1. Too Hot Hyperthermia David Johnson

2. Causes Endogenous/exogenous Excessive heat production/diminished dissipation Exertional Environmental MH, NMS, thyrotoxicosis, phaeo, drug intoxication, seizures, anticholingergic, infectious

3. Heat exhaustion vs heat stroke Diaphoresis Weakness Temp may be normal Muscles cramps Lighteheaded Syncope Nausea Vomiting Temp >41 Neurologic dysfunction Exertional or non- exertional May have hot dry skin Other altered vital signs

4. Management Cool rapidly to <39 Evaporative is best –Fans plus sprayed water Ice packs to groin/axilla Cool water, salty foods Check for causes (fever/drugs) and consquences: rhabdo, liver failure hyperkalaemia

5. Other stuff Remember aim UO 3-4mL /hour in rhabdo Consider benzos or even intubation and paralysis to prevent shivering Dantrolene only in malignant hyperthermia Antipyretics not useful for heat stroke

6. Outcome Mortality 60% Permanent neuro deficit 7-15% Poor prognosis with –High core temp –High SAPS II –Heat stroke at home (non-exertional) –Elevated INR –Use of inotropes –No air con in ICU