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Home > Emergency Medical Minute > Episode 917: Heat-Related Illnesses
Podcast: Emergency Medical Minute
Episode:

Episode 917: Heat-Related Illnesses
Category: Science & Medicine
Duration: 00:04:46
Publish Date: 2024-08-19 10:00:00
Description:

Contributor: Megan Hurley, MD

Educational Pearls: 

  • Heat cramps

    • Occur due to electrolyte disturbances

    • Most common electrolyte abnormalities are hyponatremia and hypokalemia

  • Heat edema

    • Caused by vasodilation with pooling of interstitial fluid in the extremities

  • Heat rash (miliaria)

    • Common in newborns and elderly

    • Due to accumulation of sweat beneath eccrine ducts

  • Heat syncope

    • Lightheadedness, hypotension, and/or syncope in patients with peripheral vasodilation due to heat exposure

    • Treatment is removal from the heat source and rehydration (IV fluids or Gatorade)

  • Heat exhaustion

    • Patients have elevated body temperature (greater than 38º C but less than 40º C)

    • Symptoms include nausea, tachycardia, headache, sweating, and others

    • Normal mental status or mild confusion that improves with cooling

    • Treatment is removal from the heat source and hydration

  • Classic heat stroke

    • From prolonged exposure to heat

    • Defined as a core body temperature > 40.5º C, though not required for diagnosis or treatment

    • Presentation is similar to heat exhaustion with the addition of neurological deficits including ataxia

    • Patients present “dry”

  • Exertional heat stroke

    • Prolonged exposure to heat during exercise

    • Similar to classic heat stroke but the patients present “wet” due to antecedent treatment in ice baths or other field treatments

  • Management of heat-related illnesses includes:

    • Cooling

    • Rehydration

    • Evaluation of electrolytes

    • Antipyretics are not helpful because heat-induced illnesses are not due to hypothalamic dysregulation

References

  1. Casa DJ, McDermott BP, Lee EC, et al. Cold water immersion: the gold standard for exertional heatstroke treatment. Exerc Sport Sci Rev 2007; 35:141.

  2. Ebi KL, Capon A, Berry P, et al. Hot weather and heat extremes: health risks. Lancet 2021; 398:698.

  3. Epstein Y, Yanovich R. Heatstroke. N Engl J Med 2019; 380:2449.

  4. Gardner JW, JA K. Clinical diagnosis, management, and surveillance of exertional heat illness. In: Textbook of Military Medicine, Zajitchuk R (Ed), Army Medical Center Borden Institute, Washington, DC 2001.

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

  6. Lipman GS, Gaudio FG, Eifling KP, et al. Wilderness Medical Society Clinical Practice Guidelines for the Prevention and Treatment of Heat Illness: 2019 Update. Wilderness Environ Med 2019; 30:S33.

Summarized by Jorge Chalit, OMSIII | Edited by Meg Joyce, MS1

 
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