Heat-Related Illness in Emergency and Critical Care: Recommendations for Recognition and Management with Medico-Legal Considerations
Abstract
:1. Epidemiology
2. Risk Factors
2.1. Non-Modifiable Risk Factors
2.2. Modifiable Risk Factors
Non-Modifiable Risk Factors | Modifiable Risk Factors |
---|---|
Age (geriatric patients or children) | Dehydration |
Autonomic disorders that cause widespread anhidrosis (Ross syndrome, chronic idiopathic anhidrosis, Sjögren syndrome) | Prolonged exposure in a warm humid environment |
Trauma with spine injuries | Occupational categories (military personnel, athletes, construction, field, mining, or well workers, etc.) |
Endocrinological disorders (diabetes, hyperthyroidism) | Addictive behaviors (alcoholism, cocaine, amphetamine, heroin use, etc.) |
Neurological disorders (epilepsy) | Drugs (anticholinergics, beta-blockers, diuretics, neuroleptics, anesthetics, topiramate) |
Skin diseases (scleroderma, burns) | Infections |
Hereditary disease (malignant hyperthermia) | Obesity |
3. Pathophysiology
3.1. Production of Heat
3.2. Heat Dispersion
- Conduction is the transfer of heat to a cooler object through direct contact.
- Convection is the transfer of heat at the body surface by air circulation.
- Evaporation cools the skin surfaces when sweat changes from a liquid to a vapor
- Radiation occurs through the transmission of electromagnetic waves.
3.3. Regulatory System
3.3.1. Cutaneous System
3.3.2. Cardiovascular System
4. Left Ventricular Preload and Afterload
5. Blood Volume and Coagulation
6. Renal System
7. Brain and Cerebral Circulation
8. Cytokines
9. Heat Shock Proteins
Acclimatization
10. Diagnosis and Management
10.1. Mild Forms
10.2. Moderate Forms
10.3. Severe Forms
Mild Form | Moderate Form | Severe Form |
---|---|---|
Heat edema | Exercise-associated collapse (or heat syncope) | Classic heatstroke |
Muscle cramps from heat | Hypernatremic heat exhaustion | Exertional heatstroke |
Heat rash | Hyponatremic heat exhaustion | |
Tetany |
11. Prevention
12. Point of View of the Emergency Department
12.1. General Aspects
12.2. Inpatient Treatment of Heat Stroke
13. Differential Diagnosis
14. Post-Mortem Investigations in Cases of Death by Hyperthermia
14.1. Traditional Post-Mortem Examinations
14.2. Immunohistochemistry
14.3. Biochemical Analyses
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Savioli, G.; Zanza, C.; Longhitano, Y.; Nardone, A.; Varesi, A.; Ceresa, I.F.; Manetti, A.C.; Volonnino, G.; Maiese, A.; La Russa, R. Heat-Related Illness in Emergency and Critical Care: Recommendations for Recognition and Management with Medico-Legal Considerations. Biomedicines 2022, 10, 2542. https://doi.org/10.3390/biomedicines10102542
Savioli G, Zanza C, Longhitano Y, Nardone A, Varesi A, Ceresa IF, Manetti AC, Volonnino G, Maiese A, La Russa R. Heat-Related Illness in Emergency and Critical Care: Recommendations for Recognition and Management with Medico-Legal Considerations. Biomedicines. 2022; 10(10):2542. https://doi.org/10.3390/biomedicines10102542
Chicago/Turabian StyleSavioli, Gabriele, Christian Zanza, Yaroslava Longhitano, Alba Nardone, Angelica Varesi, Iride Francesca Ceresa, Alice Chiara Manetti, Gianpietro Volonnino, Aniello Maiese, and Raffaele La Russa. 2022. "Heat-Related Illness in Emergency and Critical Care: Recommendations for Recognition and Management with Medico-Legal Considerations" Biomedicines 10, no. 10: 2542. https://doi.org/10.3390/biomedicines10102542