Heat stroke

Last updated

Heat stroke
Other namesSun-stroke, siriasis [1]
The British Army in the Middle East 1943 E26027.jpg
Person being cooled with water spray, one of the treatments of heat stroke, in Iraq in 1943
Specialty Emergency medicine
Symptoms High body temperature, red, dry or damp skin, headache, dizziness, confusion, nausea [2]
Complications Seizures, rhabdomyolysis, kidney failure [3]
TypesClassic, exertional [3]
CausesHigh external temperatures, physical exertion [3] [4]
Risk factors Extremes of age, heat waves, high humidity, certain drugs, heart disease, skin disorders [3]
Diagnostic method Based on symptoms [3]
Differential diagnosis Neuroleptic malignant syndrome, malaria, meningitis [3]
TreatmentRapid cooling, supportive care [4]
Prognosis Risk of death <5% (exercise induced), up to 65% (non-exercise induced) [3]
Deaths> 600 per year (US) [4]

Heat stroke or heatstroke, also known as sun-stroke, is a severe heat illness that results in a body temperature greater than 40.0 °C (104.0 °F), [4] along with red skin, headache, dizziness, and confusion. [2] Sweating is generally present in exertional heatstroke, but not in classic heatstroke. [5] The start of heat stroke can be sudden or gradual. [3] Heatstroke is a life-threatening condition due to the potential for multi-organ dysfunction, [6] with typical complications including seizures, rhabdomyolysis, or kidney failure. [3]

Contents

Heat stroke occurs because of high external temperatures and/or physical exertion. [3] [4] It usually occurs under preventable prolonged exposure to extreme environmental or exertional heat. [6] However, certain health conditions can increase the risk of heat stroke, and patients, especially children, with certain genetic predispositions are vulnerable to heatstroke under relatively mild conditions. [7]

Preventive measures include drinking sufficient fluids and avoiding excessive heat. [8] Treatment is by rapid physical cooling of the body and supportive care. [4] Recommended methods include spraying the person with water and using a fan, putting the person in ice water, or giving cold intravenous fluids. [4] Adding ice packs around a person is beneficial but does not by itself achieve the fastest possible cooling. [4]

Heat stroke results in more than 600 deaths a year in the United States. [4] Rates increased between 1995 and 2015. [3] Purely exercise-induced heat stroke, though a medical emergency, tends to be self-limiting (the patient stops exercising from cramp or exhaustion) and fewer than 5% of cases are fatal. Non-exertional heatstroke is a much greater danger: even the healthiest person, if left in a heatstroke-inducing environment without medical attention, will continue to deteriorate to the point of death, and 65% of the most severe cases are fatal even with treatment. [3]

Signs and symptoms

Heat stroke generally presents with a hyperthermia of greater than 40.6 °C (105.1 °F) in combination with disorientation. [5] [9] There is generally a lack of sweating in classic heatstroke, while sweating is generally present in exertional heatstroke. [5]

Early symptoms of heat stroke include behavioral changes, confusion, delirium, dizziness, weakness, agitation, combativeness, slurred speech, nausea, and vomiting. [5] In some individuals with exertional heatstroke, seizures and sphincter incontinence have also been reported. [5] Additionally, in exertional heat stroke, the affected person may sweat excessively. [10] Rhabdomyolysis, which is characterized by skeletal muscle breakdown with the products of muscle breakdown entering the bloodstream and causing organ dysfunction, is seen with exertional heatstroke. [5]

If treatment is delayed, patients could develop vital organ damage, unconsciousness and even organ failure. In the absence of prompt and adequate treatment, heatstroke can be fatal. [11]

Causes

Heat stroke occurs when thermoregulation is overwhelmed by a combination of excessive metabolic production of heat (exertion), excessive heat in the physical environment, and insufficient or impaired heat loss, resulting in an abnormally high body temperature. Substances that inhibit cooling and cause dehydration such as alcohol, stimulants, medications, and age-related physiological changes predispose to so-called "classic" or non-exertional heat stroke (NEHS), most often in elderly and infirm individuals in summer situations with insufficient ventilation. [12]

Young children have age specific physiologic differences that make them more susceptible to heat stroke including an increased surface area to mass ratio (leading to increased environmental heat absorption), an underdeveloped thermoregulatory system, a decreased sweating rate and a decreased blood volume to body size ratio (leading to decreased compensatory heat dissipation by redirecting blood to the skin). [5]

Exertional heat stroke

Exertional heat stroke (EHS) can happen in young people without health problems or medications – most often in athletes, outdoor laborers, or military personnel engaged in strenuous hot-weather activity or in first responders wearing heavy personal protective equipment. In environments that are not only hot but also humid, it is important to recognize that humidity reduces the degree to which the body can cool itself by perspiration and evaporation. For humans and other warm-blooded animals, excessive body temperature can disrupt enzymes regulating biochemical reactions that are essential for cellular respiration and the functioning of major organs. [11]

Cars

When the outside temperature is 21 °C (70 °F), the temperature inside a car parked in direct sunlight can quickly exceed 49 °C (120 °F). Young children or elderly adults left alone in a vehicle are at particular risk of succumbing to heat stroke. "Heat stroke in children and in the elderly can occur within minutes, even if a car window is opened slightly." [13] As these groups of individuals may not be able to open car doors or to express discomfort verbally (or audibly, inside a closed car), their plight may not be immediately noticed by others in the vicinity. In 2018, 51 children in the United States died in hot cars, more than the previous high of 49 in 2010. [14]

Dogs are even more susceptible than humans to heat stroke in cars, as they cannot produce whole-body sweat to cool themselves. Leaving the dog at home with plenty of water on hot days is recommended instead, or, if a dog must be brought along, it can be tied up in the shade outside the destination and provided with a full water bowl. [15]

Pathophysiology

The pathophysiology of heat stroke involves an intense heat overload followed by a failure of the body's thermoregulatory mechanisms. More specifically, heat stroke leads to inflammatory and coagulation responses that can damage the vascular endothelium and result in numerous platelet complications, including decreased platelet counts, platelet clumping, and suppressed platelet release from bone marrow. [16]

Growing evidence also suggests the existence of a second pathway underlying heat stroke that involves heat and exercise-driven endotoxemia. [17] Although its exact mechanism is not yet fully understood, this model theorizes that extreme exercise and heat disrupt the intestinal barrier by making it more permeable and allowing lipopolysaccharides (LPS) from gram-negative bacteria within the gut to move into the circulatory system. [17] High blood LPS levels can then trigger a systemic inflammatory response and eventually lead to sepsis and related consequences like blood coagulation, multi-organ failure, necrosis, and central nervous system dysfunction. [17]

Diagnosis

Heat stroke is a clinical diagnosis, based on signs and symptoms. It is diagnosed based on an elevated core body temperature (usually above 40 degrees Celsius), a history of heat exposure or physical exertion, and neurologic dysfunction. [5] However, high body temperature does not necessarily indicate that heat stroke is present, such as with people in high-performance endurance sports or with people experiencing fevers. [18] In others with heatstroke, the core body temperature is not always above 40 degrees Celsius. [5] Therefore, heat stroke is more accurately diagnosed based on a constellation of symptoms rather than just a specific temperature threshold. [18] Tachycardia (or a rapid heart rate), tachypnea (rapid breathing) and hypotension (low blood pressure) are common clinical findings. [5] Those with classic heat stroke usually have dry skin, whereas those with exertional heat stroke usually have wet or sweaty skin. [5]

A core body temperature (such as a rectal temperature) is the preferred method for monitoring body temperature in the diagnosis and management of heat stroke as it is more accurate than peripheral body temperatures (such as an oral or axillary temperatures). [5]

Other conditions which may present similarly to heat stroke include meningitis, encephalitis, epilepsy, drug toxicity, severe dehydration, and certain metabolic syndromes such as serotonin syndrome, neuroleptic malignant syndrome, malignant hyperthermia and thyroid storm. [5]

Prevention

The risk of heat stroke can be reduced by observing precautions to avoid overheating and dehydration. Light, loose-fitting clothes will allow perspiration to evaporate and cool the body. Wide-brimmed hats in light colors help prevent the sun from warming the head and neck. Vents on a hat will help cool the head, as will sweatbands wetted with cool water. Strenuous exercise should be avoided during hot weather, especially in the sun peak hours. Strenuous exercise should also be avoided if a person is ill and exercise intensity should match one's fitness level. Avoiding confined spaces (such as automobiles) without air-conditioning or adequate ventilation. [19] [20]

During heat waves and hot seasons further measures that can be taken to avoid classic heat stroke include staying in air conditioned areas, using fans, taking frequent cold showers, and increasing social contact and well being checks (especially for the elderly or disabled persons). [5]

In hot weather, people need to drink plenty of cool liquids and mineral salts to replace fluids lost from sweating. Thirst is not a reliable sign that a person needs fluids. A better indicator is the color of urine. A dark yellow color may indicate dehydration. [10]

Some measures that can help protect workers from heat stress include: [21]

Treatment

Treatment of heat stroke involves rapid mechanical cooling along with standard resuscitation measures. [22]

The body temperature must be lowered quickly via conduction, convection, or evaporation. [4] During cooling, the body temperature should be lowered to less than 39 degrees Celsius, ideally less than 38-38.5 degrees Celsius. [5]

In the field, the person should be moved to a cool area, such as indoors or to a shaded area. Clothing should be removed to promote heat loss through passive cooling. Conductive cooling methods such as ice-water immersion should also be used, if possible. Evaporative and convective cooling by a combination of cool water spray or cold compresses with constant air flow over the body, such as with a fan or air-conditioning unit, is also an effective alternative. [4]

In hospital mechanical cooling methods include ice water immersion, infusion of cold intravenous fluids, placing ice packs or wet gauze around the person, and fanning. Aggressive ice-water immersion remains the gold standard for exertional heat stroke and may also be used for classic heat stroke. [23] [24] [5] This method may require the effort of several people and the person should be monitored carefully during the treatment process. Immersion should be avoided for an unconscious person but, if there is no alternative, it can be applied with the person's head above water. A rapid and effective cooling usually reverses concomitant organ dysfunction. [5]

Immersion in very cold water was once thought to be counterproductive by reducing blood flow to the skin and thereby preventing heat from escaping the body core. However, research has shown that this mechanism does not play a dominant role in the decrease in core body temperature brought on by cold water.[ citation needed ]

Dantrolene, a muscle relaxant used to treat other forms of hyperthermia, is not an effective treatment for heat stroke. [25] Antipyretics such as aspirin and acetaminophen are also not recommended as a means to lower body temperature in the treatment of heat stroke and their use may lead to worsening liver damage. [5]

A cardiopulmonary resuscitation (CPR) may be necessary if the person goes into cardiac arrest. [5]

The person's condition should be reassessed and stabilized by trained medical personnel. And the person's heart rate and breathing should be monitored. IV fluid resuscitation is usually needed for circulatory failure and organ dysfunction and is also indicated if rhabdomyolysis is present. [5] In severe cases hemodialysis and ventilator support may be needed. [5]

Prognosis

In elderly people who experience classic heat stroke the mortality exceeds 50%. [5] The mortality rate in exertional heat stroke is less than 5%. [5]

It was long believed that heat strokes lead only rarely to permanent deficits and that convalescence is almost complete. However, following the 1995 Chicago heat wave, researchers from the University of Chicago Medical Center studied all 58 patients with heat stroke severe enough to require intensive care at 12 area hospitals between July 12 and 20, 1995, ranging in age from 25 to 95 years. Nearly half of these patients died within a year – 21 percent before and 28 percent after release from the hospital. Many of the survivors had permanent loss of independent function; one-third had severe functional impairment at discharge, and none of them had improved after one year. The study also recognized that because of overcrowded conditions in all the participating hospitals during the crisis, the immediate care – which is critical – was not as comprehensive as it should have been. [26]

In rare cases, brain damage has been reported as a permanent sequela of severe heat stroke, most commonly cerebellar atrophy. [27] [28]

Epidemiology

Various aspects can affect the incidence of heat stroke, including sex, age, geographical location, and occupation. The incidence of heat stroke is higher among men; however, the incidence of other heat illnesses is higher among women. [29] The incidence of other heat illnesses in women compared with men ranged from 1.30 to 2.89 per 1000 person-years versus 0.98 to 1.98 per 1000 person-years. [29]

Different parts of the world also have different rates of heat stroke.[ medical citation needed ]

During the 2003 European heatwave more than 70,000 people died of heat related illnesses, and during the 2022 European heatwave (which saw the highest temperatures ever recorded in Europe), 61,672 people died from heat related illnesses. [30]

Society and culture

In Slavic mythology, there is a personification of sunstroke, Poludnitsa (lady midday), a feminine demon clad in white that causes impairment or death to people working in the fields at midday. There was a traditional short break in harvest work at noon, to avoid attack by the demon. Antonín Dvořák's symphonic poem, The Noon Witch , was inspired by this tradition.

Other animals

Heatstroke can affect livestock, especially in hot, humid weather; or if the horse, cow, sheep or other is unfit, overweight, has a dense coat, is overworked, or is left in a horsebox in full sun. Symptoms include drooling, panting, high temperature, sweating, and rapid pulse.

The animal should be moved to shade, drenched in cold water and offered water or electrolyte to drink. [31]

See also

Related Research Articles

<span class="mw-page-title-main">Hyperthermia</span> Elevated body temperature due to failed thermoregulation

Hyperthermia, also known simply as overheating, is a condition in which an individual's body temperature is elevated beyond normal due to failed thermoregulation. The person's body produces or absorbs more heat than it dissipates. When extreme temperature elevation occurs, it becomes a medical emergency requiring immediate treatment to prevent disability or death. Almost half a million deaths are recorded every year from hyperthermia.

<span class="mw-page-title-main">Perspiration</span> Fluid secreted from sudoriferous glands

Perspiration, also known as sweat, is the fluid secreted by sweat glands in the skin of mammals.

<span class="mw-page-title-main">Hypothermia</span> Human body core temperature below 35 °C (95 °F)

Hypothermia is defined as a body core temperature below 35.0 °C (95.0 °F) in humans. Symptoms depend on the temperature. In mild hypothermia, there is shivering and mental confusion. In moderate hypothermia, shivering stops and confusion increases. In severe hypothermia, there may be hallucinations and paradoxical undressing, in which a person removes their clothing, as well as an increased risk of the heart stopping.

<span class="mw-page-title-main">Dehydration</span> Deficit of total body water

In physiology, dehydration is a lack of total body water, with an accompanying disruption of metabolic processes. It occurs when free water loss exceeds free water intake, usually due to exercise, disease, or high environmental temperature. Mild dehydration can also be caused by immersion diuresis, which may increase risk of decompression sickness in divers.

Heat exhaustion is a heat-related illness characterized by the body's inability to effectively cool itself, typically occurring in high ambient temperatures or during intense physical exertion. In heat exhaustion, core body temperature ranges from 37 °C to 40 °C. Symptoms include profuse sweating, weakness, dizziness, headache, nausea, and lowered blood pressure, resulting from dehydration and serum electrolyte depletion. Heat-related illnesses lie on a spectrum of severity, where heat exhaustion is considered less severe than heat stroke but more severe than heat cramps and heat syncope.

Diving disorders, or diving related medical conditions, are conditions associated with underwater diving, and include both conditions unique to underwater diving, and those that also occur during other activities. This second group further divides conditions caused by exposure to ambient pressures significantly different from surface atmospheric pressure, and a range of conditions caused by general environment and equipment associated with diving activities.

<span class="mw-page-title-main">Heat syncope</span> Medical condition

Heat syncope is fainting or dizziness as a result of overheating. It is a type of heat illness. The basic symptom of heat syncope is fainting, with or without mental confusion. Heat syncope is caused by peripheral vessel dilation, resulting in diminished blood flow to the brain and dehydration.

Normal human body temperature is the typical temperature range found in humans. The normal human body temperature range is typically stated as 36.5–37.5 °C (97.7–99.5 °F).

<span class="mw-page-title-main">Cholinergic urticaria</span> Medical condition

Cholinergic urticaria or also known as (CholU) and CU, is a rare form of hives (urticaria) that is triggered by an elevation in body temperature, breaking a sweat, or exposure to heat. It is also sometimes called exercise-induced urticaria or heat hives. The condition is considered to be one of the many rarest forms of allergies known to medical science.

Hypohidrosis is a medical condition in which a person exhibits diminished sweating in response to appropriate stimuli. In contrast with hyperhidrosis, which is a socially troubling yet often benign condition, the consequences of untreated hypohidrosis include hyperthermia, heat stroke and death. An extreme case of hypohidrosis in which there is a complete absence of sweating and the skin is dry is termed anhidrosis. The condition is also known as adiaphoresis, ischidrosis, oligidria, oligohidrosis and sweating deficiency.

<span class="mw-page-title-main">Hyperthermia therapy</span>

Hyperthermia therapy(or hyperthermia, or thermotherapy) is a type of medical treatment in which body tissue is exposed to temperatures above body temperature, in the region of 40–45 °C (104–113 °F). Hyperthermia is usually applied as an adjuvant to radiotherapy or chemotherapy, to which it works as a sensitizer, in an effort to treat cancer.

<span class="mw-page-title-main">Heat illness</span> Condition caused by the failure of the human body to dissipate heat in a hot environment

Heat illness is a spectrum of disorders due to increased body temperature. It can be caused by either environmental conditions or by exertion. It includes minor conditions such as heat cramps, heat syncope, and heat exhaustion as well as the more severe condition known as heat stroke. It can affect any or all anatomical systems. Heat illnesses include: heat stroke, heat exhaustion, heat syncope, heat edema, heat cramps, heat rash, heat tetany.

Swimming induced pulmonary edema (SIPE), also known as immersion pulmonary edema, is a life threatening condition that occurs when fluids from the blood leak abnormally from the small vessels of the lung (pulmonary capillaries) into the airspaces (alveoli).

Heat intolerance is a symptom characterized by feeling overheated in warm environments or when the surrounding environment's temperature rises. Typically, the person feels uncomfortably hot and sweats excessively.

Acquired idiopathic generalized anhidrosis (AIGA) is characterized by generalized absence of sweating without other autonomic and neurologic dysfunction. Other symptoms include facial flushing, headaches, disorientation, lassitude, hyperthermia, weakness, and palpitations.

Exertional rhabdomyolysis (ER) is the breakdown of muscle from extreme physical exertion. It is one of many types of rhabdomyolysis that can occur, and because of this, the exact prevalence and incidence are unclear.

As in other mammals, human thermoregulation is an important aspect of homeostasis. In thermoregulation, body heat is generated mostly in the deep organs, especially the liver, brain, and heart, and in contraction of skeletal muscles. Humans have been able to adapt to a great diversity of climates, including hot humid and hot arid. High temperatures pose serious stress for the human body, placing it in great danger of injury or even death. For humans, adaptation to varying climatic conditions includes both physiological mechanisms resulting from evolution and behavioural mechanisms resulting from conscious cultural adaptations.

Occupational heat stress is the net load to which a worker is exposed from the combined contributions of metabolic heat, environmental factors, and clothing worn, which results in an increase in heat storage in the body. Heat stress can result in heat-related illnesses, such as heat stroke, hyperthermia, heat exhaustion, heat cramps, heat rashes, and chronic kidney disease (CKD). Although heat exhaustion is less severe, heat stroke is a medical emergency and requires emergency treatment, which if not provided, can lead to death.

<span class="mw-page-title-main">Skin temperature</span> Temperature at the outer surface of a living body

Skin temperature is the temperature of the outermost surface of the body. Normal human skin temperature on the trunk of the body varies between 33.5 and 36.9 °C, though the skin's temperature is lower over protruding parts, like the nose, and higher over muscles and active organs. Recording skin temperature presents extensive difficulties. Although it is not a clear indicator of internal body temperature, skin temperature is significant in assessing the healthy function of skin. Some experts believe the physiological significance of skin temperature has been overlooked, because clinical analysis has favoured measuring temperatures of the mouth, armpit, and/or rectum. Temperatures of these parts typically are consistent with internal body temperature.

Thermal balance of a diver occurs when the total heat exchanged between the diver and their surroundings results in a stable temperature of the diver. Ideally this is within the range of normal human body temperature. Thermal status of the diver is the temperature distribution and heat balance of the diver. The terms are frequently used as synonyms. Thermoregulation is the process by which an organism keeps its body temperature within specific bounds, even when the surrounding temperature is significantly different. The internal thermoregulation process is one aspect of homeostasis: a state of dynamic stability in an organism's internal conditions, maintained far from thermal equilibrium with its environment. If the body is unable to maintain a normal human body temperature and it increases significantly above normal, a condition known as hyperthermia occurs. The opposite condition, when body temperature decreases below normal levels, is known as hypothermia. It occurs when the body loses heat faster than producing it. The core temperature of the body normally remains steady at around 36.5–37.5 °C (97.7–99.5 °F). Only a small amount of hypothermia or hyperthermia can be tolerated before the condition becomes debilitating, further deviation can be fatal. Hypothermia does not easily occur in a diver with reasonable passive thermal insulation over a moderate exposure period, even in very cold water.

References

  1. ↑ Herrick RT (April 1986). "Heat illness in the athlete: siriasis is serious". Alabama Medicine. 55 (10): 28, 33–28, 37. PMID   3706086.
  2. 1 2 "Warning Signs and Symptoms of Heat-Related Illness". www.cdc.gov. Archived from the original on July 13, 2017. Retrieved July 17, 2017.
  3. 1 2 3 4 5 6 7 8 9 10 11 12 Leon LR, Bouchama A (April 2015). "Heat stroke". Comprehensive Physiology. 5 (2): 611–647. doi:10.1002/cphy.c140017. ISBN   9780470650714. PMID   25880507.
  4. 1 2 3 4 5 6 7 8 9 10 11 Gaudio FG, Grissom CK (April 2016). "Cooling Methods in Heat Stroke". The Journal of Emergency Medicine. 50 (4): 607–616. doi:10.1016/j.jemermed.2015.09.014. PMID   26525947.
  5. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 Epstein Y, Yanovich R (June 2019). "Heatstroke". The New England Journal of Medicine. 380 (25): 2449–2459. doi: 10.1056/NEJMra1810762 . PMID   31216400.
  6. 1 2 Bouchama A, Knochel JP (June 2002). "Heat stroke". The New England Journal of Medicine. 346 (25): 1978–1988. doi:10.1056/nejmra011089. PMID   12075060.
  7. ↑ Wang HJ, Lee CS, Yee RS, Groom L, Friedman I, Babcock L, et al. (October 2020). "Adaptive thermogenesis enhances the life-threatening response to heat in mice with an Ryr1 mutation". Nature Communications. 11 (1): 5099. Bibcode:2020NatCo..11.5099W. doi:10.1038/s41467-020-18865-z. PMC   7547078 . PMID   33037202.
  8. ↑ "Tips for Preventing Heat-Related Illness|Extreme Heat". www.cdc.gov. June 19, 2017. Archived from the original on July 29, 2017. Retrieved July 17, 2017.
  9. ↑ McGugan EA (March 2001). "Hyperpyrexia in the emergency department". Emergency Medicine. 13 (1): 116–120. doi:10.1046/j.1442-2026.2001.00189.x. PMID   11476402.
  10. 1 2 "InfoSheet: Protecting Workers from Heat Illness" (PDF). OSHA–NIOSH. 2011. Archived (PDF) from the original on June 16, 2015. Retrieved February 10, 2015.
  11. 1 2 Fauci, Anthony, et al. (2008). Harrison's Principles of Internal Medicine (17th ed.). McGraw-Hill Professional. pp. 117–121. ISBN   978-0-07-146633-2.
  12. ↑ "Heat emergencies: MedlinePlus Medical Encyclopedia". www.nlm.nih.gov. Archived from the original on January 5, 2016. Retrieved January 19, 2016.
  13. ↑ Meadows M (2014). "A primer on summer safety". Academic OneFile. Archived from the original on October 5, 2016. Retrieved January 18, 2016.
  14. ↑ "2018 was Deadliest Year on Record for Hot Car Deaths". National Safety Council. Retrieved July 8, 2019.
  15. ↑ "Dogs in Hot Cars". Partnership for Animal Welfare. Archived from the original on February 10, 2015. Retrieved February 11, 2015.
  16. ↑ Hifumi T, Kondo Y, Shimizu K, Miyake Y (2018). "Heat stroke". Journal of Intensive Care. 6: 30. doi: 10.1186/s40560-018-0298-4 . PMC   5964884 . PMID   29850022.
  17. 1 2 3 Lim CL (October 2018). "Heat Sepsis Precedes Heat Toxicity in the Pathophysiology of Heat Stroke-A New Paradigm on an Ancient Disease". Antioxidants. 7 (11): 149. doi: 10.3390/antiox7110149 . PMC   6262330 . PMID   30366410.
  18. 1 2 Laitano O, Leon LR, Roberts WO, Sawka MN (November 2019). "Controversies in exertional heat stroke diagnosis, prevention, and treatment". Journal of Applied Physiology. 127 (5): 1338–1348. doi: 10.1152/japplphysiol.00452.2019 . PMID   31545156.
  19. ↑ "Tips for Preventing Heat-Related Illness Natural Disasters and Severe Weather". www.cdc.gov. August 16, 2022. Retrieved September 20, 2023.
  20. ↑ Gauer R, Meyers BK (April 15, 2019). "Heat-Related Illnesses". American Family Physician. 99 (8): 482–489. ISSN   1532-0650. PMID   30990296.
  21. ↑ "QuickCard: Protecting Workers from Heat Stress" (PDF). OSHA. 2014. Archived (PDF) from the original on January 17, 2015. Retrieved February 10, 2015.
  22. ↑ Tintinalli J (2004). Emergency Medicine: A Comprehensive Study Guide (6th ed.). McGraw-Hill Professional. p. 1188. ISBN   0-07-138875-3.
  23. ↑ McDermott BP, Casa DJ, Ganio MS, Lopez RM, Yeargin SW, Armstrong LE, Maresh CM (January 1, 2009). "Acute whole-body cooling for exercise-induced hyperthermia: a systematic review". Journal of Athletic Training. 44 (1): 84–93. doi:10.4085/1062-6050-44.1.84. PMC   2629045 . PMID   19180223.
  24. ↑ Gagnon D, Lemire BB, Casa DJ, Kenny GP (September 1, 2010). "Cold-water immersion and the treatment of hyperthermia: using 38.6°C as a safe rectal temperature cooling limit". Journal of Athletic Training. 45 (5): 439–444. doi:10.4085/1062-6050-45.5.439. PMC   2938313 . PMID   20831387.
  25. ↑ Laitano O, Murray KO, Leon LR (September 2020). "Overlapping Mechanisms of Exertional Heat Stroke and Malignant Hyperthermia: Evidence vs. Conjecture". Sports Medicine. 50 (9): 1581–1592. doi:10.1007/s40279-020-01318-4. PMID   32632746. S2CID   220351326.
  26. ↑ "Classic heat stroke during Chicago 1995 heat wave". University of Chicago Medicine. August 1, 1998. Archived from the original on June 4, 2012. Retrieved July 22, 2012.
  27. ↑ Bouchama A, Knochel JP (June 2002). "Heat stroke". The New England Journal of Medicine. 346 (25): 1978–1988. doi:10.1056/NEJMra011089. PMID   12075060.
  28. ↑ Bazille C, Megarbane B, Bensimhon D, Lavergne-Slove A, Baglin AC, Loirat P, et al. (November 2005). "Brain damage after heat stroke". Journal of Neuropathology and Experimental Neurology. 64 (11): 970–975. doi: 10.1097/01.jnen.0000186924.88333.0d . PMID   16254491.
  29. 1 2 Alele F, Malau-Aduli B, Malau-Aduli A, Crowe M (April 2020). "Systematic review of gender differences in the epidemiology and risk factors of exertional heat illness and heat tolerance in the armed forces". BMJ Open. 10 (4): e031825. doi:10.1136/bmjopen-2019-031825. PMC   7245403 . PMID   32265238.
  30. ↑ Ballester J, Quijal-Zamorano M, Méndez Turrubiates RF, Pegenaute F, Herrmann FR, Robine JM, Basagaña X, Tonne C, Antó JM, Achebak H (July 2023). "Heat-related mortality in Europe during the summer of 2022". Nature Medicine. 29 (7): 1857–1866. doi:10.1038/s41591-023-02419-z. hdl: 10230/58052 . PMID   37429922.
  31. ↑ Horse and Hound, 'First Aid: Handling Heatstroke', 2/8/2004
This page is based on this Wikipedia article
Text is available under the CC BY-SA 4.0 license; additional terms may apply.
Images, videos and audio are available under their respective licenses.