Experience of treating batches of exertional heat stroke patients in military training

Abstract

To explore the process and segments of intense treatment of patients suffered from exertional heat stroke (EHS), and to provide the experience and guidance for treating batches of EHS patients. A retrospective study of the curing process of eight EHS patients admitted to the Eighth Medical Center of Chinese PLA General Hospital on May 18th, 2019 was conducted, including onsite treatment and subsequent transshipment to hospital for treatment. Based on the medical history with high-intensity exercise and the clinical manifestation of central nervous system dysfunction, the eight patients were quickly diagnosed as EHS on the site, and were immediately rehydrated and attained the systematic cooling. An emergency plan for the treatment of batches of patients was initiated instantly for quick medical evacuation and care, and the patients were quickly transferred to the Eighth Medical Center of Chinese PLA General Hospital. A therapeutic principle was strictly followed, concerning the transshipment accompanied by systematic cooling while the medical evacuation and care, therapeutic preparation and immediate opening of the green channel were started up in the hospital. Sticking to the plan of allocating patients vs. nurses vs. doctor by 1:3:1, enough persons were dispatched. Ventilators, hemofiltration machines and ice blanket machines were prepared. Through the professional diagnosis and treatment in the emergency department, the patients were transferred to the ICU department. The relevant medical departments were coordinated with the centralization of the ICU department. The vital signs of patients were monitored closely. The titration and precise treatment were implemented, based on the changes in blood routine examination, blood biochemical indexes, blood clotting function, and blood gas analysis. The continuous renal replacement therapy (CRRT) was performed for four patients, the ice blanket machine cooling therapy for two patients, and the tracheal intubation and mechanical ventilation for one patient. Low molecular weight heparin sodium anticoagulant treatment was used in one patient with the diffuse intravascular coagulation (DIC) on the basis of coagulation factors such as plasmas and fibrinogens supplementation. The function of the damaged organs was significantly improved in 5-11 days. Eight patients were finally transferred out from ICU department. All patients were recovered and discharged after 11-20 days. A normative treatment process (rapid recognition on the site, rapid cooling, rapid and safe medical evacuation, in-hospital multidisciplinary collaboration) combined bundles of therapeutic strategy such as systematic cooling and rehydration, CRRT, and supplying the coagulation factors while anticoagulation treatment can provide a strong guarantee for rescuing batches of EHS patients and achieve satisfactory treatment outcomes.