Protect yourself from Heatstroke.

Heat stroke-symptoms, treatment, and prevention

This article discusses recent advances in the physiology of heat stroke. It will provide deep knowledge to identify the risk factors predisposing to heat stroke.

This blog will analyze the roles of endotoxins and cytokines in producing multiple organ damage in heat stroke.

We will study the incidence of hyperthermia and fever during heat stroke and the clinical biomarkers of organs during recovery.

You will learn about protective measures and treatment modules for heat stroke to live healthily in a hot climate.

Keywords:

Self care | Wellness | Awareness | Tropical | Subtropical | Heat waves| cytokines| Endotoxins ||enzymes |Hypothalamus| Thermoregulation | Sweating| Eelectrolytes | Heat cramps | Syncope | Exhaustation | Heat waves|tropical areas|cytokines|endotoxins|enzymes

Table of content

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What is heat stroke?

Heat stroke, also known as Sunstroke, is a severe, life-threatening condition caused by extreme heat and is the last point on a continuum of heat-related illnesses.

Heat stroke will kill if not treated properly, promptly, and vigorously. It is a medical emergency.

Heat crampsè > If not treated> Heat syncope> If not managed > it will change into>heat exhaustion >If not recognized, overlooked, and treated, heat exhaustion will turn into heat stroke.

In this condition, “core body temperature rises to 105 to 106 degrees Fahrenheit with central nervous system complications.

Heat stroke develops rapidly within 10 to 15 minutes with or without alarming features. It will develop within 10 to 15 minutes after exposure to high temperatures.

Heat stroke damages the brain and other internal organs, leading to long-term sequelae or immediate death.

Risk factor

· Age: Older people ( above 60), infants, and children below five years are more prone to develop Heat stroke.

· Sex: More typical in males

· Athletes or military personnel exercise or do heavy duty during the hot daytime.

· Manual workers, a laborer working in exposed areas with sunlight

· A person who does not drink enough water and moves on an empty stomach.

· Immunocompromised persons

· People suffer from renal, cardiac, pulmonary, and metabolic diseases like Diabetes mellitus, hypertension, and liver diseases.

· Malnourished persons may be underweight or overweight, in a poor nutritional state, and have starvation.

· Alcoholics, drug addicts

· Persons with morbidity and on drugs, for example, diuretics, sedatives, and tranquilizers.

Types of heat stroke

Depending upon the cause of heat stroke, it is divided into:

1. Classical heat stroke: This is heat stroke without apparent exertion.

2. Exertional heat stroke due to strenuous exercise.

The incidence of heat stroke is intimately related to the heat index, which is related to the environmental heat and the percentage of humidity in the atmosphere. We will learn about the heat index in detail later.

Causes of heat stroke:

· Prolonged exposure to high temperature

· High metabolic energy production due to exercise or hard work

· Dehydration

· Reduction of heat loss by the body.

Pathophysiology

Thermoregulation depends on the hypothalamus; the body gains heat from the environment and metabolic process, while heat loss is due to sweating and sweat’s evaporation from the body’s surface.

Due to excess heat of the body temperature, the regulatory mechanism fails.

The hypothalamus controls body temperature regulation and thermoregulation.

When exposed to heat hypothalamus:

· Decreases vessel myogenic tone, causing increased blood flow in the skin and excessive sweating. Evaporation of sweat causes heat loss from the body.

The hypothalamus reduces sympathetic discharge, causing dilatation of an AV anastomosis that causes increased blood flow to the skin. Therefore, heat loss occurs rapidly.

The hypothalamus directly stimulates sweat glands to secret more sweat.

When the temperature is very high, the hypothalamus fails to control or regulate thermoregulation.

Complex immunological and inflammatory components play vital roles in the production of heat stroke.

Thermo regulatory system or mechanism fails due to intense heat, and heat loss from the body ceases abruptly.

Reduced evaporation of sweat causes heat accumulation in the body.

Intense heat disturbs enzyme activities, and protein structures are disturbed.

Enzyme and protein disturbances damage vascular endothelium, increasing vascular permeability. When the permeability of the vessels increases, fluid escapes into the interstitial space, causing hemoconcentration. Blood volume decreases, reducing GFR and urine output with high-colored urine.

Decreased blood volume causes dehydration, reduces sweating, and conserves heat. After some time, the sensation of thirst will appear.

Decreasing blood volume causes hemo concentration, which causes platelet clumping and destruction. Cell destruction produces cytokines that damage tissues and organs.

Decreased blood volume, platelet clumping, and platelet destruction cause vascular occlusion, ischemia, tissue necrosis, and organ damage. This triggers a vicious cycle that causes more and more damage to cells and organs.

Necrosis of brain tissues produces immediate effects such as seizures, convulsions, and loss of consciousness.

Damage to the intestinal mucosa occurs. Intestinal mucosa becomes more permeable to water, other toxic substances, and bacteria in the gut.

Lipopolysaccharides (LPS) of Gram-negative bacteria enter into the gut and subsequently into circulation. This produces endotoxemia.

High circulatory level of LPS causes sepsis and inflammation. Endotoxins and cytokines produce necrosis in multiple organ failures and CNS dysfunction. Numerous organ failures lead to death; the sequel may persist long after being cured.

Investigations

Diagnosis of heat stroke is based on clinical diagnosis and the patient’s history. But investigations are essential to asses patients’ conditions and to exclude other diseases.

CBC, PT (prothrombin time), PTT, Blood gas analysis, Electrolyte estimation CRP C -reactive protein

Cardio and respiratory monitoring.

Differential diagnosis:

Cerebral Malaria,

Meningitis,

Neuroleptic malignant syndrome.

Complications

Seizuresà tonic or chronic

Renal failure

Convulsion

Diabetes mellitus and other metabolic endocrinal diseases due to damage of the endocrine glands conventions

Rhabdomyolysis, and

cardiopulmonary diseases.

Signs and symptoms of heat stroke:

Hyperthermia (temperature 105 degrees Fahrenheit to 106 degrees Fahrenheit, more than 40.6 degrees Centigrade) causes disorientation. Unconsciousness may occur before the development of any signs and symptoms.

In classical heat stroke -Lack of sweating, red, hot, dry skin.

During exercise-induced heat stroke, the skin is wet, damp, red, and hot.

Dizziness, lightheadedness, headache, nausea, and vomiting.

Muscle cramps, muscle weakness, staggering.

Tachycardia, fast, rapid pulse.

Rapid shallow breathing.

Reduced urine volume and high-colored urine

Delirium, coma, and death.

Treatment

If you feel that someone has had a heat stroke, call for help: dial 911, call an ambulance, and motivate others to help.

Do not hesitate to start first aid. Remember that heat stroke is always fatal without immediate medical help.

First aid :

Move the person to a cold place under a shaded space, and remove unnecessary clothes.

Wet his skin with water from a sponge or spray and fan air over the patient to speed up evaporation.

Place ice packs on the patient’s arms, groin, neck, and back.

If possible, immerse the patient in cold water or shower tub.

In Iraq, cooling with water spray was the treatment for heat stroke in 1943.

Do not use ice for the elderly, young children, and patients suffering from chronic illnesses.

In hospitals

Rapidly reduce body temperature. Put him in an air-conditioned room.

Rapidly mechanical cooling must be done to save a life.

Management of life-threatening systemic complications.

Replace electrolytes through the intravenous route. Give him fruit and vegetable juices containing electrolytes if the patient can drink. Fruit or Vegetable juices are very effective.

Monitor respiratory rate, heart rate, oxygen concentration, and pulse.

Cardiac monitoring is a must, and cardiopulmonary resuscitation may be required.

Prognosis

The risk of death is less than 5% in exercise-induced heat stroke and more than 65% in classical heat stroke.

Thousands died in the 1995 Chicago and European heat waves in 2022.

Checklist

Avoid direct sun

Avoid outdoor work and hard work,

Use a white wide-brimmed hat,

Use a thick cotton towel to protect your head, soldier, and face from sun rays when you go out the door.

No alcohol, no coffee, and no smoking.

Wear light clothes, light-colored, loose-fitting cotton clothes.

Drink excess water and fruit and vegetable juices. Sports beverages are beneficial. Drink fluids before you go outdoors.

Prevention

Prevention is better than cure.

When the heat index is high, stay in a cool place.

Avoid outdoor work and hard work,

Take rest

Use a white wide-brimmed hat,

Use a thick cotton towel to protect your head, soldier, and face from sun rays when you go out the door.

No alcohol, no coffee, and no smoking.

Wear light clothes, light-colored, loose-fitting cotton clothes.

Dark-colored urine indicates dehydration, while light-colored urine is ideal.

Try spending at least 2 hours daily in an air-conditioned environment.

To avoid direct or indirect sunlight, try to rest for at least 2 hours during peak hours of the day.

The heat index rises 10-15 points in the direct sun within minutes.

After recovery, you are more prone to heat stroke; therefore, avoid hot weather and heavy exercise.

Heat index or humiture is a combined measurement of temperature and humidity computed by adding the temperature in Fahrenheit to the relative humidity and dividing it by 2.

An increase in humidity will reduce the evaporation of sweat, reduce heat losses, and increase body temperature.

What is malignant hyperpyrexia?

Malignant hyperpyrexia is a dangerous response in susceptible persons to some medicines, especially medicine used during general anesthesia, for example, Halothane.

A rapid and sustained rise in body temperature, muscle rigidity, fever, tachycardia, and metabolic acidosis characterize malignant hyperpyrexia.

https://doi.org/10.25911/5d6cfa510ea05

Treatment is rapid cooling, drug dantrolene, and supporting treatment.

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FAQ:

Q1.What is malignant hypertension?

A. Malignant hyperpyrexia is a dangerous response in susceptible persons to some medicines, especially medicine used during general anesthesia, for example, Halothane.

A rapid and sustained rise in body temperature, muscle rigidity, fever, tachycardia, and metabolic acidosis characterize malignant hyperpyrexia.

Q2.What are seven tips to protect yourself from the harmful effects of heat ?

A. Avoid direct sun

Avoid outdoor work and hard work,

Use a white wide-brimmed hat,

Use a thick cotton towel to protect your head, soldier, and face from sun rays when you go out the door.

No alcohol, no coffee, and no smoking.

Wear light clothes, light-colored, loose-fitting cotton clothes.

Drink excess water and fruit and vegetable juices. Sports beverages are beneficial. Drink fluids before you go outdoors.

Protect yourself from Heatstroke.