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While there are physiologic differences that exist between children and adults, the primary risk factor for heat illness in children is inadequate or inappropriate supervision.
Heat-related illnesses comprise a continuum of conditions ranging from minor entities such as heat cramps to more serious conditions including heat exhaustion and heatstroke.
Heatstroke is the most severe form of heat illness, with reported mortality between 17% and 80%.
Heat exhaustion is a syndrome of dizziness, postural hypotension, nausea, vomiting, headache, weakness, and, occasionally, syncope.
Special glass or electronic thermometers are required for accurate measurement of temperatures in hypothermic patients.
Extracorporeal rewarming is the most rapid method of rewarming and is indicated in hypothermic cardiac arrest and with patients who present with completely frozen extremities.
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Heat-related illness garners much publicity and may lead to significant morbidity and mortality. The spectrum of heat illness ranges from mild, self-limited problems to major, life-threatening conditions. The majority of patients who are evaluated in the emergency department for heat illness can be appropriately treated and discharged, with only approximately 7% requiring transfer or hospitalization.1 Unfortunately, there has been a 133.5% increase in exertion-related heat illness between 1997 and 2006.2 The average annual number of deaths attributed to heat illness in the United States over the past decade was 618 per year.3 While there are multiple factors that influence these numbers, it is currently believed that the majority of the morbidity and mortality associated with heat illness is preventable.
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Traditionally, pediatric patients are included in the group who is considered to be at greater risk for developing heat-related illness. Commonly cited reasons for the pediatric patient's increased risk include a greater body surface to mass ratio adversely affecting heat absorption, higher metabolic rate leading to greater heat production, lower perspiration rate leading to decreased heat dissipation, and reduced acclimatization.4–7 Recent research investigating the validity of these potential causes challenges the notion that children are at physiologic disadvantage compared to adults.8,9 While there are obvious physiologic and metabolic differences between children and adults, it is difficult to determine whether these variances lead to increased risk. The different thermoregulatory strategies in pediatric patients do not, necessarily, constitute an inferior response to heat stress.9,10
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What is known is that children interact with the environment differently than adults and this often places them at greater risk for injury. Infants, especially those under one year of age, who are dependent upon adult supervision to ensure their safety, are at greatest risk for heat-related mortality.11 Excessive bundling alone can lead to heat illness in the very young. The development of heat illness in small children left in closed cars on hot days is a tragic situation that is entirely preventable through parental education.12 While the dependent infant is at high risk of heat injury because of inadequate ...