Dx

Epidemiologi

Gejala

Terapi

Heat Stroke

Bekerja di gurun pasir/ tempat panas

Kriteria dx:
- >40 C core temperature
- CNS abnormality: severity confusion to
coma, agitation, ataxia and irritability

Remove all equipment and excess

clothing.

Cool <30 minutes via whole body

ice water immersion (place them
in a tub/stock tank with ice and
water approximately 3558F);
stir water and add ice throughout
cooling process.

Or take into a cold shower or

move to shaded, cool area and use
rotating cold, wet towels to cover
as much of the body surface as
possible.

Maintain airway, breathing and

circulation.

After cooling has been initiated,

activate emergency medical
system by calling 911.

Monitor vital signs such as rectal

temperature, heart rate,
respiratory rate, blood pressure,
monitor CNS status.
If rectal temperature is not
available, DO NOT USE
AN ALTERNATE
METHOD (oral,
tympanic, axillary,
forehead sticker, etc.).
These devices are not
accurate and should
never be used to assess
an athlete exercising in
the heat.

Cease cooling when rectal

temperature reaches 101102F
(38.338.9C).
Exertional heat stroke has had a 100%

survival rate when immediate cooling (via

cold water immersion or aggressive whole
body cold water dousing) was initiated
within 10 minutes of collapse.

Malignant Hyperthermia Crisis

Induksi anestesi umum (halothan,

Enflurane, Isoflurane, Sevoflurane,
Desflurane) dan muscle relaxant
(Succinylcholine), inherited condition

Kriteria dx:
Unexplained increase in ETCO2 AND
Unexplained tachycardia AND
Unexplained increase in oxygen
requirement
(Previous uneventful anaesthesia does not
rule out MH)
WITHIN MINUTES AFTER
INDUCTION

STOP all trigger agents (anaesthetic

vapours, etc.)
CALL FOR HELP. Allocate specific
tasks (action plan in MH kit)
Install clean breathing system and
HYPERVENTILATE with 100% O2 high
flow Maintain anaesthesia with
intravenous agent
ABANDON/FINISH surgery as soon as
possible

Withdraw all trigger agents (i.e. all

anaesthetic vapours)
2. Install clean anaesthetic breathing
system and hyperventilate
3. Abandon surgery if feasible
4. Give dantrolene IV 1 mg/kg initially
and repeat prn up to 10 mg/kg
5. Measure arterial blood gases, K+ and
creatine phosphokinase (CPK)
6. Measure core temperature
7. Surface cooling, avoiding
vasoconstriction
Intermediate management
1. Control serious arrhythmias with
beta-blockers etc.
2. Control hyperkalaemia and
metabolic acidosis
Later management
1. Clotting screen to detect

disseminated intravascular
coagulation
2. Take first voided urine sample for

Neuroleptic Malignant Syndrome

Neuroleptic agents: haloperidol,

fluphenazine. Atypical antipsychotic drugs
(eg, clozapine, risperidone, olanzapine) as
well as antiemetic drugs (eg,
metoclopramide, promethazine)

Rigidity
Hyperthermia
Diaphoresis
Pallor
Dysphagia
Dyspnea
Tremor
Incontinence
Tachycardia
Shuffling gait
Psychomotor agitation
Delirium progressing
to lethargy, stupor,
coma
The onset can be within hours,
but on average is 4-14
days, after the start of
therapy; 90% of cases
occur within 10 days

Discontinue neuroleptic agent or

precipitating drug
Maintain cardiorespiratory stability.
Mechanical ventilation,
antiarrhythmic agents or pacemakers may
be required.15
Maintain euvolemic state using
intravenous (IV) fluids. Insensible fluid
loss from fever and diaphoresis should also
be considered.16 If CK is very elevated,
high volume IV fluids and urine
alkalinization with IV sodium bicarbonate
[Na(HCO3)] may help to prevent renal
failure from rhabdomyolysis.17
Lower the temperature using cooling
blankets, ice cold water,
gastric lavage and ice packets in axilla and
cold sponging.
Antipyretics may be used.
Lower BP, if markedly elevated.
Clonidine is effective in this
setting.
Prescribe heparin or low-molecularweight heparin (LMWH) for
DVT prevention
Use benzodiazepines (e.g. clonazepam or
lorazepam 0.51 mg)
to control agitation if necessary.