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Top Tip 2 - Emergency - Heat Stroke - Cooling your Heels
Summer may soon be ending but clients still need to remain vigilant of conditions such as heat stroke for some time yet. Furthermore, heat stroke is a common complication of seizure activity and muscle fasciculation too, so having an emergency protocol on hand can be a life saver as the months become cooler. Here's some handy hints to compare against your treatment protocol and a client handout to assist clients while the weather is still warm. This week's Top Tip gives a brief overview of heat stroke (hyperthermia) treatment for pets which present with the condition. It is important to note that patients do not necessarily present with a high temperature, they can in fact even be presented with a low temperature, especially if owners have attempted cooling at home. Although heat stroke can be inherently complex and treatment may vary, having a general plan in place covering most of the likely scenarios can help immensely in effective treatment. Click here for a copy of a patient handout we find to be helpful for clients who ask questions about the condition. It makes a wonderful non-technical supplement to the following information. Here's some notes on our general appoach to a 'classical' heatstroke to compare with your own protcol. • The usual ABC's apply – due to laryngeal oedema, you may need to intubate and all affected pets require oxygen via flow-by or nasal prongs (avoid in cerebral oedema). • Establish IV access and the blood in the stylet of catheter for BG/PCV/TP/lactate. Collect blood for baseline labs prior to fluid administration • If hypoglycaemic, bolus 1ml/kg 50% dextrose diluted in saline • Commence fluid resuscitation in boluses of 30-50ml/kg of crystalloids (Hartmanns or 0.9%NaCl - the latter if pet showing signs of cerebral oedema) over 10-15 minutes and continue until perfusion parameters improve (mentation, HR, MM colour, CRT, BP). If the patient remains hypotensive, after repeated boluses of crystalloids, consider bolus administration of colloids at 5-10ml/kg, up to a total dose of 20ml/kg. • Cool using the following guidelines (it is best if the owners start prior to presentation at a veterinary clinic)
• After initial resuscitation, IV fluids should be administered to maintain hydration and compensate for any ongoing losses • Antibiotics are indicated to combat sepsis as a result of bacterial translocation (ampicillin/metronidazole). Also consider gastroprotectant medication: H2 blockers, sucralfate • Steroids are not indicated in heat stroke and can make the situation worse by impairing healing, promoting GI ulceration and deregulating glucose metabolism • Patient monitoring should include TPR, mentation, pupil size, BP, SpO2, ECG (continuous to q4 hours, depending on patients condition) , urine output q 4-6 hours (consider placement of a urinary catheter and closed collection to make monitoring and measuring easier)PCV/TP/electrolytes/BG/lactate/blood gases/BUN/creatinine q 2-24 hours, full biochemistry/haematology/coagulation profile as dictated by the case. Lactate returning to normal is great prognostic factor • Always watch for DIC, ARDS, ARF. DIC should always be assumed as it is not evidently present until late (as seen by decreasing thrombocytes, coagulopathies, etc.). Blood diarrhoea is a sign of DIC in these cases We've found this checklist very helfpul in the treatment of patients presenting with heat stroke and hope it is equally as helpful in reviewing and validating your general approach to heat stroke. Disclaimer for non-veterinarians: This information is of a general nature only and is intended to be used as part of overall case management for a condition diagnosed and managed by a qualified veterinarian. Always consult a qualified veterinarian for advice specific to your own pet. |
