Wilderness and Rescue Medicine 7th Edition Jeffrey Isaac, PA-C and David E. Johnson, MD

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Wilderness and Rescue Medicine

General Principles

General Principles

Heat Related Illness Wilderness Perspective

Heat Stroke Continued care after cooling: • IV or PO hydration for normal urine output • Food as tolerated • Protect from heat challenge • Evacuate to hospital, urgent if abnormal mental status or abnormal urine output

High Risk Problem: • VS do not return to normal • Persistent altered mental status • Decreased urine output • Urine color becomes red or brown • You cannot prevent exposure to heat • The patient is getting worse

©2018WMA

©2018WMA

Where immediate evacuation would be high risk, transport may be deferred if mental status and other vital signs promptly return to normal. Field care should include rest and enough oral hydration to maintain normal urine output. Avoid exertion and heat exposure. Reconsider urgent evacuation if urine output decreases or urine becomes red or brown, or if the patient begins to feel worse, is unable to take food and fluids, or In the field setting, abnormal body core tem- perature is a high-risk problem. Cold inhibits clotting and exacerbates shock. Heat denatures protein, leading to tissue damage, kidney failure, and elevated ICP, contributing to vascular and volume shock. Maintaining normal body core temperature is part of routine treatment that will vastly improve outcome, even in critically ill or injured patients. Hypothermia as therapy, even with post-cardiac arrest patients, remains contro- versial. In any case, therapeutic hypothermia is reserved for carefully controlled EMS or hospital environments. exhibits mental status changes. Risk Versus Benefit

In most short-term EMS contacts, the patient is typically kept NPO (nothing by mouth). This is not appropriate in the long-term care setting where management of body core temperature is part of the treatment. Thermoregulation needs fluid and calories. Oral intake is acceptable if air- way protection is not a problem. The need to control fever in systemic illness (as opposed to heat stroke) is debatable. Generally, if a fever is making the patient uncomfortable you should act to lower body core temperature with acetaminophen, ibuprofen, or cool water. Fever associated with altered mental status indicates a critical system problem and the need for urgent evacuation.