Heat Stroke

Question 1

Heat Stroke

Heat stroke =

Answer 1

AMS or ataxia + ↑ temp- hyperdynamic vitals, oliguria, diarrhea (splanchnic vasoconstriction), anhydrosis
Rhabdomyolysis, liver injury

Question 2

Heat Stroke

ASAP:

Answer 2

Remove from heat, ABCs, 2 LB IVs, O2, monitor, VS w/ cont core temp. ± RSI/ETT for AMS

Question 3

Heat Stroke

Hx/Exam:

Answer 3

AMS, confusion, ataxia; environmental vs tox vs medical causes, SAMPLE hx

Question 4

Heat Stroke

Labs:

Answer 4

CBC, BMP, Mg, Ca, CK, LFTs, VBG, UA w/myoglobin, EKG

Question 5

Heat Stroke

Rads:

Answer 5

± CXR

Question 6

Heat Stroke

Tx:

Answer 6

Cool aggressively til < 102 F Heat Stroke
If mild sx… Undress pt and spray w/ warm Mist and Fan. IVF boluses.
If mod sx… Ice packs to axilla/groin plus mist and IVF.
If severe sx… all of the above plus NGT or foley Ice water lavage.
If temp not ↓ in 30 min… may try Ice bath but monitoring more difficult

Question 7

Heat Stroke

Treatment if shivering:

Answer 7

Demerol 50-100 mg IV, Ativan 0.5-2 mg IV, or Thorazine 25-50mg IV (or paralyze and intubate)
If rhabdo… goal UOP = 2ml/kg/hr. Alkalinize urine w/ 3 amps Bicarb in 1L D5W @ 1.5 x maint.   Mannitol once euvolemic to ↑ UOP