Barney S. Graham, MD, PhD
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Graham B.; Features and Outcomes of Classic Heat Stroke. Ann Intern Med. 1999;130:613-614. doi: 10.7326/0003-4819-130-7-199904060-00025
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Published: Ann Intern Med. 1999;130(7):613-614.
TO THE EDITOR:
I read with interest Dematte and colleagues' article on nonexertional heat stroke (1). As noted, this condition causes significant morbidity and mortality unless rapidly recognized and treated. The characteristics of susceptible persons and the environmental conditions associated with nonexertional heat stroke are well documented (2). As pointed out by the authors, this documentation makes public health interventions feasible. In this letter I address methods of treatment based on the physical properties of heat transfer.
The authors suggest that immersion in cold water and use of a body cooling unit were the only acceptable methods of cooling. Although cold-water immersion and cooling blankets are commonly used, they are not the most efficient approaches to dissipating body heat. The authors correctly state that rapid cooling is associated with improved survival. Body heat can be reduced by convection, conduction, radiation, or evaporation. Convection is the transfer of heat to circulating fluid or gas; conduction is the direct transfer of heat to another object; and radiation is the transfer of heat to objects not in direct contact with the subject. Evaporation is therefore the only available mechanism for heat loss when ambient temperatures approach body temperature. The common finding of hot, dry skin in patients with nonexertional heat stroke indicates that this physiologic mechanism has also failed. It has been shown that a combination of evaporation and convection is the most efficient mechanism of reducing body heat (3) and that this approach can be used to treat nonexertional heat with good clinical outcome (4). Cold-water immersion is uncomfortable for both patient and staff and can interfere with the resuscitation measures that are often necessary in this setting. Cold-water immersion and cooling blankets can also induce shivering and cutaneous vasoconstriction, which may lead to an undesirable increase in core body temperature. It is therefore advisable to use a combination of tepid water (delivered by a spray bottle or shower) and rapid air movement (for example, by a fan) and to rely on evaporation and convection for rapid body cooling in patients with extremely high body temperature.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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