::::::Heat stroke :::::
It is due to impairment of body heat regulating mechanism caused by failure of cutaneous circulation and sweating, following prolonged exposure to hot, humid conditions .
The onset is usually sudden with sudden collapse and loss of consciousness .
Predominant symptom may also be seen ( headache , nausea , vomiting , dizziness , mental confusion , muscles cramp, excessive thirst, excessive desire to micturate)
The skin is dry, hot and flushed with complete absence of sweating .
Body temperature rises as high as 43 degree centigrade ( hyperpyrexia) when body temperature rises above 42 degree centigrade vasodilation occur with decrease in blood volume leading to circulatory collapse and cardiac failure.
Delirium and convulsions may precede death.
Death may occur from few minute to 3 days.
Rapid reduction of the core body temperature is the cornerstone of treatment because the duration of hyperthermia is the primary determinant of outcome.
Removal of restrictive clothing and spraying water on the body, covering the patient with ice water–soaked sheets, or placing ice packs in the axillae and groin may reduce the patient's temperature significantly.
Patients who are unable to protect their airway should be intubated. Patients who are awake and responsive should receive supplemental oxygen.
Intravenous lines may be placed in anticipation of fluid resuscitation and for the infusion of dextrose and thiamine if indicated., infusion of dextrose 50% in water solution (D50W) should be considered in all patients with heatstroke.
Antipyretics (eg, acetaminophen, aspirin, other nonsteroidal anti-inflammatory drugs) have no role in the treatment of heatstroke because antipyretics interrupt the change in the hypothalamic set point caused by pyrogens; they are not expected to work on a healthy hypothalamus that has been overloaded, as in the case of heatstroke. In this situation, antipyretics actually may be harmful in patients who develop hepatic, hematologic, and renal complications because they may aggravate bleeding tendencies.
Immediate administration of benzodiazepines is indicated in patients with agitation and shivering, to stop excessive production of heat.
Dr Atul Chowdhury
Rapid Action Force