Transcript Too Hot - Frasercoasted

Too Hot
Hyperthermia
David Johnson
Causes
• Endogenous/exogenous
• Excessive heat production/diminished
dissipation
• Exertional
• Environmental
• MH, NMS, thyrotoxicosis, phaeo, drug
intoxication, seizures, anticholingergic,
infectious
Heat exhaustion vs heat stroke
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Diaphoresis
Weakness
Temp may be normal
Muscles cramps
Lighteheaded
Syncope
Nausea
Vomiting
• Temp >41
• Neurologic
dysfunction
• Exertional or nonexertional
• May have hot dry skin
• Other altered vital
signs
Management
• Cool rapidly to <39
• Evaporative is best
– Fans plus sprayed water
• Ice packs to groin/axilla
• Cool water, salty foods
• Check for causes (fever/drugs) and
consquences: rhabdo, liver failure
hyperkalaemia
Other stuff
• Remember aim UO 3-4mL /hour in rhabdo
• Consider benzos or even intubation and
paralysis to prevent shivering
• Dantrolene only in malignant hyperthermia
• Antipyretics not useful for heat stroke
Outcome
• Mortality 60%
• Permanent neuro deficit 7-15%
• Poor prognosis with
– High core temp
– High SAPS II
– Heat stroke at home (non-exertional)
– Elevated INR
– Use of inotropes
– No air con in ICU