assess and manage him?
About PowerShow.com