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Exertional Heat Illness T67.0XXA 992.0

 

synonyms:heat stroke, heat exhaustion, dehydration, heat illness

Heat Illness ICD-10

Heat Illness ICD-9

  • 992.0 Heat stroke and sunstroke  Heat apoplexy  Heat pyrexia   ictus

Heat Illness Etiology / Epidemiology / Natural History

  • Heat stroke: 10% mortality
  • Heat cramps may be related to dehydration, diet poor in minerals, large sodium/electrolyte losses in sweat.

Heat Illness Anatomy

Heat Illness Clinical Evaluation

  • Heat cramps: muscle cramps, intense muscle pain.
  • Heat Exhaustion: heat cramps with headache, weakness/fatigue, skin pale and moist, syncope, ataxia, incoordination, profuse sweating, no CNS changes.
  • Heat stroked: Warm to the touch, no visible sweating, altered consciousness, coma, convulsions, disorientation, irrational behavior, irritability, confusion, combativeness. Tachycardia, hypotension, tachypnea. Confusion, delirium and bizzare behavior are often first signs

Heat Illness Xray / Diagnositc Tests

  • Heat stoke = Rectal temperature >104°
  • Heat Illness Risk Assessment: best done with Web bulb globe thermometer (WBGT); <65°F(18°C)=low risk; 65°-73°F (18°-23°C)=moderate risk; 73°-82°F (23°-28°C)=high; >82°F(28°C)=Extreme risk.

Heat Stroke Classification / Treatment

  • Heat Cramps: move to cool dry place, rehydrate with carbohydrate/electrolyte containing sports drink.
  • Heat Exhaustion: loosen clothing, apply ice to axilla and groin, drink cool water, cool water sprays, prop legs up.
  • Heat Stroke: IV fluids and cooling. Immediate immersion in an ice water bath is the quickest and most efficent method of cooling. Consider also: cool water sprays, fans, ice bags in groin/axilla/neck. Transfer to ER ASAP.

Heat Illness Associated Injuries / Differential Diagnosis

  • Hyponatremia
  • Stroke
  • GI illness

Heat Stroke Complications

  • Death: 10%
  • End organ damage
  • Hemodynamic collapse

Heat Illness Follow-up Care

  • Prevention: maintain hydration, gradual acclimation to heat, avoid strenous exercise on high and extreme risk days.
  • Heat stroke: no strenous exercise for at least 1 week with gradual return to activity after.

Heat Illness Review References

  • Seto CK, Clin Sports Med 2005;21:695
  • Smith JE, Br J Sports Med 2005;39:503
  • Griffin LY, JBJS 2005;87:894
  • Noonan B, Bancroft RW, Dines JS, Bedi A. Heat- and cold-induced injuries in athletes: evaluation and management. J Am Acad Orthop Surg. 2012 Dec;20(12):744-54.
  • Howe AS, Boden BP. Heat-related illness in athletes. Am J Sports Med. 2007 Aug;35(8):1384-95.
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