Notes on the Summer Rush Tape
A class lecture done by Mark Wilkerson

Two methods of heat production in the body:

Cellular Respiration

Muscular activity

Blood flow adds both color and warmth to the skin

Beer is an excellent vasodilator, if the skin is protected. If not protected, it works the other way - more blood at the skin surface that gets heated by the sun.

Evaporation is the number one mechanism to loose heat.

Risk Factors associated with heat related problems:

• Some drugs, (anticholinergic) interfere with sweating.
• Some (beta blockers) prevent dilation.
• Some (diuretics) add to hypovolemia.
• Coke and amphetamines, diet pills.
• Alcohol with sun and exposed skin.
• Age extremes.
• Acclimatization.
• Preexisting diseases (cardiovascular, hypertension, renal failure, diabetes, etc.

The body responds to heat by:

Vasal dilation

Sweating

Increasing cardiac output

Three Major Kinds Of Heat Related Emergencies

1. Heat Cramps

exercise and fluid loss

stomach and calves

Sodium and calcium flux in and out of the muscle

Person loses a lot of salt - when he or she drinks more water, it dilutes the salts in the body even more. This can lead to hyponutremia and seizures.

Treatment: Balanced fluid (such as gator-ade) or salt.

(one salt pill with a liter of water)

Maybe IV - LR or Normal Saline

2. Heat exhaustion

same as heat cramps - but worse

History - hot environment, exercise, high humidity

excessive sweating - Sodium and H2O loss

CNS changes - irritable, cranky, syncope

Elevated temp - 102 po, 103 rectal

Nausea and vomiting

They're weak and exhausted

Treatment - Cool, fluids, and rest

IV - LP or Saline ( maybe 2 or 3 liters)

3. Heat Stroke - A LIFE THREATENING EMERGENCY

You have to turn them around fast or they will die.

Develops 2 ways:

Classic (nursing home) High temp, high humidity, for a long time (over 3-4 days)

Exertion (weekend warrior)

Once you have had heat stroke, you are apt to get it again.

High body temp - over 105 - brain cells are frying

CNS - agitated, delirious, seizures

Hypovolemic - heart beat way up - 160-180s

Renal failure - muscle tissue breaks down, and myoglobin clogs up the kidneys.

Typically the electrolytes and gasses are okay.

Treatment: RAPID COOLING

Ice packs in arm pits, groin, etc.

In ER - membrane

Ice and water on sheet over pt

Put FANS on them - evaporation

Seizures- valium

Ice solution lavage - NG tube

Ice solution enema

100% O2

Cardiac monitor

Fluid therapy (especially exertional ones)

Take them down to 100-101 and you won't oveshoot normal.