HYPERTHERMIA
DESIGNATION OF CONDITION
Hyperthermia is considered a sustained core temperature of greater than 101° F (38.3° C), with thermoregulatory mechanisms failing around 105.8° F (41° C). This condition can result from environmental exposure, exertion, medications, or illness. Signs and symptoms include any or all of the following: muscle cramps, weakness, exhaustion, dizziness, fainting, altered level of consciousness, unresponsiveness, and rapid heart rate. Skin may be moist or dry, and normal, cool, or hot. The most severe sign of hyperthermia is an altered level of consciousness.
EMPHASIS ON PATIENT CARE
ALL LEVELS:
1. Primary Management - Assess ABC’S and manage as indicated. Use humidified O2.
2. Rapid cooling is essential. Techniques will vary depending on level of patient’s condition: Heat Cramps, Heat Exhaustion, or Heat Stroke. Any heat related condition with an altered level of consciousness should be treated as Heat Stroke and transported.
a. Move patient to a cool, shaded area
b. Remove the patient’s clothing and cool patient with wet sheets; low-pressure water hoses may be used to continually re-wet patient
c. Manually fan patient to promote cooling by evaporation
d. Apply insulated cold packs to neck, axilla, and groin
e. DO NOT pack in ice. Dangerous reversal to hypothermia may occur
f. If able to take oral fluids carefully begin oral rehydration with carbohydrate/electrolyte drink mixes if patient is alert
3. Secondary Management - History, physical exam, vital signs
AEMT:
1. Establish an IV of NS or LR and fluid bolus to maintain adequate end organ perfusion, consider 1L fluid bolus and repeat as needed for dehydration or tachycardia. Establish a second IV at same rate if acute hyperthermia is present.
2. If nausea and vomiting present treat with Ondansetron (Zofran) 4 mg PO (ODT)/IV
PARAMEDIC:
1. Apply cardiac monitor; treat lethal dysrhythmias concurrently
Extremes of age are more prone to heat emergencies. Obtain and document patient temperature if able. Predisposed by use of: TCA anti-depressants, phenothiazines, anticholinergic medications and alcohol. Cocaine, amphetamines, and salicylates may elevate body temperature. Sweating generally disappears as body temperature rises above 104 F (40C). Intense shivering may occur as patient is cooled. Heat cramps consists of benign muscle cramping, secondary to dehydration and is not associated with an elevated temperature.
Heat exhaustion consists of dehydration, salt depletion, dizziness, fever, AMS, headache, cramping, nausea and vomiting Vital signs usually consist of tachycardia, hypotension and elevated temperature. Heat stroke consists of dehydration, tachycardia, hypotension, temperature > 104 F (40 C) and AMS.
Symptoms
Heat Exhaustion Heat Stroke
Normal mental status Clammy skin AMS Dilated pupils
Thready pulse Muscle cramps/ spasms Hot, dry skin (<25% is moist) Tachycardia
Slightly elevated temperature Dizziness Temperature often >104 F (40 C)
Nausea / Vomiting Muscle cramps / spasms Arrhythmias
Special Note: In rare exertional heat stroke cases rapid cooling on scene is advisable. Findings consist of rectal temperature greater than 104.5, altered mental status, profuse sweating, and physical exertion in a hot environment. Rapid cooling can be accomplished with 10-20 pounds of ice in a body bag with water. Place the patient in the water for 10-20 minutes until mental status improves. Patient may remain clothed during cooling. If mental status fails to improve with cooling consider transport. Patients with exertional heat stroke should be evaluated in an emergency department.
DESIGNATION OF CONDITION
Hyperthermia is considered a sustained core temperature of greater than 101° F (38.3° C), with thermoregulatory mechanisms failing around 105.8° F (41° C). This condition can result from environmental exposure, exertion, medications, or illness. Signs and symptoms include any or all of the following: muscle cramps, weakness, exhaustion, dizziness, fainting, altered level of consciousness, unresponsiveness, and rapid heart rate. Skin may be moist or dry, and normal, cool, or hot. The most severe sign of hyperthermia is an altered level of consciousness.
EMPHASIS ON PATIENT CARE
ALL LEVELS:
1. Primary Management - Assess ABC’S and manage as indicated. Use humidified O2.
2. Rapid cooling is essential. Techniques will vary depending on level of patient’s condition: Heat Cramps, Heat Exhaustion, or Heat Stroke. Any heat related condition with an altered level of consciousness should be treated as Heat Stroke and transported.
a. Move patient to a cool, shaded area
b. Remove the patient’s clothing and cool patient with wet sheets; low-pressure water hoses may be used to continually re-wet patient
c. Manually fan patient to promote cooling by evaporation
d. Apply insulated cold packs to neck, axilla, and groin
e. DO NOT pack in ice. Dangerous reversal to hypothermia may occur
f. If able to take oral fluids carefully begin oral rehydration with carbohydrate/electrolyte drink mixes if patient is alert
3. Secondary Management - History, physical exam, vital signs
AEMT:
1. Establish an IV of NS or LR and fluid bolus to maintain adequate end organ perfusion, consider 1L fluid bolus and repeat as needed for dehydration or tachycardia. Establish a second IV at same rate if acute hyperthermia is present.
2. If nausea and vomiting present treat with Ondansetron (Zofran) 4 mg PO (ODT)/IV
PARAMEDIC:
1. Apply cardiac monitor; treat lethal dysrhythmias concurrently
Extremes of age are more prone to heat emergencies. Obtain and document patient temperature if able. Predisposed by use of: TCA anti-depressants, phenothiazines, anticholinergic medications and alcohol. Cocaine, amphetamines, and salicylates may elevate body temperature. Sweating generally disappears as body temperature rises above 104 F (40C). Intense shivering may occur as patient is cooled. Heat cramps consists of benign muscle cramping, secondary to dehydration and is not associated with an elevated temperature.
Heat exhaustion consists of dehydration, salt depletion, dizziness, fever, AMS, headache, cramping, nausea and vomiting Vital signs usually consist of tachycardia, hypotension and elevated temperature. Heat stroke consists of dehydration, tachycardia, hypotension, temperature > 104 F (40 C) and AMS.
Symptoms
Heat Exhaustion Heat Stroke
Normal mental status Clammy skin AMS Dilated pupils
Thready pulse Muscle cramps/ spasms Hot, dry skin (<25% is moist) Tachycardia
Slightly elevated temperature Dizziness Temperature often >104 F (40 C)
Nausea / Vomiting Muscle cramps / spasms Arrhythmias
Special Note: In rare exertional heat stroke cases rapid cooling on scene is advisable. Findings consist of rectal temperature greater than 104.5, altered mental status, profuse sweating, and physical exertion in a hot environment. Rapid cooling can be accomplished with 10-20 pounds of ice in a body bag with water. Place the patient in the water for 10-20 minutes until mental status improves. Patient may remain clothed during cooling. If mental status fails to improve with cooling consider transport. Patients with exertional heat stroke should be evaluated in an emergency department.