5. Diagnosis
• R/O other causes first
• Exposure high temp in immediate past
• Usually pt is not acclimatised to conditions
6. Prickly heat
• Lichen tropicus
• Miliaria rubra
• obstruction of sweat gland leakage of sweat into the deeper
layers of the epidermislocal inflammatory reaction
• Maculopapular, pruritic, erythematus
May progresses to chronic dermatitis & superinfection if left
untreated
• Prevention – bath with cool water with gentle scrub, loose light
cloths
• Treatment – calamine lotion , chlorhexidine lotion, oral
antihistaminics
• Severe – 1 % salicyic acid & antibiotics
7. Heat cramps
• Spasm of muscle –
shoulder,arms,adbomen,calves
• Heavy muscular exercises in hot environment
with hypotonic fluid intake electrolyte
imbalance
• Occurs sometime after exposure when pt is
relaxing
• Oral intake of electral powder
• Severe cases – iv normal saline
8. Heat tetany
• Capropedal spasm & paraesthesiae
• Short exposure to very hot temp
• hyperventilation resp alkalosislow co2
decreased binding of calcium to albumin
low ionized calcium
• Management – reduce temp & reduce resp
rate
9. Heat syncope
• Sudden loss of conciousness
• High temp peripheral vasodilation
• T/t – recumbent position ,reduce body
temp, rehydration
10. Heat edema
• Pitting edema of hands & feets or any
dependent part
• Most common in bedridden elderly
• High tempvasodilationdependent edema
• T/t – reassurance, limb elevation, crepe
bandage , avoid high temp , adequate
rehydration
11. Heat exhaustion
• Excessive working in high temp with loss of fluid
and salts
• Normal thermoregulatory mechanism
• Symptoms --
Excessive
sweating,fatigue,malaise,nausea, giddiness
• Signs --
Pale , low volume pulse, low BP , moderately high
temp < 40 degree
12. Management –
• Could be precursor of heat stroke – should be
managed promptly and adequately
• rehydration, salt replacement, cool
environment , rest
13. Heat stroke
• Life threatening condition
• Disturbed thermoregulatory mechanism
• Exaggerated acute phase response – increased
production of inflammatory
cytokines,endothelial derived vasoactive
factors , could be activation of coagulation
process, alteration in expression of heat shock
proteins
• Dehydration very late feature
14. Symptoms and signs –
• hyperpyrexia ( > 40 degree core body temp)
• CNS dysfunctions – coma , stupor, delirium.
• sometimes subtle symptoms– confusion
, impaired judgments, abnormal behaviour.
• Anhidrosis – may or may not
• Other – shock, convulsions,icterus, signs of
dehydration
15. • Diagnosis –
1. diagnosis of exclusion
2. history of exposure to high temperature in
immediate past
3. high body temperature > 40 degrees
4. abnormal behaviour
19. Investigations
• CBC - ↑WBC, ↑HCT, ↓plt
• ↓pro time, hypofibrinogenemia, other
features of DIC
• Hypoglycemia, N/↓Cl, hypokalemia, hypocalc
emia, hypophophetemia
• ↑CPK, ↑BUN, ↑SGOT, ↑SGPT
• Urine –myoglobinuria, proteinuria, hyaline &
granular cast
20. Management
• To reduce body temp < 39 degree( 0.2 /m )—
1. Emergency - should be managed promptly
2. shift immediately to cool & shaded place
3. Put cold water or wrap soaked sheet around pt
4. Can immerse pt in cold water or put ice pack
around neck, axilla, groin.
5. Cold water gastric lavage
6. Antipyretic not proven to be effective
21. • Shock, cerebral edema, adrenal
insufficiencies- iv steroids
• Rhabdomyolysis & ARF – iv
fluids, diuretics, mannitol, sodabicarb
• Management of DIC and other complications
• Supportive – iv fluids, BP, electrolyes
22. Prognosis
• Mortality – 50%
• Deficit in survivors - 20%
• Directly proportional to temp and its duration
• Coma more than 2 hrs – very poor prognosis
23. Prevention
• Avoid sun during day time
• Drink 1 glass of water every half hour–5-6 l / d
(thirst is poor indicator of dehydration)
• Light color , loose cloth
• Avoid alcohol and other habit forming drugs
• Immediately consult doctor if typical symmp
appears