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Temperature-related
   Emergencies
  David A. Caro, MD
Temperature-related
            Emergencies
• Introduction
    Temperature Control/Physiology
    Mechanisms of Heat Dissipation
    Temperature Measurement
Temperature-related
            Emergencies
• Heat Illnesses
    Heat stress
    Heat exhaustion
    Heat stroke
Temperature-related
            Emergencies
• Cold Illnesses
    Frostbite
    Hypothermia
Introduction
      Heat Control Physiology
• Normal human temperature 96.8 to 100.4oF
  (36 -37.8oC)
  – Temperature can reach 104oF during strenuous
    exercise
• Preoptic Hypothalamus – responsible for
  temperature control via thermoregulation
Temperature Emergencies
• A rise in core temperature above the normal
  range (hyperthermia) or a decrease below
  the normal range (hypothermia) is the
  consequence of an imbalance between heat
  production and heat loss.
Heat Production



             Temperature   Ambient Heat


   Heat Loss
to environment
Skin Receptors



                 Hypothalamus



Core Receptors


                 Thermoregulation
Veins

Hypothalamus
               Sweat Glands



                Behavior
Hot


      Cold
Introduction
       Heat Dissipation Mechanisms
• Radiation - electromagnetic dissipation - 65%
• Evaporation - transfer of heat to make liquid a gas
  - 25%
• Convection - heat transferred to air and water in
  close proximity to skin - 8%
• Conduction - direct heat transfer - 2%
Radiation



AIR        EM Radiation




 The body at the higher temperature emits more energy than the one
 at the lower temperature, and the net transfer of energy (heat) is
 down the temperature gradient.
Convection



         AIR MOVEMENT



  SKIN
Evaporation
• For every ml of water evaporated from the
  surface of the skin, 0.58 Kcal are removed
  from the body.
• Insensible - skin, respiratory
  – approximately 600 ml/day
• Sensible - sweat
  – up to 3 liters/hr
Temperature Measurement
•   Axillary - most inaccurate
•   TM - wide variability
•   Oral - affected by ventilation
•   Rectal
•   Bladder, Esophageal, PA catheter - in ICU
    setting
Heat Illnesses
• Heat Stress
• Heat Exhaustion
• Heat Stroke
Heat Illness
• Heat Stress
     Heat Cramps
     Heat Tetany
     Heat Edema
     Heat Syncope
     Prickly Heat
Heat Exhaustion
• Syndrome of weakness, fatigue, headache,
  nausea, vomiting, vertigo, orthostasis, and
  impaired judgement
• NO major CNS symptoms (seizures, coma)
Heat Stroke
• Thermoregulatory Failure
• Profound CNS dysfunction
• Classic vs. exertional
Heat Stroke
•   CNS dysfunction
•   CV dysfunction
•   Hepatic dysfunction
•   Renal failure
•   Hematologic complications
Heat Stroke - Differential
              Diagnosis
•   meningitis           • DTs
•   encephalitis         • typhoid fever
•   status seizures      • hypothalamic
•   falciparum malaria     hemorrhage
•   thyroid storm
•   medications
Heat stroke treatment
• ABCs
• Cooling
  –   remove from heat; remove clothing
  –   spray water/fan
  –   ice packs/cooling blankets
  –   lavage (NG, bladder, thoracic)
  –   Dialysis/CP bypass
Heat stroke treatment
• Benzos for seizures, shivering
• IV fluids
  – replace deficits
  – treat rhabdomyolysis
• Treat coagulopathy
Cold Illnesses
• Hypothermia
• Frostbite
Hypothermia
• 92-95oF - Mild
• 87-92oF - Moderate
• < 87oF - Severe
Frostbite
• Spectrum - similar to burns
  – Mild (analagous to 1o burn)
  – Moderate (2o burn)
  – Severe (3o burn to gangrene)
Treatment - Mild Hypothermia
• Remove wet clothing; Replace with dry
  clothing/blankets
• Ambient warming
• Warmed oral fluids
Treatment - Moderate
             Hypothermia
•   Remove wet clothing; replace with dry
•   Monitor cardiac, respiratory status
•   Radiant/heat blanket warming
•   Warmed IV, oral fluids
•   Warmed, humidified oxygen
•   Warmed IV bags to groin, axillae;
       ? immerse
Treatment - Severe Hypothermia
•   All of the above
•   Careful movement; may induce V Fib
•   Intubate as needed
•   Warmed NG, Foley lavage
•   Warmed pleural/peritoneal lavage
•   Dialysis, Bypass
Frostbite
• Damage done by crystallization within
  cells/interstitium/small vessels
• Reversible to a point
Frostbite
• Treatment
  – Begin rethawing only when it can be completed
  – Warm, wet heat (immersion) is the ideal; 104 –
    110of
  – Be prepared to treat pain with narcotics
Review – Temp Emergencies
• Thermoregulation
• Heat loss/gain physiology
  – Radiation, convection, evaporation
• Temperature measurement
Review – Temp Emergencies
• Heat illnesses
  – Minor
  – Major (heat stroke)
• Cold illnesses
  – Minor
  – Major

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Temperaturelecture

  • 1. Temperature-related Emergencies David A. Caro, MD
  • 2. Temperature-related Emergencies • Introduction Temperature Control/Physiology Mechanisms of Heat Dissipation Temperature Measurement
  • 3. Temperature-related Emergencies • Heat Illnesses Heat stress Heat exhaustion Heat stroke
  • 4. Temperature-related Emergencies • Cold Illnesses Frostbite Hypothermia
  • 5. Introduction Heat Control Physiology • Normal human temperature 96.8 to 100.4oF (36 -37.8oC) – Temperature can reach 104oF during strenuous exercise • Preoptic Hypothalamus – responsible for temperature control via thermoregulation
  • 6. Temperature Emergencies • A rise in core temperature above the normal range (hyperthermia) or a decrease below the normal range (hypothermia) is the consequence of an imbalance between heat production and heat loss.
  • 7. Heat Production Temperature Ambient Heat Heat Loss to environment
  • 8. Skin Receptors Hypothalamus Core Receptors Thermoregulation
  • 9.
  • 10.
  • 11. Veins Hypothalamus Sweat Glands Behavior
  • 12. Hot Cold
  • 13. Introduction Heat Dissipation Mechanisms • Radiation - electromagnetic dissipation - 65% • Evaporation - transfer of heat to make liquid a gas - 25% • Convection - heat transferred to air and water in close proximity to skin - 8% • Conduction - direct heat transfer - 2%
  • 14. Radiation AIR EM Radiation The body at the higher temperature emits more energy than the one at the lower temperature, and the net transfer of energy (heat) is down the temperature gradient.
  • 15. Convection AIR MOVEMENT SKIN
  • 16. Evaporation • For every ml of water evaporated from the surface of the skin, 0.58 Kcal are removed from the body. • Insensible - skin, respiratory – approximately 600 ml/day • Sensible - sweat – up to 3 liters/hr
  • 17. Temperature Measurement • Axillary - most inaccurate • TM - wide variability • Oral - affected by ventilation • Rectal • Bladder, Esophageal, PA catheter - in ICU setting
  • 18. Heat Illnesses • Heat Stress • Heat Exhaustion • Heat Stroke
  • 19. Heat Illness • Heat Stress Heat Cramps Heat Tetany Heat Edema Heat Syncope Prickly Heat
  • 20. Heat Exhaustion • Syndrome of weakness, fatigue, headache, nausea, vomiting, vertigo, orthostasis, and impaired judgement • NO major CNS symptoms (seizures, coma)
  • 21. Heat Stroke • Thermoregulatory Failure • Profound CNS dysfunction • Classic vs. exertional
  • 22. Heat Stroke • CNS dysfunction • CV dysfunction • Hepatic dysfunction • Renal failure • Hematologic complications
  • 23. Heat Stroke - Differential Diagnosis • meningitis • DTs • encephalitis • typhoid fever • status seizures • hypothalamic • falciparum malaria hemorrhage • thyroid storm • medications
  • 24. Heat stroke treatment • ABCs • Cooling – remove from heat; remove clothing – spray water/fan – ice packs/cooling blankets – lavage (NG, bladder, thoracic) – Dialysis/CP bypass
  • 25. Heat stroke treatment • Benzos for seizures, shivering • IV fluids – replace deficits – treat rhabdomyolysis • Treat coagulopathy
  • 27. Hypothermia • 92-95oF - Mild • 87-92oF - Moderate • < 87oF - Severe
  • 28. Frostbite • Spectrum - similar to burns – Mild (analagous to 1o burn) – Moderate (2o burn) – Severe (3o burn to gangrene)
  • 29. Treatment - Mild Hypothermia • Remove wet clothing; Replace with dry clothing/blankets • Ambient warming • Warmed oral fluids
  • 30. Treatment - Moderate Hypothermia • Remove wet clothing; replace with dry • Monitor cardiac, respiratory status • Radiant/heat blanket warming • Warmed IV, oral fluids • Warmed, humidified oxygen • Warmed IV bags to groin, axillae; ? immerse
  • 31. Treatment - Severe Hypothermia • All of the above • Careful movement; may induce V Fib • Intubate as needed • Warmed NG, Foley lavage • Warmed pleural/peritoneal lavage • Dialysis, Bypass
  • 32. Frostbite • Damage done by crystallization within cells/interstitium/small vessels • Reversible to a point
  • 33. Frostbite • Treatment – Begin rethawing only when it can be completed – Warm, wet heat (immersion) is the ideal; 104 – 110of – Be prepared to treat pain with narcotics
  • 34. Review – Temp Emergencies • Thermoregulation • Heat loss/gain physiology – Radiation, convection, evaporation • Temperature measurement
  • 35. Review – Temp Emergencies • Heat illnesses – Minor – Major (heat stroke) • Cold illnesses – Minor – Major