New Delhi. Heat stroke guidelines released Heart Care Foundation of India today released guidelines for heat stroke and common mistakes done either at the level of the patient or while managing the condition.

Releasing the guidelines, Dr KK Aggarwal, President Heart Care Foundation of India, said that there are two types of heat stroke. First, exertional heat stroke, which occurs in younger individuals who engage in strenuous physical activity for a prolonged period of time in hot environment. However, classical non–exertional heat stroke more commonly affects sedentary elderly individuals or persons who are chronically ill and/or younger children.

If not managed properly, hundreds of lives are lost in 72 hours post heat stroke. If therapy is delayed, the mortality is 80%. This figure can be reduced to 10%, if early and proper management is done and mistakes avoided.

Mistake No. 1

Missing Diagnosis: It is the rectal temperature, which is more important than axillary or oral temperature. The diagnosis of heat stroke may be missed if rectal temperature is not measured. Heat stroke is defined as when temperature exceeds 41°C (106 degree F) in absence of sweating and altered sensorium.

Heat stroke mistaken for heat exhaustion: The two conditions can be differentiated, as there is no sweating in heat stroke.

Continous lowering of temperature: The goal of treatment should be to reduce the temperature by atleast 0.20C/minute to approximately 390C (102 degree F)

Continuing active external cooling beyond 390C: The cooling should be halted at 39°C to prevent over shooting cut–off point leading to hypothermia.

Giving anti fever medicines: Anti fever medicines like paracetamol, aspirin and other non–steroidal anti–inflammatory agents have no role. They actually may be harmful if the patients have underlying liver, blood and kidney damage. They may also cause bleeding.

Not checking temperature continuously: One should ideally place a flexible indwelling thermistor rectally to monitor temperature continuously.

Not checking fever once temperature settles down: Thermal instability may persist for a few days after the onset of heat stroke. Therefore, temperature must be continuously monitored during this period.

Not removing restrictive clothing: All clothes should be removed so that temperature can be lowered by evaporation.

Giving phenytoin during seizure: Phenytoin is not effective in controlling seizures in heat stroke.

Giving chlorpromazine to lower temperature: It was the mainstay of therapy earlier but is now avoided as it increases chances of seizures.

Patients on anti cholinergic and anti histaminic drugs: In this season, self–treatment with anti allergic and anti nasal discharge drugs can be harmful. They lead to impaired heat loss and precipitate hypothermia.

Heart patients not taking precautions: In elderly heart patients, cardiovascular drugs like beta–blockers, calcium channel blockers and diuretics may interfere with cardiovascular response to heat, heat loss and precipitate hyperthermia.

Not realizing that the patient may be on substance abuse: Stimulant drugs, including cocaine and amphetamines can generate excessive amount of heat by increasing metabolism. They can worsen heat stroke.

Ignoring mild temperature: One should remember that a high temperature would be found only if mild temperature is ignored. During peak summer, sudden onset of fever should be taken as heat stroke, unless proved otherwise.

Not giving enough fluids: Remember the internal organs are on fire and the fires can only be extinguished with fluids. Such patients need liters of intravenous fluids to manage their internal fire.

Carrying out sponging only on the head: Patients require continuous sponging of the body with tap water and not restricting to armpits or the head. Some doctors even try to immerse the patient in water. Ice massage should be avoided as it does not lower the internal core temperature.