Case Of Heat Stroke Research Articles

Heat Stroke Deaths Caused by Electric Blankets

Heat stroke is the most serious and potentially life-threatening condition of the heat-related illnesses. Heat stroke deaths caused by electric blanket are rarely reported. In this paper, we report 2 cases of fatal heat stroke caused by overheating from electric blankets in winter. One was a 41-year-old man who was found unresponsive in bed on an electric blanket. His wife shared the same bed with him and was found unconscious. The wife's axillary temperature was 40 degrees C (104 degrees C) when she was admitted to the hospital. She fully recovered after medical treatment. The husband was pronounced dead at scene, with rectal temperature at 41.2 degrees C (106.2 degrees C). The other was a 13-year-old girl who was found dead in bed on an electric blanket, with rectal temperature at 41 degrees C (105.8 degrees F). The literature is reviewed, and the pertinent findings, including scene investigations, postmortem examination, the risk and mechanism of fatal heat stroke caused by using electric blanket, are discussed.

Causes of hospitalization of pilgrims during the Hajj period of the Islamic year 1423 (2003)

BACKGROUNDApproximately 2 to 3 million pilgrims perform Hajj every year. Planning for health care requires knowledge of the pattern of diseases, complications, and outcome of pilgrims who require hospitalization during the Hajj period.METHODSIn a cross-sectional study we compiled data on all patients admitted to 1487 beds in four hospitals in Mena (793 beds) and three hospitals in Arafat (694 beds) from the seventh to the thirteenth day of the Hajj season of the Islamic year 1423, corresponding to 8 to 14 February 2003.RESULTSOf 808 patients hospitalized, most (79%) were older than 40 years. There was no sex preponderance. A total of 575 (71.2%) patients were admitted to medical wards, 105 (13.0%) to surgical wards, and 76 (9.4%) to intensive care units. Most patients (84.8%) had one acute medical problem. Pneumonia (19.7%), ischemic heart disease (12.3%), and trauma (9.4%) were the most common admitting diagnoses. More than one third (39%) had co-morbid conditions. A total of 644 (79.7%) patients were discharged from the hospital in stable condition to continue therapy in their residential camps, 140 (17.3%) were transferred to other hospitals in Makkah for specialized services or further care, 19 (2.3%) were discharged against medical advice, and 5 (0.7%) patients died.CONCLUSIONThis study provided information on the most common causes of hospitalization, pattern of diseases, and required medical services for pilgrims in Hajj. It is hoped that this data will be of help to health sector planners and officials to provide optimal and cost-effective health care services to pilgrims in Hajj.

Three cases of severe occupational heat stroke

我中心诊断了3例在高温、高湿环境下,因无防护措施而引起职业性重症中暑的病例,现报道如下. 例1 患者男,34岁,某装饰公司喷漆工,工作环境较差,车间为简易工棚,仅有顶部玻璃瓦覆盖,在2002年至2005年监测该公司车间空气中苯、甲苯、二甲苯浓度均符合 (GBZ 2-2002)规定的短时间接触容许浓度。

Two cases of severe heat stroke that have different prognosis and different complication

Two cases of severe heat stroke that have different prognosis and different complication

Youth Football: Heat Stress and Injury Risk

Michael F. Bergeron, Ph.D., FACSM (Co-Chair)Douglas B. McKeag, M.D., FACSM (Co-Chair)Douglas J. Casa, Ph.D., ATC, FACSMPriscilla M. Clarkson, Ph.D., FACSMRandall W. Dick, FACSME. Randy Eichner, M.D., FACSMCraig A. Horswill, Ph.D., FACSMAnthony C. Luke, M.D., MPHFrederick Mueller, Ph.D., FACSMThayne A. Munce, Ph.D.William O. Roberts, M.D., FACSMThomas W. Rowland, M.D., FACSM

A case of heat stroke in a lioness (Panthera leo)

INTRODUCTION Heat stroke is a condition caused by high environmental temperature and humidity. Presence of thick hair coat, feathers, lack of sweat glands and lack of drinking water may predispose animals and birds to heat stroke. Incidence of heat stroke in captive and free living animals and birds were reported earlier by various authors (Mehrotra, 2002; Rathore & Khera, 1981; Upadhye & Dhoot, 2002; Arora, 1996 and Khan, 1987).

Elevated serum beta- d-glucan level and depressed neutrophil phagocytosis in a heatstroke patient

Endotoxemia has been reported as a mechanism for the fatal sequela after heatstroke. Subsequent disseminated fungal infection in a heatstroke patient has been also described. Beta- d-glucan, a constituent of the fungal cell wall, is an early diagnostic measure for fungal infection. In a heatstroke case, we examined for the first time levels of serum beta- d-glucan and endotoxin. A 34-year-old man with a body temperature of 43.5 °C was admitted in a state of shock. Prior to the development of disseminated intravascular coagulopathy (DIC), a remarkable elevation of serum beta- d-glucan level to 116 pg/mL (normal level < 6.0 pg/mL) was revealed on the first day of admission. However, serum endotoxin was not detected when using a method that excluded beta- d-glucan contamination from endotoxin measurement (normal level < 1.0 pg/mL). This change of beta- d-glucan level was accompanied by a depressed neutrophil function, especially in phagocytosis of 34% (normal range 70–90%) but not in bacterocidal function (81% versus a normal range of 70–100%). After intensive care including continuous hemodiafiltration, the patient regained consciousness but remained ataxic due to cerebellar infarction, which might have resulted from DIC, and subsequent bilateral fungal oculitis were revealed 45 days after admission. This case report demonstrates the elevation of serum beta- d-glucan but normal endotoxin levels after heatstroke, which may prompt further study to re-examine the serum levels of endotoxin in such catastrophic insults.

Impacto de la ola de calor de 2003 en el Hospital de Riveira (A Coruña)

Last summer 2003 took place an atmospheric situation considered as a heat wave. Importance of environmental factors in chronic diseases is well known, but few works analyse those of heat excess as we do in this paper. We studied the effects of high temperatures on admission and mortality in Riveira, A Coruña, Spain, during the period from July 15th to August 15th 2003. Mean maximum temperature in this period was 26.1 degrees C. One hundred and thirty seven patients were admitted, age ranges between 16 and 93 years old. Sixteen died. Fifty four admissions (38.7%) were identified as related with heat wave and of those patients, 8 died. No heat stroke cases were identified. Main risk factors in our heat related admitted population, were previous lung disease and overweight. Heat related pathology is difficult to evaluate although it is quite important. It seems to be necessary to take measures in order to identify population at risk and reduce the effects related to this environmental factor since high risk patients are quite common in our daily practice.

A Case of Severe Heat Stroke With Abnormal Cardiac Findings

We document serial changes in the electrocardiogram (ECG) and myocardial markers in a case of severe heat stroke treated with cooling procedures. A 23-year-old comatose male with heat stroke was presented in the emergency room. The condition of the patient was complicated by hepatic failure, rhabdomyolysis, acute renal failure, and cardiac abnormalities. ECG revealed diffuse ST-T elevation; serum levels of myocardial markers were remarkably high and diffuse hypokinesis was observed on the echocardiogram. Cooling procedures, including applying cold vapor to the patient's skin, a gastric lavage with cold water, and an intravenous cold fluid infusion were not successful. Since multiple organ damage (heart, liver, central nervous system, and kidney) was evident, we utilized continuous hemodialysis and hemofiltration, using cold dialysate for efficient cooling. The patient recovered from the multiple organ damage and was removed from the intensive care unit 14 days after the onset. The cardiac abnormalities had normalized within several days without any damage to the myocardium. Q waves were not detected in any lead in the ECG. When interpreting ST-T elevation in the ECG of a heat stroke patient, caution should be used so as to not misdiagnose it as an acute myocardial infarction.

Case report: severe heat stroke with multiple organ dysfunction – a novel intravascular treatment approach

IntroductionWe report the case of a patient who developed a severe post-exertional heat stroke with consecutive multiple organ dysfunction resistant to conventional antipyretic treatment, necessitating the use of a novel endovascular device to combat hyperthermia and maintain normothermia.MethodsA 38-year-old male suffering from severe heat stroke with predominant signs and symptoms of encephalopathy requiring acute admission to an intensive care unit, was admitted to a ten-bed neurological intensive care unit of a tertiary care hospital. The patient developed consecutive multiple organ dysfunction with rhabdomyolysis, and hepatic and respiratory failure. Temperature elevation was resistant to conventional treatment measures. Aggressive intensive care treatment included forced diuresis and endovascular cooling to combat hyperthermia and maintain normothermia.ResultsAnalyses of serum revealed elevation of proinflammatory cytokines (TNF alpha, IL-6), cytokines (IL-2R), anti-inflammatory cytokines (IL-4) and chemokines (IL-8) as well as signs of rhabdomyolysis and hepatic failure. Aggressive intensive care treatment as forced diuresis and endovascular cooling (CoolGard® and CoolLine®) to combat hyperthermia and maintain normothermia were used successfully to treat this severe heat stroke.ConclusionIn this case of severe heat stroke, presenting with multiple organ dysfunction and elevation of cytokines and chemokines, which was resistant to conventional cooling therapies, endovascular cooling may have contributed significantly to the reduction of body temperature and, possibly, avoided a fatal result.

Trends In Injury From Hot Weather Exposure In Us Army Soldiers

2112 Hot weather related injury (HWRI) tragically still takes the lives of Army soldiers and is a persistent cause of morbidity, lost duty time, and decreased effectiveness in military operations and training. Previous research demonstrates that soldiers who are overweight, not physically fit, and/or unacclimatizated to hot weather are at greater risk. Despite these well-characterized risk factors however, identification of high at risk U.S. military subpopulations and characterization of HWRI hospitalization trends are still needed. PURPOSE: Our objective was to identify high-risk subgroups while documenting Army HWRI hospitalization trends between 1980 and 2002. Methods: Data were obtained from the U.S. Army Research Institute of Environmental Medicine's (USARIEM) Total Army Injury and Health Outcomes Database (TAIHOD). Hospitalizations with the following ICD-9-CM diagnosis codes were liberally included: 992.0–992.9 (heat cramps, heat exertion, heat stroke, heat syncope, and other unspeci. ed), 276.0 (hyperosmolality), 276.1 (hypoosmolality), 994.4 (exhaustion due to exposure), and 994.5 (exhaustion due to excessive exertion). We also used STANAG injury cause codes 800–809 (Excessive heat or insulation). Gender, age, race/ethnicity, type and cause of injury, home of record, rank, and years of military service were important covariates. Results: Between 1980 and 2002, 5146 soldiers were hospitalized for HWRI (12 deaths). Women in general were hospitalized 25% more frequently than men, while Caucasians were hospitalized more frequently than their Hispanic and African American counterparts. Soldiers under the age of 25, and in particular those under the age of 20, had the highest hospitalizations rate. Activity codes cause indicate that 84% of HWRI hospitalizations occurred on-duty during organized training. The HWRI hospitalization rate, after peaking at 52.2/100,000 in 1991, had decreased gradually to 24.2/100,000 by 2002. Conversely, more serious heat stroke cases gradually increased from 5.4/100,000 in 1991 to 10.1/100,000 in 2002. Conclusions: Most of the HWRI reported in this study occurred while on duty; the data demonstrate a clear need for primary prevention and control measures. Reduction of HWRI may be achieved by targeting specific subpopulations (e.g., initial entry training, women in general). Further investigation is immediately needed to examine the apparent increase in heatstroke cases.

Heat Stroke in Schizophrenia During Clozapine Treatment: Rapid Recognition and Management

A case of heatstroke is reported in a 32-year-old man diagnosed with schizophrenia and on clozapine monotherapy. The importance of the need to avoid misdiagnosing heat stroke as neuroleptic malignant syndrome is reviewed.

Demographic, pathologic, and toxicological profiles of 127 decedents testing positive for ephedrine alkaloids

The relative toxicity of ephedra-containing dietary supplements is disputed. In order to ascertain the magnitude of the problem, we reviewed all autopsies in our Medical Examiner’s jurisdiction, from 1994 to 2001, where ephedrine or any its isomers (E+) were detected. Toxicology testing results were tabulated and anatomic findings in E+ cases were compared to those in a control group of drug-free trauma victims. Of 127 E+ cases identified, 33 were due to trauma. Decedents were mostly male (80.3%) and mostly Caucasian (59%). Blood ephedrine concentrations were <0.49mg/l in 50% of the cases, range 0.07–11.73mg/l in trauma victims, and 0.02–12.35mg/l in non-trauma cases. Norephedrine (NE) was present in the blood of 22.8% (mean of 1.81mg/l, S.D.=3.14mg/l) and in the urine of 36.2% (mean of 15.6mg/l, S.D.=21.50mg/l). Pseudoephedrine (PE) was present in the blood of 6.3% (8/127). More than 88% (113/127) of the decedents also tested positive for other drugs, the most common being cocaine (or its metabolites) and morphine. The most frequent pathologic diagnoses were hepatic steatosis (27/127) and nephrosclerosis (22/127). Left ventricular hypertrophy was common, and coronary artery disease (CAD) detected in nearly one third of the cases. The most common findings in E+ deaths are those generally associated with chronic stimulant abuse, and abuse of other drugs was common in those with CAD. There were no cases of heat stroke or rhabdomyolysis. In most cases, norephedrine was not detected, suggesting it plays no role in ephedrine toxicity.

FOOTBALL UNIFORMS AND UNCOMPENSABLE HEAT STRESS, EXPRESSED AS WET BULB GLOBE TEMPERATURE

Heat stroke cases during pre-season football practice are an annual rite of summer in the United States. Previous work (Kulka, T. J., and W.L Kenney. Heat Balance Limits in Football Uniforms. Phys. Sportsmed. 30:29–39, 2002) examined esophageal temperature during treadmill walking in an environmental chamber at 35% of VO2 max. Subjects wore a full football uniform or a full football uniform with shorts instead of padded pants. Results were expressed as a series of dry bulb temperatures (T) and associated relative humidities (RH) at which the exercising subjects could no longer maintain thermal balance. Translation of these limiting conditions into Wet Bulb Globe Temperature (WBGT) could help to standardize environmental guidelines for football. PURPOSE To express these uncompensable environmental conditions as WBGT. METHODS The exercise study graphs were digitally sampled to provide data points. Each uncompensable pair of T and RH was used to calculate an equivalent wet bulb temperature (WB). A general relationship between black globe temperature (GT) and T was calculated using summertime data from a grassy field and from a grandstand. 7266 pairs of GT and T were utilized, with the relationship between GT and T being GT = 0.9411T+23.665 (r = 0.69, mean error = 0 ± 6.7°F). [In °C, GT = 0.9411T + 12.1]. A GT was then calculated for each exercise study T, and each set of WB, GT and T values was used to calculate a WBGT for each data point using the formula WBGT = 0.7WB+0.2GT+0.1T. RESULTS WBGT limits for uncompensable heat stress were as follows: Full uniform 76.5 to 83.1°F (24.7–28.4°C); partial uniform 82.4–85.2°F (28–29.6°C); T-shirt and shorts 88.8–91.5°F (31.6–33.1°C). (These values are stated as ranges due to interactions between T and RH.) CONCLUSION These findings suggest that exercise in a football uniform can lead to uncompensable heat stress in conditions commonly found in late summer in the US. Use of a WBGT monitoring instrument could provide a convenient method for adjusting football workout protocol in light of practice field environmental conditions.

Heat-related illness in children

Summer heat is responsible for a significant number of illnesses and emergency department visits. Although more common in elderly patients, infants, children, and adolescents are also vulnerable. Those involved in the care of pediatric patients need to be aware of the differences in physiology and behavior, as well as predisposing factors that put children at risk. Heat illness constitutes a spectrum of maladies, ranging from the very mild and irritating prickly heat, to severe and potentially life-threatening cases of heatstroke. Milder forms of heat illness respond to removal from the hot environment, rest, and hydration. Heat exhaustion and heatstroke must be recognized early, and rapid cooling and fluid resuscitation must be initiated promptly. Many cases of heat illness can be prevented by paying careful attention to the type of clothing worn, gradual acclimatization to hot and humid conditions, limiting exposure during the hottest part of the day, and drinking fluids both before and during outdoor play or exercise.

CLASSIC HEAT STROKE IN A CASE OF SIMPLE HYPOHYDROSIS WITH “BAD PROGNOSTIC INDICATORS” BUT A REMARKABLE RECOVERY

Heat stroke occurs in the desert area of Saudi Arabia quite frequently and manifest in different patterns including coagulopathy . Frequently encountered complications include renal or hepatic failure, rhabdomyolysis, acute respiratory distress syndrome (ARDS), disseminated intravascular coagulation (DIC), and seizure . Not all of these complications usually occur in the same patient, in case it occurs the mortality reported is significantly high. We describe a case of heat stroke that had nearly all the known complications of heat stroke but recovered from all, except minor neurological deficit in the form of dysarthria and exaggerated deep reflexes.

Temperature and Air Pollution as Risk Factors for Heat Stroke in Tokyo, July and August 1980-1995

Heat stroke is associated with prolonged exposures to high air temperatures that usually occur in the summer months of July and August in Tokyo, Japan. Also during July and August, residents of Tokyo are often exposed simultaneously to high concentrations of air pollutants. To assess the impacts of these combined exposures, daily numbers of heat stroke emergency transport cases/million residents for Tokyo were stratified by gender and three groups: 0-14, 15-64; and &gt; 65 years of age, for the months of July and August in 1980-1995. A regression model was constructed using daily maximum temperature (Tmax) and daily average concentrations of NO2 and O3 as model covariates. Classification indices were added to make it possible to compare the expected number of heat stroke cases by age and gender. Lag times of 1-4 days in Tmax and air quality covariates and terms to account for interactions between pairs of model covariates were also included as additional risk factors. Generalized linear models (GLMs), assuming a Poisson error structure for heat stroke emergency transport cases, were used to determine which covariates were significant risk factors for heat stroke for the three age groups of males and females. Same-day Tmax and concentrations of NO2 were the most significant risk factors for heat stroke in all age groups of males and females. The number of heat stroke emergency transport cases/million residents was greater in males than in females in the same age groups. The smallest number of heat stroke emergency transport cases/million residents occurred for females 0-14 years of age and the greatest number of heat stroke emergency transport cases/million residents occurred for males &gt; 65 years of age.

Temperature and air pollution as risk factors for heat stroke in Tokyo, July and August 1980-1995.

Heat stroke is associated with prolonged exposures to high air temperatures that usually occur in the summer months of July and August in Tokyo, Japan. Also during July and August, residents of Tokyo are often exposed simultaneously to high concentrations of air pollutants. To assess the impacts of these combined exposures, daily numbers of heat stroke emergency transport cases/million residents for Tokyo were stratified by gender and three groups: 0-14, 15-64; and > 65 years of age, for the months of July and August in 1980-1995. A regression model was constructed using daily maximum temperature (Tmax) and daily average concentrations of NO2 and O3 as model covariates. Classification indices were added to make it possible to compare the expected number of heat stroke cases by age and gender. Lag times of 1-4 days in Tmax and air quality covariates and terms to account for interactions between pairs of model covariates were also included as additional risk factors. Generalized linear models (GLMs), assuming a Poisson error structure for heat stroke emergency transport cases, were used to determine which covariates were significant risk factors for heat stroke for the three age groups of males and females. Same-day Tmax and concentrations of NO2 were the most significant risk factors for heat stroke in all age groups of males and females. The number of heat stroke emergency transport cases/million residents was greater in males than in females in the same age groups. The smallest number of heat stroke emergency transport cases/million residents occurred for females 0-14 years of age and the greatest number of heat stroke emergency transport cases/million residents occurred for males > 65 years of age.

A Case of Heat Stroke in an Aluminium Utensil Plant

A Case of Heat Stroke in an Aluminium Utensil Plant

Fatal Heatstroke in a Young Woman with Previously Undiagnosed Hashimoto's Thyroiditis

Heatstroke represents the most severe form of the heat-related illnesses. Potentially fatal, heatstroke most often affects the elderly, obese, or chronically ill. Thyroid disease, which may interfere with the normal regulation of body temperature, has not previously been reported in cases of heatstroke. A fatal case is reported in a young woman discovered unconscious in a sauna who was found to have preexisting Hashimoto's thyroiditis on subsequent autopsy. The diagnosis of hypothyroidism in heatstroke rests on clinical information and morphologic observations. This case underscores the importance of evaluating the thyroid in unusual cases of heatstroke.