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The diagnosis of heat syncope is done during a physical examination. During the physical exam the practitioner will test the blood pressure of the patient, and the pulse. If the patient is experiencing heat syncope the blood pressure will be low, and the pulse will be elevated. Observation of excess sweating will also be a key sign. Finally, the practitioner will ask questions figuring out the history of the patient's symptoms. If the patient developed symptoms while engaging in physical activity and high temperatures it will then be a true case of heat syncope.
First aid for heat exhaustion includes:
- Moving the person to a cool place
- Having the patient take off extra layers of clothes
- Cooling the patient down by fanning them and putting wet towels on their body
- Having them lie down and put their feet up if they are feeling dizzy
- Having them drink water or sports drinks – but only if they are awake, not confused nor vomiting
- Turning the person on their side if they are vomiting
The basic treatment for heat syncope is like that for other types of fainting: the patient is positioned in a seating or supine position with legs raised. Water containing salt, or another drink containing electrolytes, is administered slowly, and the patient is moved to a cooler area, such as the shade.
The affected person should rest and recover, because heat syncope can lead to heat stroke or heat exhaustion.
If a person with heat exhaustion gets medical treatment, Emergency Medical Technicians (EMTs) or doctors and/or nurses may also:
- Give them supplemental oxygen
- Give them intravenous fluids and electrolytes if they are too confused to drink and/or are vomiting
Mild disease can be treated with fluids by mouth. In more significant disease spraying with mist and using a fan is useful. For those with severe disease putting them in lukewarm water is recommended if possible with transport to a hospital.
Prevention includes avoiding medications that can increase the risk of heat illness (e.g. antihypertensives, diuretics, and anticholinergics), gradual adjustment to heat, and sufficient fluids and electrolytes.
When ambient temperature is excessive, humans and many animals cool themselves below ambient by evaporative cooling of sweat (or other aqueous liquid; saliva in dogs, for example); this helps prevent potentially fatal hyperthermia. The effectiveness of evaporative cooling depends upon humidity. Wet-bulb temperature, which takes humidity into account, or more complex calculated quantities such as wet-bulb globe temperature (WBGT), which also takes solar radiation into account, give useful indications of the degree of heat stress and are used by several agencies as the basis for heat-stress prevention guidelines. (Wet-bulb temperature is essentially the lowest skin temperature attainable by evaporative cooling at a given ambient temperature and humidity.)
A sustained wet-bulb temperature exceeding 35 °C is likely to be fatal even to fit and healthy people unclothed in the shade next to a fan; at this temperature, environmental heat gain instead of loss occurs. , wet-bulb temperatures only very rarely exceeded 30 °C anywhere, although significant global warming may change this.
In cases of heat stress caused by physical exertion, hot environments, or protective equipment, prevention or mitigation by frequent rest breaks, careful hydration, and monitoring body temperature should be attempted. However, in situations demanding one is exposed to a hot environment for a prolonged period or must wear protective equipment, a personal cooling system is required as a matter of health and safety. There is a variety of active or passive personal cooling systems; these can be categorized by their power sources and whether they are person- or vehicle-mounted.
Because of the broad variety of operating conditions, these devices must meet specific requirements concerning their rate and duration of cooling, their power source, and their adherence to health and safety regulations. Among other criteria are the user's need for physical mobility and autonomy. For example, active-liquid systems operate by chilling water and circulating it through a garment; the skin surface area is thereby cooled through conduction. This type of system has proven successful in certain military, law enforcement, and industrial applications. Bomb-disposal technicians wearing special suits to protect against improvised explosive devices (IEDs) use a small, ice-based chiller unit that is strapped to one leg; a liquid-circulating garment, usually a vest, is worn over the torso to maintain a safe core body temperature. By contrast, soldiers traveling in combat vehicles can face microclimate temperatures in excess of 65 °C and require a multiple-user, vehicle-powered cooling system with rapid connection capabilities. Requirements for hazmat teams, the medical community, and workers in heavy industry vary further.
Heat cramps, a type of heat illness, are muscle spasms that result from loss of large amount of salt and water through exercise. Heat cramps are associated with cramping in the abdomen, arms and calves. This can be caused by inadequate consumption of fluids or electrolytes. Frequently, they don't occur until sometime later, especially at night or when relaxing. Heavy sweating causes heat cramps, especially when the water is replaced without also replacing salt or potassium.
Although heat cramps can be quite painful, they usually don't result in permanent damage, though they can be a symptom of heat stroke or heat exhaustion. Heat cramps can indicate a more severe problem in someone with heart disease or if they last for longer than an hour.
In order to prevent them, one may drink electrolyte solutions such as sports drinks during exercise or strenuous work or eat potassium-rich foods like bananas and apples. When heat cramps occur, the affected person should avoid strenuous work and exercise for several hours to allow for recovery.
The underlying cause must be removed. Mild hyperthemia caused by exertion on a hot day may be adequately treated through self-care measures, such as increased water consumption and resting in a cool place. Hyperthermia that results from drug exposure requires prompt cessation of that drug, and occasionally the use of other drugs as counter measures. Antipyretics (e.g., acetaminophen, aspirin, other nonsteroidal anti-inflammatory drugs) have no role in the treatment of heatstroke because antipyretics interrupt the change in the hypothalamic set point caused by pyrogens; they are not expected to work on a healthy hypothalamus that has been overloaded, as in the case of heatstroke. In this situation, antipyretics actually may be harmful in patients who develop hepatic, hematologic, and renal complications because they may aggravate bleeding tendencies.
When body temperature is significantly elevated, mechanical cooling methods are used to remove heat and to restore the body's ability to regulate its own temperatures. Passive cooling techniques, such as resting in a cool, shady area and removing clothing can be applied immediately. Active cooling methods, such as sponging the head, neck, and trunk with cool water, remove heat from the body and thereby speed the body's return to normal temperatures. Drinking water and turning a fan or dehumidifying air conditioning unit on the affected person may improve the effectiveness of the body's evaporative cooling mechanisms (sweating).
Sitting in a bathtub of tepid or cool water (immersion method) can remove a significant amount of heat in a relatively short period of time. It was once thought that immersion in very cold water is counterproductive, as it causes vasoconstriction in the skin and thereby prevents heat from escaping the body core. However, a British analysis of various studies stated: "this has never been proven experimentally. Indeed, a recent study using normal volunteers has shown that cooling rates were fastest when the coldest water was used." The analysis concluded that cool water immersion is the most-effective cooling technique for exertional heat stroke. No superior cooling method has been found for non-exertional heat stroke. Thus, aggressive ice-water immersion remains the gold standard for life-threatening heat stroke.
When the body temperature reaches about 40 °C, or if the affected person is unconscious or showing signs of confusion, hyperthermia is considered a medical emergency that requires treatment in a proper medical facility. In a hospital, more aggressive cooling measures are available, including intravenous hydration, gastric lavage with iced saline, and even hemodialysis to cool the blood.
Accurate determination of core temperature often requires a special low temperature thermometer, as most clinical thermometers do not measure accurately below . A low temperature thermometer can be placed in the rectum, esophagus or bladder. Esophageal measurements are the most accurate and are recommended once a person is intubated. Other methods of measurement such as in the mouth, under the arm, or using an infrared ear thermometer are often not accurate.
As a hypothermic person's heart rate may be very slow, prolonged feeling for a pulse could be required before detecting. In 2005, the American Heart Association recommended at least 30–45 seconds to verify the absence of a pulse before initiating CPR. Others recommend a 60-second check.
The classical ECG finding of hypothermia is the Osborn J wave. Also, ventricular fibrillation frequently occurs below and asystole below . The Osborn J may look very similar to those of an acute ST elevation myocardial infarction. Thrombolysis as a reaction to the presence of Osborn J waves is not indicated, as it would only worsen the underlying coagulopathy caused by hypothermia.
Appropriate clothing helps to prevent hypothermia. Synthetic and wool fabrics are superior to cotton as they provide better insulation when wet and dry. Some synthetic fabrics, such as polypropylene and polyester, are used in clothing designed to wick perspiration away from the body, such as liner socks and moisture-wicking undergarments. Clothing should be loose fitting, as tight clothing reduces the circulation of warm blood. In planning outdoor activity, prepare appropriately for possible cold weather. Those who drink alcohol before or during outdoor activity should ensure at least one sober person is present responsible for safety.
Covering the head is effective, but no more effective than covering any other part of the body. While common folklore says that people lose most of their heat through their heads, heat loss from the head is no more significant than that from other uncovered parts of the body. However, heat loss from the head is significant in infants, whose head is larger relative to the rest of the body than in adults. Several studies have shown that for uncovered infants, lined hats significantly reduce heat loss and thermal stress. Children have a larger surface area per unit mass, and other things being equal should have one more layer of clothing than adults in similar conditions, and the time they spend in cold environments should be limited. However children are often more active than adults, and may generate more heat. In both adults and children, overexertion causes sweating and thus increases heat loss.
Building a shelter can aid survival where there is danger of death from exposure. Shelters can be of many different types, metal can conduct heat away from the occupants and is sometimes best avoided. The shelter should not be too big so body warmth stays near the occupants. Good ventilation is essential especially if a fire will be lit in the shelter. Fires should be put out before the occupants sleep to prevent carbon monoxide poisoning. People caught in very cold, snowy conditions can build an igloo or snow cave to shelter.
The United States Coast Guard promotes using life vests to protect against hypothermia through the 50/50/50 rule: If someone is in water for 50 minutes, he/she has a 50 percent better chance of survival if wearing a life jacket. A heat escape lessening position can be used to increase survival in cold water.
Babies should sleep at 16-20 °C (61-68 °F) and housebound people should be checked regularly to make sure the temperature of the home is at least 18 °C (64 °F).
International Organization for Standardization helps set standards for monitoring environments, analyzing data, and interpreting results.
A horse developing ER will usually begin showing signs right after the beginning of exercise, although for mild cases, signs may not be seen until after the horse is cooled out. Signs include reluctance to move, stiffness or shortened gait when the animal is forced to move, and muscle spasms or cramps, with hard, painful muscles (especially the hindquarters) when palpated. If an observer is unfamiliar with ER, initial symptoms may appear to be tiredness or perhaps lameness but the condition is far more complex.
Signs of a severe bout of ER may include: reluctance to move, sweating, elevated heart and respiratory rates as a result of the pain, anxious expression, shifting of weight from side to side, standing hunched and tense, passing reddish-brown urine, dehydration, shock, and inability to rise. Usually there is a correlation between how long it takes the signs to be seen and how severe the bout of ER is, with the more severe bouts of ER displaying signs right after work has begun.
If signs of ER are seen, the horse should not be moved. Movement can cause further muscle damage. If the animal is far from the barn, it is best to trailer him back rather than move him.
After a bout of ER, blood levels of CPK and AST rise.
There are no tests required to diagnose widow spider bites, or latrodectism symptoms. The diagnosis is clinical and based on historic evidence of widow spider bites. Pathognomonic symptoms such as localized sweating and piloerection provide evidence of envenomation. Unlike the brown recluse, the widow species are easily identified by most people.
Diagnosis is obvious in most people reporting contact with a "Latrodectus" spider. However, without a spider, either through inability to communicate or unawareness, the diagnosis may be missed as symptoms overlap with a variety of other serious clinical syndromes such as tetanus or acute abdomen. Blood values are typically unimportant but may be needed to show myocarditis or dehydration from vomiting.
The horse should receive several days of NSAIDs, rest, and grain or pellets should be withheld. To improve blood flow to the muscles and help to with muscle spasms, heat therapy and Equine Massage may be beneficial, as well as hand-walking if the horse is comfortable walking. Turn-out in a pasture or paddock will encourage movement. A horse should be moving normally within 12–36 hours after the attack.
Occupational heat stress is the net load to which a worker is exposed from the combined contributions of metabolic heat, environmental factors, and clothing worn which results in an increase in heat storage in the body. Heat stress can result in heat-related illnesses, such as heat stroke, hyperthermia, heat exhaustion, heat cramps or heat rashes. Although heat exhaustion is less severe, hyperthermia is a medical emergency and requires emergency treatment, which if not provided can even lead to death.
Heat stress causes illness but also may account for an increase in workplace accidents, and a decrease in worker productivity. Worker injuries attributable to heat include those caused by: sweaty palms, fogged-up safety glasses, and dizziness. Burns may also occur as a result of accidental contact with hot surfaces or steam. In United States, occupational heat stress in becoming more significant as the average temperatures increase but remains overlooked. There are few studies and regulations regarding heat exposure of workers.
The treatment options for hypohidrosis and anhidrosis is limited. Those with hypohidrosis should avoid drugs that can aggravate the condition (see medication-causes). They should limit activities that raise the core body temperature and if exercises are to be performed, they should be supervised and be performed in a cool, sheltered and well-ventilated environment. In instances where the cause is known, treatment should be directed at the primary pathology. In autoimmune diseases, such as Sjogren syndrome and systemic sclerosis, treatment of the underlying disease using immunosuppressive drugs may lead to improvement in hypohidrosis. In neurological diseases, the primary pathology is often irreversible. In these instances, prevention of further neurological damage, such as good glycaemic control in diabetes, is the cornerstone of management. In acquired generalized anhidrosis, spontaneous remission may be observed in some cases. Numerous cases have been reported to respond effectively to systemic corticosteroids. Although an optimum dose and regime has not been established, pulse methylprednisolone (up to 1000 mg ⁄ day) has been reported to have good effect.
Sweat is readily visualized by a topical indicator such as iodinated starch (Minor test) or sodium alizarin sulphonate, both of which undergo a dramatic colour change when moistened by sweat. A thermoregulatory sweat test can evaluate the body’s response to a thermal stimulus by inducing sweating through a hot box ⁄ room, thermal blanket or exercise. Failure of the topical indicator to undergo a colour change during thermoregulatory sweat testing indicates hypohidrosis, and further tests may be required to localize the lesion.
Magnetic resonance imaging of the brain and ⁄ or spinal cord is the best modality for evaluation when the lesion is suspected to be localized to the central nervous system.
Skin biopsies are useful when anhidrosis occurs as part of a dermatological disorder. Biopsy results may reveal the sweat gland destruction, necrosis or fibrosis, in addition to the findings of the primary dermatological disorder.
People who have been bitten by a black widow spider are recommended to seek professional medical assistance for symptoms. Symptoms self-resolve in hours to days in a majority of bites without medical intervention.
Medical treatments have varied over the years. Some treatments (e.g. calcium gluconate) have been discovered to be useless. Currently, treatment usually involves symptomatic therapy with pain medication, muscle relaxants, and antivenom. When the pain becomes unbearable, antivenom is administered. Antivenom historically completely resolves pain in a short time. Antivenom is made by injecting horses with latrodectus venom over a period of time. The horse develops antibodies against the venom. The horse is bled and the antibodies purified for later use. Doctors recommend the use of anti-inflammatory medications before antivenom administration, because antivenom can induce allergic reactions to the horse proteins. The efficacy of antivenom has come under scrutiny as patients receiving placebo have also recovered quickly.
Antivenom is used widely in Australia for redback bites; however, in the United States it is less commonly used. Antivenom made from prior spider bite victims has been used since the 1920s. Opiates such as morphine relieve pain and benzodiazepines ease muscle spasm in most patients.
Heat urticaria presents within five minutes after the skin has been exposed to heat above 43 degrees Celsius (109.4 degrees Fahrenheit), with the exposed area becoming burned, stinging, and turning red, swollen, and indurated.
The amount of potassium deficit can be calculated using the following formula:
Meanwhile, the daily body requirement of potassium is calculated by multiplying 1 mmol to body weight in kilogrammes. Adding potassium deficit and daily potassium requirement would give the total amount of potassium need to be corrected in mmol. Dividing mmol by 13.4 will give the potassium in grams.
The earliest electrocardiographic (ECG) findings associated with hypokalemia is a decrease in T waves height. Then, ST depression and T inversion happens as serum potassium reduces further. Due to prolonged repolarization of ventricular Purkinje fibers, prominent U wave occurs (usually seen at V2 and V3 leads), frequently superimposed upon the T wave and therefore produces the appearance of a prolonged QT interval when serum potassium reduces to below 3 mEq/L.
There is some laboratory tests that may aid in diagnosis of GSD-V. A muscle biopsy will note the absence of myophosphorylase in muscle fibers. In some cases, acid-Schiff stained glycogen can be seen with microscopy.
Genetic sequencing of the PYGM gene (which codes for the muscle isoform of glycogen phosphorylase) may be done to determine the presence of gene mutations, determining if McArdle's is present. This type of testing is considerably less invasive than a muscle biopsy.
The physician can also perform an ischemic forearm exercise test as described above. Some findings suggest a nonischemic test could be performed with similar results. The nonischemic version of this test would involve not cutting off the blood flow to the exercising arm. Findings consistent with McArdle’s disease would include a failure of lactate in venous blood and exaggerated ammonia levels. These findings would indicate a severe muscle glycolytic block. Ammonia arises from the impaired buffering of ADP, which leads to an increase in AMP concentration resulting in an increase in AMP deamination.
Physicians may also check resting levels of creatine kinase, which are moderately increased in 90% of patients. In some, the level is increased by multitudes - a person without GSD-V will have a CK between 60 and 400IU/L, while a person with the syndrome may have a level of 5,000 IU/L at rest, and may increase to 35,000 IU/L or more with muscle exertion. This can help distinguish McArdle's syndrome from carnitine palmitoyltransferase II deficiency (CPT-II), a lipid-based metabolic disorder which prevents fatty acids from being transported into mitochondria for use as an energy source. Also, serum electrolytes and endocrine studies (such as thyroid function, parathyroid function and growth hormone levels) will also be completed. Urine studies are required only if rhabdomyolysis is suspected. Urine volume, urine sediment and myoglobin levels would be ascertained. If rhabdomyolysis is suspected, serum myoglobin, creatine kinase, lactate dehydrogenase, electrolytes and renal function will be checked.
Once a diagnosis of dysmenorrhea is made, further workup is required to search for any secondary underlying cause of it, in order to be able to treat it specifically and to avoid the aggravation of a perhaps serious underlying cause.
Further work-up includes a specific medical history of symptoms and menstrual cycles and a pelvic exam. Based on results from these, additional exams and tests may be motivated, such as:
- Laboratory tests
- Gynecologic ultrasonography
- Laparoscopy may be required.
Tetany or tetany seizure is a medical sign consisting of the involuntary contraction of muscles, which may be caused by disease or other conditions that increase the action potential frequency of muscle cells or the nerves that innervate them. Muscle cramps which are caused by the disease tetanus are not classified as tetany; rather, they are due to a lack of inhibition to the neurons that supply muscles.