Exertional Heatstroke: Early Recognition and Outcome With Aggressive Combined Cooling—a 12-Year Experience

Sithinamsuwan, Pasiri; Piyavechviratana, Kunchit; Kitthaweesin, Thitisak; Chusri, Watcharapong; Orrawanhanothai, Patima; Wongsa, Adisorn; Wattanathum, Anan; Chinvarun, Yotin; Nidhinandana, Samart; Satirapoj, LT Bancha; Supasyndh, Ouppatham; Sriswasdi, Chantrapa; Prayoonwiwat, Wichai

doi:10.7205/milmed-d-02-5908

Cited by 58 publications

(52 citation statements)

References 16 publications

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“…The literature reports that a subset of heatstroke patients may have a normal initial chest radiograph (4,5,11), which was encountered in 20% of our patients. The majority of chest radiographic findings previously described were contributed to pulmonary edema or acute respiratory distress syndrome (ARDS) (4,6,7,(12)(13)(14).…”

Section: Ijsrnetmentioning

confidence: 96%

“…The majority of chest radiographic findings previously described were contributed to pulmonary edema or acute respiratory distress syndrome (ARDS) (4,6,7,(12)(13)(14). Of note, the literature on the topic is not imaging-oriented and does not address specific imaging signs on chest radiography.…”

Section: Ijsrnetmentioning

confidence: 99%

“…The respiratory system may be involved with heat stroke in various ways (1)(2)(3). To the best of our knowledge, the literature describing the initial chest radiographic imaging features of patients with heat stroke is sparse (1)(2)(3)(4)(5)(6)(7). In this study, we aimed to evaluate the initial chest radiographic findings in a group of heatstroke patients referred to our care as a result of the September 2015 Mecca stampede(8).…”

Section: Introductionmentioning

confidence: 99%

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Initial Chest Radiographic Findings in Heatstroke Patients

2016

IJSR

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Abstract:Objective: To describe imaging-specific findings on the initial chest radiographs in a group of heatstroke patients. Materials and Methods: An experienced radiologist retrospectively evaluated the initial chest radiographs of 15 heatstroke patients from the September 2016 Mecca stampede. The presence of endotracheal intubation, pleural effusions, airspace opacities, interstitial opacities or bronchial wall thickening was recorded. The chest radiographs were also assessed for being unilaterally or bilaterally abnormal. Results: Assessment included eight (53%) males and seven (47%) females (average age of 54 +/-slandered deviation 12 years), eight (53%) of which were intubated. 12 (80%) radiographs were abnormal; nine (60%) bilateral. There were five (33%) cases of pleural effusions. There were two (13%) cases of ground-glass opacities, six (40%) cases with atelectasis, eight (53%) cases of bilateral bronchial wall thickening and three (20%) cases of bilateral interstitial lung opacities. No pneumothoraces or consolidations were detected. Conclusion: Most heatstroke patients had bilateral nonspecific initial chest radiographic findings. Bronchial wall thickening, interstitial opacities, and partial atelectasis were most encountered while pleural effusions and ground-glass opacities were less frequent. Further studies are required before our results could be generalized.

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Section: Ijsrnetmentioning

confidence: 96%

Section: Ijsrnetmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Initial Chest Radiographic Findings in Heatstroke Patients

2016

IJSR

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“…4 Important factors such as underlying viral or bacterial illness, 9 low physical fitness, 5 high body mass, 9 sleep deprivation, 9,10 lack of acclimatization, 9 exercise intensity (metabolic rate of the athlete) unmatched by physical fitness, 9 immune deficiency responses, 11 and environmental conditions such as high ambient temperature, humidity, and radiant energy have been linked to EHS. 3,4 Other potential causes include a history of heat intolerance, 4 genetics (eg, malignant hyperthermia), 4 barriers to evaporation (clothing, equipment, or both), dietary supplements, 4 the predominance of type II muscle fibers, 12 male sex, 13 and hydration status immediately before the exercise bout (hypohydration). 10 Although prevention is paramount, the elimination of every heat-stroke event may be difficult because the cause is still unknown; however, prompt diagnosis and proper treatment should prevent a fatal or catastrophic outcome.…”

mentioning

confidence: 99%

Cold-Water Immersion Cooling Rates in Football Linemen and Cross-Country Runners With Exercise-Induced Hyperthermia

Godek

Morrison

Scullin

2017

Journal of Athletic Training

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Context: Ideal and acceptable cooling rates in hyperthermic athletes have been established in average-sized participants. Football linemen (FBs) have a small body surface area (BSA)-to-mass ratio compared with smaller athletes, which hinders heat dissipation. Objective: To determine cooling rates using cold-water immersion in hyperthermic FBs and cross-country runners (CCs). Design: Cohort study. Setting: Controlled university laboratory. Patients or Other Participants: Nine FBs (age = 21.7 ± 1.7 years, height = 188.7 ± 4 cm, mass = 128.1 ± 18 kg, body fat = 28.9% ± 7.1%, lean body mass [LBM] = 86.9 ± 19 kg, BSA = 2.54 ± 0.13 m2, BSA/mass = 201 ± 21.3 cm2/kg, and BSA/LBM = 276.4 ± 19.7 cm2/kg) and 7 CCs (age = 20 ± 1.8 years, height = 176 ± 4.1 cm, mass = 68.7 ± 6.5 kg, body fat = 10.2% ± 1.6%, LBM = 61.7 ± 5.3 kg, BSA = 1.84 ± 0.1 m2, BSA/mass = 268.3 ± 11.7 cm2/kg, and BSA/LBM = 298.4 ± 11.7 cm2/kg). Intervention(s): Participants ingested an intestinal sensor, exercised in a climatic chamber (39°C, 40% relative humidity) until either target core temperature (Tgi) was 39.5°C or volitional exhaustion was reached, and were immediately immersed in a 10°C circulated bath until Tgi declined to 37.5°C. A general linear model repeated-measures analysis of variance and independent t tests were calculated, with P < .05. Main Outcome Measure(s): Physical characteristics, maximal Tgi, time to reach 37.5°C, and cooling rate. Results: Physical characteristics were different between groups. No differences existed in environmental measures or maximal Tgi (FBs = 39.12°C ± 0.39°C, CCs = 39.38°C ± 0.19°C; P = .12). Cooling times required to reach 37.5°C (FBs = 11.4 ± 4 minutes, CCs = 7.7 ± 0.06 minutes; P < .002) and therefore cooling rates (FBs = 0.156°C·min−1 ± 0.06°C·min−1, CCs = .255°C·min−1 ± 0.05°C·min−1; P < .002) were different. Strong correlations were found between cooling rate and body mass (r = −0.76, P < .001), total BSA (r = −0.74, P < .001), BSA/mass (r = 0.73, P < .001), LBM/mass (r = 0.72, P < .002), and LBM (r = −0.72, P < .002). Conclusions: With cold-water immersion, the cooling rate in CCs (0.255°C·min−1) was greater than in FBs (0.156°C·min−1); however, both were considered ideal (≥0.155°C·min−1). Athletic trainers should realize that it likely takes considerably longer to cool large hyperthermic American-football players (>11 minutes) than smaller, leaner athletes (7.7 minutes). Cooling rates varied widely from 0.332°C·min−1 in a small runner to only 0.101°C·min−1 in a lineman, supporting the use of rectal temperature for monitoring during cooling.

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“…[56] Removal from the heat stress and rapid whole body cooling are essential to mitigate encephalopathy, coagulopathy, and multi-organ failure. [57][58][59] The optimal cooling technique is total body immersion in ice or cold water, but this intervention is usually not practical in wilderness settings. Under these circumstances, skin wetting and aggressive fanning can be used in an attempt to lower the patient's temperature.…”

Section: Hyperthermiamentioning

confidence: 99%