Heat stroke

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"Heatstroke" and "Heatstrokes" redirect here. For the film, see Heatstroke (film). For the song by
Krokus, see Metal Rendez-vous.

Heatstroke
Classification and external resources

ICD-10

T67.0

ICD-9

992.0

DiseasesDB

5690

MedlinePlus

000056

eMedicine

med/956

MeSH

D018883

Heatstroke (or sunstroke) is a heat illness defined as a body temperature of greater than 40.6 C
(105.1 F) due to environmental heat exposure with lack of thermoregulation. This is distinct from
a fever, where there is a physiological increase in the temperatureset point of the body.
Treatment involves rapid physical cooling.
Contents
[hide]

1 Sign and symptoms

2 Causes
o

2.1 Children and pets in cars

2.2 Forgotten baby syndrome

3 Prevention

4 Treatment

5 Prognosis

6 References

7 External links

Sign and symptoms[edit]

Heat stroke presents with a hyperthermia of greater than 40.6 C (105.1 F) in combination with
confusion and a lack of sweating.[1]

Causes[edit]
Substances that inhibit cooling and cause dehydration such
as alcohol, caffeine, stimulants, medications, and age-related physiological changes predispose to
so-called "classic" heat stroke. Exertional heat stroke can happen in young people without health
problems or medications, most often in athletes and military recruits.

Children and pets in cars[edit]

Children, elderly adults, or disabled individuals left alone in a vehicle are at particular risk of
succumbing to heat stroke, even with windows partially open. As these groups of individuals may not
be able to express discomfort verbally (or audibly, inside a closed car), their plight may not be
immediately noticed by others in the vicinity. A stuffed toy or other child's toy is recommended for a
parent or guardian to keep with himself or herself in the front seat as a reminder that at least one
child is present. For larger groups, checking the van or bus for stragglers at the end of the trip is
essential, complemented by other procedures such as a head count.[2]
Pets are even more susceptible than humans to heat stroke in cars, as dogs (the animals usually
involved), cats and many other animals cannot produce whole body sweat. Non-guide dogs are
prohibited from being brought into many establishments, and opening a vehicle window sufficiently
may present an escape opportunity or bite hazard. Leaving the pet at home with plenty of water on
hot days is recommended instead, or, if a dog must be brought along, tied up outside the destination
and provided with a full water bowl.[3]
Between 1998 and 2011, at least 500 children in the United States died from being inside hot cars,
and 75% of them were less than 2 years old. When the outside temperature is 70 degrees
Fahrenheit (21.1C), the temperature inside the car can exceed 120 degrees (48.8C), even when
the windows are partially open.[4]
Legal prosecution of parents in this situation varies greatly. In separate incidents, a college professor
in California forgot his son in a hot car and a horse trainer in Florida deliberately left his daughter in a
hot car. Each resulted in the unintentional death of a child, but the college professor was never
prosecuted, while the horse trainer was sentenced to 20 years in prison.[5]
Among all child deaths in hot cars, slightly more than half occur because parents forget that the child
is in the car, 18% happen after parents intentionally leave the child in a car without understanding
how hot it can get, and 30% happen after the child had climbed into the car to play.[6]

Forgotten baby syndrome[edit]

Forgotten baby syndrome (FBS) is a pseudo-medical term for the danger of
adult caregivers forgetting about the presence of a child and consequently subjecting the child to
danger. In spite of the word "syndrome" this is not a recognized medical condition; however the term
has achieved some currency in newspapers, magazines, blogs, and otherpopular media.[7][8]

Prevention[edit]

The risk of heatstroke can be reduced by observing precautions to avoid overheating and
dehydration. Light, loose-fitting clothing will allow perspiration to evaporate and cool the body. Widebrimmed hats in light colours keep the sun from warming the head and neck and block the powerful
radiation from hurting the eyes; vents on a hat will allow perspiration to cool the head. Strenuous
exercise should be avoided during daylight hours in hot weather; so should remaining in enclosed
spaces (such as automobiles). The temperature inside cars can reach 200F (c. 93C) at the right
exterior temperature, sunlight, color of vehicle, and type of vehicle.[9] Temperatures that high, without
proper cooling, could be dangerous and even fatal, especially with young children and pets.[10]
In environments that are not only hot but also humid, it is important to recognize that humidity
reduces the degree to which the body can lose heat by evaporation. In such environments, it helps
to wear light clothing such as cotton in light colors, that is pervious to sweat but impervious to radiant
heat from the sun. This minimizes the gaining of radiant heat, while allowing as much evaporation to
occur as the environment will allow. Clothing such as plastic fabrics that are impermeable to sweat
and thus do not facilitate heat loss through evaporation can actually contribute to heat stress.[11]
In hot weather people need to drink plenty of liquids to replace fluids lost from sweating. Thirst is not
a reliable sign that a person needs fluids.[12] A better indicator is the color ofurine. A dark yellow color
may indicate dehydration. The Occupational Safety and Health Administration in the United States
publishes a heat stress Quick Card [13] that contains a checklist designed to help prevent heat stress.
This list, known as the KBUDWA list, includes:

Know signs/symptoms of heat-related illnesses

Block out direct sun or other heat sources

Use air-conditioning; rest regularly

Drink sufficient, cold water and drinks

Wear lightweight, light colored, loose-fitting clothes

Avoid alcohol, caffeinated drinks, or heavy meals

Treatment[edit]
Treatment involves rapid mechanical cooling along with standard resuscitation measures.[14]
The body temperature must be lowered immediately. The patient should be moved to a cool area
(indoors, or at least in the shade) and clothing removed to promote heat loss (passive cooling).
Active cooling methods may be used: The person is bathed in cool water or a hyperthermia vest can
be applied. However, wrapping the patient in wet towels or clothes can actually act as insulation and
increase the body temperature. Cold compresses to the torso, head, neck, and groin will help cool
the victim. A fan or dehumidifying air conditioning unit may be used to aid in evaporation of the water
(evaporative method).
Immersing a patient into a bathtub of cool (but not cold) water (immersion method) is a recognized
method of cooling. This method requires the effort of 4-5 people and the patient should be monitored
carefully during the treatment process. Immersion should be avoided for an unconscious patient, but
if there is no alternative, the patient's head must be held above water. Immersion in very cold water
is counterproductive, as it causes vasoconstriction in the skin and thereby prevents heat from
escaping the body core.
This hypothesis however has been challenged in experimental studies,[15][16] as well as by systematic
reviews of the clinical data[17][18] indicating that cutaneous vasoconstriction and shivering
thermogenesis do not play a dominant role in the radiant decrease in core body temperature brought

on by cold water immersion. This effect can be seen in the effect of (non-therapeutic)
submersion hypothermia, where the body temperature decrease is directly related to environmental
temperature, and though bodily defenses slow the decrease in temperature for a time, they
ultimately fail to maintain endothermic homeostasis. Dantrolene, a direct-acting paralytic, abolishes
shuddering and is effective in many other forms of hyperthermia, including centrally-, peripherallyand cellularly-mediated thermogenesis, has no individual or additive effects to cooling in the context
of heatstroke,[19] showing a lack of endogenous thermogenic response to cold water immersion.
Thus, aggressive ice-water immersion remains the gold standard for life-threatening heatstroke.[citation
needed]

Hydration is of paramount importance in cooling the patient. In mild cases of concomitant

dehydration, this can be achieved by drinking water, or commercial isotonic drinks may be used as a
substitute. In exercise- or heat-induced dehydration, electrolyte derangement can result, and may
actually result in worsened by excess consumption of water.Hyponatremia can be corrected by
intake of hypertonic fluids. Absorption is rapid and complete in most patients, but if the patient is
confused, unconscious, or unable to tolerate oral fluid, intravenous rehydration & electrolyte
replacement (via a drip) may be necessary.
The patient's condition should be reassessed and stabilized by trained medical personnel. The
patient's heart rate and breathing should be monitored, and CPR may be necessary if the patient
goes into cardiac arrest.

Prognosis[edit]
It is widely believed that heat stroke leads only rarely to permanent deficits and the convalescence is
almost complete.[20] American researchers from the University of Chicago Medical Centre followed
58 subjects chosen from more than 3,000 patients with heat-related conditions who were admitted to
Chicago area hospitals between July 12 and July 20, 1995 during the 1995 Chicago heat wave. All
58 subjects experienced symptoms of near-fatal heat stroke. Each was interviewed at the time of
their discharge from the hospital, with a follow up interview scheduled one year later. Subjects
ranged in age from 25 to 95, with the average age of the group being around 67. Nearly half of the
patients admitted to Chicago-area ICUs for heat stroke died within a year21 percent before
discharge and another 28 percent after release from the hospital. Many of the survivors suffered
permanent loss of independent function; one-third had severe functional impairment at discharge,
and none of them had improved after one year.[20] The study also recognized the fact that because
of overcrowded conditions in all of the participating hospitals during this crisis, the immediate care
which is critical was not as comprehensive as it should have been, underlining how important it is
to quickly seek medical attention when the first signs occur.

References[edit]
1. Jump up^ McGugan, Elizabeth A (2001). "Hyperpyrexia in the emergency
department".Emergency Medicine Australasia 13 (1): 11620. doi:10.1046/j.14422026.2001.00189.x. PMID 11476402.
2. Jump up^ Extreme Heat Guide, Centers for Disease Control and Prevention (CDC)
3. Jump up^ http://www.paw-rescue.org/PAW/PETTIPS/DogTip_HotCars.php

[full citation needed]

4. Jump up^ Heat danger: 500th child dies in a hot car, Consumer Reports, June 3, 2011
5. Jump up^ Court outcomes vary when kids die in hot cars, Associated Press, 2011

6. Jump up^ More kids die in hot cars, half because parents forget them, USA Today, June 30,
2010
7. Jump up^ Weingarten, Gene (March 8, 2009). "Forgetting a child in the back seat of a hot,
parked car is a horrifying, inexcusable mistake. But is it a crime?". The Washington Post.
Retrieved May 2, 2010.
8. Jump up^ "The Last Word: Forgotten Baby Syndrome". The Week. March 26, 2009.
9. Jump up^ http://phoenix.about.com/od/car/a/summercar.htm
10. Jump up^ "Avoiding Classic Heat Stroke", Institute for Good Medicine at the Pennsylvania
Medical Society
11. Jump up^ Guyton, Arthur. (1976) Textbook of Medical Physiology. (5th ed). Philadelphia: W.B.
Saunders.

[page needed]

12. Jump up^ Working in Hot Environments. National Institute for Occupational Safety and Health,
1992. NIOSH Publication No. 86-112. Accessed May 21, 2009.
13. Jump up^ http://www.osha.gov/Publications/osha3154.pdf

[full citation needed]

14. Jump up^ Tintinalli, Judith (2004). Emergency Medicine: A Comprehensive Study Guide (6th
ed.). McGraw-Hill Professional. p. 1188. ISBN 0-07-138875-3.