Emergency Medicine Hyperthermia By Anjali Hulbanni MD and Mudassir Khan MD

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medskl.com is a free, global medical education site (FOAMEd) covering the fundamentals of clinical medicine with animations, lectures and concise summaries. medskl.com is working with over 170 award-winning medical school professors to provide content in 200+ clinical presentations. • Emergency Medicine – Hyperthermia: What You Need to Know • Whiteboard Animation Transcript • with Hulbanni, MD and Mudassir Khan, MD • https://medskl.com/Module/Index/hyper... • Hyperthermia is very different from fever. • Fever is the body’s regulated response to a new set point temperature. Hyperthermia, however, is an unregulated body temperature and is associated with high morbidity and mortality. You don’t want to miss it. • The 2 most common causes of hyperthermia are drug induced - think about this in a patient exposed to inhaled anesthesia - or antipsychotic mediations. • And heat stroke caused by external environmental factors. Think about this particularly in the elderly during times of heat waves in those with no access to air conditioning. • • There are 3 major drug induced hyperthermias: • Malignant hyperthermia is caused by a faulty calcium channel receptor thus increasing calcium and causing uncontrolled muscle contraction. Dantrolene can be used as a reversal agent. • Serotonin syndrome is caused by drugs that increase serotonin levels – classically monoamine oxidase inhibitors or MAOIs. Patients have hyper-reflexia, large pupils, and clonus. Cyproheptadine – a serotonin antagontist - can be used as adjunctive therapy. • Neuroleptic Malignant Syndrome or NMS is caused by antipsychotics. Presentation can occur up to eight days after exposure, as opposed to the 24-hour window with other drug induced causes. Patients are hypo-reflexic and have normal pupils. There is no effective antidote. • • Rapid cooling is the main therapeutic intervention for ALL hyperthermias – regardless of cause. • Ice bath submersion is the most effective means of cooling and must be done as quickly as possible. Antipyretics are not effective in these patients. Patients with drug-induced hyperthermia may need intubation and paralysis to stop further muscle contraction.

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