CURRENT Essentials of Critical Care.pdf

250 Current Essentials of Critical Care■■■Heat StrokeEssentials of Diagnosis• Confusion, stupor, seizures, coma• Hot dry skin, hypovolemia, hypotension, tachycardia, body temperatureapproaching 40°C or more• Rhabdomyolysis, myocardial depression, disseminated intravascularcoagulation, platelet dysfunction with bleeding, renalfailure; intracerebral hemorrhages and cerebral edema mayoccur• Elevated hematocrit, potassium, creatine kinase, prolonged coagulationtimes• Failure of thermoregulatory mechanism.• Hyperthermia and CNS dysfunction must be presentDifferential Diagnosis• Sepsis• Neuroleptic malignant syndrome• Malignant hyperthermiaTreatment• Intubation, mechanical ventilation if patient unconscious.• IV fluids• Rapid reduction of body temperature to 39°C, using surfacecooling with ice, ice water, cooling blankets, water plus fans• May also use cold IV fluids, cold water gastric or rectal lavage,peritoneal dialysis with cold fluid• Once temperature down to 38°C, cease active cooling measuresto avoid hypothermia• Multiple organ dysfunction may occur after normalization oftemperature and should be managed using standard therapies■ PearlAcetaminophen and other antipyretics are ineffective in heat stroke,as the hyperthermia in heat stroke is not due to an increase in temperatureregulatory set point, as it is in other causes of fever.ReferenceBouchama A et al: Heat stroke. N Engl J Med 2002;346:1978. [PMID:12075060]