Epidemic Classical Heat Stroke

Hart, Gary R.; Anderson, Ron J.; Crumpler, Charles P.; Shulkin, Alan; Reed, Gary; Knöchel, James P.

doi:10.1097/00005792-198205000-00005

Cited by 155 publications

(11 citation statements)

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“…Arterial oxygenation was generally low and one-tenth of patients required intubation and ventilatory support during their illness. Both normal and abnormal plasma electrolytes, including hypokalemia, hypophosphatemia, hyponatremia, hypocalcemia, and hyperglycemia, were observed as reported in previous studies [68,69].…”

Section: Discussionsupporting

confidence: 79%

Classic heat stroke in a desert climate: A systematic review of 2632 cases

et al. 2023

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Background Although classic heat stroke (HS) is one of the most ancient conditions known to humans, the description of its early clinical manifestations, natural course, and complications remains uncertain. Objectives A systematic review of the demographics, clinical characteristics, biomarkers, therapy, and outcomes of HS during the Muslim (Hajj) pilgrimage in the desert climate of Mecca, Saudi Arabia. Methods We searched the MEDLINE, Embase, Web of Science Core Collection, SCOPUS, and CINAHL databases from inception to April 2022. We summarized the data from eligible studies and synthesized them in narrative form using pooled descriptive statistics. Results Forty‐four studies, including 2632 patients with HS, met the inclusion criteria. Overweight or obesity, diabetes, and cardiovascular disease were prevalent among cases of HS. Evidence suggests that extreme hyperthermia (pooled mean = 42.0°C [95% confidence interval (CI): 41.9, 42.1], range 40–44.8°C) with hot and dry skin (>99% of cases) and severe loss of consciousness (mean Glasgow Coma Scale <8 in 53.8% of cases) were the dominant clinical characteristics of classic HS. Hypotension, tachypnea, vomiting, diarrhea, and biochemical biomarkers indicating mild‐to‐moderate rhabdomyolysis, acute kidney, liver, heart injury, and coagulopathy were frequent at the onset. Concomitantly, stress hormones (cortisol and catecholamines) and biomarkers of systemic inflammation and coagulation activation were increased. HS was fatal in 1 in 18 cases (pooled case fatality rate = 5.6% [95%CI: 4.6, 6.5]). Conclusions The findings of this review suggest that HS induces an early multiorgan injury that can progress rapidly to organ failure, culminating in death, if it is not recognized and treated promptly.

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Section: Discussionsupporting

confidence: 79%

Classic heat stroke in a desert climate: A systematic review of 2632 cases

et al. 2023

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“…90,94,109 Cold-water immersion may be considered in non-EHS, although this may not be practical for the typically older patients with multiple comorbidities in the critical care environment. 90,110 In the absence of cold-water immersion, wetted ice packs covering the entire body can cool through conduction. 99 Recommendations.…”

Section: Conductive Coolingmentioning

confidence: 99%

Wilderness Medical Society Clinical Practice Guidelines for the Prevention and Treatment of Heat Illness: 2019 Update

Lipman

Gaudio

Eifling

et al. 2019

Wilderness & Environmental Medicine

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The Wilderness Medical Society convened an expert panel in 2011 to develop a set of evidence-based guidelines for the recognition, prevention, and treatment of heat illness. We present a review of the classifications, pathophysiology, and evidence-based guidelines for planning and preventive measures, as well as best practice recommendations for both fieldand hospital-based therapeutic management of heat illness. These recommendations are graded based on the quality of supporting evidence and balance the benefits and risks or burdens for each modality. This is an updated version of the original Wilderness Medical Society Practice Guidelines for the Treatment and Prevention of Heat-Related Illness published in 2013.

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“…Although it is rare clinically to see exertional heat stroke victims cease sweating (Shibolet et al, 1967), it is a more common finding in classical heat stroke (Knochel & Goodman, 1997). Classic heat stroke cases become more dehydrated because of behavioral and physiological impairments; they suffer from underlying illnesses and using drugs that might impair thermoregulation (Hart et al, 1982; Bouchama et al, 2007).…”

Section: Thermoregulatory Failure (The Uncompensable Phase)mentioning

confidence: 99%

The pathopysiology of heat stroke: an integrative view of the final common pathway

Epstein

Roberts

2011

Scandinavian Med Sci Sports

169

138

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Heat stroke is defined as a condition in which body temperature is elevated to such a level that it becomes a noxious agent causing body tissue dysfunction and damage with a characteristic multi-organ clinical and pathological syndrome. Marked hyperthermia, usually above 40.5°C and associated encephalopathy, occurs after thermoregulation is subordinated to circulatory and metabolic demands and to the associated systemic inflammatory reaction. Exertional heat stroke is a function of both intrinsic and extrinsic modulators. Intrinsic modulators like genetics, fitness, acclimatization, illness, medications, and sleep quality can alter individual risk and outcomes, while extrinsic modulators like exercise intensity and duration, clothing and equipment, ambient temperature, relative humidity, and solar radiation can affect the group risk and outcomes. This review integrates the current theoretical and accepted knowledge of physiological alterations into one model that depicts a common pathway from heat stress to heat stroke.

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Epidemic Classical Heat Stroke

Cited by 155 publications

References 0 publications

Classic heat stroke in a desert climate: A systematic review of 2632 cases

Classic heat stroke in a desert climate: A systematic review of 2632 cases

Wilderness Medical Society Clinical Practice Guidelines for the Prevention and Treatment of Heat Illness: 2019 Update

The pathopysiology of heat stroke: an integrative view of the final common pathway

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