Question

It is midsummer and you work in an urban ED. An 85 year old male is brought into the ED that is unresponsive, skin is very dry, pale, low blood pressure, and slight tachycardia. He has a history of hypertension and admits taking a beta blocker and a diuretic to help control this. His air conditioning unit has been working on and off. He lives with his wife of 50 years and they live a very conservative lifestyle. Wife is very concerned because he dosen’t get a round very well anymore. (Learning Objectives 8 and 9)

1. What do you suspect is the primary problem for this patient?(3.33 points)
2. What will be the immediate treatment for this disorder from which he is suffering?(3.33 points)
3. What do you expect his ED disposition to be?(33 points)

Answer 1

The primary problem for this patient may be heat stroke.

Rationale: His symptoms are unresponsive, dry skin, hypotension and tachycardia occur in summer season, his air conditioning unit is also working on and off. He is taking a beta blocker and a diuretic. So he may dehydrated, lose heat control mechanism, heat stroke may occur.

Immediate treatment of heat stroke is

• check vitals, temp may > or = 104degree celsius indicates heat stroke.
• Immerse the patient in a cold water tub with the full of cold water
• Place ice packs over armpits, forehead, groin region
• Provide well cool room
• Take necessary steps to avoid shivering, because shivering may induce heat production and body temperature rise.
• Cover patient with cool blanket.
• Monitor temperature and other vitals

ED disposition

Brain injury

Multiorgan distress syndrome or death