Heat stroke & DIC????

[angle71054]

So I am not an ER nurse, I am a ICU nurse. I had a scary experience with a patient the other day and I am a little freaked out. I know Heat stroke is dangerous. That it has the capacity to shut down your kidneys and other damage, but I have never seen anything like it. I am not wanting to break HIPPA. I am an agency RN that does not work in the city I live in. But forgive my attempt at being geniric as possible.

A man walked into this hospital stating he did not feel well. He stated he got over heated working outside, then episodes of diarrhea. He was purple. Like really purple from head to toe. He seemed to be a Caucasian that was very tan. But he was like really purple. The skin looked like swirls of jaundice yellow and purple. They ended up intubating the man and transfering him to ICU where he later coded and died. His labs indicated he was going into DIC. Is it really possible for heat stroke to do this. I've not worked in hot enviroments, so it was new to me.

I mean I am an experienced RN for 13yrs, and never have seen anything like this. It really freaked me out. Any info would be great. I hate not understanding things that can happen to my patients.

[Pheebz777, BSN, RN]

I live near the Texas/Mexican border and we get patients suffering from heat stroke, rhabdo and DIC when they present to the E.R. The rhabdo alone caused by the extreme exposure would be enough to throw your body outta wack. Severe cases usually are brought in by EMS in severe dehydration and multiple organ failure and rarely make it. We had a Chinese guy entering MExico to enter the US illegally. He was here in the ICU with us for over 6 months and was in severe DIC as well.

[Altra, BSN, RN]

Dehydration & rhabdomyolysis --> multi-organ failure.

[BSN16]

I live near the Texas/Mexican border and we get patients suffering from heat stroke, rhabdo and DIC when they present to the E.R. The rhabdo alone caused by the extreme exposure would be enough to throw your body outta wack. Severe cases usually are brought in by EMS in severe dehydration and multiple organ failure and rarely make it. We had a Chinese guy entering MExico to enter the US illegally. He was here in the ICU with us for over 6 months and was in severe DIC as well.

yup, had this exact same thing

[Anna Flaxis, BSN, RN]

This may be slightly off topic, but you seem a bit surprised that the patient walked in, and did not come by ambulance.

Some of the sickest people I've seen have been walk-ins. The sickest don't always come by ambulance. They can be walking and talking one moment, and coding the next.

To answer your question, yes, heat stroke can lead to rhabdomyolysis, of which DIC is a late complication. It sounds to me like, for whatever reason, your patient waited too long before seeking treatment.

[irishicugal]

What's DIC? Sorry, not a US nurse, sometimes your abbreviations and acronyms baffle me...

[offlabel]

What's DIC? Sorry, not a US nurse, sometimes your abbreviations and acronyms baffle me...

Disseminated intravascular coagulation....pathologic consumption of clotting factors causing coagulopathy and catastrophic, systemic bleeding.

Slainte ! :)

[offlabel]

To the OP, any acute rise in temperature beyond 106-108 F is likely to cause a severe coagulopathy. There are those patients that are genetically predisposed to a "heat stroke" event, those that just over heat in the environment they are in or have a drug induced hyperthermic event.

The very first thing to do in these situations is bury the patient in ice and move on from there. But once the temp is high enough for coagulopathy, the likelihood of survival is pretty grim.