Answer
Patients at risk for heat illness include the following [5, 6] :
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Athletes exercising strenuously in hot climates
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Elderly patients (because of decreased efficacy of thermoregulation, comorbid illness or medications, lack of fans or air conditioning, inappropriate dress)
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Infants and small children (because of high ratio of surface area to weight, inability to control fluid intake)
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Patients with cardiac disease or those taking beta-blockers (because of inability to increase cardiac output sufficiently for vasodilation)
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Patients who are dehydrated because of poor fluid intake, gastroenteritis, and diuretic or alcohol use (Dehydration increases demand on ATPase pumps, which contribute 25-45% of basal metabolic rate.)
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Patients prone to higher endogenous heat production (eg, infection, thyrotoxicosis)
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Patients taking medications that inhibit sweat production or increase heat production (eg, anticholinergics, antidepressants, antihistamines, neuroleptics, zonisamide, sympathomimetics, alpha- and beta-blockers), especially in hot weather; deaths from cocaine are markedly increased when the ambient temperature increases [7]
Recognizing the clinical signs associated with heat illness determines the appropriate therapy, from fluid replacement for heat exhaustion to rapid aggressive cooling for heatstroke. [4, 5, 6]
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Sample display of equipment useful for various cooling techniques. Clockwise from top: ice pack and water, air-cooling blanket, Foley catheter, and intravenous fluids.
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Sample display of equipment useful for cooling via gastric lavage. Clockwise from top: ice water, nasogastric tube, endotracheal tube, and lavage bag.
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Sample display of equipment useful for cooling via peritoneal lavage. Clockwise from top: iced water, peritoneal catheter, and saline fluid.
