11/57. 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. ( info) |
12/57. Exertional heat stroke in a young woman: gender differences in response to thermal stress. Exertional heat stroke (EHS) is an acute life-threatening emergency that necessitates the immediate institution of cooling measures. Reported here is a case of EHS in a nonacclimatized young woman who was undergoing strenuous exercise. The patient developed many of the characteristic features of EHS, including central nervous system disturbances, lactic acidosis, rhabdomyolysis, coagulopathy, and abnormal myocardial conduction. While EHS is relatively common in young men, the condition is rare in women. This case presentation addresses gender differences in the response to the thermal stress of intense physical activity. ( info) |
| The diagnosis of heat stroke is difficult to establish in forensic medicine due to the absence of observations made on the victims whilst alive. A recent case, concerning the death of two children in a vehicle, was restudied by taking into account calculations of thermophysiology. The results obtained allowed some assumptions of the investigation to be checked, and adds to the data provided previously in literature on the subject. ( info) |
14/57. Antithrombin and near-fatal exertional heat stroke. Heat waves result in excess deaths, excess emergency department visits, and intensive care unit admissions for heat stroke. We describe the clinical features and 3-month outcome of a patient with near-fatal heat stroke, admitted to our intensive care unit in July, 2001. After heavily working for hours at a construction site during a heat wave, the 28-year-old male presented with 41.4 degrees C body temperature and multiorgan failure, consisting of neurological impairment, rhabdomyolysis, acute renal failure, disseminated intravascular coagulation, and acute respiratory distress syndrome (ARDS). In the first week there was no evidence of infection. Treatment included cooling, aggressive volume resuscitation, administration of antithrombin-III concentrates and steroids. The patient survived and recovered normal neurological, renal, respiratory and haematological function, and no disability persisted. This case illustrates survival and complete recovery after multiorgan failure in heat stroke with vigorous intensive care. Treatment with antithrombin and steroids and may well have contributed to the favourable outcome. Correction of reduced antithrombin iii levels to supranormal by therapeutic administration of antithrombin iii concentrate in disseminated intravascular coagulation of heat stroke was not associated with any bleeding complications. ( info) |
| The recent death of a famous football player raised public awareness of the fatal nature of heat stroke, which is actually the third leading cause of death among American athletes. We present a typical case of heat stroke to illustrate its clinical manifestation and recovery process; risk factors, treatment options, and the importance of prevention are also discussed. Although heat stroke is not a common admission diagnosis for inpatient rehabilitation, physiatrists need to be aware of its pathophysiology, rehabilitation management, and prevention. ( info) |
16/57. Exertional heatstroke in an infantry soldier taking ephedra-containing dietary supplements. This is a case report of a highly trained, heat-acclimatized infantry soldier who suffered from exertional heatstroke during a 12-mile road march shortly after taking an ephedra-based supplement. Heatstroke is associated with systemic complications and a high mortality rate if not recognized early. Control of risk factors is key to the prevention of heatstroke. Since there are no clear ergogenic benefits in using ephedra alone, clinicians and military commanders should strongly discourage the use of ephedra-containing substances in active duty soldiers undergoing strenuous exercise. ( info) |
17/57. Heat-related deaths--chicago, illinois, 1996-2001, and united states, 1979-1999. Heat waves (i.e., >/=3 consecutive days of air temperatures >/=90 degrees F [>/=32.2 degrees C]) are meteorologic events that contribute significantly to heat-related deaths. Exposure to excessive heat can cause illness, injury, and death. This report describes four cases of heat-related deaths, as reported by the Office of the Medical Examiner, Cook County, chicago, that occurred during 1996-2001; summarizes total heat-related deaths in chicago during 1996-2001; and compares the number of heat-related deaths during the 1995 and 1999 chicago heat waves. This report also summarizes trends in the united states during 1979-1999, describes risk factors associated with heat-related deaths and symptoms, and outlines preventive measures for heat-related illness, injury, and death. persons at risk for heat-related death should reduce strenuous outdoor activities, drink water or nonalcoholic beverages frequently, and seek air conditioning. ( info) |
18/57. Hot on the inside. When a disease process becomes life-threatening, it is termed to be malignant. Hyperthermia is a heat illness that arises from one of two basic causes: 1) the body's normal thermoregulatory mechanisms are overwhelmed by the environment (an exogenous heat load) or, more commonly, by excessive exercise in a moderate-to-extreme environment (an endogenous heat load); or 2) failure of the thermoregulatory mechanisms, such as those encountered in the elderly or debilitated patient. Either cause can lead to heat illnesses such as heat cramps, heat exhaustion or heatstroke. Heat cramps are brief, intermittent and often severe muscular cramps that frequently occur in muscles fatigued by heavy work or exercise. They are believed to be caused by a rapid change in the extracellular fluid osmolarity resulting from sodium and water loss. heat exhaustion is a more severe form of heat illness characterized by minor changes in mental status (poor judgment, irritability), dizziness, nausea and headache. In severe cases, the patient may have an altered LOC. Just as with heat cramps, profuse sweating is present. Removing the patient from the hot environment and administering fluids will usually result in a rapid recovery. [table: see text] Left untreated, heat exhaustion may progress to heatstroke. Heatstroke results when there is a complete collapse of thermoregulatory mechanisms. This will lead to a rise in body core temperature in excess of 105.8 degrees F (41 degrees C), which will produce multisystem tissue damage and physiological collapse. Severe cases can cause death. The patient in this case had an axillary temperature taken and recorded at 101.4 degrees F. Typically, axillary temperatures are one degree cooler than oral temperatures, which are one degree cooler than core temperatures. This patient, then, had a core temperature of 103 degrees F or higher. There are two types of heatstroke: classic and exertional. Classic heatstroke occurs during periods of sustained high ambient temperatures and humidity. Exertional heatstroke more often occurs in athletes, military personnel and people who work strenuosly in the environment. In these situations, endogenous heat accumulates more rapidly than the body can dissipate it in the environment. Although sweating is usually absent in the classic form of heatstroke, 50% of exertional heatstroke cases have persistent sweating as a result of catecholamine release. The presence of sweating does not preclude the diagnosis of heatstroke, and cessation of sweating is not the cause of it. As the illness progresses, peripheral vasodilation occurs, resulting in hypotension and shunting. As internal temperatures rise, myocardial contractility begins to decrease, manifested by bradycardia and irritability of the myocardium. No matter the age group, the presence of hypotension and decreased cardiac output indicates a poor prognosis for the patient. ( info) |
19/57. MR imaging of heat stroke: external capsule and thalamic T1 shortening and cerebellar injury. We present a case of increased signal intensity of the cerebrum (symmetric involvement of the paraventricular thalamus and external capsule) and cerebellum on both T1- and T2-weighted images in a patient with documented heat stroke. An ischemic and hemorrhagic mechanism is proposed, and the contributions of the direct effects of hyperthermia are discussed. ( info) |
20/57. Transient cardiac dysfunction and pulmonary edema in exertional heat stroke. Exertional heat stroke is a medical emergency that uncommonly results in severe cardiac dysfunction. The military physician diagnosed a 19-year-old military recruit from an elite unit to have exertional heat stroke. Immediate treatment in the field with rapid ice water cooling and vigorous fluid administration resulted in pulmonary edema. Transthoracic echocardiography on admission to the emergency department revealed moderate reduction in left and right ventricular function. After treatment, within a few days, rapid myocardial recovery was noted and persisted after 6 months of follow-up. Possible mechanisms of cardiac dysfunction in exertional heat stroke and treatment strategies are discussed. It is suggested that intravenous fluid administration to patients with suspected exertional heat stroke should preferably be done with appropriate hemodynamic monitoring and after cardiac dysfunction has been ruled out. ( info) |