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Gossack-Keenan K, Yeom DS, Kanu J, Hau JP, Rosychuk RJ, Clark D, Bola R, Tze C, Niosco C, Emery H, Yeung P, Hohl CM. Heatstroke presentations to urban hospitals during BC's extreme heat event: lessons for the future. CAN J EMERG MED 2024; 26:111-118. [PMID: 38153655 PMCID: PMC10861625 DOI: 10.1007/s43678-023-00622-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 11/07/2023] [Indexed: 12/29/2023]
Abstract
BACKGROUND Climate change is leading to more extreme heat events in temperate climates that typically have low levels of preparedness. Our objective was to describe the characteristics, treatments, and outcomes of adults presenting to hospitals with heatstroke during BC's 2021 heat dome. METHODS We conducted a review of consecutive adults presenting to 7 hospitals in BC's Lower Mainland. We screened the triage records of all patients presenting between June 25th and 30th, 2021 for complaints related to heat, and reviewed the full records of those who met heatstroke criteria. Our primary outcome was in-hospital mortality. We used Mann-Whitney U tests and logistic regression to investigate associations between patient and treatment factors and mortality. RESULTS Among 10,247 consecutive presentations to urban hospitals during the extreme heat event, 1.3% (139; 95% confidence intervals [CI] 1.1-1.6%) met criteria for heatstroke. Of heatstroke patients, 129 (90.6%) were triaged into the two highest acuity levels. Patients with heatstroke had a median age of 84.4 years, with 122 (87.8%) living alone, and 101 (84.2%) unable to activate 911 themselves. A minority (< 5, < 3.6%) of patients presented within 48 h of the onset of extreme heat. Most patients (107, 77.0%) required admission, and 11.5% (16) died in hospital. Hypotension on presentation was associated with mortality (odds ratio [OR] 5.3). INTERPRETATION Heatstroke patients were unable to activate 911 themselves, and most presented with a 48-h delay. This delay may represent a critical window of opportunity for pre-hospital and hospital systems to prepare for the influx of high-acuity resource-intensive patients.
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Affiliation(s)
- Kira Gossack-Keenan
- Department of Emergency Medicine, University of British Columbia, Vancouver, BC, Canada.
- Faculty of Medicine, Diamond Health Care Centre, 11th Floor, 2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada.
| | - David Seonguk Yeom
- Department of Emergency Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Josephine Kanu
- Department of Emergency Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Jeffrey P Hau
- Department of Emergency Medicine, University of British Columbia, Vancouver, BC, Canada
- Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada
| | | | - Dylan Clark
- Climate Institute Canada, Vancouver, BC, Canada
| | - Rajan Bola
- Department of Emergency Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Caris Tze
- Department of Emergency Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Chris Niosco
- Department of Emergency Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Hayley Emery
- Department of Emergency Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Phillip Yeung
- Department of Emergency Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Corinne M Hohl
- Department of Emergency Medicine, University of British Columbia, Vancouver, BC, Canada
- Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada
- Emergency Department, Vancouver General Hospital, Vancouver, BC, Canada
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2
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Yang HS, Choi JM, In J, Sung TY, Kim YB, Sultana S. Current clinical application of dantrolene sodium. Anesth Pain Med (Seoul) 2023; 18:220-232. [PMID: 37691593 PMCID: PMC10410554 DOI: 10.17085/apm.22260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 06/26/2023] [Accepted: 06/27/2023] [Indexed: 09/12/2023] Open
Abstract
Dantrolene sodium (DS) was first introduced as an oral antispasmodic drug. However, in 1975, DS was demonstrated to be effective for managing malignant hyperthermia (MH) and was adopted as the primary therapeutic drug after intravenous administration. However, it is difficult to administer DS intravenously to manage MH. MH is life-threatening, pharmacogenomically related, and induced by depolarizing neuromuscular blocking agents or inhalational anesthetics. All anesthesiologists should know the pharmacology of DS. DS suppresses Ca2+ release from ryanodine receptors (RyRs). RyRs are expressed in various tissues, although their distribution differs among subtypes. The anatomical and physiological functions of RyRs have also been demonstrated as effective therapeutic drugs for cardiac arrhythmias, Alzheimer's disease, and other RyR-related diseases. Recently, a new formulation was introduced that enhanced the hydrophilicity of the lipophilic DS. The authors summarize the pharmacological properties of DS and comment on its indications, contraindications, adverse effects, and interactions with other drugs by reviewing reference articles.
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Affiliation(s)
- Hong Seuk Yang
- Department of Anesthesiology and Pain Medicine, Daejeon Eulji Medical Center, Eulji University School of Medicine, Daejeon, Korea
| | - Jae Moon Choi
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Junyong In
- Department of Anesthesiology and Pain Medicine, Dongguk University Ilsan Hospital, Dongguk University, Goyang, Korea
| | - Tae-yun Sung
- Department of Anesthesiology and Pain Medicine, Konyang University Hopsital, Konyang University College of Medicine, Daejeon, Korea
| | - Yong Beom Kim
- Department of Anesthesiology and Pain Medicine, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Shofina Sultana
- Department of Anesthesia, Analgesia and lntensive Care lVedicine, Bangabandhu Sheikh Mujib Medical University Dhaka, Bangladesh
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Patel J, Boyer N, Mensah K, Haider S, Gibson O, Martin D, Walter E. Critical illness aspects of heatstroke: A hot topic. J Intensive Care Soc 2023; 24:206-214. [PMID: 37260431 PMCID: PMC10227888 DOI: 10.1177/17511437221148922] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2023] Open
Abstract
Heatstroke represents the most severe end of the heat illness spectrum, and is increasingly seen in those undergoing exercise or exertion ('exertional heatstroke') and those exposed to high ambient temperatures, for example in heatwaves ('classical heatstroke'). Both forms may be associated with significant thermal injury, leading to organ dysfunction and the need for admission to an intensive care unit. The process may be exacerbated by translocation of bacteria or endotoxin through an intestinal wall rendered more permeable by the hyperthermia. This narrative review highlights the importance of early diagnosis, rapid cooling and effective management of complications. It discusses the incidence, clinical features and treatment of heatstroke, and discusses the possible role of intestinal permeability and advances in follow-up and recovery of this condition. Optimum treatment involves an integrated input from prehospital, emergency department and critical care teams, along with follow-up by rehabilitation teams and, if appropriate, sports or clinical physiologists.
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Affiliation(s)
- Jesal Patel
- Department of Intensive Care, Royal
Surrey County Hospital, Guildford, UK
| | - Naomi Boyer
- Department of Intensive Care, Royal
Surrey County Hospital, Guildford, UK
| | - Kwabena Mensah
- Department of Intensive Care, Royal
Surrey County Hospital, Guildford, UK
| | - Syeda Haider
- Department of Intensive Care, Royal
Surrey County Hospital, Guildford, UK
| | - Oliver Gibson
- Division of Sport, Health and Exercise
Sciences, Brunel University, London, UK
| | - Daniel Martin
- Department of Intensive Care, Derriford
Hospital, Plymouth, UK
- Peninsula Medical School, University of
Plymouth, UK
| | - Edward Walter
- Department of Intensive Care, Royal
Surrey County Hospital, Guildford, UK
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Severe heat stress modulated nuclear factor erythroid 2-related factor 2 and macrophage migration inhibitory factor pathway in rat liver. J Cell Commun Signal 2022; 16:547-566. [PMID: 35260968 PMCID: PMC9733776 DOI: 10.1007/s12079-022-00668-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 01/31/2022] [Indexed: 12/13/2022] Open
Abstract
Heat stress impairs physiology and overall functionality of the body at tissue and organ level in animals. Liver being a vital organ performs more than hundreds regulatory functions of the body. Present study investigates the modulation of molecular pathways that are responsible for liver damage triggered by heat stress. Male Sprague dawley rats were exposed to heat stress (45 °C) in heat simulation chamber till core temperature reaches 40 °C and 42 °C in 25 and 42 min respectively. For in-depth evaluation of liver functions during severe heat stress, hepatic transcriptome and proteome were analysed by microarray and two dimensional gel electrophoresis respectively. Results revealed major alterations in redox status, inflammation, mitochondrial dysfunction and proteostasis related pathways. Data of molecular pathway analysis demonstrate that nuclear factor erythroid 2-related factor 2 (NRF-2) mediated oxidative stress response and macrophage migration inhibitory factor (MIF) regulated inflammatory pathways were upregulated in severe heat stressed liver. Expression levels of downstream molecules of above pathways such as heat shock protein 90AB 1, peroxiredoxin 5, Jun N-terminal kinases 1/2, heme-oxygenase 1, apolipoprotein 1 and interleukin 10 were examined and result suggested the upregulation of these genes modulates the NRF-2 and MIF regulated pathways in heat stressed liver. Irregularity in molecular signalling networks lead to mitochondrial dysfunction indicated by upregulation of ATP synthase β and peroxiredoxin 1 along with decreased levels of glucose-6-phosphate dehydrogenase and enhanced activity of cytochrome c in liver mitochondria. Thus, current study demonstrated heat induced alterations in key liver functions were regulated by NRF-2 and MIF pathways.
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5
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On the Built-Environment Quality in Nearly Zero-Energy Renovated Schools: Assessment and Impact of Passive Strategies. ENERGIES 2021. [DOI: 10.3390/en14102799] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Indoor Environmental Quality (IEQ) is a crucial issue in school buildings, because of the conditions that pupils and students are exposed to. From this assumption, potentialities of retrofit actions with Nearly Zero-Energy Building (NZEB) targets were analyzed in existing school buildings, focusing on the impact of such measures of IEQ. Numerical analyses in a transient regime for a typical school building were carried out to assess the impacts on the thermal comfort and Indoor Air Quality (IAQ). The study took into account several building configurations and three reference cities. The results showed severe overheating risks in retrofitted schools: the operative temperature increased by several degrees with respect to the existing configuration, leading to thermal discomfort for a relevant part of the observation period. Passive techniques, namely external solar protection devices and night ventilative cooling, were applied to assess their mitigation potential. Results showed that the combination of the two solutions restored the pre-retrofit performance. CO2 levels were found to be too high for naturally ventilated buildings, regardless of the building configuration; acceptable levels might be reached only with long opening times of windows, which are unrealistic for real building operation.
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6
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Liu S, Xing L, Wang J, Xin T, Mao H, Zhao J, Li C, Song Q. The relationship between 24-hour indicators and mortality in patients with exertional heat stroke. Endocr Metab Immune Disord Drug Targets 2021; 22:241-246. [PMID: 33480352 DOI: 10.2174/1871530321666210122153249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 10/27/2020] [Accepted: 11/23/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Exertional heat stroke (EHS) is a life-threatening illness that can lead to multiple organ damage in the early stage. OBJECTIVE This study aimed to investigate the relationship between 24-hour indicators and mortality in patients with EHS. METHODS The records of EHS patients hospitalized were collected and divided into the death group and the survival group. We then analyzed the demographic characteristics and APACHE II scores and laboratory results of the participants in the blood within the first 24 h after hospitalization, and assessed whether these candidate indicators differed between the death group and the survival group. Cox regression analysis of the survival data was performed to explore the relationship between early indicators and prognosis. RESULTS The levels of plasma PT, APTT, TT, and INR were significantly higher in the death group than in the survival group. The blood PLT count and the levels of PTA and Fb were significantly lower in the death group than in the survival group, while the levels of BU, SCr, ALT, AST, TBil, and DBil were significantly higher in the death group than in the survival group. Furthermore, the levels of Mb, LDH, TNI, and NT-proBNP were significantly higher in the death group than in the survival group, while there was no significant difference in CK levels between the two groups. CONCLUSION Patients with EHS often had multiple organ injuries in the early stage (within 24 h), while those cases in the death group were more severe.
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Affiliation(s)
- Shuyuan Liu
- Medical School of Chinese PLA, Beijing 100853. China
| | - Ling Xing
- Medical School of Chinese PLA, Beijing 100853. China
| | - Jinpeng Wang
- Department of Epidemic, the Jingzhong Medical Center, Chinese PLA General Hospital, Beijing 100120. China
| | - Tianyu Xin
- Department of Emergency, Sixth Medical Center, Chinese PLA General Hospital, Beijing 100048. China
| | - Handing Mao
- Medical School of Chinese PLA, Beijing 100853. China
| | - Jinbao Zhao
- Medical School of Chinese PLA, Beijing 100853. China
| | - Cong Li
- Medical School of Chinese PLA, Beijing 100853. China
| | - Qing Song
- Medical School of Chinese PLA, Beijing 100853. China
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7
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Kakamu T, Endo S, Hidaka T, Masuishi Y, Kasuga H, Fukushima T. Heat-related illness risk and associated personal and environmental factors of construction workers during work in summer. Sci Rep 2021; 11:1119. [PMID: 33441683 PMCID: PMC7806839 DOI: 10.1038/s41598-020-79876-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 12/14/2020] [Indexed: 11/30/2022] Open
Abstract
Heat-related illness (HRI) is a common occupational injury, especially in construction workers. To explore the factors related to HRI risk in construction workers under hot outdoor working conditions, we surveyed vital and environmental data of construction workers in the summer season. Sixty-one workers joined the study and the total number of days when their vital data during working hours and environmental data were recorded was 1165. Heart rate with high-risk HRI was determined using the following formula: 180 − 0.65 × age. As a result of the logistic regression analysis, age, working area, maximum skin temperature, and heart rate immediately after warming up were significantly positively related, and experience of construction was significantly negatively related to heart rate with high-risk HRI. Heart rate immediately after warming up may indicate morning fatigue due to reasons such as insufficient sleep, too much alcohol intake the night before, and sickness. Asking morning conditions may lead to the prevention of HRI. For occupational risk management, monitoring of environmental and personal conditions is required.
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Affiliation(s)
- Takeyasu Kakamu
- Department of Hygiene and Preventive Medicine, Fukushima Medical University, Fukushima City, 1 Hikarigaoka, Fukushima, 960-1295, Japan.
| | - Shota Endo
- Department of Hygiene and Preventive Medicine, Fukushima Medical University, Fukushima City, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Tomoo Hidaka
- Department of Hygiene and Preventive Medicine, Fukushima Medical University, Fukushima City, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Yusuke Masuishi
- Department of Hygiene and Preventive Medicine, Fukushima Medical University, Fukushima City, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Hideaki Kasuga
- Department of Hygiene and Preventive Medicine, Fukushima Medical University, Fukushima City, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Tetsuhito Fukushima
- Department of Hygiene and Preventive Medicine, Fukushima Medical University, Fukushima City, 1 Hikarigaoka, Fukushima, 960-1295, Japan
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8
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Abstract
BACKGROUND: Exertional heat stroke (EHS) is defined by a core body temperature that exceeds 40°C with associated central nervous system dysfunction, skeletal muscle injury, and multiple organ damage. The most important initial focus of treatment involves reduction of patient temperature. First approaches to achieve temperature reduction often include ice packs, water blankets, and cold intravenous fluid administration. When these measures fail, more advanced temperature management methods may be deployed but often require surgical expertise. Esophageal temperature management (ETM) has recently emerged as a new temperature management modality in which an esophageal heat transfer device replaces the standard orogastric tube routinely placed after endotracheal intubation and adds a temperature modulation capability. The objective of this case study is to report the first known use of ETM driven by bedside nursing staff in the treatment of EHS. METHOD: An ETM device was placed after endotracheal intubation in a 28-year-old man experiencing EHS over a 5-day course of treatment. RESULTS: Because the ETM device was left in place, when the patient experienced episodes of increasing temperature as high as 39.1°C, which required active cooling, nursing staff were able to immediately adjust the external heat exchange unit settings to achieve aggressive cooling at bedside. CONCLUSION: This nurse-driven technology offers a new means to rapidly deploy cooling to critically ill patients without needing to implement advanced surgical approaches or obstruct access to the patient, freeing the provider to continue optimal care in high-morbidity conditions.
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9
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Alele FO, Malau-Aduli BS, Malau-Aduli AEO, J. Crowe M. Epidemiology of Exertional Heat Illness in the Military: A Systematic Review of Observational Studies. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E7037. [PMID: 32993024 PMCID: PMC7579124 DOI: 10.3390/ijerph17197037] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 09/22/2020] [Accepted: 09/23/2020] [Indexed: 12/13/2022]
Abstract
Exertional heat illness (EHI) is an occupational hazard among military personnel. This systematic review describes the incidence, risk factors, clinical manifestations, and biomarkers of EHI in the military. Six databases from inception to 28 May 2020 were systematically reviewed using the PRISMA guidelines. Forty-one articles met the inclusion criteria and the incidence of EHI ranged from 0.2 to 10.5 per 1000 person years, while the prevalence rates ranged from 0.3% to 9.3%. Intrinsic risk factors influencing EHI were gender, physical fitness, obesity, previous history of heat illness, and motivation, while the extrinsic factors included hot environmental conditions and service unit. Evidence suggests that loss of consciousness, absence of sweating and confusion were the common clinical features of exertional heat stroke (EHS). The mean core temperature ranged from 40 to 41.6 °C, while elevated levels of creatine phosphokinase, liver enzymes, and creatinine were common biochemical markers of EHS. The findings of the review suggest a variation in the incidence of EHI among military populations possibly due to the varying definitions used. Although some risk factors of EHI were identified, more analytical studies are needed to investigate the association between EHI and other important factors such as acclimatisation and occlusive clothing.
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Affiliation(s)
- Faith O. Alele
- College of Healthcare Sciences, James Cook University, Townsville QLD 4811, Australia
| | - Bunmi S. Malau-Aduli
- College of Medicine and Dentistry, James Cook University, Townsville QLD 4811, Australia;
| | - Aduli E. O. Malau-Aduli
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville QLD 4811, Australia;
| | - Melissa J. Crowe
- Division of Tropical Health and Medicine, James Cook University, Townsville QLD 4811, Australia;
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10
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Liu SY, Song JC, Mao HD, Zhao JB, Song Q. Expert consensus on the diagnosis and treatment of heat stroke in China. Mil Med Res 2020; 7:1. [PMID: 31928528 PMCID: PMC6956553 DOI: 10.1186/s40779-019-0229-2] [Citation(s) in RCA: 92] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Accepted: 11/20/2019] [Indexed: 12/18/2022] Open
Abstract
Heat stroke (HS) is a fatal disease caused by thermal damage in the body, and it has a very high mortality rate. In 2015, the People's Liberation Army Professional Committee of Critical Care Medicine published the first expert consensus on HS in China, Expert consensus on standardized diagnosis and treatment for heat stroke. With an increased understanding of HS and new issues that emerged during the HS treatment in China in recent years, the 2015 consensus no longer meet the requirements for HS prevention and treatment. It is necessary to update the consensus to include the latest research evidence and establish a new consensus that has broader coverage, is more practical and is more in line with China's national conditions. This new expert consensus includes new concept of HS, recommendations for laboratory tests and auxiliary examinations, new understanding of diagnosis and differential diagnosis, On-site emergency treatment and In-hospital treatment, translocation of HS patients and prevention of HS.
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Affiliation(s)
- Shu-Yuan Liu
- Emergency Department, Sixth Medical Center, Chinese PLA General Hospital, Beijing, 100048, China
| | - Jing-Chun Song
- Department of Critical Care Medicine, No. 908th Hospital of PLA, Nanchang, 360104, China
| | - Han-Ding Mao
- Department of Critical Care Medicine, First Medical Center, Chinese PLA General Hospital, Beijing, 100853, China
| | - Jin-Bao Zhao
- Emergency Department, Sixth Medical Center, Chinese PLA General Hospital, Beijing, 100048, China
| | - Qing Song
- Department of Critical Care Medicine, First Medical Center, Chinese PLA General Hospital, Beijing, 100853, China.
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Koman PD, Romo F, Swinton P, Mentz GB, de Majo RF, Sampson NR, Battaglia MJ, Hill-Knott K, Williams GO, O'Neill MS, Schulz AJ. MI-Environment: Geospatial patterns and inequality of relative heat stress vulnerability in Michigan. Health Place 2019; 60:102228. [PMID: 31654921 PMCID: PMC6944282 DOI: 10.1016/j.healthplace.2019.102228] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 09/16/2019] [Accepted: 09/20/2019] [Indexed: 10/25/2022]
Abstract
Heat stress causes morbidity and mortality and is increasing with climate change. Heat stress can pose particular challenges in northern regions not well adapted to heat. To assist decision makers, we identified the relative vulnerability of census tracts within Michigan to factors that increase exposure to heat stress or reflect susceptibilities in the population based on a California heat vulnerability index. In the MI-Environment assessment, we used a Geographic Information System (GIS) to combine future ensemble climate model projections to create a total of 9 geospatial and demographic variables. As part of a broader planned cumulative environmental exposure assessment, the statewide heat vulnerability index (HVI) maps display the location and relative magnitude of exposure on three metrics: built environment (Place), future expected long-term temperature averages (Temperature), and population susceptibility (People). We observed varied and distinct patterns for each of the three component indices. We assessed how equitably those exposures are distributed by racial and socioeconomic factors. This analysis showed that each of the component indices and the aggregate HVI are disproportionately distributed along racial and socioeconomic lines in Michigan. Census tracts with higher percentages of people of color had larger exposure to HVI factors with a deviation from equity of -0.115 [95% CI -0.108, -0.122]. Similarly, for census tracts with higher percentage of people experiencing poverty, the deviation from equity was -0.101 [95% CI -0.094, -0.107]. The MI-Environment visualization tool can help communities prepare for climate change and resolve inequities by identifying census tracts with the most vulnerable residents and highest potential exposures.
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Affiliation(s)
- Patricia D Koman
- University of Michigan School of Public Health, Environmental Health Sciences Department, 1415 Washington Heights, Ann Arbor, MI, 48109, USA.
| | - Frank Romo
- University of Michigan Taubman College of Architecture and Urban Planning, 2000 Bonisteel Blvd, Ann Arbor, MI, 48109, USA.
| | - Peter Swinton
- University of Michigan Taubman College of Architecture and Urban Planning, 2000 Bonisteel Blvd, Ann Arbor, MI, 48109, USA.
| | - Graciela B Mentz
- University of Michigan School of Public Health, Department of Health Behavior and Health Education, 1415 Washington Heights, Ann Arbor, MI, 48109, USA.
| | - Ricardo F de Majo
- University of Michigan School of Public Health, Department of Health Behavior and Health Education, 1415 Washington Heights, Ann Arbor, MI, 48109, USA.
| | - Natalie R Sampson
- University of Michigan -Dearborn, Department of Health & Human Services, 19000 Hubbard Drive, Fairlane Center South, Dearborn, MI, 48126, USA.
| | - Michael J Battaglia
- Michigan Technological Research Institute, Michigan Technological University, 3600 Green Road, Suite 100, Ann Arbor, MI, 48105, USA.
| | - Kimberly Hill-Knott
- Detroiters Working for Environmental Justice, 4750 Woodward Ave, Detroit, MI, 48201, USA.
| | - Guy O Williams
- Detroiters Working for Environmental Justice, 4750 Woodward Ave, Detroit, MI, 48201, USA.
| | - Marie S O'Neill
- University of Michigan School of Public Health, Department of Epidemiology and Environmental Health Sciences Department, 1415 Washington Heights, Ann Arbor, MI, 48109, USA.
| | - Amy J Schulz
- University of Michigan School of Public Health, Department of Health Behavior and Health Education, 1415 Washington Heights, Ann Arbor, MI, 48109, USA.
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12
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Xie S, Nicholson A, Woolford L, McWhorter TJ. Physiological, biochemical and histopathological changes associated with heatstroke in the galah (Eolophus roseicapilla) and rock dove (Columba livia). Avian Pathol 2018; 48:57-72. [PMID: 30411638 DOI: 10.1080/03079457.2018.1546824] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The pathophysiology of heat illnesses in birds has not been well characterized. In this study, we describe the changes in heart rate, respiratory rate, blood biochemistry and histopathological findings in galahs and rock doves after heat exposure under standardized conditions designed to induce heatstroke. Birds in the heat-exposed group were exposed to environmental heat stress and compared to control birds. Both groups of birds were under general anaesthesia throughout the experiment and serial blood collections were performed for biochemical analyses, while organs were collected at the end of the experiment for histopathology. No electromyography traces consistent with the onset of heat cramps were observed in any of the birds. Biochemical changes suggestive of skeletal muscle and hepatocellular injury, including hyperkalaemia and increased serum muscle and hepatic enzyme activities, were often observed in heat-exposed galahs and rock doves at the onset of heatstroke. Microscopic analyses did not reveal any significant cardiac changes, although some lungs had signs of acute congestion. Some heat-exposed rock doves had microscopic changes indicative of necrosis in the pectoral muscle. There were significant hepatic changes in some heat-exposed galahs, but not in rock doves. This suggests that there may be species differences amongst birds in the organs most affected by heatstroke. The observed species differences in the physiological, biochemical and histopathological changes indicate that bird species should be studied separately for clinical syndromes such as heatstroke. RESEARCH HIGHLIGHTS Biochemical changes suggestive of skeletal muscle and hepatocellular injury in heat-exposed galahs and rock doves at the onset of heatstroke No electromyography traces consistent with the onset of heat cramps were observed Some heat-exposed rock doves had indications of necrosis in the pectoral muscle There were significant hepatic changes in some heat-exposed galahs.
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Affiliation(s)
- Shangzhe Xie
- a Department of Conservation , Research and Veterinary Services, Wildlife Reserves Singapore , Singapore , Singapore.,b School of Animal & Veterinary Sciences , University of Adelaide , Adelaide , Australia
| | - Anthony Nicholson
- b School of Animal & Veterinary Sciences , University of Adelaide , Adelaide , Australia
| | - Lucy Woolford
- b School of Animal & Veterinary Sciences , University of Adelaide , Adelaide , Australia
| | - Todd J McWhorter
- b School of Animal & Veterinary Sciences , University of Adelaide , Adelaide , Australia
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13
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Panuganti B, Chang ES, Helm CW, Schwartz T, Hsueh EC, Piao J, Lai J, Veerapong J. Cytoreductive Surgery and Normothermic Intraperitoneal Chemotherapy for Signet Ring Cell Appendiceal Adenocarcinoma With Peritoneal Metastases in the Setting of Cirrhosis. Gastroenterology Res 2018; 11:247-251. [PMID: 29915638 PMCID: PMC5997481 DOI: 10.14740/gr1029w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Accepted: 05/15/2018] [Indexed: 12/15/2022] Open
Abstract
Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) are combined to treat peritoneal surface malignancies (PSM). The objective of cytoreduction is to eradicate macroscopic disease, while HIPEC addresses residual microscopic disease. Currently, there are no protocols guiding treatment of cirrhotic patients with PSM. We report the case of a cirrhotic patient with signet ring cell (SRC) appendiceal adenocarcinoma who underwent normothermic, as opposed to hyperthermic intraperitoneal chemotherapy (IPC). A 50-year-old woman with compensated class A cirrhosis and chronic hepatitis B and C underwent a right hemicolectomy in 2007 and adjuvant chemotherapy in 2008 for appendiceal SRC adenocarcinoma. In 2011, she was found to have peritoneal disease after a laparotomy. She subsequently experienced intolerance to chemotherapy, with stable disease on serial restaging. In light of her cirrhosis, the decision was made to perform CRS and IPC without hyperthermia to treat her residual disease. In 2012, she underwent CRS (omentectomy, total abdominal hysterectomy, left salpingo-oophorectomy) and IPC with mitomycin C. Thirty-day postoperative morbidity included delayed abdominal closure (Clavien-Dindo Grade IIIb), prolonged ventilator support (IIIa), vasopressor requirements (II), and confusion (II). The patient’s liver function remained stable. Eight months later, she had evidence of recurrence on computed tomography. Twenty-two months later, she developed an extrinsic compression secondary to evolving disease, requiring a palliative endoscopic stent. The patient expired from her disease 29 months after her CRS and IPC. The criteria guiding selection of suitable candidates for CRS continues to evolve. Concomitant compensated cirrhosis in patients with PSM should not constitute a reason independently to exclude CRS with intraperitoneal chemotherapy, given the oncologic benefits of the procedure.
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Affiliation(s)
- Bharat Panuganti
- Department of Surgery, University of California-San Diego, La Jolla, CA, USA
| | - Ea-Sle Chang
- Department of General Surgery, Saint Louis University, Saint Louis, MO, USA
| | - Cyril W Helm
- Royal Cornwall Hospitals NHS Trust, Treliske, Truro, Cornwall, TR1 3LJ, United Kingdom
| | - Theresa Schwartz
- Division of Surgical Oncology, Department of General Surgery, Saint Louis University, Saint Louis, MO, USA
| | - Eddy C Hsueh
- Division of Surgical Oncology, Department of General Surgery, Saint Louis University, Saint Louis, MO, USA
| | - Jinhua Piao
- Department of Pathology, Saint Louis University, Saint Louis, MO, USA
| | - Jinping Lai
- Department of Pathology, Immunology, and Laboratory Medicine, University of Florida College of Medicine, Gainesville, FL, USA
| | - Jula Veerapong
- Division of Surgical Oncology, Department of General Surgery, University of California-San Diego, La Jolla, CA, USA
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Koh YH. Heat Stroke with Status Epilepticus Secondary to Posterior Reversible Encephalopathy Syndrome (PRES). Case Rep Crit Care 2018; 2018:3597474. [PMID: 29984005 PMCID: PMC6011167 DOI: 10.1155/2018/3597474] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 04/17/2018] [Accepted: 05/08/2018] [Indexed: 11/25/2022] Open
Abstract
Heat stroke is a life threatening, multisystem disorder characterized by severe hyperthermia (core body temperature > 41.1°C) with central nervous system dysfunction and/or other end organ damage. Neurological complications, such as disturbances of consciousness, convulsion, profound mental change, disorientation, or even prolonged coma, were present in almost all cases of exertional heat stroke (EHS). We present a case of EHS with severe rhabdomyolysis and acute oliguric kidney injury in a 20-year-old healthy marathon runner, who developed status epilepticus on Day 4 of his admission. The patient was managed in ICU with renal replacement therapy and aggressive seizure control. He made a full recovery after 2 weeks of ICU stay. Diagnosis of EHS with posterior reversible encephalopathy syndrome (PRES) secondary to acute kidney injury was made.
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Affiliation(s)
- Y. H. Koh
- Department of Neurology, Singapore General Hospital, Singapore
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Abstract
Background Heat stroke is a life-threatening injury requiring neurocritical care; however, heat stroke has not been completely examined due to several possible reasons, such as no universally accepted definition or classification, and the occurrence of heat wave victims every few years. Thus, in this review, we elucidate the definition/classification, pathophysiology, and prognostic factors related to heat stroke and also summarize the results of current studies regarding the management of heat stroke, including the use of intravascular balloon catheter system, blood purification therapy, continuous electroencephalogram monitoring, and anticoagulation therapy. Main body Two systems for the definition/classification of heat stroke are available, namely Bouchama’s definition and the Japanese Association for Acute Medicine criteria. According to the detailed analysis of risk factors, prevention strategies for heat stroke, such as air conditioner use, are important. Moreover, hematological, cardiovascular, neurological, and renal dysfunctions on admission are associated with high mortality, which thus represent the potential targets for intensive and specific therapies for patients with heat stroke. No prospective, comparable study has confirmed the efficacy of intravascular cooling devices, anticoagulation, or blood purification in heat stroke. Conclusion The effectiveness of cooling devices, drugs, and therapies in heat stroke remains inconclusive. Further large studies are required to continue to evaluate these treatment strategies.
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Affiliation(s)
- Toru Hifumi
- 1Emergency Medical Center, Kagawa University Hospital, 1750-1 Ikenobe, Miki, Kita, Kagawa 761-0793 Japan.,5Department of Emergency and Critical Care Medicine, St. Luke's International Hospital, 9-1 Akashi-cho, Chuo-ku, Tokyo, 104-8560 Japan
| | - Yutaka Kondo
- 2Department of Emergency and Critical Care Medicine, Juntendo University, Urayasu Hospital, 2-1-1 Tomioka,Urayasu-shi, Chiba, 279-0021 Japan
| | - Keiki Shimizu
- Emergency and Critical Care Center, Tokyo Metropolitan Tama Medical Centre, 2-8-29 Musashidai, Fuchu-shi, Tokyo, 183-8524 Japan
| | - Yasufumi Miyake
- 4Department of Emergency Medicine, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-Ku, Tokyo, 173-8606 Japan
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Hayashida K, Kondo Y, Hifumi T, Shimazaki J, Oda Y, Shiraishi S, Fukuda T, Sasaki J, Shimizu K. A novel early risk assessment tool for detecting clinical outcomes in patients with heat-related illness (J-ERATO score): Development and validation in independent cohorts in Japan. PLoS One 2018; 13:e0197032. [PMID: 29742138 PMCID: PMC5942769 DOI: 10.1371/journal.pone.0197032] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Accepted: 04/25/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND We sought to develop a novel risk assessment tool to predict the clinical outcomes after heat-related illness. METHODS Prospective, multicenter observational study. Patients who transferred to emergency hospitals in Japan with heat-related illness were registered. The sample was divided into two parts: 60% to construct the score and 40% to validate it. A binary logistic regression model was used to predict hospital admission as a primary outcome. The resulting model was transformed into a scoring system. RESULTS A total of 3,001 eligible patients were analyzed. There was no difference in variables between development and validation cohorts. Based on the result of a logistic regression model in the development phase (n = 1,805), the J-ERATO score was defined as the sum of the six binary components in the prehospital setting (respiratory rate≥22 /min, Glasgow coma scale<15, systolic blood pressure≤100 mmHg, heart rate≥100 bpm, body temperature≥38°C, and age≥65 y), for a total score ranging from 0 to 6. In the validation phase (n = 1,196), the score had excellent discrimination (C-statistic 0.84; 95% CI 0.79-0.89, p<0.0001) and calibration (P>0.2 by Hosmer-Lemeshow test). The observed proportion of hospital admission increased with increasing J-ERATO score (score = 0, 5.0%; score = 1, 15.0%; score = 2, 24.6%; score = 3, 38.6%; score = 4, 68.0%; score = 5, 85.2%; score = 6, 96.4%). Multivariate analyses showed that the J-ERATO score was an independent positive predictor of hospital admission (adjusted OR, 2.43; 95% CI, 2.06-2.87; P<0.001), intensive care unit (ICU) admission (3.73; 2.95-4.72; P<0.001) and in-hospital mortality (1.65; 1.18-2.32; P = 0.004). CONCLUSIONS The J-ERATO score is simply assessed and can facilitate the identification of patients with higher risk of heat-related hospitalization. This scoring system is also significantly associated with the higher likelihood of ICU admission and in-hospital mortality after heat-related hospitalization.
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Affiliation(s)
- Kei Hayashida
- Department of Emergency and Critical Care Medicine, School of Medicine, Keio University, Tokyo, Japan
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital/ Harvard Medical School, Boston, Massachusetts, United States of America
| | - Yutaka Kondo
- Department of Emergency Medicine, Graduate School of Medicine, University of Ryukyus, Okinawa, Japan
| | - Toru Hifumi
- Emergency Medical Center, Kagawa University Hospital, Kagawa, Japan
| | - Junya Shimazaki
- Advanced Medical Emergency and Critical Care Center, Osaka University Hospital, Osaka, Japan
| | - Yasutaka Oda
- Advanced Medical Emergency and Critical Care Center, Yamaguchi University School of Medicine, Yamaguchi, Japan
| | | | - Tatsuma Fukuda
- Department of Emergency Medicine, Graduate School of Medicine, University of Ryukyus, Okinawa, Japan
| | - Junichi Sasaki
- Department of Emergency and Critical Care Medicine, School of Medicine, Keio University, Tokyo, Japan
| | - Keiki Shimizu
- Emergency and Critical Care Center, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan
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Strapazzon G, Reisten O, Argenone F, Zafren K, Zen-Ruffinen G, Larsen GL, Soteras I. International Commission for Mountain Emergency Medicine Consensus Guidelines for On-Site Management and Transport of Patients in Canyoning Incidents. Wilderness Environ Med 2018; 29:252-265. [PMID: 29422373 DOI: 10.1016/j.wem.2017.12.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Revised: 11/23/2017] [Accepted: 12/08/2017] [Indexed: 10/18/2022]
Abstract
Canyoning is a recreational activity that has increased in popularity in the last decade in Europe and North America, resulting in up to 40% of the total search and rescue costs in some geographic locations. The International Commission for Mountain Emergency Medicine convened an expert panel to develop recommendations for on-site management and transport of patients in canyoning incidents. The goal of the current review is to provide guidance to healthcare providers and canyoning rescue professionals about best practices for rescue and medical treatment through the evaluation of the existing best evidence, focusing on the unique combination of remoteness, water exposure, limited on-site patient management options, and technically challenging terrain. Recommendations are graded on the basis of quality of supporting evidence according to the classification scheme of the American College of Chest Physicians.
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Affiliation(s)
- Giacomo Strapazzon
- Institute of Mountain Emergency Medicine, Eurac Research, Bolzano, Italy; Corpo Nazionale Soccorso Alpino e Speleologico, National Medical School (CNSAS SNaMed), Milan, Italy (Dr Strapazzon); International Commission of Mountain Emergency Medicine (ICAR MEDCOM), Kloten, Switzerland (Drs Strapazzon, Reisten, Zafren, Zen-Ruffinen, and Soteras).
| | - Oliver Reisten
- International Commission of Mountain Emergency Medicine (ICAR MEDCOM), Kloten, Switzerland (Drs Strapazzon, Reisten, Zafren, Zen-Ruffinen, and Soteras); Air Zermatt Air and Mountain Rescue, Alpine Rescue Center, Zermatt, Switzerland; Rescue Service, Solothurn Hospital, Solothurn, Switzerland (Dr Reisten)
| | - Fabien Argenone
- Helicopter Emergency Medical Service 04, ICU, Centre Hospitalier de Digne, Digne les Bains, France; French Mountain Rescue Association (ANMSM Medcom), Grenoble, France (Dr Argenone)
| | - Ken Zafren
- International Commission of Mountain Emergency Medicine (ICAR MEDCOM), Kloten, Switzerland (Drs Strapazzon, Reisten, Zafren, Zen-Ruffinen, and Soteras); Department of Emergency Medicine, Stanford University Medical Center, Stanford, CA; Department of Emergency Medicine, Alaska Native Medical Center, Anchorage, AK (Dr Zafren)
| | - Greg Zen-Ruffinen
- International Commission of Mountain Emergency Medicine (ICAR MEDCOM), Kloten, Switzerland (Drs Strapazzon, Reisten, Zafren, Zen-Ruffinen, and Soteras); Air Glaciers SA et GRIMM, Sion, Switzerland (Dr Zen-Ruffinen)
| | - Gordon L Larsen
- Department of Emergency Medicine, Dixie Regional Medical Centre, St. George, UT; Search and Rescue Service, Zion National Park, Springdale, UT (Dr Larsen)
| | - Inigo Soteras
- International Commission of Mountain Emergency Medicine (ICAR MEDCOM), Kloten, Switzerland (Drs Strapazzon, Reisten, Zafren, Zen-Ruffinen, and Soteras); Cerdanya Hospital, Puigcerdà, Spain; Faculty of Medicine, Girona University, Girona, Spain (Dr Soteras)
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Heat Stroke: A Medical Emergency Appearing in New Regions. Case Rep Crit Care 2017; 2017:6219236. [PMID: 29057127 PMCID: PMC5615989 DOI: 10.1155/2017/6219236] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 07/25/2017] [Accepted: 08/06/2017] [Indexed: 12/31/2022] Open
Abstract
Heat stroke is an acute, life-threatening emergency characterized clinically by elevated body temperature and central nervous system dysfunction. Early recognition and treatment including aggressive cooling and management of life-threatening systemic complications are essential to reduce morbidity and mortality. This case report describes two Danish patients diagnosed with heat stroke syndrome during a heat wave in the summer of 2014. Both patients were morbidly obese and had several predisposing illnesses. However since heat stroke is a rare condition in areas with temperate climate, they were not diagnosed until several days after admittance; hence treatment with cooling was delayed. Both patients were admitted to the intensive care unit, where they were treated with an external cooling device and received treatment for complications. Both cases ended fatally. As global warming continues, more heat waves will occur in previously cooler regions. Therefore it is important to raise awareness of heat stroke since outcome depends on early recognition and rapid cooling.
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Jagai JS, Grossman E, Navon L, Sambanis A, Dorevitch S. Hospitalizations for heat-stress illness varies between rural and urban areas: an analysis of Illinois data, 1987-2014. Environ Health 2017; 16:38. [PMID: 28388909 PMCID: PMC5384150 DOI: 10.1186/s12940-017-0245-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Accepted: 03/30/2017] [Indexed: 05/10/2023]
Abstract
BACKGROUND The disease burden due to heat-stress illness (HSI), which can result in significant morbidity and mortality, is expected to increase as the climate continues to warm. In the United States (U.S.) much of what is known about HSI epidemiology is from analyses of urban heat waves. There is limited research addressing whether HSI hospitalization risk varies between urban and rural areas, nor is much known about additional diagnoses of patients hospitalized for HSI. METHODS Hospitalizations in Illinois for HSI (ICD-9-CM codes 992.x or E900) in the months of May through September from 1987 to 2014 (n = 8667) were examined. Age-adjusted mean monthly hospitalization rates were calculated for each county using U.S. Census population data. Counties were categorized into five urban-rural strata using Rural Urban Continuum Codes (RUCC) (RUCC1, most urbanized to RUCC5, thinly populated). Average maximum monthly temperature (°C) was calculated for each county using daily data. Multi-level linear regression models were used, with county as the fixed effect and temperature as random effect, to model monthly hospitalization rates, adjusting for the percent of county population below the poverty line, percent of population that is Non-Hispanic Black, and percent of the population that is Hispanic. All analyses were stratified by county RUCC. Additional diagnoses of patients hospitalized for HSI and charges for hospitalization were summarized. RESULTS Highest rates of HSI hospitalizations were seen in the most rural, thinly populated stratum (mean annual summer hospitalization rate of 1.16 hospitalizations per 100,000 population in the thinly populated strata vs. 0.45 per 100,000 in the metropolitan urban strata). A one-degree Celsius increase in maximum monthly average temperature was associated with a 0.34 increase in HSI hospitalization rate per 100,000 population in the thinly populated counties compared with 0.02 per 100,000 in highly urbanized counties. The most common additional diagnoses of patients hospitalized with HSI were dehydration, electrolyte abnormalities, and acute renal disorders. Total and mean hospital charges for HSI cases were $167.7 million and $20,500 (in 2014 US dollars). CONCLUSION Elevated temperatures appear to have different impacts on HSI hospitalization rates as function of urbanization. The most rural and the most urbanized counties of Illinois had the largest increases in monthly hospitalization rates for HSI per unit increase in the average monthly maximum temperature. This suggests that vulnerability of communities to heat is complex and strategies to reduce HSI may need to be tailored to the degree of urbanization of a county.
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Affiliation(s)
- Jyotsna S. Jagai
- Division of Environmental and Occupational Health Sciences, School of Public Health, University of Illinois at Chicago, Chicago, USA
| | - Elena Grossman
- Division of Environmental and Occupational Health Sciences, School of Public Health, University of Illinois at Chicago, Chicago, USA
| | - Livia Navon
- Centers for Disease Control and Prevention, Illinois Department of Public Health, Chicago, USA
| | - Apostolis Sambanis
- Division of Environmental and Occupational Health Sciences, School of Public Health, University of Illinois at Chicago, Chicago, USA
| | - Samuel Dorevitch
- Division of Environmental and Occupational Health Sciences, School of Public Health, University of Illinois at Chicago, Chicago, USA
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Heytens K, De Bleecker J, Verbrugghe W, Baets J, Heytens L. Exertional rhabdomyolysis and heat stroke: Beware of volatile anesthetic sedation. World J Crit Care Med 2017; 6:21-27. [PMID: 28224104 PMCID: PMC5295166 DOI: 10.5492/wjccm.v6.i1.21] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Revised: 09/27/2016] [Accepted: 11/17/2016] [Indexed: 02/06/2023] Open
Abstract
In view of the enormous popularity of mass sporting events such as half-marathons, the number of patients with exertional rhabdomyolysis or exercise-induced heat stroke admitted to intensive care units (ICUs) has increased over the last decade. Because these patients have been reported to be at risk for malignant hyperthermia during general anesthesia, the intensive care community should bear in mind that the same risk of life-threatening rhabdomyolysis is present when these patients are admitted to an ICU, and volatile anesthetic sedation is chosen as the sedative technique. As illustrated by the three case studies we elaborate upon, a thorough diagnostic work-up is needed to clarify the subsequent risk of strenuous exercise, and the anesthetic exposure to volatile agents in these patients and their families. Other contraindications for the use of volatile intensive care sedation consist of known malignant hyperthermia susceptibility, congenital myopathies, Duchenne muscular dystrophy, and intracranial hypertension.
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Ghatak I, Dhat V, Tilak MA, Roy I. Analysis of Arterial Blood Gas Report in Chronic Kidney Diseases - Comparison between Bedside and Multistep Systematic Method. J Clin Diagn Res 2016; 10:BC01-5. [PMID: 27656429 DOI: 10.7860/jcdr/2016/19830.8252] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2016] [Accepted: 05/24/2016] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Acid Base Disorders (ABDs) are commonly encountered in critically ill Chronic Kidney Disease (CKD) patients. Timely and correct analysis of Arterial Blood Gases (ABG) is critical for the diagnosis, treatment and prediction of outcome of the patients. AIM The aim was to explore type and prevalence of ABDs in 31 critically ill CKD patients from a tertiary care hospital in Maharashtra, to compare two methods of analysis- bedside and systematic approaches and to clinically correlate the nature of ABDs in these patients. MATERIALS AND METHODS The initial ABG reports of 31 consecutive CKD patients were analysed by two methods. Medica Easy stat analyser was the equipment for analysis with Principle of potentiometry and ion selective electrode for pH and pCO2 and amperometry for pO2. Serum albumin was also measured by Bromocresol green dye binding method using liquixx albumin kit in Erba XL 300 autoanalyser. STATISTICAL ANALYSIS Chi-square test was used for statistical analysis using Epi Info version 3.5.4 and SPSS 14.0 softwares. RESULTS The systematic method showed a significantly higher prevalence of mixed disorders (50%) compared to bedside method (12.9%). Most prevalent disorder by bedside method was metabolic acidosis in 15 cases (48.39%). By the systematic method, 3 reports were invalid. As a single category, most prevalent type was both simple respiratory alkalosis and mixed metabolic acidosis with respiratory alkalosis- 6 of 31 cases in each type (19.36% each). As a whole, metabolic acidosis (including both High Anion Gap Metabolic Acidosis or HAGMA and Non Anion Gap Metabolic Acidosis or NAGMA with 4 in each type) was most prevalent- 8 of 31(25.8%). CONCLUSION Systematic approach was more effective in diagnosing mixed acid base disorders. By systematic method the findings of analysis in most cases could be correlated with the clinical condition and provisional diagnosis. Thus interpretation of ABDs by using stepwise approach could be useful to the clinicians in early diagnosis and management of the patients.
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Affiliation(s)
- Ishita Ghatak
- Resident, Department of Biochemistry, Dr D Y Patil Medical College , Pimpri, Pune, Maharashtra, India
| | - Vaishali Dhat
- Professor, Department of Biochemistry, Dr D Y Patil Medical College , Pune, Maharashtra, India
| | - Mona A Tilak
- Professor and Head, Department of Biochemistry, Dr D Y Patil Medical College , Pune, Maharashtra, India
| | - Indranath Roy
- Medical Officer in Charge-Government Blood Bank, Chandannagar SD Hospital , Government of West Bengal, India
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Sugg MM, Konrad CE, Fuhrmann CM. Relationships between maximum temperature and heat-related illness across North Carolina, USA. INTERNATIONAL JOURNAL OF BIOMETEOROLOGY 2016; 60:663-75. [PMID: 26364040 DOI: 10.1007/s00484-015-1060-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Revised: 08/28/2015] [Accepted: 08/29/2015] [Indexed: 05/25/2023]
Abstract
Heat kills more people than any other weather-related event in the USA, resulting in hundreds of fatalities each year. In North Carolina, heat-related illness accounts for over 2,000 yearly emergency department admissions. In this study, data on emergency department (ED) visits for heat-related illness (HRI) were obtained from the North Carolina Disease Event Tracking and Epidemiologic Collection Tool to identify spatiotemporal relationships between temperature and morbidity across six warm seasons (May-September) from 2007 to 2012. Spatiotemporal relationships are explored across different regions (e.g., coastal plain, rural) and demographics (e.g., gender, age) to determine the differential impact of heat stress on populations. This research reveals that most cases of HRI occur on days with climatologically normal temperatures (e.g., 31 to 35 °C); however, HRI rates increase substantially on days with abnormally high daily maximum temperatures (e.g., 31 to 38 °C). HRI ED visits decreased on days with extreme heat (e.g., greater than 38 °C), suggesting that populations are taking preventative measures during extreme heat and therefore mitigating heat-related illness.
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Affiliation(s)
- Margaret M Sugg
- Department of Geography and Planning, Appalachian State University Boone, Rankin Science West, P.O. Box 32066, Boone, NC, 28608, USA.
| | - Charles E Konrad
- Southeast Regional Climate Center, Department of Geography, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Kalaiselvan MS, Renuka MK, Arunkumar AS. A retrospective study of clinical profile and outcomes of critically ill patients with heat-related illness. Indian J Anaesth 2016; 59:715-20. [PMID: 26755836 PMCID: PMC4697243 DOI: 10.4103/0019-5049.170030] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Background and Aims: Heat-related illness (HRI) due to high ambient temperatures is a common feature during the Indian summer. HRI often results in Intensive Care Unit (ICU) admissions and are associated with significant morbidity and mortality. However, published report on the effects of HRI among the Indian population is lacking. This study was undertaken to identify the profile of patients admitted to ICU with clinical features of HRI and study their clinical outcomes. Methods: This was a retrospective case series of patients admitted with features of HRI during the summer of 2012 in our multidisciplinary ICU. Data on demographics, co-morbid illness, admission severity of illness (Acute Physiology and Chronic Health Evaluation II [APACHE II]), organ failure scores (Sequential Organ Failure Assessment [SOFA]) and neuroimaging studies were collected. Outcome data studied included mortality, ICU length of stay (LOS), ventilator days and hospital LOS. Statistical analysis was performed using Student's t-test, Chi-square test and multivariate analysis. Results: Twenty-six patients met the diagnostic criteria for HRI. Fifteen were males. The mean age was 53.12 ± 18.6 years. Mean APACHE II score was 19.6 ± 7.7 and mean SOFA score was 7.5 ± 2.6. The common presenting symptoms were fever with neurological impairment (100%) and gastrointestinal symptoms (30%). Major organ systems involvement include neurological (100%), renal (57%), hepatic (34%) and coagulation abnormalities (26%). Most common metabolic abnormality noted was hyponatraemia (73%). Magnetic resonance imaging findings suggestive of heat stroke were seen in 5 of 26 patients. Mortality rate was 34%. 8 of 17 survivors had residual neurological impairment. Conclusion: HRI carries a high mortality and significant neurological morbidity.
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Affiliation(s)
- M S Kalaiselvan
- Department of Critical Care Medicine, Sri Ramachandra Medical College and Research Institute, Chennai, Tamil Nadu, India
| | - M K Renuka
- Department of Anesthesiology, Sri Ramachandra Medical College and Research Institute, Chennai, Tamil Nadu, India
| | - A S Arunkumar
- Department of Critical Care Medicine, Sri Ramachandra Medical College and Research Institute, Chennai, Tamil Nadu, India
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Poussel M, Guerci P, Kaminsky P, Heymonet M, Roux-Buisson N, Faure J, Fronzaroli E, Chenuel B. Exertional Heat Stroke and Susceptibility to Malignant Hyperthermia in an Athlete: Evidence for a Link? J Athl Train 2015; 50:1212-4. [PMID: 26565425 DOI: 10.4085/1062-6050-50.12.01] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To describe the possible association (pathophysiologic and clinical features) between exertional heat stroke (EHS) and malignant hyperthermia (MH). BACKGROUND Both EHS and MH are acute and life-threatening disorders. It has repeatedly been shown that EHS can occur in well-trained patients with known MH-associated mutation in the RYR1 gene in the absence of any extreme environmental conditions or extreme physical activity, thereby supporting a possible link between EHS and MH. In this case, a highly trained 30-year-old male athlete suddenly collapsed while running. He had initial hyperthermia (40.2°C) and progressive multiple organ failure requiring medical management in an intensive care unit. After he recovered completely, a maximal exercise test was performed and showed an obvious abnormality of oxidative metabolism in muscle; genetic analysis of the RYR1 gene identified a heterozygous missense variation p.K1393R. Consequently, the athlete was given appropriate information and allowed to progressively return to sport competition. DIFFERENTIAL DIAGNOSIS Doping, use of drugs and toxic agents, exercise-associated hyponatremia, exertional heat illness. TREATMENT Initial management started with the basic resuscitative guidelines of airway, breathing, and circulation (intubation). Cooling, administration of fresh frozen plasma, and intensive rehydration resulted in improvement. UNIQUENESS To our knowledge, ours is the first description of this MH mutation (p.K1393R) in the RYR1 gene that was associated with exertional rhabdomyolysis involving a dramatic impairment of oxidative metabolism in muscle. CONCLUSIONS Common features are shared by EHS and MH. Careful attention must therefore be paid to athletes who experience EHS, especially in temperate climates or when there are no other predisposing factors.
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Affiliation(s)
| | | | | | - Marie Heymonet
- Centre Hospitalier Regional Universitaire de Nancy, France
| | | | - Julien Faure
- Centre Hospitalier Universitaire de Grenoble, France
| | | | - Bruno Chenuel
- Centre Hospitalier Regional Universitaire de Nancy, France
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Kakamu T, Hidaka T, Hayakawa T, Kumagai T, Jinnouchi T, Tsuji M, Nakano S, Koyama K, Fukushima T. Risk and preventive factors for heat illness in radiation decontamination workers after the Fukushima Daiichi Nuclear Power Plant accident. J Occup Health 2015; 57:331-8. [DOI: 10.1539/joh.14-0218-oa] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Takeyasu Kakamu
- Department of Hygiene and Preventive MedicineFukushima Medical University School of MedicineJapan
| | - Tomoo Hidaka
- Department of Hygiene and Preventive MedicineFukushima Medical University School of MedicineJapan
| | - Takehito Hayakawa
- Department of Hygiene and Preventive MedicineFukushima Medical University School of MedicineJapan
| | - Tomohiro Kumagai
- Department of Hygiene and Preventive MedicineFukushima Medical University School of MedicineJapan
| | - Takanobu Jinnouchi
- Department of Hygiene and Preventive MedicineFukushima Medical University School of MedicineJapan
| | - Masayoshi Tsuji
- Department of Hygiene and Preventive MedicineFukushima Medical University School of MedicineJapan
| | | | - Kikuo Koyama
- Fukushima Occupational Health Promotion CenterJapan
| | - Tetsuhito Fukushima
- Department of Hygiene and Preventive MedicineFukushima Medical University School of MedicineJapan
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Truhlář A, Deakin CD, Soar J, Khalifa GEA, Alfonzo A, Bierens JJLM, Brattebø G, Brugger H, Dunning J, Hunyadi-Antičević S, Koster RW, Lockey DJ, Lott C, Paal P, Perkins GD, Sandroni C, Thies KC, Zideman DA, Nolan JP, Böttiger BW, Georgiou M, Handley AJ, Lindner T, Midwinter MJ, Monsieurs KG, Wetsch WA. European Resuscitation Council Guidelines for Resuscitation 2015: Section 4. Cardiac arrest in special circumstances. Resuscitation 2015; 95:148-201. [PMID: 26477412 DOI: 10.1016/j.resuscitation.2015.07.017] [Citation(s) in RCA: 527] [Impact Index Per Article: 58.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Anatolij Truhlář
- Emergency Medical Services of the Hradec Králové Region, Hradec Králové, Czech Republic; Department of Anaesthesiology and Intensive Care Medicine, University Hospital Hradec Králové, Hradec Králové, Czech Republic.
| | - Charles D Deakin
- Cardiac Anaesthesia and Cardiac Intensive Care, NIHR Southampton Respiratory Biomedical Research Unit, Southampton University Hospital NHS Trust, Southampton, UK
| | - Jasmeet Soar
- Anaesthesia and Intensive Care Medicine, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | | | - Annette Alfonzo
- Departments of Renal and Internal Medicine, Victoria Hospital, Kirkcaldy, Fife, UK
| | | | - Guttorm Brattebø
- Bergen Emergency Medical Services, Department of Anaesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway
| | - Hermann Brugger
- EURAC Institute of Mountain Emergency Medicine, Bozen, Italy
| | - Joel Dunning
- Department of Cardiothoracic Surgery, James Cook University Hospital, Middlesbrough, UK
| | | | - Rudolph W Koster
- Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands
| | - David J Lockey
- Intensive Care Medicine and Anaesthesia, Southmead Hospital, North Bristol NHS Trust, Bristol, UK; School of Clinical Sciences, University of Bristol, UK
| | - Carsten Lott
- Department of Anesthesiology, University Medical Center, Johannes Gutenberg-Universitaet, Mainz, Germany
| | - Peter Paal
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, Queen Mary University of London, London, UK; Department of Anaesthesiology and Critical Care Medicine, University Hospital Innsbruck, Austria
| | - Gavin D Perkins
- Warwick Medical School, University of Warwick, Coventry, UK; Critical Care Unit, Heart of England NHS Foundation Trust, Birmingham, UK
| | - Claudio Sandroni
- Department of Anaesthesiology and Intensive Care, Catholic University School of Medicine, Rome, Italy
| | | | - David A Zideman
- Department of Anaesthetics, Imperial College Healthcare NHS Trust, London, UK
| | - Jerry P Nolan
- Anaesthesia and Intensive Care Medicine, Royal United Hospital, Bath, UK; School of Clinical Sciences, University of Bristol, UK
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Hopkins P, Rüffert H, Snoeck M, Girard T, Glahn K, Ellis F, Müller C, Urwyler A. European Malignant Hyperthermia Group guidelines for investigation of malignant hyperthermia susceptibility. Br J Anaesth 2015; 115:531-9. [DOI: 10.1093/bja/aev225] [Citation(s) in RCA: 133] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Sagui E, Montigon C, Abriat A, Jouvion A, Duron-Martinaud S, Canini F, Zagnoli F, Bendahan D, Figarella-Branger D, Brégigeon M, Brosset C. Is there a link between exertional heat stroke and susceptibility to malignant hyperthermia? PLoS One 2015; 10:e0135496. [PMID: 26258863 PMCID: PMC4530942 DOI: 10.1371/journal.pone.0135496] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2014] [Accepted: 07/22/2015] [Indexed: 11/18/2022] Open
Abstract
Objective The identification of a predisposition toward malignant hyperthermia (MH) as a risk factor for exertional heat stroke (EHS) remains a matter of debate. Such a predisposition indicates a causal role for MH susceptibility (MHS) after EHS in certain national recommendations and has led to the use of an in vitro contracture test (IVCT) to identify the MHS trait in selected or unselected EHS patients. The aim of this study was to determine whether the MHS trait is associated with EHS. Methods EHS subjects in the French Armed Forces were routinely examined for MHS after experiencing an EHS episode. This retrospective study compared the features of IVCT-diagnosed MHS (iMHS) EHS subjects with those of MH-normal EHS patients and MH patients during the 2004–2010 period. MHS status was assessed using the European protocol. Results During the study period, 466 subjects (median age 25 years; 31 women) underwent MHS status investigation following an EHS episode. None of the subjects reported previous MH events. An IVCT was performed in 454 cases and was diagnostic of MHS in 45.6% of the study population, of MH susceptibility to halothane in 18.5%, of MH susceptibility to caffeine in 9.9%, and of MH susceptibility to halothane and caffeine in 17.2%. There were no differences in the clinical features, biological features or outcomes of iMHS EHS subjects compared with those of MH-normal or caffeine or halothane MHS subjects without known prior EHS episode. The recurrence rate was 12.7% and was not associated with MH status or any clinical or biological features. iMHS EHS patients exhibited a significantly less informative IVCT response than MH patients. Conclusions The unexpected high prevalence of the MHS trait after EHS suggested a latent disturbance of calcium homeostasis that accounted for the positive IVCT results. This study did not determine whether EHS patients have an increased risk of MH, and it could not determine whether MH susceptibility is a risk factor for EHS.
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Affiliation(s)
- Emmanuel Sagui
- French Military Hospital Laveran, Marseille, France
- Val de Grâce Military School, Paris, France
- Unité mixte de recherche 7291, laboratoire de neurosciences cognitives, Aix Marseille University, Marseille, France
- * E-mail:
| | - Coline Montigon
- French Military Hospital Laveran, Marseille, France
- Val de Grâce Military School, Paris, France
| | | | | | | | - Frédéric Canini
- Val de Grâce Military School, Paris, France
- Armed Forces Biomedical Research Institute, Brétigny/Orge, France
| | - Fabien Zagnoli
- Val de Grâce Military School, Paris, France
- French Military Hospital Clermont-Tonnerre, Brest, France
| | - David Bendahan
- Unité mixte de recherché 7339, Center for Magnetic Resonance in Biology and Medicine, Aix Marseille University, Marseille, France
| | - Dominique Figarella-Branger
- Service d’anatomie pathologique et de neuropathologie, Timone hospital, assistance publique/hôpitaux de Marseille, Marseille, France
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Rosenberg H, Pollock N, Schiemann A, Bulger T, Stowell K. Malignant hyperthermia: a review. Orphanet J Rare Dis 2015; 10:93. [PMID: 26238698 PMCID: PMC4524368 DOI: 10.1186/s13023-015-0310-1] [Citation(s) in RCA: 286] [Impact Index Per Article: 31.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2015] [Accepted: 07/22/2015] [Indexed: 02/06/2023] Open
Abstract
Malignant hyperthermia (MH) is a pharmacogenetic disorder of skeletal muscle that presents as a hypermetabolic response to potent volatile anesthetic gases such as halothane, sevoflurane, desflurane, isoflurane and the depolarizing muscle relaxant succinylcholine, and rarely, in humans, to stressors such as vigorous exercise and heat. The incidence of MH reactions ranges from 1:10,000 to 1: 250,000 anesthetics. However, the prevalence of the genetic abnormalities may be as great as one in 400 individuals. MH affects humans, certain pig breeds, dogs and horses. The classic signs of MH include hyperthermia, tachycardia, tachypnea, increased carbon dioxide production, increased oxygen consumption, acidosis, hyperkalaemia, muscle rigidity, and rhabdomyolysis, all related to a hypermetabolic response. The syndrome is likely to be fatal if untreated. An increase in end-tidal carbon dioxide despite increased minute ventilation provides an early diagnostic clue. In humans the syndrome is inherited in an autosomal dominant pattern, while in pigs it is autosomal recessive. Uncontrolled rise of myoplasmic calcium, which activates biochemical processes related to muscle activation leads to the pathophysiologic changes. In most cases, the syndrome is caused by a defect in the ryanodine receptor. Over 400 variants have been identified in the RYR1 gene located on chromosome 19q13.1, and at least 34 are causal for MH. Less than 1 % of variants have been found in CACNA1S but not all of these are causal. Diagnostic testing involves the in vitro contracture response of biopsied muscle to halothane, caffeine, and in some centres ryanodine and 4-chloro-m-cresol. Elucidation of the genetic changes has led to the introduction of DNA testing for susceptibility to MH. Dantrolene sodium is a specific antagonist and should be available wherever general anesthesia is administered. Increased understanding of the clinical manifestation and pathophysiology of the syndrome, has lead to the mortality decreasing from 80 % thirty years ago to <5 % in 2006.
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Affiliation(s)
- Henry Rosenberg
- Department of Medical Education and Clinical Research, Saint Barnabas Medical Center, Livingston, NJ, 07039, USA.
| | - Neil Pollock
- Department of Anesthesia and Intensive Care, Palmerston North Hospital, Palmerston North, New Zealand.
| | - Anja Schiemann
- Institute of Fundamental Sciences, Massey University, Palmerston North, New Zealand.
| | - Terasa Bulger
- Department of Anesthesia and Intensive Care, Palmerston North Hospital, Palmerston North, New Zealand.
| | - Kathryn Stowell
- Institute of Fundamental Sciences, Massey University, Palmerston North, New Zealand.
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Wen YT, Liu TT, Lin YF, Chen CC, Kung WM, Huang CC, Lin TJ, Wang YH, Wei L. Heatstroke Effect on Brain Heme Oxygenase-1 in Rats. Int J Med Sci 2015; 12:737-41. [PMID: 26392811 PMCID: PMC4571551 DOI: 10.7150/ijms.12517] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Accepted: 08/09/2015] [Indexed: 02/05/2023] Open
Abstract
Exposure to high environmental temperature leading to increased core body temperature above 40°C and central nervous system abnormalities such as convulsions, delirium, or coma is defined as heat stroke. Studies in humans and animals indicate that the heat shock responses of the host contribute to multiple organ injury and death during heat stroke. Heme oxygenase-1 (HO-1)-a stress-responsive enzyme that catabolizes heme into iron, carbon monoxide, and biliverdin-has an important role in the neuroprotective mechanism against ischemic stroke. Here, we investigated the role of endogenous HO-1 in heat-induced brain damage in rats. RT-PCR results revealed that levels of HO-1 mRNA peaked at 0 h after heat exposure and immunoblot analysis revealed that the maximal protein expression occurred at 1 h post-heat exposure. Subsequently, we detected the HO-1 expression in the cortical brain cells and revealed the neuronal cell morphology. In conclusion, HO-1 is a potent protective molecule against heat-induced brain damage. Manipulation of HO-1 may provide a potential therapeutic approach for heat-related diseases.
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Affiliation(s)
- Ya-Ting Wen
- 1. Department of Neurosurgery, Taipei Medical University-Wan Fang Hospital, Taipei 11696, Taiwan
| | - Tsung-Ta Liu
- 2. Department of Biology and Anatomy, National Defense Medical Center, Taipei 114, Taiwan
| | - Yuh-Feng Lin
- 3. Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan
| | - Chun-Chi Chen
- 4. Division of Nephrology, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan
| | - Woon-Man Kung
- 5. Department of Neurosurgery, Lo-Hsu Foundation, Lotung Poh-Ai Hospital, Luodong, Yilan 265, Taiwan
- 6. Department of Exercise and Health Promotion, College of Education, Chinese Culture University, Taipei 11114, Taiwan
| | - Chi-Chang Huang
- 7. Graduate Institute of Sports Science, National Taiwan Sport University, Taoyuan 33301, Taiwan
| | - Tien-Jen Lin
- 1. Department of Neurosurgery, Taipei Medical University-Wan Fang Hospital, Taipei 11696, Taiwan
- 8. Graduate Institute of Injury Prevention and Control, College of Public Health and Nutrition, Taipei Medical University, Taipei 11031, Taiwan
| | - Yuan-Hung Wang
- 3. Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan
- 9. Division of General Surgery, Department of Urology, Shuang Ho Hospital, Taipei Medical University, New Taipei City 23561, Taiwan
- ✉ Corresponding authors: Dr. Li Wei: Department of Neurosurgery, Taipei Medical University-Wan Fang Hospital, Taipei, Taiwan. Tel.: +886-2-29307930 (ext. 6942). E-Mail: . Dr. Yuan-Hung Wang: Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan. Tel.: +886-2-22490088 (ext. 8891). E-Mail:
| | - Li Wei
- 1. Department of Neurosurgery, Taipei Medical University-Wan Fang Hospital, Taipei 11696, Taiwan
- 10. The PhD Program of Translational Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan
- ✉ Corresponding authors: Dr. Li Wei: Department of Neurosurgery, Taipei Medical University-Wan Fang Hospital, Taipei, Taiwan. Tel.: +886-2-29307930 (ext. 6942). E-Mail: . Dr. Yuan-Hung Wang: Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan. Tel.: +886-2-22490088 (ext. 8891). E-Mail:
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Stallings JD, Ippolito DL, Rakesh V, Baer CE, Dennis WE, Helwig BG, Jackson DA, Leon LR, Lewis JA, Reifman J. Patterns of gene expression associated with recovery and injury in heat-stressed rats. BMC Genomics 2014; 15:1058. [PMID: 25471284 PMCID: PMC4302131 DOI: 10.1186/1471-2164-15-1058] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2014] [Accepted: 11/24/2014] [Indexed: 02/08/2023] Open
Abstract
Background The in vivo gene response associated with hyperthermia is poorly understood. Here, we perform a global, multiorgan characterization of the gene response to heat stress using an in vivo conscious rat model. Results We heated rats until implanted thermal probes indicated a maximal core temperature of 41.8°C (Tc,Max). We then compared transcriptomic profiles of liver, lung, kidney, and heart tissues harvested from groups of experimental animals at Tc,Max, 24 hours, and 48 hours after heat stress to time-matched controls kept at an ambient temperature. Cardiac histopathology at 48 hours supported persistent cardiac injury in three out of six animals. Microarray analysis identified 78 differentially expressed genes common to all four organs at Tc,Max. Self-organizing maps identified gene-specific signatures corresponding to protein-folding disorders in heat-stressed rats with histopathological evidence of cardiac injury at 48 hours. Quantitative proteomics analysis by iTRAQ (isobaric tag for relative and absolute quantitation) demonstrated that differential protein expression most closely matched the transcriptomic profile in heat-injured animals at 48 hours. Calculation of protein supersaturation scores supported an increased propensity of proteins to aggregate for proteins that were found to be changing in abundance at 24 hours and in animals with cardiac injury at 48 hours, suggesting a mechanistic association between protein misfolding and the heat-stress response. Conclusions Pathway analyses at both the transcript and protein levels supported catastrophic deficits in energetics and cellular metabolism and activation of the unfolded protein response in heat-stressed rats with histopathological evidence of persistent heat injury, providing the basis for a systems-level physiological model of heat illness and recovery. Electronic supplementary material The online version of this article (doi:10.1186/1471-2164-15-1058) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jonathan D Stallings
- Environmental Health Program, U,S, Army Center for Environmental Health Research, Bldg, 568 Doughten Drive, MD 21702-5010 Fort Detrick, Maryland.
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Li Y, Wang Y, Ma L. An association study of CASQ1 gene polymorphisms and heat stroke. GENOMICS, PROTEOMICS & BIOINFORMATICS 2014; 12:127-32. [PMID: 24887214 PMCID: PMC4411341 DOI: 10.1016/j.gpb.2014.03.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Accepted: 03/31/2014] [Indexed: 11/17/2022]
Abstract
Although molecular mechanisms of heat stroke under physiological and pathological conditions have not yet been elucidated, a novel disease-associated gene encoding a calcium-binding protein, calsequestrin-1 (CASQ1), was suggested relevant based on results from a transgenic murine model. Here, we show the association between single nucleotide polymorphisms (SNPs) of CASQ1 and physiological parameters for heat stroke from a study involving 150 patients. Pooled DNA from heat stroke patients were subjected to sequencing and 3 SNPs were identified. Genotypes were assigned for all patients according to g. 175A>G, one SNP which leads to a nonsynonymous substitution (N59D) in the first exon of human CASQ1 gene. We analyzed the genotypic data with a linear model based on significance scores between SNP (175A>G) and heat stroke parameters. As a result, we found a significant association between SNP A175G and heat stroke (P<0.05). Further bioinformatics analysis of the 1-Mb flanking sequence revealed the presence of two genes that encode DDB1 and CUL4 associated factor 8 (DCAF8), and peroxisomal biogenesis factor 19 (PEX19), respectively, which might be functionally related to CASQ1. Our results showed that the blood calcium of patients with allele D increased significantly, compared to patients with allele N (P<0.05), which may result from the decreased calcium in muscle, suggesting that N59D in CASQ1 might account for the dysfunction of CASQ1 in calcium regulation during heat stroke.
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Affiliation(s)
- Ying Li
- Department of Radiology, Chinese PLA Medical School, Beijing 100853, China
| | - Yu Wang
- Department of Health Medicine, Beijing Electric Power Hospital, Beijing 100073, China
| | - Lin Ma
- Department of Radiology, Chinese PLA Medical School, Beijing 100853, China.
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Ji J, Zhou F, Yue H, Song Q. Protective mechanism of Xuebijing injection against heat stroke in rats. Exp Ther Med 2014; 7:1745-1751. [PMID: 24926378 PMCID: PMC4043590 DOI: 10.3892/etm.2014.1639] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2013] [Accepted: 02/25/2014] [Indexed: 12/03/2022] Open
Abstract
This study aimed to investigate the protective mechanism of Xuebijing injection (XBJ) against heat stroke (HS) in rats. Adult male Sprague Dawley rats were randomly divided into normal control (NC), normal saline-treated HS (NS-HS) and XBJ-treated HS (XBJ-HS) groups. At 47 and 57 min from the initiation of heat stress (42.5–43.5°C), the plasma levels of certain cytokines [interleukin (IL)-1β, IL-6 and tumor necrosis factor-α], biochemical indicators (creatinine, blood urea nitrogen, aspartate aminotransferase, alanine aminotransferase and alkaline phosphatase) and coagulation indicators (activated partial thromboplastin time, prothrombin time, fibrinogen degradation products and D-dimer) were detected, and microscopy of the liver tissue of the rats was conducted. At 47 and 57 min after the initiation of the heat stress, the levels of the cytokines, coagulation indicators and biochemical indicators in the NS-HS group were significantly higher than those in the NC group (P<0.05). In the NS-HS group, the levels of the aforementioned indices were significantly reduced compared with those in the NC and NS-HS groups (P<0.05). In the NS-HS group, serious liver cell congestion, nuclear swelling and central vein dilation were visible, along with the appearance of bubbles in the liver tissue. In the XBJ-HS group, only a small number of congestive liver cells were identified, with occasional nuclear swelling but no bubbles, which was similar to the observations in the NC group. Early intervention treatment of HS with XBJ is able to reduce the systemic inflammatory response and coagulation activity and decrease the tissue ischemia and injury degree, thus extending the survival time of rats with HS.
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Affiliation(s)
- Jun Ji
- Department of Critical Care Medicine, Chinese People's Liberation Army General Hospital, Beijing 100853, P.R. China
| | - Feihu Zhou
- Department of Critical Care Medicine, Chinese People's Liberation Army General Hospital, Beijing 100853, P.R. China
| | - Hui Yue
- Department of Critical Care Medicine, Chinese People's Liberation Army General Hospital, Beijing 100853, P.R. China
| | - Qing Song
- Department of Critical Care Medicine, Chinese People's Liberation Army General Hospital, Beijing 100853, P.R. China
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Heat-related deaths in hot cities: estimates of human tolerance to high temperature thresholds. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2014; 11:3304-26. [PMID: 24658410 PMCID: PMC3987036 DOI: 10.3390/ijerph110303304] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/19/2013] [Revised: 03/07/2014] [Accepted: 03/07/2014] [Indexed: 11/22/2022]
Abstract
In this study we characterized the relationship between temperature and mortality in central Arizona desert cities that have an extremely hot climate. Relationships between daily maximum apparent temperature (ATmax) and mortality for eight condition-specific causes and all-cause deaths were modeled for all residents and separately for males and females ages <65 and ≥65 during the months May–October for years 2000–2008. The most robust relationship was between ATmax on day of death and mortality from direct exposure to high environmental heat. For this condition-specific cause of death, the heat thresholds in all gender and age groups (ATmax = 90–97 °F; 32.2‒36.1 °C) were below local median seasonal temperatures in the study period (ATmax = 99.5 °F; 37.5 °C). Heat threshold was defined as ATmax at which the mortality ratio begins an exponential upward trend. Thresholds were identified in younger and older females for cardiac disease/stroke mortality (ATmax = 106 and 108 °F; 41.1 and 42.2 °C) with a one-day lag. Thresholds were also identified for mortality from respiratory diseases in older people (ATmax = 109 °F; 42.8 °C) and for all-cause mortality in females (ATmax = 107 °F; 41.7 °C) and males <65 years (ATmax = 102 °F; 38.9 °C). Heat-related mortality in a region that has already made some adaptations to predictable periods of extremely high temperatures suggests that more extensive and targeted heat-adaptation plans for climate change are needed in cities worldwide.
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Jeon J, Song S, Kim MC, Kim KM, Lee S. The effect of long-term oral dantrolene on the neuromuscular action of rocuronium: a case report. Korean J Anesthesiol 2014; 66:153-6. [PMID: 24624274 PMCID: PMC3948443 DOI: 10.4097/kjae.2014.66.2.153] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2012] [Revised: 01/17/2013] [Accepted: 01/28/2013] [Indexed: 11/10/2022] Open
Abstract
Oral dantrolene causes a dose-dependent depression of skeletal muscle contractility. A 52-year-old man treated with oral dantrolene for spasticity after spinal cord injury was scheduled to undergo irrigation and drainage of a thigh abscess under general anesthesia. He had taken 50 mg oral dantrolene per day for 3 years. Under standard neuromuscular monitoring, anesthesia was performed with propofol, rocuronium, and sevoflurane. A bolus dose of ED95 (0.3 mg/kg) of rocuronium could not depress T1 up to 95%. An additional dose of rocuronium depressed T1 completely and decreased the train-of-four (TOF) count to zero. There was no apparent prolongation of the neuromuscular blocking action of rocuronium. The TOF ratio was recovered to more than 0.9 within 40 minutes after the last dose of rocuronium. A small dose of oral dantrolene does not prolong the duration of action and recovery of rocuronium.
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Affiliation(s)
- Jinwoo Jeon
- Department of Anesthesiology and Pain Medicine, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Sejin Song
- Department of Anesthesiology and Pain Medicine, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Mun-Cheol Kim
- Department of Anesthesiology and Pain Medicine, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Kye-Min Kim
- Department of Anesthesiology and Pain Medicine, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Sangseok Lee
- Department of Anesthesiology and Pain Medicine, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
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Rakesh V, Stallings JD, Helwig BG, Leon LR, Jackson DA, Reifman J. A 3-D mathematical model to identify organ-specific risks in rats during thermal stress. J Appl Physiol (1985) 2013; 115:1822-37. [DOI: 10.1152/japplphysiol.00589.2013] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Early prediction of the adverse outcomes associated with heat stress is critical for effective management and mitigation of injury, which may sometimes lead to extreme undesirable clinical conditions, such as multiorgan dysfunction syndrome and death. Here, we developed a computational model to predict the spatiotemporal temperature distribution in a rat exposed to heat stress in an attempt to understand the correlation between heat load and differential organ dysfunction. The model includes a three-dimensional representation of the rat anatomy obtained from medical imaging and incorporates the key mechanisms of heat transfer during thermoregulation. We formulated a novel approach to estimate blood temperature by accounting for blood mixing from the different organs and to estimate the effects of the circadian rhythm in body temperature by considering day-night variations in metabolic heat generation and blood perfusion. We validated the model using in vivo core temperature measurements in control and heat-stressed rats and other published experimental data. The model predictions were within 1 SD of the measured data. The liver demonstrated the greatest susceptibility to heat stress, with the maximum temperature reaching 2°C higher than the measured core temperature and 95% of its volume exceeding the targeted experimental core temperature. Other organs also attained temperatures greater than the core temperature, illustrating the need to monitor multiple organs during heat stress. The model facilitates the identification of organ-specific risks during heat stress and has the potential to aid in the development of improved clinical strategies for thermal-injury prevention and management.
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Affiliation(s)
- Vineet Rakesh
- Department of Defense Biotechnology High Performance Computing Software Applications Institute, Telemedicine and Advanced Technology Research Center, United States Army Medical Research and Materiel Command, Fort Detrick, Maryland
| | - Jonathan D. Stallings
- Biomarkers Program, United States Army Center for Environmental Health Research, Fort Detrick, Maryland; and
| | - Bryan G. Helwig
- Thermal Mountain Medicine Division, United States Army Research Institute of Environmental Medicine, Natick, Massachusetts
| | - Lisa R. Leon
- Thermal Mountain Medicine Division, United States Army Research Institute of Environmental Medicine, Natick, Massachusetts
| | - David A. Jackson
- Biomarkers Program, United States Army Center for Environmental Health Research, Fort Detrick, Maryland; and
| | - Jaques Reifman
- Department of Defense Biotechnology High Performance Computing Software Applications Institute, Telemedicine and Advanced Technology Research Center, United States Army Medical Research and Materiel Command, Fort Detrick, Maryland
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Hindle EM, Henning JD. Critical care at extremes of temperature: effects on patients, staff and equipment. J ROY ARMY MED CORPS 2013; 160:279-85. [PMID: 24254745 DOI: 10.1136/jramc-2013-000076] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Modern travel and military operations have led to a significant increase in the need to provide medical care in extreme climates. Presently, there are few data on what happens to the doctor, their drugs and equipment when exposed to these extremes. A review was undertaken to find out the effects of 'extreme heat or cold' on anaesthesia and critical care; in addition, subject matter experts were contacted directly. Both extreme heat and extreme cold can cause a marked physiological response in a critically ill patient and the doctor treating these patients may also suffer a decrement in both physical and mental functioning. Equipment can malfunction when exposed to extremes of temperature and should ideally be stored and operated in a climatically controlled environment. Many drugs have a narrow range of temperatures in which they remain useable though some have been shown to remain effective if exposed to extremes of temperature for a short period of time. All personnel embarking on an expedition to an extreme temperature zone should be of sufficient physical robustness and ideally should have a period of acclimatisation which may help mitigate against some of the physiological effects of exposure to extreme heat or extreme cold. Expedition planners should aim to provide climatic control for drugs and equipment and should have logistical plans for replenishment of drugs and medical evacuation of casualties.
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Affiliation(s)
- Elise M Hindle
- Department of Anaesthesia, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - J D Henning
- Intensive Care Unit, James Cook University Hospital, Middlesbrough, UK
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Herlich A. Perioperative temperature elevation: not all hyperthermia is malignant hyperthermia. Paediatr Anaesth 2013; 23:842-50. [PMID: 23890328 DOI: 10.1111/pan.12244] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/08/2013] [Indexed: 12/01/2022]
Abstract
OBJECTIVES The objective of this review is to assist the readers, anesthesiologists, intensivists, and emergency physicians in making a more accurate diagnosis of perioperative fever or hyperthermia and subsequently choose the proper course of treatment. AIM To identify the many sources of perioperative fever and after a more accurate differential diagnosis, select appropriate treatment options. Most anesthesiologists, intensivists, and emergency physicians are not familiar with an expansive differential of perioperative fever. This article attempts to expose these physicians to that differential diagnosis. BACKGROUND Much of the medical literature has anecdotal reports, small case series, or limited reviews of the possible sources of hyperthermia or fever. This is especially true of the anesthesia literature. RESULTS A literature search was performed which identified many possible common and uncommon sources of fever. Some of these sources are quite relevant to the anesthesiologist. Other sources had potential relevance in obscure cases.
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Affiliation(s)
- Andrew Herlich
- Department of Anesthesiology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15261, USA.
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Kanikowska D, Sato M, Sugenoya J, Shimizu Y, Nishimura N, Inukai Y, Iwase S. Attenuated thermoregulatory responses with increased plasma osmolality in obese subjects during two seasons. INTERNATIONAL JOURNAL OF BIOMETEOROLOGY 2013; 57:663-667. [PMID: 23053063 DOI: 10.1007/s00484-012-0592-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2012] [Revised: 07/18/2012] [Accepted: 09/06/2012] [Indexed: 06/01/2023]
Abstract
Obese subjects may be more vulnerable to injury from heat stress, and appear to be less efficient at thermoregulation. Sweat rate, tympanic temperature and osmolality in obese subjects were investigated in Japan during two seasons. The purpose of this study was to examine the relationship between obesity, thermoregulatory response and season. Five obese (BMI, 32.0 ± 4.9 kg/m²) and five non-obese (BMI, 23.2 ± 2.9 kg/m²) men participated in this experiment at latitude 35°10' N and longitude 136°57.9'E. The average atmospheric temperature was 29.1 ± 1.0 °C in summer and 3.3 ± 1.4 °C in winter. Tympanic temperature and sweat rate were measured during leg water immersion at 42 °C for 30 min. Blood samples were analyzed for plasma osmolality. The relationship between tympanic temperature and sweat rate decreased significantly in obese compared to in non-obese subjects in both seasons, there being a lowered sweat rate for any core temperature in obese subjects. Plasma osmolality was significantly higher in obese than in non-obese subjects in both seasons. Thermal sensation increased significantly in non-obese than in obese in winter but not in summer. Our data show that thermoregulatory responses are attenuated in obese subjects compared with controls, suggesting that obese people are at increased risk of heat-related illnesses.
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Raj VMS, Alladin A, Pfeiffer B, Katsoufis C, Defreitas M, Edwards-Richards A, Chandar J, Seeherunvong W, McLaughlin G, Zilleruelo G, Abitbol CL. Therapeutic plasma exchange in the treatment of exertional heat stroke and multiorgan failure. Pediatr Nephrol 2013; 28:971-4. [PMID: 23338054 DOI: 10.1007/s00467-013-2409-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2012] [Revised: 12/24/2012] [Accepted: 01/02/2013] [Indexed: 10/27/2022]
Abstract
BACKGROUND Exertional heat stroke (EHS) results in a constellation of systemic inflammatory responses resulting in multiorgan failure and an extremely high mortality. CASE DIAGNOSIS AND TREATMENTS We present the case of an 11-year-old obese male who suffered EHS with rhabdomyolysis and concurrent renal, pulmonary, and hepatic failure. Conventional therapies including continuous veno-venous hemodiafiltration (CVVHDF) were ineffective in preventing ongoing deterioration in clinical status. Liver biopsy was reported as "extensive hepatocyte ballooning" and liver-kidney transplantation was tentatively planned. CONCLUSIONS The addition of therapeutic plasma exchange using the Prismaflex® system (Gambro, Lakewood, CO, USA) resulted in a reversal of the inflammatory process and recovery from multiorgan failure. Liver biopsy was not a reliable indicator of irreversible hepatic injury.
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Affiliation(s)
- Vimal Master Sankar Raj
- Department of Pediatrics, Division of Pediatric Nephrology (R-714), University of Miami/Holtz Children's Hospital at Jackson Health System, PO Box 016960, Miami, FL 33101, USA
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Fatal heat stroke in a schizophrenic patient. Case Rep Crit Care 2012; 2012:924328. [PMID: 24860681 PMCID: PMC4010046 DOI: 10.1155/2012/924328] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2012] [Accepted: 10/22/2012] [Indexed: 11/18/2022] Open
Abstract
Objective. The case of a patient who developed a fatal post-exertional heat stroke is reported. Case Report. A 20-year-old man with a history of morbid obesity, hypertension, and schizophrenia was admitted to our intensive care unit because of multiorgan failure due to severe heat stroke. He had been working under the sun. Treatment included aggressive body cooling but, in spite of the best supportive care, the patient succumbed in a few hours. We concluded that the adverse event was possibly associated with his obesity and the use of antipsychotics. Histological evaluation revealed lesions consistent with severe hyperthermia and shock. Conclusions. Heat stroke is an uncommon clinical entity characterized by systemic heat and loss of the body's normal mechanisms for dealing with heat stress, such as sweating and temperature control. When heat stroke is diagnosed early and supportive care begins promptly the prognosis is optimal but it becomes a life-threatening disease when treatment is delayed. Lack of physical acclimatization and the use of certain medications that interfere with salt and water balance can impair thermoregulation under conditions of high environmental temperature. Health professionals must be adequately prepared to prevent, recognise, and treat them urgently.
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Sonkar SK, Soni D, Sonkar GK. Heat stroke presented with disseminated intravascular coagulation and bilateral intracerebral bleed. BMJ Case Rep 2012; 2012:bcr-2012-007027. [PMID: 23087280 DOI: 10.1136/bcr-2012-007027] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Heat stroke is a life-threatening condition which is characterised by nausea, vomiting, confusion, disorientation and coma. Aggressive treatment in the form of intravenous fluids along with other symptomatic management can be life saving. Here we present an unusual case of heat stroke followed by disseminated intravascular coagulation, multiple organ dysfunction with bilateral intracerebral bleed who survived with judicious management and recovered without any neurological sequeale.
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Gupta S, Carmichael C, Simpson C, Clarke MJ, Allen C, Gao Y, Chan EYY, Murray V. Electric fans for reducing adverse health impacts in heatwaves. Cochrane Database Syst Rev 2012; 2012:CD009888. [PMID: 22786530 PMCID: PMC6457598 DOI: 10.1002/14651858.cd009888.pub2] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Heatwaves are hot weather events, which breach regional or national thresholds, that last for several days. They are likely to occur with increasing frequency in some parts of the world. The potential consequences were illustrated in Europe in August 2003 when there were an estimated 30,000 excess deaths due to a heatwave. Electric fans might be used with the intention of reducing the adverse health effects of a heatwave. Fans do not cool the ambient air but can be used to draw in cooler air from outside when placed at an open window. The aim of the fans would be to increase heat loss by increasing the efficiency of all normal methods of heat loss, but particularly by evaporation and convection methods. However, it should be noted that increased sweating can lead to dehydration and electrolyte imbalances if these fluids and electrolytes are not replaced quickly enough. Research has also identified important gaps in knowledge about the use of fans, which might lead to their inappropriate use. OBJECTIVES To determine whether the use of electric fans contributes to, or impedes, heat loss at high ambient temperatures during a heatwave, and to contribute to the evidence base for the public health impacts of heatwaves. SEARCH METHODS We sought unpublished and published studies that had been published in any language. The review team were able to assess studies reported in English, Chinese, Dutch, French and German; and reports in other languages would have been translated into English as necessary. We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, CINAHL, the Indian biomedical literature (IndMED and MedIND) and databases of Chinese literature (Chinese Journal Net and Digital Periodical of WanFang Data). The most recent electronic searches were done in April 2012. We also checked the reference lists of relevant articles and the websites of relevant national and international organisations, and consulted with researchers and policy makers with experience in strategies to manage heatwaves to identify additional studies. The titles and abstracts from each search were checked independently by two review authors. The full text articles that we retrieved were checked independently by at least two authors for their relevance and for references to potentially eligible studies. SELECTION CRITERIA Randomised trials and other experimental designs, such as interrupted time series and controlled before-and-after studies, comparing the use of electric fans with no fans during a heatwave were eligible for this review. The electric fans could be hand-held (battery operated), portable or mounted on the wall or ceiling, or in a window. We sought interventions delivered to anyone for whom a heatwave was likely to have serious adverse health impacts. This would include people of all ages but with a particular focus on some groups (for example older people). Populations from high-, middle- and low-income countries were eligible for the review. DATA COLLECTION AND ANALYSIS If we had identified eligible studies, they would have been assessed independently by at least two review authors and data would have been extracted on the characteristics of the study, its participants and interventions, as well as the effects on health outcomes. The primary outcomes were mortality, hospital admission and other contacts with healthcare services. MAIN RESULTS We did not identify any eligible studies despite the extensive searching and correspondence with several experts in this topic area. We identified retrospective, observational studies, usually with a case-control design, that investigated the association between the use of electric fans and health outcomes, including death. The results of these studies were mixed. Some studies found that the use of fans was associated with better health outcomes, others found the reverse. AUTHORS' CONCLUSIONS The evidence we identified does not resolve uncertainties about the health effects of electric fans during heatwaves. Therefore, this review does not support or refute the use of electric fans during a heatwave. People making decisions about electric fans should consider the current state of the evidence base, and they might also wish to make themselves aware of local policy or guidelines when making a choice about whether or not to use or supply electric fans. The main implication of this review is that high quality research is needed to resolve the long standing and ongoing uncertainty about the benefits and harms of using electric fans during a heatwave, for example randomised trials comparing the health effects in people with electric fans to those in people without them.
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Affiliation(s)
- Saurabh Gupta
- Ambition Health Private LimitedPublic Health, Epidemiology and Biostatistics120, Good Earth City CentreSector 50GurgaonIndia122018
| | - Catriona Carmichael
- Centre for Radiation, Chemicals and Environmental HazardsExtreme Events and Health Protection SectionHealth Protection Agency151 Buckingham Palace RoadLondonUKSW1W 9SZ
| | - Christina Simpson
- Health CanadaClimate Change and Health Office269 Laurier Ave. WRoom 9‐077OttawaONCanadaK1A 0K9
| | - Mike J Clarke
- Queen's University BelfastCentre for Public HealthInstitute of Clinical Sciences, Block B, Royal Victoria HospitalGrosvenor RoadBelfastNorthern IrelandUKBT12 6BJ
| | - Claire Allen
- Evidence Aid1st Floor, Gibson Building (c/o CEBM)Radcliffe Observatory QuarterOxfordUKOX2 6GG
| | - Yang Gao
- Hong Kong Baptist UniversityDepartment of Physical EducationKowloonHong Kong
| | - Emily Y Y Chan
- The Chinese University of Hong KongCERT‐CUHK‐Oxford University Centre for Disaster and Medical Humanitarian ResponseCERT‐CUHK‐Oxford UniversitySchool of Public Health and Primary CareShatinNew TerritoriesHong Kong
| | - Virginia Murray
- Centre for Radiation, Chemicals and Environmental HazardsExtreme Events and Health Protection SectionHealth Protection Agency151 Buckingham Palace RoadLondonUKSW1W 9SZ
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Chen CF, Wang D, Leu FJ, Chen HI. The protective role of nitric oxide and nitric oxide synthases in whole-body hyperthermia-induced hepatic injury in rats. Int J Hyperthermia 2012; 28:421-30. [DOI: 10.3109/02656736.2012.677928] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Gupta S, Murray V, Clarke MJ, Carmichael C, Allen C, Simpson C. Electric fans for reducing adverse health impacts in heatwaves. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2012. [DOI: 10.1002/14651858.cd009888] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Abstract
The increasing popularity of mass participation endurance events necessitates that on-site medical teams be well versed in the management of both common and life-threatening conditions. Exertional heat stroke is one such condition, which if left untreated can be fatal.
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Ozcetin M, Arslan MT, Yilmaz R, Yildirim A. Rare Cause of Cerebral Damage: Child with Heatstroke Found inside an Enclosed Vehicle. HONG KONG J EMERG ME 2012. [DOI: 10.1177/102490791201900208] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Many children suffer from preventable diseases. Heat stress is one of the neglected causes of mortality and morbidity. We report here the clinical features of a 3-year-old boy who suffered from near-fatal heatstroke in an enclosed car. He developed multiple organs failure, including neurological insult, acute renal failure, and disseminated intravascular coagulation. Although life-threatening complications were treated with supportive measures and conventional external cooling in the intensive care unit, neurological sequelae persisted. This type of heatstroke is almost always preventable. Similar to many other pediatric emergencies, it can be life-threatening and may result in severe untoward outcomes.
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Affiliation(s)
| | - MT Arslan
- Private Defne Hospital, Department of Paediatrics, Hatay, Turkey
| | - R Yilmaz
- Gaziosmanpasa University Faculty of Medicine, Department of Paediatrics, Tokat, Turkey
| | - A Yildirim
- Gaziosmanpasa University Faculty of Medicine, Forensic Medicine, Tokat, Turkey
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Effects of continuous venous-venous hemofiltration on heat stroke patients: a retrospective study. ACTA ACUST UNITED AC 2012; 71:1562-8. [PMID: 22182867 DOI: 10.1097/ta.0b013e31822a71c2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Heat stroke (HS) is a fatal illness characterized by an elevated core body temperature above 40°C and complicated with rhabdomyolysis and acute renal failure. We retrospectively analyzed the effect of continuous veno-venous hemofiltration (CVVH) in patients with HS. METHODS A total of 16 patients with HS were retrospectively analyzed. All patients were treated by CVVH for at least 96 hours, and CVVH was initiated with replacement fluid between 25°C and 30°C for 2 hours to 2.5 hours, and 36°C thereafter. The vital signs were monitored and blood samples were collected during CVVH to measure serum urea, creatinine, myoglobin, creatine kinase, and total bilirubin. RESULTS All patients survived. The core temperature of the patients decreased from 41.3 ± 0.2°C to 38.7 ± 0.1°C after 2 hours and to 36.7 ± 0.1°C after 5 hours during CVVH (p < 0.05). Compared with values before starting CVVH, there were remarkable improvements in mean arterial blood pressure, heart rate, and oxygenation index (p < 0.05). The serum creatinine, urea, myoglobin, and creatine kinase decreased significantly (p < 0.05), while the bilirubinemia had no obvious decline (p > 0.05). The scores of APACHE II and arterial lactate had also obvious decline (p < 0.05). The hemodynamic variables were stabilized during CVVH, and no obvious side effects related to CVVH were found. CONCLUSIONS CVVH is safe and feasible in the treatment of patients with HS by lowering core temperature, removal of myoglobin, support of multiorgan function, and modulating systemic inflammatory response syndrome (SIRS). The impact of CVVH on patient outcome, however, still needs proof by larger randomized controlled trials.
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