hot as hell
DESCRIPTION
Nathan Cleveland, MD, MSTRANSCRIPT
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