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Indtroduction
Heat stroke is a life threatening condition that is more of an issue
during hot summers especially during heat waves. Heat-stroke is a
medical emergency with mortality approaching 10% to 30%.
It also affects athletes undergoing intense exercise where their
organizers fail to prepare them appropriately to cope with heat
issues.
An even more tragic aspect is in the heat stroke of young children
left unintentionally in cars by their care givers.
Associated with neurological presentations with multi -organ
dysfunction and may often be misleadingly diagnosed as sepsis by
care providers man- aging these patients

Definition
The heat related conditions of heat exhaustion and
heat stroke are part of a continuum.
Heat exhaustion is characterized by a body
temperature of 37-40 C and the patient complains of
thirst, malaise, dizziness, headache and weakness.
In heat stroke the core temperature is higher than
40C and there is obvious neurological dysfunction in
the form of convulsions, delirium and coma.

HEAT ILLNESS

Heat
Heat
cramps
cramps

Heat
Heat
exhaustio
exhaustio
n
n

Heat
Heat
stroke
stroke

Heat Stroke Classification

Exertional
Exertional heat
heat stroke
stroke

Classical
Classical heatstroke
heatstroke

Involved in prolonged
excessive activities like
marathons where the
heat loss does not match
the Heat production.
The condition occurs very
rapidly over a few hours
>> young people

>> older age group

Chronic illness
Develops over days when
the heat loss from the
body is hampered.
This usually occurs when
the environmental
temperatures are high.

Prevalence
Japan, 2014 there were 33 deaths recorded due to heat stroke, with more
than 18,000 seeking emergency care for heat related illness. 2012 and
2013: there were 28 and 114 deaths
In July 2013, it was estimated that 760 people in the United Kingdom 11
lost their lives due to heat stroke and heat related illness when
temperatures reached beyond 32 C for a few days.
3rd most common cause of mortality in athletes behind cardiac events
and head/neck trauma.
by the National Highway Traffic Administration14 flagged that there has
been more than 600 deaths between 1998 and 2013 of children dying of
heat stroke after they have been inadvertently left behind in vehicles.

Thermoregulation

Conduction: heat loss through direct contact with

cooler object
Convection: dissipation of heat when relatively cool
air passes over exposed skin
Radiation: release of heat from the body directly
into the environment
Evaporation: through perspiration , most effective
cooling method, dissipating up tp 600 kcal per hour

Whats causing heat

stroke?
Heatstroke and heat exhaustion occur when the bodys
thermoregulatory responses are inadequate to preserve
homeostasis
This can result from extrinsic factors that make heat
dissipation less efficient, such as extremes of temperature,
physical effort, and environ- mental conditions.
It also can result from physiologic limitations, putting
children, elderly persons, and those who are chronically ill
at increased risk.

Pathophysiology
of Heat Stroke
HR, CO, and ventilation increase
under hyperthermic conditions,
while viceral perfusion decrease.
Inflammatory factors are
released and gastrointestinal
permeability increases, which
may allow endotoxins into the
circulation.
Cellular destruc- tion occurs
more quickly and completely at
higher temper- atures.

Diagnosis

Hyperthermia
Hyperthermia

CNS
CNS
dysfunction
dysfunction

HEAT
HEAT
STROKE
STROKE

Clinical manifestation
>40C
>40C

Anhidrosis
Anhidrosis

Tachycardia/A
Tachycardia/A
rrhythmia
rrhythmia

Tachypnoea
Tachypnoea

Unsteady
Unsteady
gait/Ataxia
gait/Ataxia

Confusion
Confusion

Irritability
Irritability

Reduced
Reduced
consciousness
consciousness

Convulsion
Convulsion

Coma
Coma

Seizures
Seizures

Risk factors

High
High environmental
environmental
temperatures
temperatures
Summer
Summer temperature
temperature(>35
(>35C)
C)
Working
outdoors
Working outdoors

Vulnerable
Vulnerable groups
groups
Young
Youngchildren
children
Obese
Obese
Certain
Certainmedicine
medicineconsumption
consumption
Dehydrated
Dehydrated

High
High metabolic
metabolic
load
load
Athlete
Athlete

Management
The primary objectives of clinical heat stroke
treatments are to reduce body temperature as
rapidly as possible, reestablish normal CNS
function, and stabilize peripheral multiorgan
system function.

Supportive
Supportive
Therapy
Therapy
Causative
Causative

Rapid
Rapid
cooling
cooling

Cooling methods
External
cooling
Internal
cooling

Evaporative cooling
Immersion cooling

Gastric, bladder, and rectal coldwater lavage

Intravenous fluids that are previously
cooled

To facilitate cooling, the individual should be

placed into a supine position and as many clothes
as possible removed to expose a large surface
area of the body to facilitate heat transfer.
The goal of all cooling methods is to rapidly
decrease and maintain body temperature below
39 C (102.2 F) and to prevent rebound
hyperthermia.

Medication
Muscle relaxants, benzodiazepines and neuroleptic
agents have been used to inhibit shivering. Shivering
will add to the heat burden in a heat stroke patient.
NSAIDs have been considered as therapeutics based
on their potent anti-inflammatory and antipyretic
effects. The action(s) of classic NSAIDs, such as,
aspirin, ibuprofen, and acetaminophen, are attributed
primarily to blockade of the cyclooxygenase (COX)
pathway of eicosanoid metabolism

Complication
Heat stroke morbidity and mortality rates
remain quite high, and multi organ system
dysfunction continues to claim the lives of
heatstroke victims during ensuing years of
recovery.

Prognosis

Thankyou for your attention