Heatstroke
Considered to be the most-severe of all heat-related problems, Heatstroke results from exercise and extremely heavy work combined with fluid intakes that are below adequate amounts. Other factors may include alcohol intake, dehydration, certain medicines and cardiovascular diseases. Furthermore, older people, children, obese people and people with sweating disorders are the ones at the most risk of suffering from heatstroke.
Symptoms of heatstroke include a rise in the body temperature of the patient abnormally to 40°C with sudden personality changes, confusion, or even coma. What makes this situation dangerous to the patient is that sweating and temperature control, the body’s coping mechanisms to heat stress, is not present anymore. This makes the condition severe and may cause life-threatening effects to the patient if not treated immediately.
To detect heatstroke, there are several symptoms to be aware of. Nausea, light-headedness, lowering of blood pressure, and the ceasing of a person’s sweating mechanism coupled with rapid heartbeat and breathing are signs of heatstroke. In older people, fainting also occurs as a sign.
Through the years, no specific method has been recommended as the best way in treating heatstroke. Every method that has been tested basically relies on the premise that the patient’s exposure time to the heat source should be abruptly stopped in order to stop the flow of heat. It has been a long belief in the medical community that this decreases the long term and possibly fatal effects of heatstroke to patients. But until now, no studies are made to compare the methods of treating heatstroke to come up with the best way to treat the said condition.
For now, the widely accepted method is basically lower the patient’s temperature by removing insulation from the body such as clothes and afterwards, spraying the victim’s body with water or just covering the body with sheets soaked in ice-cold water. Placing ice packs on strategic places of the body namely the groin and the axillae may also gradually reduce the patient’s temperature. In addition to that, conscious patients should be given supplemental oxygen and intravenous lines as well in preparation of fluid resuscitation. Dextrose and thiamine would also be infused, if necessary. However, dextrose 50% in water solution or D50W should be considered generally in all patients as hypoglycemia is also a common occurrence, an indication that there is liver failure.
In addition to the above-mentioned treatments, intensive care personnel should also pay extra attention to limitation and gradually decreasing the body temperature of the patient as well as the airways of the patient. Constant monitoring for complications is also a must. Insertion of a thermostat for temperature monitoring and nasogastric tube for gastrointestinal bleeding and fluid losses should also be administered. Urine output should be monitored by a Foley catheter. Generally, the objective of the said treatments is to reduce the body temperature of the patient up to 39°C with a temperature decrease speed of 0.2° per min; after which, the external cooling procedures are stopped to prevent iatrogenic hypothermia. During the following treatments, insert an indwelling thermostat rectally to monitor core body temperature. An esophageal probe may also be used. Temperature must always be monitored until the patient would have stable condition as thermal instability may come and go after the heatstroke sets in.
In the case that the blood pressure, urine output and pulse rate do not provide the much needed hemodynamic information that is significant, fluid administration should be guided by more invasive parameters such as pulmonary capillary wedge pressure, central venous pressure, and the like. Other parameters include the systemic vascular resistance index, or SVRI, and cardiac index (CI) measurements. Cor pulmonale is also a common occurrence among patients. And contrary to popular belief, aggressive fluid resuscitation is not generally recommended as it leads to pulmonary edema.