Rapid cooling of victims to below 42 °C is necessary as cells sustain injury above this temperature. Since cellular metabolism increases exponentially with temperature elevation and certain cellular changes are reversible, mere removal from the heat source and provision of a cool environment rapidly reduces body temperature below this critical value (Kashmeery.and1..As„h,.1995). Intravascular monitoring should be used to avoid the lag seen with rectal probes.
Prevention of vasoconstriction by avoidance of overcooling is important. Vasoconstriction and shivering are inhibited by sweating and hyperthermia, and it has recently been suggested that Pdoxical shivering with elevated brain and vascular temperature does not occur ( A.s.h a.D.d Kas.hm.ee.ry 1995). Shivering is commonplace after marathon races in cool weather.
The time-honored treatment of aggressive cooling has been modified significantly in recent years. The empirical use of immersion in an ice water bath has given way to various modalities of cooling by evaporation and fanning. Tapwater and fanning are as efficient as ice water ( ASh.l.§D.d.l.Ka.S.h.m§e^[y..l19.9.5). At Mecca, muslin gauze and evaporative cooling are as effective as the Mecca Body-Cooling Unit. To avoid vasoconstriction, internal cooling with cold intravenous infusions (up to 1000 ml at 12 °C for heat exhaustion and at 5 °C for heatstroke) has been used successfully at the Hajj ( Kashmeery..aD.d AS.h 1995).
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