109C 218 Definition An acute and dangerous reaction to heat exposure characterized by a rapid rise to an ex- tremely high body temperature and disturbance of the sweating mechanism. Heat builds up instead of dissipating. Predisposing factors include age, obesity, fever, dehydration, strenuous exercise, chronic car- diovascular illness, alcohol consumption, use of diuretics, thyroid hormones, amphetamines, anticholinergics, phenothiazines, or tricyclic antidepressants. Characteristics Clinical manifestations include headache and visual disturbances dizziness and nausea hot, flushed, dry skin weak, rapid, and irregular pulse decreased level of consciousness often preceded by delirium high fever (core body temperature 104°F) cessation of sweat- ing muscle cramping agitation confusion seizures pulmonary edema circulatory collapse to hypotension. Policy Heat stroke is a life-threatening emergency requiring immediate medical care. Provide initial treatment in the occupational health unit and arrange for immediate transport to the hospital. Objectives Clinical Assessments and Interventions Referral for Medical Action Heat Disorder: Heat Stroke Arrange for immediate medical evaluation and treatment (i.e., transport to hospital). Follow-up Actions Counsel regarding avoidance of immediate re-exposure to high heat once the condition is stabi- lized (may remain hypersensitive to high heat for a considerable time). Educate regarding acclimation to hot environments. Assess for return to work and ex- clude from heat exposure for at least 4 weeks because sweat gland functioning may be impaired. If condition persists, heat exposure should be avoided permanently. Caution about use of imperme- able protective clothing that can block evaporation. Assess employee status. Lower body temperature. Maintain blood circulation. Protect from injury caused by possible seizures. Monitor vital signs every 5 to 10 minutes. Monitor urinary output. Place in cool environment and cool as fast as possible. Initiate measures to reduce body tempera- ture to 102ºF (rectal/core temperature) posi- tion lying down, with head elevated remove outer clothing spray the employee with cool mist while using fans to enhance airflow over body and apply hypothermia blanket or ice packs to axillae and groin to attain a core body temperature 103ºF. Massage body and extremities. Administer oxygen by nasal cannula at 6 liters/minute per standing order. Start IV of normal saline or lactated Ringer’s solution slowly, per standing order. If seizure occurs, protect and turn employee on side to prevent aspiration. Maintain open airway. Administer medications per standing order. Arrange for immediate transfer to the hospital. Refer to Guideline 93, Convulsion or Seizure, page 188. Guideline continues on next page
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