Hyperthermia treatment and prevention

Indications for cooling include any signs of heat-related illness in the presence of an elevated body temperature. Previously, heat-related illness has been defined as core body temperature greater than 40 C (Wasserman, DD. 2020). Cooling treatment of hyperthermia consisting of measures which will rapidly lower core body temperature. However, care must be taken to avoid causing vasoconstriction or shivering. Vasoconstriction will impede heat loss and shivering will create heat.

Once heat stroke has developed, the prognosis is poor, particularly with advanced age. The treatment goal is to reduce tissue damage by lowering the temperature of vital structures such as the brain, heart and liver. Tissue damage ensues when core temperature reaches 109F (43C). Cooling treatments can be internal or external.

Internal cooling techniques such as ice water gastric or rectal lavage, extracorporeal blood cooling, and peritoneal or thoracic lavage are effective but they are also difficult to manage and associated with complications.

External cooling techniques are usually easier to implement, well tolerated and effective.

Conductive cooling techniques include direct application of sources such as hypothermic blanket, ice bath, or ice packs to neck, axillae and groin
Convective techniques include removal of clothing and use of fans and air conditioning.
Evaporative cooling can be accelerated by removing clothing and using a fan in conjunction with misting the skin with tepid water or applying a single layer wet sheet to bare skin.

Hyperthermia is a condition that is much better prevented than treated in an elderly person. Elderly patients should be cautioned about the dangers of hot weather. For those elders at very high risk, such as those living alone without air conditioning or ventilation, temporary relocation to a more protected environment such as a shelter or community center should be implemented. Nurses can suggest several specific strategies that can help elderly people avoid hyperthermia during heat waves.

These strategies include:

Drink 2 to 3 quarts of water daily.
Avoid exertion or exercise, especially during the hottest part of the day.
If traveling, allow 2 to 3 weeks in an unusually hot climate before attempting any type of exertion.
When outside, wear a hat and loose clothing; when indoors, remove as much clothing as needed to be comfortable.
Take a tepid bath or shower.
Use cold wet towels or dampen clothing with tepid water when the heat is extreme.
Avoid hot, heavy meals.
Avoid alcohol.
Determine if the person is taking any medications that increase hyperthermia risk; if so, consult with the patient's physician.

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In a severe and prolonged heat wave, elderly people who live alone without air conditioning or appropriate ventilation may require assistance to temporarily relocate to safer quarters.

References

Wasserman DD, Creech JA, Healy M. Cooling Techniques For Hyperthermia. [Updated 2020 Aug 24]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 https://www.ncbi.nlm.nih.gov/books/NBK459311/