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 which is characteristic of Heat Stroke.
EMPHASIS ON PATIENT CARE
ALL LEVELS:
1. Primary Management - Assess ABC’S and manage as indicated.
2. Rapid cooling is essential. Techniques will vary depending on level of patient’s condition: Heat Exhaustion, or Heat Stroke. Any heat related condition with an altered level of consciousness should be treated as Heat Stroke and transported after cooling on-scene.
a. Move patient to a cool, shaded area.
b. For simple Heat Exhaustion passive cooling methods may be effective: shade, air conditioning, ice packs, wet towels. Push fluids in Heat Exhaustion PO or IV if needed.
c. Heat Stroke: 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. Be certain to empty patient’s pockets prior to immersion.
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
Notes:
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) rectally. Intense shivering may occur as patient is cooled.
Heat exhaustion consists of dehydration, salt depletion, dizziness, fever, headache, cramping, nausea and vomiting. Vital signs usually consist of tachycardia, hypotension and elevated temperature. Heat stroke typically consists of dehydration, dry skin, red skin, tachycardia, hypotension, temperature > 104 F (40 C) rectally and AMS.
Non-rectal temperature measurements are inaccurate and only estimate body temperature.
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 like in classic Heat Stroke. 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. Be certain to empty patient’s pockets prior to immersion. 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 which is characteristic of Heat Stroke.
EMPHASIS ON PATIENT CARE
ALL LEVELS:
1. Primary Management - Assess ABC’S and manage as indicated.
2. Rapid cooling is essential. Techniques will vary depending on level of patient’s condition: Heat Exhaustion, or Heat Stroke. Any heat related condition with an altered level of consciousness should be treated as Heat Stroke and transported after cooling on-scene.
a. Move patient to a cool, shaded area.
b. For simple Heat Exhaustion passive cooling methods may be effective: shade, air conditioning, ice packs, wet towels. Push fluids in Heat Exhaustion PO or IV if needed.
c. Heat Stroke: 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. Be certain to empty patient’s pockets prior to immersion.
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
Notes:
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) rectally. Intense shivering may occur as patient is cooled.
Heat exhaustion consists of dehydration, salt depletion, dizziness, fever, headache, cramping, nausea and vomiting. Vital signs usually consist of tachycardia, hypotension and elevated temperature. Heat stroke typically consists of dehydration, dry skin, red skin, tachycardia, hypotension, temperature > 104 F (40 C) rectally and AMS.
Non-rectal temperature measurements are inaccurate and only estimate body temperature.
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 like in classic Heat Stroke. 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. Be certain to empty patient’s pockets prior to immersion. If mental status fails to improve with cooling, consider transport. Patients with exertional heat stroke should be evaluated in an emergency department.