1/9. Sudden death during jungle trekking: a case of heat stroke.heat stroke, which is also known as "sun stroke," is a medical emergency, and fatalities can occur unless it is diagnosed early and treated efficiently. heat stroke may manifest quite suddenly, giving little time to differentiate it from extreme physical exhaustion in collapsed subjects. It is also known to lead to serious disseminated intravascular coagulation. Sudden death in a young female is presented who collapsed after trekking in a hilly, jungle area in malaysia on a warm, humid day. She had joined a weight reduction programme a few weeks earlier. She was found collapsed and in a semiconscious state in the jungle by her groupmates and was taken to hospital. On admission she was unconscious, hyperpyrexic, with rapid, thready pulse and a low blood pressure. Biochemical studies revealed metabolic acidosis, elevated liver and cardiac enzymes and impairment of renal function. Her coagulation profile was found to be impaired and she started bleeding through the mouth and nostrils. She also developed watery diarrhoea and initially a septicaemic condition, including acute enteritis was suspected. Despite active treatment, her condition deteriorated and she died eight hours after admission. autopsy confirmed a generalised bleeding tendency, with pulmonary, oesophageal and gastrointestinal mucosal haemorrhages. Flame-shaped subendocardial shock haemorrhages were seen in the interventricular septum on the left side of the heart. The findings support a diagnosis of heat stroke. Various aspects related to heat stroke, the autopsy diagnosis and its prevention are discussed.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
2/9. Exertional heat stroke--the prevention of a medical emergency.In most cases, exertional heat stroke (EHS) can be prevented in the military setting. The actions taken by the israel Defense Forces (IDF) and their outcome prove this well. Unfortunately, despite the available information, there are still incidents of failure of command in conducting physical exercise, leading to EHS. In our experience, most incidences are a consequence of disregarding safety regulations. The application of simple and reasonable measures will not only prevent accidents from happening, but will also result in better trained soldiers.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
3/9. Entrapment in small, enclosed spaces: a case report and points to consider regarding the mechanism of death.The mechanism of death due to confinement in an enclosed space is usually ascribed to asphyxia from oxygen deprivation. We report the case of the decomposed remains of a 23-year-old man discovered in an unused industrial size refrigerator in which the mechanism of death is heatstroke. The investigation of the death indicates the subject most likely voluntarily entered the refrigerator and for unknown reasons, closed the door. Injuries identified at autopsy and damage to the inside of the structure indicate he struggled to exit the cabinet. The autopsy shows no significant natural disease processes and toxicology studies were negative. The diagnosis of heat stroke typically rests on the evaluation of multiple features, including the age and size of the decedent, the ambient temperature, the medical history of the decedent, whole body hydration, body fat content, alcohol and drug use, medication history, general physical condition, and many other factors. The diagnosis of heatstroke due to confinement in an enclosed container requires evaluation of the heat stress of the container, the heat strain experienced by the individual, autopsy findings suggesting signs of a struggle to exit the container, and other factors. In all such cases, a careful death investigation with correlation of autopsy findings is required to accurately determine the mechanism and cause of death. We suggest that for all such deaths, physiological and environmental factors promoting hyperthermia and heatstroke be considered as a possible mechanism of death, along with those associated with the more obvious danger of asphyxiation.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
4/9. 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.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
5/9. Successful conservative management of acute hepatic failure following exertional heatstroke.Acute hepatic failure is a rare complication of exertional heatstroke with poor prognosis. We herein report a 24-year-old man presenting with acute hepatic failure and rhabdomyolysis following exertional heatstroke during hard physical work on a construction site. Acute hepatic failure occurred after 2 days and led to massive impairment of coagulation parameters. On day 3 after heatstroke the patient fulfilled standard criteria for emergency liver transplantation (i.e. the 'london criteria' and the 'Clichy criteria') but was not transplanted. Nevertheless liver function improved spontaneously thereafter and the patient recovered completely within 12 days. In contrast, the outcome of emergency liver transplantation was dismal in three cases of exertional heatstroke in the literature. Thus conservative management appears to be justified in heatstroke-associated liver failure even in the presence of accepted criteria for emergency liver transplantation.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
6/9. heat stroke: a comprehensive review.heat stroke (HS) is a serious and potentially life-threatening condition defined as a core body temperature >40.6 degrees C. Two forms of HS are recognized, classic heat stroke, usually occurring in very young or elderly persons, and exertional heat stroke, more common in physically active individuals. An elevated body temperature and neurologic dysfunction are necessary but not sufficient to diagnose HS. Associated clinical manifestations such as extreme fatigue; hot dry skin or heavy perspiration; nausea; vomiting; diarrhea; disorientation to person, place, or time; dizziness; uncoordinated movements; and reddened face are frequently observed. Potential complications related to severe HS are acute renal failure, disseminated intravascular coagulation, rhabdomyolysis, acute respiratory distress syndrome, acid-base disorders, and electrolyte disturbances. Long-term neurologic sequelae (varying degrees of irreversible brain injury) occur in approximately 20% of patients. The prognosis is optimal when HS is diagnosed early and management with cooling measures and fluid resuscitation and electrolyte replacement begins promptly. The prognosis is poorest when treatment is delayed >2 hours.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
7/9. Heatstroke in the super-sized athlete.We present a 16-year-old male athlete with hyperthermia, altered mental status, and respiratory distress during summer football practice. Multisystem organ failure ensued, which he survived. malignant hyperthermia was suspected in this patient who had a history of rhabdomyolysis. Specific muscle contracture testing later eliminated this diagnosis. This case discusses the importance of rapid hydration with isonatremic fluid, aggressive cooling, and full support measures, including plasmapheresis, further diagnostic efforts to evaluate potential causes of rhabdomyolysis, and planning for physical and emotional rehabilitation.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
8/9. rhabdomyolysis following severe physical exercise in a patient with predisposition to malignant hyperthermia.A 21-year-old man suffered from exertional heat stroke with impaired consciousness and rhabdomyolysis after strenuous physical exercise. Within two weeks the patient recovered completely without any specific therapy. Based on the symptoms and laboratory investigations, this episode suggested a moderate form of malignant hyperthermia. An in vitro contracture test was performed and a predisposition to malignant hyperthermia was diagnosed; other muscular diseases were excluded by histological examination. At present, the in vitro contracture test is the only method used to determine susceptibility to malignant hyperthermia and should be performed when the diagnosis is suggested on clinical grounds.- - - - - - - - - - ranking = 5keywords = physical (Clic here for more details about this article) |
9/9. infant death presumably due to exertional self-overheating in bed: an autopsy case of suspected child abuse.We report a case of accidental infant death presumably due to exertional self-overheating in bed. On a winter morning, a 9-month-old female baby was found dead in her bed at home. She had been confined to the bed overnight by her father, totally covered with a blanket and a thick quilt, because her night crying disturbed his sleep. The clothing and bedclothes were extremely wet with sweat. Many petechial hemorrhages were observed in the upper chest and thoracic viscera. The blood was concentrated, indicative of dehydration. Histological and immunohistochemical investigation revealed findings of shock and myolysis in the cardiac and skeletal muscles. There was no evidence of natural diseases. The main cause of death was diagnosed as circulatory collapse from overheating (hyperpyrexia and dehydration; heat stroke/exhaustion) probably precipitated by struggling in the closed space. Although there was no apparent evidence of battering or any other repetitive physical violence, this case was regarded as an atypical type of fatal child abuse.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |