Rehabilitation of a Patient with Heat Stroke

Abstract

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.

Recovery and Return to Activity Following Exertional Heat Stroke: Considerations for the Sports Medicine Staff

“…One case report showed a patient displayed child-like behaviors with limited memory four months post-injury. 13 Even four years after incident, this patient was confined to a wheelchair with only partial mental abilities. This case suggests the possibility of a poor neurological prognosis following EHS due to damage incurred at the time of injury.…”

“…It has been reported that some patients demonstrate or claim that they have had several minutes of lucid behavior just prior to or after collapse; 5 however, CNS abnormality is often the primary marker, or the first visible sign, of EHS. [2][3][4][6][7][8][9][10][11][12][13][14][15][16] There are no premonitory signs or symptoms that consistently forewarn EHS, although some report that patients experience prodromal symptoms. 4 Figure 1 -Organs of the body possibly affected by the hyperthermia of EHS.…”

Biochemical recovery from exertional heat stroke follows a 16-day time course

“…Previous clinical descriptions of EHS presentation and recovery have limited generalizability, due to small patient populations [12,30,31], and often focus on the most severe or fatal forms of injury [11,32]. This study includes a much larger cohort, and includes all available cases without regard for an arbitrary severity designation.…”

A Case of Multiple Organ Failure due to Heat Stoke Following a Warm Bath

“…Classical heat stroke is usually caused by exposure to sustained high temperatures, especially when the humidity is high; the most susceptible victims are elderly patients suffering with comorbid conditions such as diabetes, congestive heart failure, malnutrition or dehydration2). When the ambient temperature is higher than the core body temperature, sweating with vaporization accounts for almost all of heat loss, but when the humidity exceeds 75%, sweating becomes inefficient3).…”

“…Brain dysfunction is invariably present and other complications that fall within the category of multiorgan dysfunction syndrome such as rhabdomyolysis, acute renal failure, hepatic failure, myocardial injury and DIC can be life threatening2). Although mild hepatic injury that is represented by elevated transaminase levels is known to be common, fulminant liver failure leading to a death has rarely been reported.…”