Heat Illness and Stroke

Heat Cramps

Defined as painful contractions of large muscle groups because of decreased hydration and a decrease of serum sodium and chloride.
Cramps can also occur secondary to increased water intake leading to dilutional hyponatremia
Treatment
- rapid cooling
- stretching
- electrolyte and fluid replacement

Heat Syncope

Defined as transient loss of consciousness with peripheral vasodilation and decreased cardiac output with normal body temperature.
Results from sever orthostatic event secondary to elevated temperatures
Treatment
- Fluid replacement
- lying supine with leg elevation

Heat Exhaustion

The most common heat-induced condition
Defined as a core temperature of less than 102.2 degrees F (39 degrees C) and an absence of central nervous system dysfunction.
Symptoms consist of profuse sweating and nausea/vomiting
Hypernatremic heat exhaustion results from inadequate water replacement.
Treatment
- table salts
- IV hydration
- cooling

Heat Illness

Treatment
- drink fluids
- low osmolarity solution (<10%)
- carbs and stimulate GI fluid absorption
Monitor weight
5% loss - not able to return to play
7% loss - see physician

Heat Stroke

Second most common cause of death in football players
Defined as
- hyperthermia
- tachycardia/tachypnea
- central nervous system dysfunction
- cessation of sweating with hot, dry skin
- anhidrosis
- Body temperature above 40.5 degrees Celsious
A medical emergency with a high death rate that results from failure of the thermoregulatory mechanisms of the body.
Treatment
- rapid reduction in body core temperature
  - lower temp below 39°C (102° F) with
  - ice immersion
  - cooling blanket
  - fanning
  - internal cooling if needed
  - IV hydration
Complications
- heat sensitivity may last 1 year

TAG

(SBQ07.43) Which of the following conditions are characterized by hyperthermia, central nervous system dysfunction, and loss of thermo-regulatory function? Topic

Review Topic

1. Heat syncope
2. Heat cramps
3. Heat exaustion
4. Heat stroke
5. Heat shock

PREFERRED RESPONSE ▶

DISCUSSION: Heat stroke consists of hyperthermia (greater than 105.8 degrees F [41 degrees C]), central nervous system dysfunction, and cessation of sweating with hot, dry skin. It is a medical emergency that results from failure of the thermo-regulatory mechanisms of the body. It has a high death rate and requires rapid reduction in body core temperature. Heat syncope is characterized by a transient loss of consciousness with peripheral vasodilation and decreased cardiac output with normal body temperature. Heat cramps involve painful contractions of large muscle groups because of decreased hydration and a decrease of serum sodium and chloride. Heat exhaustion is distinguished by a core temperature of less than 102.2 degrees F (39 degrees C) and an absence of central nervous system dysfunction. Hypernatremic heat exhaustion results from inadequate water replacement. The reference by Knochel et al. reviews some unusual etiologies of environmental-induced heat illnesses. The reference by Khosla et al. also reviews heat induced illnesses and their treatment.

REFERENCES:

1. Knochel JP. Environmental heat illness: An eclectic review. Arch Intern Med 1974;133:841-864 PMID:4821779 (Link to Abstract)

2. Hubbard RW, Gaffin SL, Squire DL. Heat related illness, in Wilderness Medicine, ed 3. St Louis, MO, Mosby, 1995, p 167

3. Khosla R, Guntupalli KK. Heat-related illnesses. Crit Care Clin 1999;15:251-263 PMID:10331127 (Link to Abstract)

Question Authors:

Ben Taylor MD, Patrick McCulloch MD, Eric Shirley MD,

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Textbooks

Review of Orthopaedics, 6th Edition, Mark D. Miller MD, Stephen R. Thompson MBBS MEd FRCSC, Jennifer Hart MPAS PA-C ATC, an imprint of Elsevier, Philadelphia, Copyright 2012
AAOS Comprehensive Orthopaedic Review, Jay R. Leiberman. Published by American Academy of Orthopaedic Surgeons, Rosemont IL. Copyright 2009
Orthopaedic Knowledge Update 10, John M Flyn. Published by American Academy of Orthopaedic Surgeons, Rosemont IL. Copyright 2011
Hoppenfeld SP. Surgical Exposures in Orthopaedics: The Anatomic Approach. Lipponcott, Williams, and Wilkins, Philadelphia, PA, Copyright 2009
Orthopaedic In-training Examination (OITE) Questions 2004-2012, American Academy of Orthopaedic Surgeons, Rosemont IL. Copyright 2004-2012
Self-Assessment Examination (SAE) Questions 2004-2012, American Academy of Orthopaedic Surgeons, Rosemont IL. Copyright 2004-2012
Hubbard RW, Gaffin SL, Squire DL. Heat related illness, in Wilderness Medicine, ed 3. St Louis, MO, Mosby, 1995, p 167

Undefined

Khosla R, Guntupalli KK. Heat-related illnesses. Crit Care Clin 1999;15:251-263 PMID:10331127 (Link to Abstract)
Knochel JP. Environmental heat illness: An eclectic review. Arch Intern Med 1974;133:841-864 PMID:4821779 (Link to Abstract)

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