hyperthermia
Hyperthermia in its advanced state referred to as heat stroke
or sunstroke, is an acute condition which occurs when the body
produces or absorbs more heat than it can dissipate. It is
usually due to excessive exposure to heat. The heat-regulating
mechanisms of the body eventually become overwhelmed and unable
to effectively deal with the heat, and body temperature climbs
uncontrollably. This is a medical emergency that requires
immediate medical attention.
Hyperthermia can be created artificially by drugs or medical
devices. In these instances it may be used to treat cancer and
other conditions. Malignant hyperthermia is a rare complication
of some types of general anesthesia.
Hyperthermia is the opposite of hypothermia.
Progression
Body temperatures above 40°C (104 °F) are life-threatening. This
compares to normal body temperature of 36-37°C (97-98°F). At
41°C (106 °F), brain death begins, and at 45°C (113°F) death is
nearly certain. Internal temperatures above 50°C (122°F) will
cause rigidity in the muscles and certain, immediate death.
Heat stroke may come on suddenly, but usually follows a
less-threatening condition commonly referred to as heat
exhaustion or heat prostration.
Signs and symptoms
One of the body's most important methods of temperature
regulation is perspiration. This process draws heat from inside,
allowing it to be carried off by radiation or convection.
Evaporation of the sweat furthers cooling, since this
endothermic process draws yet more heat from the body. When the
body becomes sufficiently dehydrated to prevent the production
of sweat this avenue of heat reduction is closed. When the body
is no longer capable of sweating core temperature begins to rise
swiftly.
Victims may become confused, may become hostile, often
experience headache, and may seem intoxicated. Blood pressure
may drop significantly from dehydration, leading to possible
fainting or dizziness, especially if the victim stands suddenly.
Heart rate and respiration rate will increase (tachycardia and
tachypnea) as blood pressure drops and the heart attempts to
supply enough oxygen to the body. The skin will become red as
blood vessels dilate in an attempt to increase heat dissipation.
The decrease in blood pressure will cause blood vessels to
contract as heat stroke progresses, resulting in a pale or
bluish skin colour. Complaints of feeling hot may be followed by
chills and trembling, as is the case in fever. Some victims,
especially young children, may suffer convulsions. Acute
dehydration such as that accompanying heat stroke can produce
nausea and vomiting; temporary blindness may also be observed.
Eventually, as body organs begin to fail, unconsciousness and
coma will result.
Under very rare circumstances a person may exhibit symptoms
similar to heat stroke without suffering a heat stroke.
First aid
Heat stroke is a medical emergency requiring hospitalization,
and the local emergency services should be notified as soon as
possible.
The body temperature must be lowered immediately. The victim
should be moved to a cool area (indoors, or at least in the
shade) and clothing removed to promote heat loss (passive
cooling). Active cooling methods may be used: The person is
bathed in cool water, a hyperthermia vest can be applied, or the
person may be wrapped in a cool wet towel. Cold compresses to
the torso, head, neck, and groin will help cool the victim. A
fan may be used to aid in evaporation of the water (evaporative
method). Ice and very cold water can produce hypothermia; they
should be used only when there are means to monitor the victim's
temperature continuously.
Immersing a victim into a bathtub of cold water (immersion
method) is a recognized method of cooling. This method requires
the effort of 4-5 persons and the victim should be monitored
carefully during the treatment process. This should be avoided
for an unconscious victim; if there is no alternative, the
victim's head must be held above water.
Hydration is of paramount importance in cooling the victim. This
is achieved by drinking water (Oral rehydration). Commercial
isotonic drinks may be used as a substitute. Some authorities
are opposed to giving any fluids, except by emergency personnel.
Intravenous hydration (via a drip) is necessary if the victim is
confused, unconscious, or unable to tolerate oral fluids.
Alcohol rubs will cause further dehydration and impairment of
consciousness and should be avoided. The victim's condition
should be reassessed and stabilized by trained medical
personnel. The victim's heart rate and breathing should be
monitored, and CPR may be necessary if the victim goes into
cardiac arrest.The victim should be placed into the recovery
position to ensure that the person's airway remains open.
Prevention
The risk of heatstroke can be reduced by observing precautions
to avoid overheating and dehydration. Light, loose-fitting
clothing will allow perspiration to evaporate. Wide-brimmed hats
in bright colour keep the sun from warming the head and neck;
vents on a hat will allow perspiration to cool the head.
Strenuous exercise should be avoided during daylight hours in
hot weather; so should remaining in enclosed spaces (such as
automobiles). People who must be outside should be aware that
humidity and the presence of direct sunlight may cause the heat
index to be 10 °C (18 °F) hotter than the temperature indicated
by a thermometer.
In hot weather people need to drink plenty of liquids to replace
fluids lost from sweating. Thirst is not a reliable sign that a
person needs fluids. A better indicator is the color of urine. A
dark yellow color indicates dehydration. Water or sports drinks
are the most effective in replacing lost fluids.
Especially susceptible populations
While anyone can be affected by hyperthermia, some populations
are especially susceptible to heat illness and injury. As noted
by Joseph Rampulla in the The Health Care of Homeless
Persons : :
Heat illness most seriously affects the poor, urban-dwellers,
young children, those with chronic physical and mental
illnesses, substance abusers, the elderly, and people who engage
in excessive physical activity under harsh conditions.




