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An Evidence-Based Approach To Hyperthermia And Other Heat-Related Emergencies - $30.00
This issue includes 4 AMA/ACEP category 1, AAFP Prescribed, or AOA Category 2B CME credits.
Authors: Janet Lin, MD, MPH, FACEP Ralph Losey, MD, FACEP Heather M. Prendergast, MD, MPH, FACEP
Peer Reviewers: Paula J. Whiteman, MD, FACEP, FAAP Ari Cohen, MD
Publication Date: April 1, 2009 ;Volume 6, Number 4
Excerpt from the issue… It is a hot July afternoon when an EMS dispatcher notifies your emergency department of an incoming patient. Paramedics are bringing in a 23-month-old toddler who was accidentally left in his child safety seat for 15 minutes in a sweltering van. The child is noted to have blistering of his face and extremities. Upon arrival to the ED, the child is unresponsive.
Conclusion to the above case study... Initial examination revealed a toddler with decreased respiratory effort and pallor. Initial vital signs included a blood pressure of 75/28 mm Hg, heart rate of 42 beats per minute, respiratory rate of 8 breaths per minute, and a rectal temperature of 106.2°F (41.2°C). A diagnosis of heatstroke was made. This toddler’s presentation and unstable vital signs dictated the need for emergent intervention. Initial ED care focused on respiratory and circulatory support combined with cooling measures. Rapid-sequence induction intubation was performed and Advanced Cardiac Life Support (ACLS) protocol was started while fluid resuscitation continued. Ice packs were continued to the toddler’s groin and axillae, and wet towels were placed on the skin surfaces. Continuous cold water was applied to the wet towels and a fan was used to increase evaporative heat loss.
After resuscitation and stabilization, the patient was admitted to the pediatric intensive care unit (PICU) for continued management. On arrival in the PICU, the patient’s temperature had decreased to 103.1°F (39.5°C). Active cooling was continued until the temperature decreased to 101.5°F (38.6°C). Shortly after arrival in the unit, the toddler began having seizures and became hypotensive requiring inotropic support. Even with continued aggressive clinical intervention, the patient developed multi-system organ failure, coagulopathy, and progressive cerebral edema. The patient died 3 days after his presentation.
About this article: This issue of Pediatric Emergency Medicine Practice reviews the evidence regarding the assessment and treatment of hyperthermia and other heat-related illnesses in the pediatric population.
