ENVIRONMENTAL EMERGENCIES■ Nausea and vomiting
■ Core temperature is typically normal, but may be elevated (<40°C).
DIAGNOSIS
■ Based on clinical presentation
■ Electrolytesmay be abnormal: Hyponatremia, hypochloremia, elevated
BUN
■ LFTs are normal.
TREATMENT
■ Remove patient from heat source.
■ Replete fluids with electrolyte solutions (oral or intravenous, depending on
severity).
Heat Stroke
Heat stroke is severe form of heat injury with a high mortality rate in which
homeostatic thermoregulatory mechanisms fail, leading to hyperthermia and
multisystem organ dysfunction.
It is historically classified as classicorexertional.
■ Classic heatstroke: Elderly or debilitated patients without access to air con-
ditioning; sweating is often absent
■ Exertional heatstroke: Younger individuals exercising in a hot environment
This classification has no clinical bearing as the treatment is the same.
SYMPTOMS/EXAM
■ Altered mental status and CNS dysfunction
■ Possible seizure
■ Anhydrosis: Hot/dry skin (not reliable)
■ Core body temperature usually >40.5°C rectal (may be lower)
■ Jaundice 24–72 hours later
■ Cardiovascular dysfunction: Hypotension, pulmonary edema
DIAGNOSIS
■ Based on clinical presentation
■ Marked elevation of AST/ALT is expected with peak in 24–72 hours.
Complete recovery is expected.
■ Renal injury is common and may be due to volume depletion, direct thermal
injury, or rhabdomyolysis.
■ Fluid, electrolyte, and hematologic disorders vary.
TREATMENT
■ Supportive therapy
■ Continuous temperature monitoring
■ Correct electrolyte imbalances.
■ Rapid cooling(within 1 hour) to core temperature of 39–40°C
■ Removing clothing.
■ Evaporative cooling(moisten skin with tepid water and fan skin with
warm air) or
■ Cold water immersion (downside = less access to patient)
Heat stroke = Hyperthermia
with CNS dysfunction.Hepatic damage is nearly
always present in heat stroke.