Hyperthermia damage/ heat stroke

Re: Hyperthermia damage/ heat stroke

Sammy82 — Mon, 05 Aug 2013 17:41:00 GMT

Thank you for all the input! The dog is doing very well, did not need further treatment and does not seem to have suffered any permanent damage.

Re: Hyperthermia damage/ heat stroke

james herriot lied — Thu, 18 Jul 2013 17:50:35 GMT

Hottest day of the year so far - and had my heat stroke for the day. Young, manic springer which literally ran itself into the ground. Many thanks to all of those with good suggestions - always something new to try. Temperature 'only' 41C, but in a really bad state. Bloods with classic neutropaenia, mild hypokalaemia and raised haematocrit; usual V/D (no, not parvo). Currently on fluids, but I may give it several hours more before sending home.

An excellent chance to get all the team on board with emergency responses etc, so hopefully some good will come out of it. If I could ask one question - does anybody have volumes/frequency for bladder lavage?

Re: Hyperthermia damage/ heat stroke

Mark Holmes — Mon, 15 Jul 2013 07:11:16 GMT

[quote user="Evelyn Barbour-Hill"]

[quote user="Mark Holmes"]but large vines if gokd water can be used very quickly.[/quote]

A very good point, Professor Unwin!

[/quote] Ok volumes of cold water

Re: Hyperthermia damage/ heat stroke

Evelyn Barbour-Hill — Sun, 14 Jul 2013 23:16:13 GMT

[quote user="Mark Holmes"]but large vines if gokd water can be used very quickly.[/quote]

A very good point, Professor Unwin!

Re: Hyperthermia damage/ heat stroke

Mark Holmes — Sun, 14 Jul 2013 22:22:12 GMT

My tips 4% glucose rather than saline. They only need water not sodium. (Water being whats left once liver metabolises glucose) They can be sodium overloaded. I use cold water enema. Shove a hose up and turn it on. I appreciate you cannot then monitor rectal temperature but large vines if gokd water can be used very quickly.

Re: Hyperthermia damage/ heat stroke

Julie Innes — Sun, 14 Jul 2013 20:14:05 GMT

I've read Bad Pharma, and it does make you think!It actually makes me wish I'd paid more attention in that god-awful boring statistics class!

Re: Hyperthermia damage/ heat stroke

Linda Filshie — Sun, 14 Jul 2013 19:15:07 GMT

[quote user="james herriot lied"]

Ooh, get you..

Your contribution was in no way spurious or trumpy, Linda. You might have gathered that the prevailing atmosphere on here is one of EBM - and as such, all links to relevant research are useful. But equally, not all research is that applicable when viewed at more than face value. My comments weren't directed at you in any case, but were made in support of Richard, who was giving his (fairly well reasoned) justification for using dex - and who was initially getting shot down by the red star snipers. It's one of the uglier sides of the site: I do red star people myself, but generally in conjunction with an argument as to why I think they're talking rubbish.

But have you read 'Bad Pharma' by Ben Goldacre? It's fairly direct and simplistic in its message, but it did have an effect on the way that I view the kind of 'research' that the reps bombard us with for the latest wonder-drug. And made me realise just how little clinically useful research actually gets done, for conditions that we see commonly but on which we have widely differing treatment views. There's just no interest in funding anything which doesn't have a specific marketing licence to be gained as a result.

[/quote] Ah - it all becomes clear! Context is everything :) Not read Bad Pharma yet, but it's in the (massive) to be read pile by the side of my bed, so I must move it up the stack.

Re: Hyperthermia damage/ heat stroke

james herriot lied — Sun, 14 Jul 2013 12:40:04 GMT

Ooh, get you..

Re: Hyperthermia damage/ heat stroke

Linda Filshie — Sun, 14 Jul 2013 11:07:04 GMT

Apologies if my contribution was "spurious" or seen as an attempt to play top trumps. I was merely highlighting some research I found interesting which discussed a relevant issue.

Re: Hyperthermia damage/ heat stroke

Chris Geddes — Sat, 13 Jul 2013 18:00:43 GMT

[quote user="Richard Carter"]

In the days of parvo

[/quote]

But the days of Parvo are very much still here. PDSA reported 300 cases in its pet aid hospitals in one month alone

Do you work in an area of the country where you don't see it at all? (I left practice in 2009 but was still seeing plenty in N Wales)

Re: Hyperthermia damage/ heat stroke

Malcolm Ness — Sat, 13 Jul 2013 13:48:29 GMT

[quote user="james herriot lied"]Because 23.7% of dogs show a 54.97% improvement based upon a 78.3% morbidity within the lateralised constraints of a double-blinded exclusion principle of 16.32:1 (adjusted with a Chi-squared test to reflect underlying pathology).[/quote]

87.9% of statistics are made up. (Reeves (2004))

Incidentally, +1 for JHL's comments in support of the reasoned explanation for the use of Dex. I don't use dex in these cases - I am happy to be shown good evidence to show that Dex is right and I am wrong but in the mean time,well thought through opinion based on whatever evidence we have (including clinical experience) is the best we can do and the fact that that ends up with differing opinions, I see more as a call to action for clinical research than an excuse to jump for the red button. The "evidence" put forward in this thread is a lab-based rat study looking at mainly indirect (and possibly spurious) end points. While there was undeniably a statistically significant difference in outcome, wrt the only vaguely clinically relevant outcome assessment (survival time) one treatment group lived 29 minutes and another 34 minutes. Sadly the potentially useful concept of EBM is currently being hijacked in much of the veterinary world and turned into some kind of mindless "Literature Top Trumps" game.

Just to play devil's advocate, those who were shouting out for Rules rather than Guidelines on another now infamous thread relating to the DC, this must be a pretty obvious scenario where confusion can be averted and a rule can be made. Questions: What should the rule be - to Dex or not to Dex?; Who should make the rule?; What should be the sanction/punishment for those that dex when they shouldn't have or vice-versa?

Re: Hyperthermia damage/ heat stroke

james herriot lied — Sat, 13 Jul 2013 13:19:31 GMT

Because 23.7% of dogs show a 54.97% improvement based upon a 78.3% morbidity within the lateralised constraints of a double-blinded exclusion principle of 16.32:1 (adjusted with a Chi-squared test to reflect underlying pathology).

Re: Hyperthermia damage/ heat stroke

Evelyn Barbour-Hill — Sat, 13 Jul 2013 12:39:08 GMT

[quote user="Noweia"]The critical temperature we were taught is 42.7 and anythign higher leads to organ necrosis. [/quote]

No offence to you, Noweia, but this sort of precision irritates me. Why 42.7? why not 42.6 or 42.8? I wondered if it were a translation of some round figure in Fahrenheit, but it's not that either.

Re: Hyperthermia damage/ heat stroke

james herriot lied — Sat, 13 Jul 2013 12:35:36 GMT

Just out of interest, what kind of volumes are people using for bladder lavage, and are you cooling the fluids first, or just putting them in at room temp?

Re: Hyperthermia damage/ heat stroke

james herriot lied — Sat, 13 Jul 2013 12:34:19 GMT

[quote user="Richard Carter"]

My rationale for using it is

[/quote]

And whilst the jury's still out for me as to whether the dex is helping or not, I think your reasoning is logical and, importantly, demonstrates a certain empathy for your patient - something which is often lost in the bright young things who slavishly follow the latest (often not real-world-applicable) bit of research. So I'm sorry you're being red-starred, Richard - this seems to be the worst of vetsurgeon, where people will anonymously hit the button without really coming forwards with a proper rebuttal.

Have five stars from me for a reasoned contribution.

Re: Hyperthermia damage/ heat stroke

Noweia — Sat, 13 Jul 2013 12:03:30 GMT

[quote user="Julie Innes"]

I had a dog with heatstroke today- collapsed, panting +++, temp off thermometer scale (ie over 43) Had only been to the park for 5 minutes, gentle exercise, but has a very thick coat. We poured cool water over him (with a watering can!), put him in a kennel lined with wet towel, cooled IV fluids, fan, O2. He did ok, temp came down to 38.7, then we stopped, but then his temp started going up again, so more watering, ice packs groin. He walked out tonight and I am hopeful he will be fine, will do bloods in a week or so, or before if he seems unwell. Was a bit scary, but on the plus side my student nurse needed an emergency case to write up...

[/quote]

Lucky dog! The critical temperature we were taught is 42.7 and anythign higher leads to organ necrosis. Definitely the ones we've had higher than this have died.

Re: Hyperthermia damage/ heat stroke

Linda Filshie — Sat, 13 Jul 2013 10:21:30 GMT

[quote user="robloxley"]

[quote user="Linda Filshie"]Presuming you mean the high dose dex, I was wondering the same. Very quick google search came up with http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2959042/[/quote]

Though their figures show the most improvment is due to the colloids, colloid+dex better, but dex alone not much different to control?

[/quote] Yes - I wasn't necessarily supporting the contention that the use was supported. Interestingly one of the referenced studies (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2959042/) showed that pre-treatment with dex (i.e. before heat exposure) had a significant protective effect. Interestingly the results of that study also show that treatment with high dose (6mg/kg) dex at the time of onset of heat stroke had a significant beneficial effect on cerebral blood flow and neuronal damage scores (somewhat at odds with the study I initially highlighted). But given these animal were killed 15 minutes after the onset of heat stroke to determine these data we probably can't extrapolate morbidity/mortality! Food for thought anyway.

Re: Hyperthermia damage/ heat stroke

Richard Carter — Sat, 13 Jul 2013 10:06:50 GMT

My rationale for using it is that inflammatory products are exploding out of damaged cells and setting off all the cascades, not to mention cerebral oedema and various other consequences of rapid fluid replacement into an animal in a collapsed condition. Makes me feel better at night may be the only scientific explanation but I have certainly seen collapsed animals revive on shock dose dex even if the only improvement may be keeping the patient trying to survive. In the days of parvo, the rotties that survived were the ones getting dex. I love my cortisone - never killed anything with it yet and cannot say the same for NSAIDs

Re: Hyperthermia damage/ heat stroke

Rob Loxley — Sat, 13 Jul 2013 08:42:12 GMT

[quote user="Linda Filshie"]Presuming you mean the high dose dex, I was wondering the same. Very quick google search came up with http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2959042/[/quote]

Though their figures show the most improvment is due to the colloids, colloid+dex better, but dex alone not much different to control?

Re: Hyperthermia damage/ heat stroke

Linda Filshie — Fri, 12 Jul 2013 23:55:52 GMT

[quote user="robloxley"]

Is there any evidence for this?

[/quote] Presuming you mean the high dose dex, I was wondering the same. Very quick google search came up with http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2959042/

Re: Hyperthermia damage/ heat stroke

Rob Loxley — Fri, 12 Jul 2013 22:55:03 GMT

Is there any evidence for this?

Re: Hyperthermia damage/ heat stroke

Julie Innes — Fri, 12 Jul 2013 21:47:46 GMT

Re: Hyperthermia damage/ heat stroke

james herriot lied — Fri, 12 Jul 2013 20:47:42 GMT

Had a cow with heatstroke today. In middle of field, started calving, most likely got hit with a milk fever and by time we were called, had been sitting in the sun for a few hours. Temp 40.8

Got her into a frontloader bucket and into the shed. Turned the hose on and kept it on, with a large bolus of cold water in the front end and calcium / glucose iv. Still waiting to see how she gets on - but her treatment options are perhaps more limited than with the smallies. Interestingly, calcium supplementation may have a role in treatment of heat stroke in people.

Haven't had one for about three years - which is probably the last time we had any sunshine.

Re: Hyperthermia damage/ heat stroke

Richard Carter — Fri, 12 Jul 2013 16:49:08 GMT

I also use shock dose i.v dex with fluids to try reduce oxidation damage

Re: Hyperthermia damage/ heat stroke

Jo Cobbett — Fri, 12 Jul 2013 16:31:30 GMT

Clipping the jugulars and applying spirit is a great way to bring temperature down too.