Heat exhaustion and heat stroke should be differentiated promptly

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Most parts of the country are experiencing high temperatures. With the ongoing heat wave, cases of heat–related disorders are also bound to increase. Heat cramps, heat exhaustion and heat stroke are the three forms of heat-related disorders that occur with prolonged exposure to heat and differ in their severity. Hence, it is important to differentiate between the three conditions.

Clinically, both heat exhaustion and heat stroke may manifest as fever, dehydration and other symptoms such as headache, thirst, malaise, nausea or vomiting, rapid pulse etc. The main difference between heat exhaustion and heat stroke is the presence of sweat in the former and absence in the latter.’

Normally, the axillae will always be wet even if a person has severe dehydration. If the axillae are dry and the person has high fever, this invariably means that the person has progressed from heat exhaustion to heat stroke and this should be treated as a medical emergency.

In heat exhaustion, the core temperature is between 37°C and 40°C. While in heat stroke, the core temperature is very high, > 400C and needs to be lowered within minutes and not hours. Rapid reduction in body temperature can be accomplished by cool or tepid bathing preferably using damp sponges. Submersion should be avoided so that body heat loss by evaporation can occur. Cooling blankets should also be avoided.

The absence of sweating, dry armpit, non-passage of urine for 8 hours or presence of high grade fever in summer seasonare ‘red flags’ and medical attention should be sought immediately.

Heat cramps are muscle spasms in the arms, legs, or abdomen that result from loss of large amount of salt and water through exercise. The treatment is replacing fluid and salt orally.

Dr KK Aggarwal
National President IMA & HCFI

BE FAST: A modified assessment tool to identify stroke

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‘Time is brain’. A patient with suspected stroke or ‘brain attack’ should therefore be shifted to hospital at the earliest and given a clot dissolving therapy. Jeffrey L. Saver reported in the journal Stroke that “every minute in which a large vessel ischemic stroke is untreated, the average patient loses 1.9 million neurons, 13.8 billion synapses, and 12 km (7 miles) of axonal fibers. And, each hour in which treatment fails to occur, the brain loses as many neurons as it does in almost 3.6 years of normal aging” (Stroke. 2006;36:263-6).

The American Stroke Association recommends the mnemonic FAST to recall the signs of stroke and quickly identify victims of stroke; “F” stands for Face drooping; “A” stands for arm weakness i.e. inability to raise arms high, “S” stands for Speech difficulty – slurring of speech and “T” stands for Time – time to call for emergency medical help.

A new research has devised a modified version of this simple prehospital stroke assessment tool, ‘BE FAST’ for early identification of patients with occlusion of large vessel, which was presented at the American Stroke Association’s International Stroke Conference 2017, which concludes in Houston, USA today (AHA News, February 22, 2017).

The acronym ‘BE FAST’ evaluates:

• Balance/coordination
• Eye deviation
• Facial weakness
• Arm/leg weakness
• Slurred speech/sensory deficits
• Time of onset

Researchers examined 455 ischemic stroke patient charts from July 2014 to June 2015, using information about patients’ symptoms and physical findings. The sensitivity i.e. positively recognizes a large vessel occlusion, for the ‘BE FAST’ score was found to be 83%.

Stroke is an emergency and getting timely help and treatment is extremely important. Hence, it is very important to act fast to identify these patients. Early treatment improves the chances of recovery.

In Paralysis, Act Fast

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Brain attack should be tackled like a heart attack. As time is brain, a patient with suspected paralysis/stroke or brain attack should be shifted to hospital at the earliest and given a clot dissolving therapy if the CT scan is negative for brain hemorrhage. Prevention for paralysis is the same as prevention for heart attack. All patients with paralysis should be investigated for underlying heart disease and all patients with heart diseases should undergo testing to detect blockages in the neck artery, which can cause future paralysis.

Facts

  • One should rule out brain hemorrhage as soon as possible.
  • Obtain emergent brain imaging (with CT or MRI) and other important laboratory studies, including cardiac monitoring during the first 24 hours after the onset of ischemic stroke.
  • Check glucose and correct high or low sugar. If the blood sugar is over 180 mg/dL start insulin.
  • Maintain normothermia for at least the first several days after an acute stroke.
  • For patients with acute ischemic stroke who are not treated with thrombolytic therapy, treat high blood pressure only if the hypertension is extreme (systolic blood pressure >220 mmHg or diastolic blood pressure >120 mmHg), or if the patient has another clear indication (active ischemic coronary disease, heart failure, aortic dissection, hypertensive encephalopathy, acute renal failure, or pre–eclampsia/eclampsia).
  • For patients with acute ischemic stroke who will receive thrombolytic therapy, antihypertensive treatment is recommended so that systolic blood pressure is ≤185 mmHg and diastolic blood pressure is ≤110 mmHg.
  • Antithrombotic therapy should be initiated within 48 hours of stroke onset.
  • For patients receiving statin therapy prior to stroke onset it should be continued.

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