Management Of Heat Stroke Research Articles

High-volume plasma exchange in a patient with acute liver failure due to non-exertional heat stroke in a sauna

Heat stroke is a life-threatening condition characterized by an increased core body temperature (over 40°C) and a systemic inflammatory response, which may lead to a syndrome of multiple organ dysfunction. Heat stroke may be due to either strenuous exercise or non-exercise-induced exposure to a high environmental temperature. Current management of heat stroke is mostly supportive, with an emphasis on cooling the core body temperature and preventing the development of multiple organ dysfunction. Prognosis of heat stroke depends on the severity of organ involvement. Here, we report a rare case of non-exercise-induced heat stroke in a 73-year-old male patient who was suffering from acute liver failure after prolonged exposure in a hot sauna room. We successfully managed this patient by administering high-volume plasma exchange, and the patient recovered completely after treatment.

Exertional Heat Stroke Management Strategies in United States High School Football

Background: The 5-year period of 2005-2009 saw more exertional heat stroke–related deaths in organized sports than any other 5-year period in the past 35 years. The risk of exertional heat stroke appears highest in football, particularly during the preseason. Purpose: To estimate the incidence of exertional heat stroke events and assess the utilization of exertional heat stroke management strategies during the 2011 preseason in United States high school football programs. Study Design: Cross-sectional study; Level of evidence, 3. Methods: A self-administered online questionnaire addressing the incidence of exertional heat stroke events and utilization of exertional heat stroke management strategies (eg, removing athlete’s football equipment, calling Emergency Medical Services [EMS]) was completed in May to June 2012 by 1142 (18.0%) athletic trainers providing care to high school football athletes during the 2011 preseason. Results: Among all respondents, 20.3% reported treating at least 1 exertional heat stroke event. An average of 0.50 ± 1.37 preseason exertional heat stroke events were treated per program. Athletic trainers responding to exertional heat stroke reported using an average of 6.6 ± 1.8 management strategies. The most common management strategies were low-level therapeutic interventions such as removing the athlete’s football equipment (98.2%) and clothing (77.8%) and moving the athlete to a shaded area (91.6%). Few athletic trainers reported active management strategies such as calling EMS (29.3%) or using a rectal thermometer to check core body temperature (0.9%). Athletic trainers in states with mandated preseason heat acclimatization guidelines reported a higher utilization of management strategies such as cooling the athlete through air conditioning (90.1% vs 65.0%, respectively; P < .001), immersion in ice water (63.0% vs 45.4%, respectively; P = .01), or fans (54.3% vs 42.0%, respectively; P = .06) and monitoring the athlete’s temperature (60.5% vs 46.2%, respectively; P = .04). Conclusion: Preseason exertional heat stroke events, which are likely to be fatal if untreated, were reported by one fifth of all athletic trainers in high school football programs. The standard of care is (and should be) to treat proactively; therefore, treatment is not a perfect proxy for incidence. Nevertheless, there is an urgent need for improved education and awareness of exertional heat stroke in high school football. Areas of improvement include the greatly increased use of rectal thermometers and immersion in ice water.

The recurring epidemic of heat stroke in children in Muzaffarpur, Bihar, India

Context: Characterization of heat stroke cases on arrival to hospital may lead to early recognition and improved management. Delay in treatment leading to high rate of mortality and poor outcomes so a high index of clinical suspicion in appropriate setting is warranted. Aims: Recurring seasonal(summer) outbreak of heat stroke among children from Muzaffarpur district, Bihar was investigated to describe clinico-epidemiological features. Materials and Methods: A retrospective study involving 50 patients of classic heat stroke admitted to Sri Krishna Medical College and Hospital (SKMCH) Muzaffarpur in June 2005 and June 2011 were carried out. These patients had presented with a rectal temperature of more than 40°C and central nervous system disturbance. The patients were treated with standard regimen of management of heat stroke and sponging in ICU after emergency resuscitation. Results: A total of 50 case records were studied of children below12 years of age. Case fatality ratio was 60% .The disease had peak incidence in June. Previously healthy, rural children (mean age-3.78 yr) of very low socio-economic background were found most vulnerable. The main presenting feature ware high fever (100%), convulsion (100%), unconsciousness (100%), decebrate rigidity (50%), tachycardia (80%), and tachypnea (80%). No one had splenomegaly. Cerebrospinal fluid (CSF) was under high pressure but normal otherwise in all cases. Biochemical investigation reveled hyponatremia (50%), hypokalemia (5%), mild raised SGPT (30%), blood urea (40-50mg/dl) (40%) with normal creatinine. Smear for malarial parasites were negative. CT scan of head done in 20 cases; 10- showed feature of generalized cerebral edema while rest was normal. ECG showed non-specific ST-T changes and tachyarrhythmia. Moderate to severe residual neurologic deficit was observed in 20% of survivors. Male to female ratio was 1.5:1.No infective organism or its antigen or antibody was found in the any of the samples tested locally or at various apex virological centers of India. Conclusions: Heat stroke is a medical emergency with serious complication and requires prompt treatment. It is associated with multi-organ dysfunction with high mortality and substantial neurological squeals.

Growing concern about heatstroke this summer in Japan after Fukushima nuclear disaster

Heat stroke management will be a major challenge following the Fukushima nuclear plant accident that occurred due to the Great East Japan Earthquake. In this article, a number of actions to meet this challenge are proposed.

External Cooling Methods for Treatment of Fever in Adults: a Systematic Review

External Cooling Methods for Treatment of Fever in Adults: a Systematic Review

Hypothermic retrograde jugular vein flush in heatstroke rats provides brain protection by maintaining cerebral blood flow but not by hemodilution.

To determine the fundamental mechanism of brain protection by hypothermic retrograde jugular vein flush (HRJVF) in heatstroke rats. Randomized, controlled, and prospective study. University physiology research laboratory. Sprague-Dawley rats (270-320 g, males). Rats were randomized into four groups as follows: a) normothermic control (NC, n = 8); b) heatstroke rats without cold saline delivery (HS, n = 8); c) heatstroke rats treated with cold saline via femoral vein (HS+F, n = 8); and d) heatstroke rats treated with HRJVF (HS+J, n = 8). Right external jugular vein and right femoral vein were cannulated in each rat. The cannulation in the jugular vein was with cranial direction. To produce heatstroke, rats were placed in a chamber with an ambient temperature of 43 degrees C. The cold saline (4 degrees C, 1.7 mL/100 g) was delivered via the cannula in either the femoral vein or jugular vein immediately after the onset of heatstroke. Glutamate release in the brain, cerebral blood flow (CBF), and hematocrit of arterial blood were determined. After onset of heatstroke, HRJVF significantly decreased the glutamate release. In contrast, cold saline delivery via femoral vein could only delay the elevation of glutamate release in the brain. The CBF of HS and HS+F rats decreased rapidly after the onset of heatstroke, but the CBF of HS+J rats was initially elevated by HRJVF and was maintained at baseline 30 mins after onset of heatstroke. Hematocrit in all the rats did not change after testing. HRJVF protects the brain by maintaining cerebral blood flow in rats after heatstroke. To preserve brain function and prolong survival after severe heatstroke, maintenance of cerebral blood flow is important in the management of heatstroke.

Heat Illness

Heatstroke is a true sports emergency. By recognizing the key signs and symptoms—a core body temperature above 40.5°C and mental status changes—on-site physicians can begin urgent management of heatstroke. Cooling must begin immediately; ice water immersion is best if practical, but other measures can be effective. Other conditions common in the heat, like ‘heat cramps,’ ‘heat exhaustion,’ and ‘heat syncope,’ are less serious and generally require less drastic measures. Cramps typically respond to sodium replacement, and heat exhaustion and syncope require rest and possibly cooling and rehydration.

Direct activation of platelets by heat is the possible trigger of the coagulopathy of heat stroke

SummaryThe trigger of the coagulopathy that complicates heat stroke is obscure, but direct platelet activation by heat is a possibility we set out to study. Platelet rich plasma (PRP), prepared from blood donors, was incubated at increasing temperatures (38–45°C) and then platelet aggregation was undertaken in response to decreasing low doses of ADP (&lt;2.0 μmol/l). Hyperaggregability was manifested when the incubation temperature reached 43°C and was maximum at 44°C before complete inhibition of responses at 45°C.The platelet hyperactivity induced by heating at 44°C persisted after reincubating PRP samples at 37°C. These platelet responses could not be triggered in PRP samples prepared from subjects after the overnight ingestion of aspirin or after the addition of aspirin to PRP before starting the heating procedure. However, aspirin was less effective when added to PRP after the appearance of the heat‐induced hyperaggregability.In conclusion, these results indicate that platelets can be activated directly by heat. This mechanism which may be operational in heat stroke, is unaffected by cooling (body cooling being basic in the management of heat stroke) but can be prevented by the early administration of aspirin.

Direct activation of platelets by heat is the possible trigger of the coagulopathy of heat stroke

The trigger of the coagulopathy that complicates heat stroke is obscure, but direct platelet activation by heat is a possibility we set out to study. Platelet rich plasma (PRP), prepared from blood donors, was incubated at increasing temperatures (38-45 degrees C) and then platelet aggregation was undertaken in response to decreasing low doses of ADP (less than 2.0 mumol/l). Hyperaggregability was manifested when the incubation temperature reached 43 degrees C and was maximum at 44 degrees C before complete inhibition of responses at 45 degrees C. The platelet hyperactivity induced by heating at 44 degrees C persisted after reincubating PRP samples at 37 degrees C. These platelet responses could not be triggered in PRP samples prepared from subjects after the overnight ingestion of aspirin or after the addition of aspirin to PRP before starting the heating procedure. However, aspirin was less effective when added to PRP after the appearance of the heat-induced hyperaggregability. In conclusion, these results indicate that platelets can be activated directly by heat. This mechanism which may be operational in heat stroke, is unaffected by cooling (body cooling being basic in the management of heat stroke) but can be prevented by the early administration of aspirin.

Management of Heat Stroke

Management of Heat Stroke

Morning Report at Charity Hospital: Heat Stroke New Orleans Style

An in-depth discussion of Classic Heat Stroke (CHS) and Exertional Heat Stroke (EHS) Syndromes occurred during morning report at a large metropolitan teaching institution during a New Orleans heat wave. The opportunity arose to compare the syndromes via case reports of two patients admitted the same day to the same housestaff teams. The physiology of the hyperthermic state, maladaptions predisposing the hyperthermic syndrome and current heat stroke management updates are reviewed in detail. This report should compel the reader to remain attentive to the subtleties and differences presented in life-threatening high-heat and humidity-related illnesses and how to act rapidly and prudently in management of the illnesses.

Rapid Cooling in Management of Heat Stroke: Clinical Methods and Practical Implications

ABSTRACT Evaporative rapid cooling by a body cooling unit (BCU) has proved successful in management of heat stroke victims at the Mecca pilgrimage, or Haj, since 1979. A conventional method (CM) of...

Management of Heatstroke

To the Editor.— The development of new treatment for pilgrims to Mecca who experience heatstroke and related articles inThe Journal(1982; 247:3332) prompted me to relate a treatment often used in tropical areas. Applicable anywhere, particularly for a febrile child whose hot, dry skin recoils from the usual frightening and chilling regimen of ice and/or alcohol sponging (which increases the physiological thermal blanket with thickened gooseflesh as the shivering muscles respond to raise the temperature), this effective and comforting treatment is by the application of large, warm, sopping-wet towels up to the chin of the stripped body lying on a plastic sheet or old blankets; the wet warmth provides relaxation to the vasoconstricted skin; when the wet towels are removed after a few seconds, the pseudosweat, in a normal evaporative fashion, cools pleasantly; as drying or recurring goosebumps are noted, the warm, wet application is repeated as long as

Management of heatstroke

Management of heatstroke

Management of Heatstroke

Management of Heatstroke