WordNet

treat gingerly or carefully; "You have to stroke the boss"
a sudden loss of consciousness resulting when the rupture or occlusion of a blood vessel leads to oxygen lack in the brain (同)apoplexy, cerebrovascular_accident, CVA
(golf) the unit of scoring in golf is the act of hitting the ball with a club; "Nicklaus won by three strokes"
(sports) the act of swinging or striking at a ball with a club or racket or bat or cue or hand; "it took two strokes to get out of the bunker"; "a good shot requires good balance and tempo"; "he left me an almost impossible shot" (同)shot
a light touch with the hands (同)stroking
a single complete movement
any one of the repeated movements of the limbs and body used for locomotion in swimming or rowing
a light touch
a mark made on a surface by a pen, pencil, or paintbrush; "she applied the paint in careful strokes"
the oarsman nearest the stern of the shell who sets the pace for the rest of the crew
row at a particular rate
strike a ball with a smooth blow
touch lightly and repeatedly, as with brushing motions; "He stroked his long beard"
provide with heat; "heat the house"
a form of energy that is transferred by a difference in temperature (同)heat energy
make hot or hotter; "the sun heats the oceans"; "heat the water on the stove" (同)heat_up
gain heat or get hot; "The room heated up quickly" (同)hot up, heat_up
the trait of being intensely emotional (同)warmth, passion
the sensation caused by heat energy (同)warmth
a preliminary race in which the winner advances to a more important race
the 5th letter of the Hebrew alphabet
marked by emotional heat; vehement; "a heated argument"
made warm or hot (`het is a dialectal variant of `heated' (同)heated up, het, het_up
the process of becoming warmer; a rising temperature (同)warming

PrepTutorEJDIC

(こぶし・武器・金づちなどの)『一打ち』,一撃,打告《+of+名》 / 《単数形で》(運の)巡り合わせ《+of+名》 / 《単数形で》(…の)ひと仕事,ひと働き;みごとな成果《+of+名》 / (鐘・時計などの)『打つ音』《+of+名》 / (時計などが打って示す)時刻 / (繰り返される動作・運動の)『一動作』,一行程 / (ペン・鉛筆・筆などの)ひと筆,ひとなで;筆の運び,筆致 / 卒中 / (ゴルフ・テニスなどの)一打ち,ストローク / (心臓などの)一打ち,鼓動,脈搏 / (ボートの)整調[手] / 〈ボート〉‘の'整調をこぐ / 《副詞[句]を伴って》〈ボール〉‘を'打つ
〈髪・動物など〉‘を'なでる,さする / 〈人〉‘を'なだめる《+名+down, down+名》 / 一なで,一さすり
〈U〉『熱さ』,『暑さ』,熱い状態 / 〈U〉熱度,温度 / 〈U〉(家などの)暖房装置 / 〈U〉熱心,熱烈;(物事の)最高潮《+『of』+『名』》 / 〈U〉(エネルギーとしての)熱 / 〈C〉(競技の)1回,1ラウンド / …‘を'『熱する』,暖める《+『up』+『名,』+『名』+『up』》 / …‘を'興奮させる,怒らせる《+『up』+『名,』+『名』+『up』》 / 熱くなる,暖まる《+『up』》
（雌の）発情（in heatとして使う）・金・銭・緊迫、プレッシャー、批判、批評、警察の追跡
彼は,彼が / 《指す人の性別が分からないか,または分かる必要のない場合に》その人,あの人,自分 / 《he who(that)の形で》《文》…するものはだれでも / (動物の)おす(雄)
鬼ごっこ(tag,tick,tig)
熱せられた / 興奮した,怒った
加熱;暖房[装置]

Wikipedia preview

出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2017/06/19 06:53:08」(JST)

wiki en

Heat stroke, also known as sun stroke, is a severe heat illness, defined as hyperthermia with a body temperature greater than 40.6 °C (105.1 °F) because of environmental heat exposure with lack of thermoregulation. This is distinct from a fever, where there is a physiological increase in the temperature set point of the body. The term "stroke" in "heat stroke" is a misnomer in that it does not involve a blockage or hemorrhage of blood flow to the brain. Preventive measures include drinking plenty of cool liquids and avoiding excessive heat and humidity, especially in unventilated spaces, such as parked cars, that can overheat quickly. Treatment requires rapid physical cooling of the body.

Signs and symptoms

Heat stroke generally presents with a hyperthermia of greater than 40.6 °C (105.1 °F) in combination with disorientation and a lack of sweating.^[2] Before a heat stroke occurs, people show signs of heat exhaustion such as dizziness, mental confusion, headaches, and weakness; if a heat stroke occurs when the person is asleep, symptoms may be harder to notice. However, in exertional heat stroke, the affected person may sweat excessively.^[3] Young children, in particular, may have seizures. Eventually, unconsciousness, organ failure, and death will result.^[4]

Causes

Biological

Heat stroke occurs when thermoregulation is overwhelmed by a combination of excessive metabolic production of heat (exertion), excessive environmental heat, and insufficient or impaired heat loss, resulting in an abnormally high body temperature. Substances that inhibit cooling and cause dehydration such as alcohol,^[5] stimulants, medications, and age-related physiological changes predispose to so-called "classic" or non-exertional heat stroke (NEHS), most often in elderly and infirm individuals in summer situations with insufficient ventilation. Exertional heat stroke (EHS) can happen in young people without health problems or medications – most often in athletes, outdoor laborers, or military personnel engaged in strenuous hot-weather activity or in certified first responders wearing heavy personal protective equipment. In environments that are not only hot but also humid, it is important to recognize that humidity reduces the degree to which the body can cool itself by perspiration and evaporation. For humans and other warm-blooded animals, excessive body temperature can disrupt enzymes regulating biochemical reactions that are essential for cellular respiration and the functioning of major organs.^[4]

Cars

Between 1998 and 2011, at least 500 children in the United States died from being inside hot cars and 75% of the victims were less than 2 years old. When the outside temperature is 21 °C (70 °F), the temperature inside a car parked in direct sunlight can quickly exceed 49 °C (120 °F).^[6]

Young children, elderly adults, or disabled individuals left alone in a vehicle are at particular risk of succumbing to heat stroke. "Heat stroke in children and in the elderly can occur within minutes, even if a car window is opened slightly."^[7] As these groups of individuals may not be able to open car doors or to express discomfort verbally (or audibly, inside a closed car), their plight may not be immediately noticed by others in the vicinity. It is recommended that parents put their purse, wallet, or anything that is valuable in the backseat so that when they get their items out of the backseat they can see that their child is there as well. For larger groups in a van or bus, checking for stragglers at the end of the trip is essential, complemented by other procedures such as a head count.^[8]

Pets are even more susceptible than humans to heat stroke in cars, as dogs (the animals usually involved), cats, and many other animals cannot produce whole-body sweat to cool themselves. Leaving the pet at home with plenty of water on hot days is recommended instead, or, if a dog must be brought along, it can be tied up outside the destination and provided with a full water bowl.^[9]

Among recent child deaths in hot cars, approximately half occurred because parents forgot that the child was in the car, 18% happened after parents intentionally left the child in the car without understanding how hot it could get, and 30% happened after the child climbed into the car to play.^[10]^[11]^[12] Legal prosecution of parents in these situations can vary greatly. In separate incidents, a college professor in California forgot that his son was in a hot car, and a horse groomer in Florida knowingly left his daughter in his car during horse races. Each resulted in the unintentional death of a child; the college professor was never prosecuted, while the horse groomer was sentenced to 20 years in prison followed by deportation.^[13]

Forgotten baby syndrome

"Forgotten baby syndrome" is a pseudo-medical term for the danger of adult caregivers forgetting about the presence of a young child and consequently subjecting the child to danger. In spite of the word "syndrome", this is not a recognized medical condition. However, the term has achieved some currency in newspapers, magazines, blogs, and other popular media.^[14]^[15]^[16] "Forgotten baby syndrome" can result in the child being severely injured or dying due to entrapment in a hot car. In general, this is the unintentional behaviour of continuously busy parents who either forget to remove their child from the rear seat of a vehicle or forget to drop them off at an intended destination, often because of a deviation from their automatic habits.^[17]

Prevention

The risk of heat stroke can be reduced by observing precautions to avoid overheating and dehydration. Light, loose-fitting clothes will allow perspiration to evaporate and cool the body. Wide-brimmed hats in light colors help prevent the sun from warming the head and neck. Vents on a hat will help cool the head, as will sweatbands wetted with cool water. Strenuous exercise should be avoided during daylight hours in hot weather, as should remaining in confined spaces (such as automobiles) without air-conditioning or adequate ventilation.

In hot weather, people need to drink plenty of cool liquids to replace fluids lost from sweating. Thirst is not a reliable sign that a person needs fluids. A better indicator is the color of urine. A dark yellow color may indicate dehydration.^[3]

The Occupational Safety and Health Administration in the United States publishes a QuickCard with a checklist designed to help protect from heat stress:^[18]

Know signs/symptoms of heat-related illnesses.
Block out direct sun and other heat sources.
Drink fluids often, and before you are thirsty.
Wear lightweight, light-colored, loose-fitting clothes.
Avoid beverages containing alcohol or caffeine.

Treatment

Person being cooled with water spray

Treatment of heat stroke involves rapid mechanical cooling along with standard resuscitation measures.^[19]

The body temperature must be lowered quickly. The person should be moved to a cool area (indoors, or at least in the shade) and clothing removed to promote heat loss (passive cooling). Active cooling methods should also be used, if possible: The person is bathed in cold water, or a hyperthermia vest can be applied. (However, wrapping the person in wet towels or clothes can actually act as insulation and increase the body temperature.) Cold compresses to the torso, head, neck, and groin will help cool the victim. A fan or dehumidifying air-conditioning unit may be used to aid in evaporation of the water (evaporative method).

Immersing a person into a tub of cold water (immersion method) is a widely recognized method of cooling. This method may require the effort of several people and the person should be monitored carefully during the treatment process. Immersion should be avoided for an unconscious person, but if there is no alternative, the person's head must be held above water.

Immersion in very cold water was once thought to be counterproductive by reducing blood flow to the skin and thereby preventing heat from escaping the body core. However, this hypothesis has been challenged in experimental studies,^[20]^[21] as well as by systematic reviews of the clinical data,^[22]^[23] indicating that cutaneous vasoconstriction and shivering thermogenesis do not play a dominant role in the decrease in core body temperature brought on by cold water immersion. This can be seen in the effect of submersion hypothermia, where the body temperature decrease is directly related to environmental temperature, and though bodily defenses slow the decrease in temperature for a time, they ultimately fail to maintain endothermic homeostasis. Dantrolene, a direct-acting paralytic which abolishes shuddering and is effective in many other forms of hyperthermia, including centrally-, peripherally- and cellularly-mediated thermogenesis, has no individual or additive effects to cooling in the context of heat stroke,^[24] showing a lack of endogenous thermogenic response to cold water immersion. Thus, aggressive ice-water immersion remains the gold standard for life-threatening heat stroke.^[22]

Hydration is important in cooling the person. In mild cases of concomitant dehydration, this can be achieved by drinking water, or commercial isotonic sports drinks may be used as a substitute. In exercise- or heat-induced dehydration, electrolyte imbalance can result, and can be worsened by excess consumption of water. Hyponatremia can be corrected by intake of hypertonic fluids. Absorption is rapid and complete in most people but if the person is confused, unconscious, or unable to tolerate oral fluid, then an intravenous drip may be necessary for rehydration and electrolyte replacement.

The person's condition should be reassessed and stabilized by trained medical personnel. The person's heart rate and breathing should be monitored, and CPR may be necessary if the person goes into cardiac arrest.

Prognosis

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

Epidemiology

In India, hundreds die every year from summer heat waves,^[26] including more than 2,500 in the year 2015.^[27] Later that same summer, the 2015 Pakistani heat wave caused about 2,000 deaths.^[28] An extreme 2003 European heat wave caused tens of thousands of deaths.^[29]

References

^ Herrick, RT (1986). "Heat illness in the athlete: siriasis is serious.". Alabama Medicine. 55 (10): 28, 33–37. PMID 3706086.
^ McGugan, Elizabeth A (2001). "Hyperpyrexia in the emergency department". Emergency Medicine Australasia. 13 (1): 116–120. PMID 11476402. doi:10.1046/j.1442-2026.2001.00189.x.
^ ^a ^b "InfoSheet: Protecting Workers from Heat Illness" (PDF). OSHA–NIOSH. 2011. Retrieved February 10, 2015.
^ ^a ^b Fauci, Anthony; et al. (2008). Harrison's Principles of Internal Medicine (17th ed.). McGraw-Hill Professional. pp. 117–121. ISBN 978-0-07-146633-2.
^ "Heat emergencies: MedlinePlus Medical Encyclopedia". www.nlm.nih.gov. Retrieved 2016-01-19.
^ Barth, Liza (June 3, 2011). "Heat danger: 500th child dies in a hot car". Consumer Reports. Retrieved February 11, 2015.
^ Meadows, Michelle (2014). "A primer on summer safety". Academic OneFile. Retrieved January 18, 2016.
^ Extreme Heat Prevention Guide, Centers for Disease Control and Prevention (CDC)
^ "Pets in Hot Cars". Partnership for Animal Welfare. Retrieved February 11, 2015.
^ Szabo, Liz (June 30, 2010). "More kids die in hot cars, half because parents forget them". USA Today. Retrieved February 11, 2015.
^ "Child deaths in hot cars: 10 key facts". USA TODAY. 2 July 2014. Retrieved 25 August 2016.
^ http://ggweather.com/heat/
^ "Court outcomes vary when kids die in hot cars". Associated Press. July 28, 2007. Retrieved February 11, 2015.
^ Weingarten, Gene (March 8, 2009). "Fatal Distraction: Forgetting a Child in the Backseat of a Car Is a Horrifying Mistake. Is It a Crime?". The Washington Post. Retrieved May 2, 2010.
^ Weingarten, Gene (March 26, 2009). "The Last Word: Forgotten Baby Syndrome". The Week. Retrieved May 2, 2010.
^ Eisenstein, Paul A. (July 11, 2014). "Death in Hot Cars: Why Can't the Automakers Prevent the Danger?". NBC News. Retrieved July 13, 2014.
^ Dunn, Mark (July 23, 2014). "Experts say Jayde Poole may have suffered 'forgotten baby syndrome' when she left her baby in fatally hot car". Herald Sun. Retrieved February 10, 2015.
^ "QuickCard: Protecting Workers from Heat Stress" (PDF). OSHA. 2014. Retrieved February 10, 2015.
^ Tintinalli, Judith (2004). Emergency Medicine: A Comprehensive Study Guide (6th ed.). McGraw-Hill Professional. p. 1188. ISBN 0-07-138875-3.
^ Clements, JM; Casa, DJ; Knight, J; McClung, JM; Blake, AS; Meenen, PM; Gilmer, AM; Caldwell, KA (2002). "Ice-Water Immersion and Cold-Water Immersion Provide Similar Cooling Rates in Runners with Exercise-Induced Hyperthermia". Journal of athletic training. 37 (2): 146–150. PMC 164337 . PMID 12937427.
^ Proulx, CI; Ducharme, MB; Kenny, GP (2003). "Effect of water temperature on cooling efficiency during hyperthermia in humans". Journal of Applied Physiology. 94 (4): 1317–1323. PMID 12626467. doi:10.1152/japplphysiol.00541.2002.
^ ^a ^b McDermott, Brendon P.; Casa, Douglas J.; Ganio, Matthew S.; Lopez, Rebecca M.; Yeargin, Susan W.; Armstrong, Lawrence E.; Maresh, Carl M. (2009). "Acute Whole-Body Cooling for Exercise-Induced Hyperthermia: A Systematic Review". Journal of Athletic Training. 44 (1): 84–93. PMC 2629045 . PMID 19180223. doi:10.4085/1062-6050-44.1.84.
^ Gagnon, Daniel; Lemire, Bruno B.; Casa, Douglas J.; Kenny, Glen P. (2010). "Cold-Water Immersion and the Treatment of Hyperthermia: Using 38.6°C as a Safe Rectal Temperature Cooling Limit". Journal of Athletic Training. 45 (5): 439–444. PMC 2938313 . PMID 20831387. doi:10.4085/1062-6050-45.5.439.
^ Hausfater, Pierre (2004). "Dantrolene and heatstroke: A good molecule applied in an unsuitable situation". Critical Care. 9 (1): 23–24. PMC 1065093 . PMID 15693976. doi:10.1186/cc2939.
^ "Classic heat stroke during Chicago 1995 heat wave". University of Chicago Medicine. August 1, 1998. Retrieved July 22, 2012.
^ Mallapur, Chaitanya (27 May 2015). "61% Rise In Heat-Stroke Deaths Over Decade". IndiaSpend. Retrieved 26 June 2015.
^ "India heatwave: death toll passes 2,500 as victim families fight for compensation". Reuters. 2 June 2015. Retrieved 26 June 2015.
^ Haider, Kamran; Anis, Khurrum (24 June 2015). "Heat Wave Death Toll Rises to 2,000 in Pakistan’s Financial Hub". Bloomberg News. Retrieved 3 August 2015.
^ Robine, Jean-Marie; et al. (February 2008). "Death toll exceeded 70,000 in Europe during the summer of 2003". Comptes Rendus Biologies. 331 (2): 171–178. ISSN 1631-0691. PMID 18241810. doi:10.1016/j.crvi.2007.12.001.

External links

Heat stroke on MedicineNet.com

UpToDate Contents

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1. 成人における重度非労作性高熱（古典的熱中症） severe nonexertional hyperthermia classic heat stroke in adults
2. 小児における熱射病 heat stroke in children
3. 思春期および成人における労作性熱中症：疫学、体温調節、危険因子、および診断 exertional heat illness in adolescents and adults epidemiology thermoregulation risk factors and diagnosis
4. 思春期および成人における労作性熱中症：管理および予防 exertional heat illness in adolescents and adults management and prevention
5. 小児における熱中症（熱射病を除く） heat illness other than heat stroke in children

English Journal

Heat stroke during treatment with olanzapine, trihexyphenidyl, and trazodone in a patient with schizophrenia.

Lee CP1, Chen PJ1, Chang CM1.
Acta neuropsychiatrica.Acta Neuropsychiatr.2015 Dec;27(6):380-5. doi: 10.1017/neu.2015.29.
OBJECTIVE: Heat stroke is a medical emergency. Psychiatric patients are particularly susceptible to heat stroke. Therefore, awareness and preventive measures of heat stroke are important for both clinicians and patients. Case description A 49-year-old man with schizophrenia, who was under maintenanc
PMID 26503496

Dietary nitrate reduces the O2 cost of desert marching but elevates the rise in core temperature.

Kuennen M1,2, Jansen L3, Gillum T4, Granados J3, Castillo W3, Nabiyar A5, Christmas K6.
European journal of applied physiology.Eur J Appl Physiol.2015 Dec;115(12):2557-69. doi: 10.1007/s00421-015-3255-0. Epub 2015 Sep 4.
PURPOSE: Dietary nitrate (NO3 (-)) supplementation reduces the O2 cost of fixed-workload tasks performed in temperate environments but has not been examined in the heat. If this effect were retained it could reduce heatstroke risk in military personnel that are deployed for desert combat.METHODS: Ni
PMID 26338830

A pathophysiological role of TRPV1 in ischemic injury after transient focal cerebral ischemia in mice.

Miyanohara J1, Shirakawa H2, Sanpei K1, Nakagawa T3, Kaneko S1.
Biochemical and biophysical research communications.Biochem Biophys Res Commun.2015 Nov 20;467(3):478-83. doi: 10.1016/j.bbrc.2015.10.027. Epub 2015 Oct 8.
Transient receptor potential vanilloid 1 (TRPV1) is a non-selective cation channel with high Ca(2+) permeability, which functions as a polymodal nociceptor activated by heat, protons and several vanilloids, including capsaicin and anandamide. Although TRPV1 channels are widely distributed in the mam
PMID 26456642

Japanese Journal

熱中症に伴うDICの診断・治療 (特集急性期DIC : 診断・治療の最前線)

救急医学 = The Japanese journal of acute medicine 39(11), 1577-1581, 2015-10
NAID 40020619751

症例報告熱中症に伴う心電図変化と一過性左室壁運動異常を呈した1例

広島医学 68(8), 424-427, 2015-08
NAID 40020582959

熱中症を発症した高齢者の体験プロセス分析

応用老年学 9(1), 19-30, 2015-08
NAID 40020577248

Related Pictures

★リンクテーブル★

リンク元	「熱中症」「体温」「heat attack」
関連記事	「heat」「stroke」「heating」

「熱中症」

Heat stroke
Synonyms	siriasis
Classification and external resources
Specialty	emergency medicine
ICD-10	T67.0
ICD-9-CM	992.0
DiseasesDB	5690
MedlinePlus	000056
eMedicine	med/956
MeSH	D018883
	[edit on Wikidata]

　　[★]

英: heat illness, heat stroke( → 熱射病という意味で使う(YN.K-38))
関

重症度による分類

熱痙攣 heat cramp：電解質の喪失
熱疲労 heat exhaustion：体液の喪失による循環不全
熱射病 heat stroke：熱中枢障害 or 過剰な熱産生による臓器障害

熱疲労と熱射病の違いは中枢神経障害の有無(beyond resident 2-156)

WMM.707

ICU.607

YN.K-38改変

beyond resident 2-154

研修医直御法度第5版 155

研修医直御法度症例帳 143

マイナーエマージェンシー 6

	熱痙攣	熱疲労	熱射病
	heat cramp	heat exhaustion	heat stroke
			古典的熱射病	努力性熱射病
疫学			幼小児、老人基礎疾患(脳血管障害、虚血性心疾患、アルコール依存症) 薬剤性(フェノチアジン系(抗精神病薬)、抗コリン薬、利尿薬) 死亡率：40%	小児～成人死亡率：10% 横紋筋融解症、DIC、MOF合併多い
原因	電解質喪失	脱水	温熱中枢障害	熱産生＞＞熱放射
病態生理		細胞外液の減少(≒循環血漿量の減少)→頻脈、	高温により熱中枢が障害されるあるいは、心拍出量、発汗能力、血管調節能力の低下により体温調節能が失われる ↓ 汗が出ないことがある。
意識			意識障害あり
体温	→	↑～↑↑	↑～↑↑↑	↑↑↑
血圧		低血圧	？	低血圧
発汗	＋＋	＋＋＋	－～＋＋＋	＋＋＋
筋肉	有痛性筋収縮		筋肉崩壊
その他症状		悪心・嘔吐、頭痛、めまい
治療	ストレッチ、マッサージ経口補液(飲めねば静注)	冷却(外部冷却)。⇔冷却は必要なし(ICU.607)	冷却(外部冷却・内部冷却)

熱中症の新分類

内科救急診療指針1st

従来の分類	新分類	症状
熱痙攣熱失神	I度	めまい、大量発汗、失神、筋肉痛、筋肉の硬直(こむら返り)
熱疲労	II度	頭痛、嘔吐、倦怠感、虚脱感、集中力や判断力の低下、血圧低下、頻拍
熱射病	III度	下記３症状のうちいずれか１つ以上 ①中枢神経症状：意識障害、小脳症状、けいれん発作 ②肝・腎機能障害：AST/ALT、UN、Cr上昇 ③血液凝固異常：急性期DIC診断基準(日本救急医学会)にてDICと診断

身体所見

まず、バイタル！ショックを評価。心不全はあるかどうか？

検査

血液検査(生化学(浸透圧も評価)、血算、凝固(熱射病疑いとして))
尿検査(尿ミオグロビンを捕まえる　→　赤血球(-)かつ潜血(+)　)

治療

(心不全症状なければ)輸液　←　末梢静脈ラインを確保すると同時に採血

YN.K-39

(血漿浸透圧330mOsm未満)生理食塩水　　　尿あれば乳酸リンゲルでok
(血漿浸透圧330mOsm以上)生理食塩水＋5%ブドウ糖

死因

熱射病の場合；横紋筋融解症、高カリウム血症、低カルシウム血症、高乳酸血症

救急外来stragegy

1. バイタルチェック(体温、血圧、脈拍)　　→　　熱中症に合致しそうか？　ちなみに直腸温はかれないときはどうする？
2. 現病歴　　→　　ひととおりさらっと聴く
3. 現症

発汗の有無、皮膚の乾燥・湿潤、
筋痙攣　　→　　熱痙攣を疑いたくなる
悪心、嘔吐、頭痛、倦怠感　　→　　熱疲労～熱射病を疑いたくなる
筋肉痛、筋攣縮、中枢神経機能異常(譫妄、運動失調、昏睡、痙攣)、DIC、MOF　　→　　熱射病を疑いたくなる
感染症による発熱を疑いたくなったら、頚部リンパ節、咽頭所見、感冒症状、関節痛、呼吸音、尿回数・量、CVA叩打痛、項部硬直、Jolt accentuationをチェック

4. 既往歴

古典的熱射病で心不全を有している場合、輸液不可より昇圧剤を使えと(beyond resident 2-154)

5. 末梢静脈ルート確保して採血(生化学、血算、凝固)し、まずは生理食塩水を落とす。血漿浸透圧高値が明らかになれば1/2生理食塩水に切り替え。
6. 尿検査提出
7. 適切なクーリングをしつつ、結果を待つ。

職場における予防

職場における熱中症予防対策マニュアル - 厚生労働省労働基準局安全衛生部労働衛生課

https://www.mhlw.go.jp/file/06-Seisakujouhou-11200000-Roudoukijunkyoku/manual.pdf

作業環境管理

WBGT値の低減
休憩所などの整備：高温多湿作業場所の近隣に冷房を備えた休憩場所、あるいは風通しのよい日陰等の休憩場所を整備する。氷、冷たい飲料が摂取でき、水風呂やシャワーを浴びることができる設備を設置。

作業管理

作業時間の短縮：休憩時間を確保し、熱暑での作業が連続しないようすること、身体作業強度が高い作業を避けること、作業場所を変更すること。
熱への馴化：7日以上かけて熱暑への暴露時間を長くしていく。
水分及び塩分の摂取
服装・帽子：熱を吸収し熱を蓄えやすい服装を避け、透湿性・通気性の良い服装を装着させるようにする。
作業中の巡視

健康管理

健康診断の結果などによる対応
日常の健康管理など
労働者の健康状態の確認
自発的脱水
予防的・定期的な水分・塩分補給：口渇、口腔内乾燥、尿量減少、体温・心拍の増加は脱水に夜体重減少が2-5%になると自覚されるが、既に脱水に陥っていることになる。そのため、口渇を感じなくても定期的に水分・塩分を摂ることが必要である。
身体の状況の確認
労働衛生教育

参考

1. 今後の暑さ指数|環境省熱中症予防情報サイト

http://www.nies.go.jp/health/HeatStroke/

2. 熱中症環境保健マニュアル 2018 - 環境省

https://www.wbgt.env.go.jp/pdf/manual/heatillness_manual_full.pdf

3. 暑さ指数と熱中症救急搬送者数との関係 - 環境省

http://www.wbgt.env.go.jp/heatillness_report.php

4. 熱中症を防ごう / スポーツ医・科学 - 日体協

http://www.japan-sports.or.jp/medicine/guidebook1.html

5. 熱中症診療ガイドライン2015 - 厚生労働省

https://www.mhlw.go.jp/file/06-Seisakujouhou-10800000-Iseikyoku/heatstroke2015.pdf

6. 「日常生活における熱中症予防指針」Ver.3確定版日本生気象学会

http://seikishou.jp/pdf/news/shishin.pdf

7. wiki ja

http://ja.wikipedia.org/wiki/%E7%86%B1%E4%B8%AD%E7%97%87

「体温」

　　[★]

英: body temperature
関: 発熱

口腔温：36.8±0.4 ℃
部位：直腸(口腔温度より0.4℃高い) > 口腔 > 腋窩
時間：夕方(18時)＞朝(6時)　差は0.5℃

臨床関連

体温の異常

高体温 hyperthermia====

熱射病 heat stroke
悪性高熱症 malignant hyperthermia：麻酔
(神経遮断性)悪性症候群 neuroleptic malignant hyperthermia：抗精神病薬の中断

低体温 hypothermia

病態の診断基準

SIRSの診断基準：37℃より±1℃より大きいまたは小さいこと。すなわち、＞38℃ or ＜36℃

「heat attack」

　　[★]

熱中症

関: heat stroke

「heat」

　　[★]

n.

熱、(生物)発情、発情期

v.

加熱する、加温する

関: estrous、estrus、heating、hot、rewarming

「stroke」

　　[★] 脳卒中　　　　　　　　　　　　　　　

「heating」

　　[★]

n.

加温

関: heat、rewarming

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[OSH-3] "InfoSheet: Protecting Workers from Heat Illness" (PDF). OSHA–NIOSH. 2011. Retrieved February 10, 2015.

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[10] Szabo, Liz (June 30, 2010). "More kids die in hot cars, half because parents forget them". USA Today. Retrieved February 11, 2015.

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[12] ttp://ggweather.com/heat/

[13] "Court outcomes vary when kids die in hot cars". Associated Press. July 28, 2007. Retrieved February 11, 2015.

[14] Weingarten, Gene (March 8, 2009). "Fatal Distraction: Forgetting a Child in the Backseat of a Car Is a Horrifying Mistake. Is It a Crime?". The Washington Post. Retrieved May 2, 2010.

[15] Weingarten, Gene (March 26, 2009). "The Last Word: Forgotten Baby Syndrome". The Week. Retrieved May 2, 2010.

[16] Eisenstein, Paul A. (July 11, 2014). "Death in Hot Cars: Why Can't the Automakers Prevent the Danger?". NBC News. Retrieved July 13, 2014.

[17] Dunn, Mark (July 23, 2014). "Experts say Jayde Poole may have suffered 'forgotten baby syndrome' when she left her baby in fatally hot car". Herald Sun. Retrieved February 10, 2015.

[18] "QuickCard: Protecting Workers from Heat Stress" (PDF). OSHA. 2014. Retrieved February 10, 2015.

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[20] Clements, JM; Casa, DJ; Knight, J; McClung, JM; Blake, AS; Meenen, PM; Gilmer, AM; Caldwell, KA (2002). "Ice-Water Immersion and Cold-Water Immersion Provide Similar Cooling Rates in Runners with Exercise-Induced Hyperthermia". Journal of athletic training. 37 (2): 146–150. PMC 164337 . PMID 12937427.

[21] Proulx, CI; Ducharme, MB; Kenny, GP (2003). "Effect of water temperature on cooling efficiency during hyperthermia in humans". Journal of Applied Physiology. 94 (4): 1317–1323. PMID 12626467. doi:10.1152/japplphysiol.00541.2002.

[J-Athl-22] McDermott, Brendon P.; Casa, Douglas J.; Ganio, Matthew S.; Lopez, Rebecca M.; Yeargin, Susan W.; Armstrong, Lawrence E.; Maresh, Carl M. (2009). "Acute Whole-Body Cooling for Exercise-Induced Hyperthermia: A Systematic Review". Journal of Athletic Training. 44 (1): 84–93. PMC 2629045 . PMID 19180223. doi:10.4085/1062-6050-44.1.84.

[23] Gagnon, Daniel; Lemire, Bruno B.; Casa, Douglas J.; Kenny, Glen P. (2010). "Cold-Water Immersion and the Treatment of Hyperthermia: Using 38.6°C as a Safe Rectal Temperature Cooling Limit". Journal of Athletic Training. 45 (5): 439–444. PMC 2938313 . PMID 20831387. doi:10.4085/1062-6050-45.5.439.

[24] Hausfater, Pierre (2004). "Dantrolene and heatstroke: A good molecule applied in an unsuitable situation". Critical Care. 9 (1): 23–24. PMC 1065093 . PMID 15693976. doi:10.1186/cc2939.

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[26] Mallapur, Chaitanya (27 May 2015). "61% Rise In Heat-Stroke Deaths Over Decade". IndiaSpend. Retrieved 26 June 2015.

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[28] Haider, Kamran; Anis, Khurrum (24 June 2015). "Heat Wave Death Toll Rises to 2,000 in Pakistan’s Financial Hub". Bloomberg News. Retrieved 3 August 2015.

[29] Robine, Jean-Marie; et al. (February 2008). "Death toll exceeded 70,000 in Europe during the summer of 2003". Comptes Rendus Biologies. 331 (2): 171–178. ISSN 1631-0691. PMID 18241810. doi:10.1016/j.crvi.2007.12.001.

Heat stroke
Synonyms	siriasis^[1]
Classification and external resources
Specialty	emergency medicine
ICD-10	T67.0
ICD-9-CM	992.0
DiseasesDB	5690
MedlinePlus	000056
eMedicine	med/956
MeSH	D018883
[edit on Wikidata]

匿名

検索

案内

heat stroke