Hyperthermia Flashcards

1
Q

Where is the thermoregulatory centre located?

A

In the anterior hypothalamus :

Senses deviations from the temperature set-point and sends signals to initiate heat dissipation measures

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2
Q

What are the 4 principle mechanisms for heat loss or heat gain in dogs and cats?

A

Convection: heat transfer between skin and moving air or water (loss or gain)

Radiation: heat loss or gain to the environment along a temperature gradient, without direct contact, heat can also be gained from solar energy (loss or gain)

Evaporation: moisture evaporites into the air, pulling heat away from the body (heat loss only)

Conduction: heat transfer between skin and objects in contact with the skin (loss or gain)

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3
Q

True fever

A
  • Pyrexia
  • normal body response to invasion or injury
  • one of the several components of the “acute phase response”
  • increased neutrophil counts
  • increased lymphocyte activity
  • increased fibroblast activity
  • fatigue
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4
Q

What causes pyrexia?

A

Exogenous pathogens: bacteria, viruses, fungi, and some pharmological agents

-This leads to production of endogenous pyrogens

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5
Q

What are pyrogens

A
  • proteins that are produced by leukocytes or tumour cells, and trigger a febrile response
  • Also known as cytokines
  • travels to the anterior hypothalamus stimulating the release of prostaglandins = cases increases in temperature
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6
Q

Why do you not treat mild to moderate fevers?

A
  • fever plays a role in interfering with the growth and reproduction of the causative organism
  • active cooling can be detrimental as body will work harder to maintain new set temperature and if active cooling suddenly stopped, a patient can rebound to an even higher temperature
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7
Q

What do you use to treat a fever?

A

NSAIDs

  • inhibits prostaglandin synthesis
  • increase mortality in rabbits with Pasterurella infections
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8
Q

At what temperature do you consider a fever extreme and how do you treat it?

A
  • 41.6 degrees celcius (106 F)

* active cooling

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9
Q

Examples of heat dissipation in a dog

A

Panting and hypersalivation, peripheral vasodilation

Dogs and cats will actively look for a cooler environment by finding shaded area, and lying on cool substrates

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10
Q

At a low humidity ambient temperature of 32C (89.6F), what mechanisms are used to maintain body temperature?

A

Convection, conduction and radiation

*Passive processes and do not require additional energy expenditure to dissipate heat

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11
Q

What initially happens if a dog needs to actively dissipate heat?

A
  • Pant to increase evaporative heat loss
  • Peripheral vasodilation increases to increase convection and radiation of heat from the body
  • Panting uses large muscle groups + vasodilation increases cardiac output to maintain MAP= generates heat
  • If heat load exceeds heat dissipation = heatstroke
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12
Q

Definition of heatstroke

A

A body temperature greater than 41C (105.8F) PLUS CNS dysfunction

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13
Q

What causes heat stroke?

A

*Extreme environmental heat often in combination with high humidity

*Humidity hinders heat dissipation methods by reducing the evaporation of water
= animal has to expend more energy to dissipate heat, increasing metabolic components of heat load and not able to dissipate heat.

  • Other predisposing factors: obesity, laryngeal paralysis, tracheal collapse, brachycephalic syndrome
  • Exertional heatstroke : when dogs are worked in extreme heat without sufficient cooling opportunities
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14
Q

What is the upper lethal temperature in dogs?

A

43C (109.4F)

But irreversible brain damage has been identified at 41C (105.8F)

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15
Q

How would a heatstroke patient usually present?

A

Recumbent, dry or tacky, hyperemic MM, a very fast or very slow CRT and will be heavily panting

Neurological signs may be present: ranging from loss of consciousness to blindness, seizures, and coma.

Tx for suspected cerebral Edelman must be implemented as soon as possible to prevent brain herniation

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16
Q

Active cooling in the hospital setting

A
  • Administer cool IVF
  • wetting the patient with tepid water
  • Using a fan to evaporate water
  • Placing on a stainless steel table with no blankets
  • Ice packs on areas of the body with large vessels such as around the inguinal area and neck
17
Q

What substance is contraindicated in active cooling of a heatstroke patient?

A

The use of alcohol as an evaporative medium as appreciable amount of alcohol can be absorbed across the skin and into the blood stream.

18
Q

Examples of invasive methods of cooling

A
  • bladder lavage with room temperature sterile saline
  • cool water enemas
  • gastric lavage with cool water
  • downside: difficult to get an accurate body temperature
  • can easily cause a patient to become hypothermic
19
Q

At what temperature do you STOP active cooling?

A

Until the patient reaches a high normal temperature of 103F (39.4C)

20
Q

Why should shivering be avoided in a patient?

A

Shivering is a normal physiological response to a rapid decrease in temperature as it serves to increase body temperature and can lead to rebound hyperthermia

21
Q

Why should oxygen be provided at every hyperthermia patient at the emergent phase?

A
  • Hyperthermia will cause an increase oxygen demand to the body because of increased metabolic demands
  • Perfusion and oxygen delivery to the tissues will be impaired due to metabolic shock
  • Supple oxygen via methods that will not cause additional heating - flow by or the use of nasal prongs or cannula
  • oxygen cages and tents often increase body temperature as they can trap heat
  • if airway compromise is present, incubate and ventilate
22
Q

What are the minimal database for hyperthermic patients?

A
PCV/TS
BG
BUN
Blood gas
Electrolytes 
Coagulation test  - ACT, or PT/APTT
If possible: urine dipstick and USG
23
Q

What are the blood abnormalities you expect to find in a heatstroke patient?

A

Elevated PCV and TP (both can be decreased if hemorrhage has occurred)

Hypoglycemia: secondary to acute hepatic insult and increased metabolic demands

Azotemia secondary to dehydration and/or acute renal failure

Coagulopathy due to DIC

Mixed acid base disturbance: typically a metabolic acidosis (from increased lactate reflecting poor tissue perfusion) and a respiratory alkalosis from excessive panting

24
Q

What are the normal secondary insults that a heatstroke patient experience once the immediate crisis has passed?

A

DIC, ARF, GI bleeding, pulmonary edema, cerebral edema, cardiac arrhythmias