Environmental Flashcards
Elderly Hyperthermia and Collapse
2023.2 Case based discussion
COMPLICATIONS:
Neurological - confusion, delirium, coma, cerebral oedema, seizure, encephalopathy,
Rhabdomyolysis and renal failure
Metabolic - hypoglycemia
Electrolytes - hyponatremia
Cardiac - stress induced cardiomyopathy, MI, arrythmias
Respiratory - ARDS, pulmonary oedema
Haematological - DIC
CAUSES FOR ELDERLY COLLAPSE:
Geriatric causes:
- polypharmacy
- cognitive impairment
- visual or hearing impairment
- parkinsons
- postural hypotension
- deconditioning
Medical causes:
metabolic - hypoglycemia, hyponatremia
cardiac - arrythmias
haemorrhage
anaemia
TIA/stroke
DIFFERENTIAL DIAGNOSES FOR HYPERTHERMIA:
Environmental
- Heat stroke
Infection
- Sepsis
Toxicological
- malignant hyperthermia
- neuroleptic malignant syndrome,
- serotonin syndrome,
- anticholinergic toxidrome,
- salicylate toxicity,
- sympathomimetics - cocaine
Endocrinology
- thyroid storm
Heat stroke:
- Core temp >40
- Neurological disturbance - altered mental status, confusion, coma, seizure
- Anhydrosis
HISTORY - hyperthermia:
Heat exposure - no air conditioning
Lack of hydration
Medication review - new medications, discontinued medications, drug interactions
Infective symptoms - cough, urinary symptoms, abdominal pain, diarrhoea, vomiting, headache, photophobia, meningism
personal or family history of malignant hyperthermia
Thyroid disorders
- goitre
- weight loss
- proptosis
HISTORY - fall:
Preceding symptoms
Collapse vs. mechanical fall
Loss of consciousness
Injuries obtained
Anticoagulation
INVESTIGATIONS:
glucose for altered mentation
ECG - arrythmias
VBG - metabolic acidosis (lactic acidosis), respiratory alkalosis (hyperventilation)
CK - rhabdomyolysis
UEC - renal failure and electrolyte disturbances
Inflammatory markers raised in infection
Coagulation profile including fibrinogen in DIC
LFT’s - hepatic failure
TSH - thyroid storm
CT brain - altered mentation, fall with intracranial haemorrhage
Septic screen - urinalysis, CXR
MANAGEMENT:
core temperature - rectal or bladder probe (non-intubated patients), esophageal probe (intubated patient)
aim to drop core temp to 38 degrees within 1hr reduces mortality
Remove clothes
Place on specialised cooling mats
spray body with lukewarm water and fan
cool IV crystalloids - 4 degrees
ice packs to groin, axilla and neck
ice bath immersion - most effective, difficult to monitor patient
consideration of ECMO - though invasive, not readily available, labor intensive
consideration of pleural cavity, bladder and peritoneal lavage - though invasive and labor intensive
control shivering and agitation
- diazepam 1-2mg IV, repeat every 5 minutes
treat agitation - sedation or RSI and intubate - paralyse to prevent shivering and further heat production
IDC - maintain urine output 1-2ml/kg/hr (rhabdymyolysis)
Broad spectrum antibiotics
