Heat Related Injury

Normal human oral temperature is 37°C (98.6°F), but it can range between 36.3°C (97.3°F) and 37.1°C (98.8°F) in the morning. Oral temperature is normally 0.5°C (.9°F) lower than rectal temperature. Hyperthermia is defined as the elevation of the core body temperature above the normal diurnal range of 36°C (96.8°F) to 37.5°C (99.5°F) due to failure of thermoregulation. There is a spectrum of core body temperature at which symptoms will occur. Some individuals will have core temperatures higher or lower than normal without symptoms. Measured temperatures, especially skin or oral, will show a wider range of variation than true core temperature. Table 33.1 summarizes heat effects on the body, their prevention and their treatment (1,2).

Table 33.1. Heat effects._

Condition Characteristic Prevention Treatment

First Degree Burn Second Degree Burn

Third Degree Burn

Fourth Degree Burn

Heat Rash

Sunburn

Dehydration

Heat Cramps Heat Exhaustion

Heat Stroke

Malignant Hyperthermia

Superficial skin

Into dermis of skin, blister

Through the dermis, nerve endings destroyed

Muscle, bone involved

Rash from eruption of the sweat glands Ultraviolet ray damage to skin Loss of water

Water and sodium depletion, muscle cramps, sweating, mildly elevated body temp

As for Heat Cramps with further depletion. Higher elevation body temperature, irritability, malaise, confusion

As for Heat Exhaustion but sweating often ceases, organ shut down, cardiac irregularity or arrest, muscle break down, core temperature over 40.5 degrees C

Reaction to anesthetics but can be seen with heat exposure. Life threatening hyper-metabolic syndrome

Avoid contact Avoid contact

Avoid contact

Avoid contact

Keep skin dry, clean Avoid exposure, sun block Acclimatization. Fluid and electrolyte intake Acclimatization. Maintain fluid and electrolyte intake. Rest. Proper clothing. As for Heat

Cramps, removal to a cool environment.

As for Heat Exhaustion, more urgent

Obtain family and personal history of possible prior events and avoid triggers

Nothing or bland moisturizing topical Local wound care, topical antibiotics, protective cover Fluids, debridement, systemic antibiotics

Hospitalization, fluid replacement, treat shock, debridement, reconstruction, antibiotics Seek cool, powders

Treat as per burn depending on degree Fluid replacement

Fluid replacement and electrolyte replacement. Oral usually adequate.

Fluid and electrolyte replacement, oral and possible intravenous. Cooling, typically external.

Immediate need for intravenous fluid and electrolyte replacement, immediate need for cooling including core cooling. Cardiac monitoring, monitor kidney and urine.

As for Heat Stroke.

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