POTD: Heatstroke Cooling in High Humidity

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How do I cool my patient with heatstroke?

Heatstroke

  • AMS

  • Core body temp > 40.5 C (105 F)

  • Exposure to high temperatures or exercise

Cooling down their core temperature ASAP provides mortality and morbidity benefit

  • Delayed treatment can have a mortality as high as 70%!

We learn that evaporative cooling is the best method 
(spraying tepid water and cooling with fans). 

HOWEVER, when humidity is high this may not work! 

  • Because sweat on the skin cannot evaporate into the surrounding air and body temperature cooling fails.

  • This occurs in some studies at humidity levels >50-55%

So what else can you do?

Ice Bath

  • Practically speaking, place the patient in a body bag up to their neck and add ice and water.

If an ice bath isn't possible, apply ice packs to neck, armpits, and groin. 

Stay cool!

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Wellness POTD: Sleep

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Importance of sleep:

  • Helps with memory consolidation and improving retention of new knowledge

  • Increases metabolism

  • Improves mood

  • Improves cardiovascular health

  • Boosts immune system

Effects of sleep restriction:

  • First thing to go is compassion and empathy, NOT medical judgment

  • Increased cortisol levels

  • Increased insulin resistance

  • Increased hunger

  • Irritability

  • Testosterone levels drop

  • Reaction times diminished

  • Driving while sleep deprived can be similar to driving while intoxicated

Sleep hygiene tips

  1. Make a bed time routine

  2. Avoid screen time (TV, phone, computer) before sleep

  3. If you must have screen time before bed, use a computer app that decreased blue light when its dark out (I like Flux)

  4. Use your bed only for sleeping

  5. Avoid caffeinated drinks a few hours before bed

  6. Exercise regularly

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POTD: Neonatal Procalcitonin

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  • Neonates will have physiologically elevated procalcitonin.

  • Normalizes around 3 days.

procalcitonin neonates.jpg

  • Studies show that procalcitonin is useful in detecting/managing sepsis in neonates.

    • Neonates who have procalcitonin trended seem have shorter duration of antibiotic therapy.

References

  • Chiesa C, Panero A, Rossi N, Stegagno M, DeGiusti M, Osborn JF, Pacifico L: Reliability of Procalcitonin concentrations for the diagnosis of sepsis in critically ill neonates. Clin Infect Dis. 1998, 26: 664-672. 10.1086/514576.

  • Stocker, M., Hop, W. C., & van Rossum, A. M. (2010). Neonatal Procalcitonin Intervention Study (NeoPInS): Effect of Procalcitonin-guided decision making on Duration of antibiotic Therapy in suspected neonatal early-onset Sepsis: A multi-centre randomized superiority and non-inferiority Intervention Study. BMC Pediatrics, 10(1).doi:10.1186/1471-2431-10-89

  • https://www.procalcitonin.com/clinical-utilities/neonatal-sepsis.html



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