hot as hell

HOT AS HELL

LESSONS FROM THE DESERTEVIDENCE-BASED CARE

FOR HEAT-RELATED ILLNESS

NATHAN CLEVELAND, MD, MS, FAAEM

CASE #2INTRODUCTIO

NCASE #1

HOT AS HELL

EVIDENCE-BASED CARE FOR HEAT-RELATED ILLNESS

CASE #2INTRODUCTIO

NCASE #1

HOT AS HELL

EVIDENCE-BASED CARE FOR HEAT-RELATED ILLNESS

CASE #2INTRODUCTIO

NCASE #1

HOT AS HELL

EVIDENCE-BASED CARE FOR HEAT-RELATED ILLNESS

CASE #2INTRODUCTIO

NCASE #1

HOT AS HELL

EVIDENCE-BASED CARE FOR HEAT-RELATED ILLNESS

CASE #2INTRODUCTIO

NCASE #1

HOT AS HELL

EVIDENCE-BASED CARE FOR HEAT-RELATED ILLNESS

CASE #1 CASE #2INTRODUCTION

OBJECTIVES

HOT AS HELL

EVIDENCE-BASED CARE FOR HEAT-RELATED ILLNESS

OBJECTIVESCASE #1 CASE #2

HOT AS HELL

EVIDENCE-BASED CARE FOR HEAT-RELATED ILLNESS

CASE #2 OBJECTIVESCASE #1 MORTALITY

HOT AS HELL

EVIDENCE-BASED CARE FOR HEAT-RELATED ILLNESS

OBJECTIVES MORTALITYCASE #2

HOT AS HELL

EVIDENCE-BASED CARE FOR HEAT-RELATED ILLNESS

MORTALITYCASES OBJECTIVES

HOT AS HELL

EVIDENCE-BASED CARE FOR HEAT-RELATED ILLNESS

HOT AS HELL

EVIDENCE-BASED CARE FOR HEAT-RELATED ILLNESS

OBJECTIVES

OBJECTIVES MORTALITYCASES HEAT ILLNESS

1. Review heat stroke

2. Identify best practices

for management

MORTALITY HEAT ILLNESSOBJECTIVES MANAGEMENT

HOT AS HELL

EVIDENCE-BASED CARE FOR HEAT-RELATED ILLNESS

Leon LR, Helwig BG. Heat stroke: Role of the systemic inflammatory response. J Appl Physiol 2010;109:1980-8.

HEAT STROKE

Mortality rate?

21-63%

HEAT ILLNESS MANAGEMENTHYPERTHERMI

AHEAT STROKE

HOT AS HELL

EVIDENCE-BASED CARE FOR HEAT-RELATED ILLNESS

Khosla R, Guntupalli KK. Heat-related illnesses. Crit Care Clin 1999;15:251-63

HEAT-RELATEDILLNESS

End-organ Dysfunction = “Heatstroke”

MANAGEMENT HEAT STROKEHEAT ILLNESS HEAT BALANCE

HOT AS HELL

EVIDENCE-BASED CARE FOR HEAT-RELATED ILLNESS

Bouchama A, Knochel JP. Heat Stroke. N Engl J Med 2002;346:1978-88

Supportive Care

RapidCooling

MANAGEMENT

HEAT STROKE HEAT BALANCEMANAGEMENT CONDUCTION

HOT AS HELL

EVIDENCE-BASED CARE FOR HEAT-RELATED ILLNESS

Bouchama A, Knochel JP. Heat Stroke. N Engl J Med 2002;346:1978-88

HEAT STROKECLASSIC EXERTIONAL

HEAT BALANCE

CONDUCTIONHEAT STROKE EVAPORATION

HOT AS HELL

EVIDENCE-BASED CARE FOR HEAT-RELATED ILLNESS

Lugo-Amador NM, Rothenhaus T, Moyer P. Heat-related illness. Emerg Med Clin N Am 2004;22:315-27.

HEAT BALANCE

HEATIN

HEATOUT

RADIATION

TEMPERATURE

METABOLISM

RADIATION

CONVECTION

CONDUCTION

EVAPORATION

CONDUCTION EVAPORATIONHEAT

BALANCE

HOT AS HELL

EVIDENCE-BASED CARE FOR HEAT-RELATED ILLNESS

Lugo-Amador NM, Rothenhaus T, Moyer P. Heat-related illness. Emerg Med Clin N Am 2004;22:315-27.

HEAT BALANCE

HEATIN

HEATOUT

RADIATION

TEMPERATURE

METABOLISM

RADIATION

CONVECTION

EVAPORATION X

CONDUCTION

CONDUCTION EVAPORATIONHEAT

BALANCECONVECTION

HOT AS HELL

EVIDENCE-BASED CARE FOR HEAT-RELATED ILLNESS

Exerc Sport Sci Rev 2007;35:141-9.

CONDUCTION Cold Water Immersion

CONDUCTION

HOT AS HELL

EVIDENCE-BASED CARE FOR HEAT-RELATED ILLNESS

CONDUCTION Ice Packs

Kielblock AJ, Van Rensburg JP, Franz RM. Body cooling as a method for reducing hyperthermia: An evaluation of techniques.S Afr Med J 1986; 69:378-80

EVAPORATION CONVECTION

HOT AS HELL

EVIDENCE-BASED CARE FOR HEAT-RELATED ILLNESS

Resus 2007;73:46-53

CONDUCTION Cold IV Fluids

CONDUCTION EVAPORATION CONVECTION

HOT AS HELL

EVIDENCE-BASED CARE FOR HEAT-RELATED ILLNESS

Aviation, Space, Enviro Med. 2009;80:720-2.

EVAPORATION Mist / Water-Dousing

EVAPORATION CONVECTIONCONDUCTION SUMMARY

CONVECTION SUMMARYEVAPORATION NEW IDEAS

HOT AS HELL

EVIDENCE-BASED CARE FOR HEAT-RELATED ILLNESS

Wyndham CH, Strydom NB, et al. Methods of cooling subjects with hyperpyrexia. J Appl Physiol. 1959;14:771–776.

CONVECTION Fans

SUMMARY NEW IDEASCONVECTION

HOT AS HELL

EVIDENCE-BASED CARE FOR HEAT-RELATED ILLNESS

COMBINATION Fans + Mist / Dousing

HOT AS HELL

EVIDENCE-BASED CARE FOR HEAT-RELATED ILLNESS

SUMMARY

SUMMARY NEW IDEASCONVECTION TAKE HOME

Immersion 0.2-0.35 ⁰C/minWater+Fans 0.15-0.25 ⁰C/minDousing + Ice Massage 0.2 ⁰C/min

Cool IV Fluid 0.015-0.076 ⁰C/minIce Packs 0.028-0.034 ⁰C/minFan Alone 0.02-0.04 ⁰C/min

Casa DJ, et al. Cold water immersion: the gold standard for heat stroke treatment. Exerc Sport Sci Rev 2007;35:141-9.

NEW IDEAS TAKE HOMESUMMARY THE END

HOT AS HELL

EVIDENCE-BASED CARE FOR HEAT-RELATED ILLNESS

Acad Emerg Med 2001;17:360-7.

FUTURE DIRECTIONS Cooling Blankets /

Garments

TAKE HOME THE ENDNEW IDEAS

HOT AS HELL

EVIDENCE-BASED CARE FOR HEAT-RELATED ILLNESS

FUTURE DIRECTIONS Metabolism - Intubation

HOT AS HELL

EVIDENCE-BASED CARE FOR HEAT-RELATED ILLNESS

J Parenter Enteral Nutr. 2003;27:27-35.

FUTURE DIRECTIONS Metabolism - Paralysis

TAKE HOME THE ENDNEW IDEAS

TAKE HOME THE ENDNEW IDEAS

HOT AS HELL

EVIDENCE-BASED CARE FOR HEAT-RELATED ILLNESS

THE ENDTAKE HOME

HOT AS HELL

EVIDENCE-BASED CARE FOR HEAT-RELATED ILLNESS

TAKE HOME

1. Aggressive supportive care

THE ENDTAKE HOME

HOT AS HELL

EVIDENCE-BASED CARE FOR HEAT-RELATED ILLNESS

TAKE HOME

2. Rapidly cool by:-Cooling blanket -Ice massage -Cool IV fluids

-Water dousing / Mist

-Fans

THE ENDTAKE HOME

HOT AS HELL

EVIDENCE-BASED CARE FOR HEAT-RELATED ILLNESS

TAKE HOME

3. Consider:-Early intubation / mechanical ventilation

-Short period of neuromuscular blockade

HOT AS HELL

EVIDENCE-BASED CARE FOR HEAT-RELATED ILLNESS

THE ENDTAKE HOME

HOT AS HELL

EVIDENCE-BASED CARE FOR HEAT-RELATED ILLNESS

QUESTIONS?THE END