WordNet

collapse caused by exposure to excessive heat (同)heat_hyperpyrexia

PrepTutorEJDIC

=sunstroke

Wikipedia preview

出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2013/08/07 22:09:01」(JST)

wiki en

"Heatstroke" and "Heatstrokes" redirect here. For the film, see Heatstroke (film). For the song by Krokus, see Metal Rendez-vous.

Heat stroke is a heat illness defined as a body temperature of greater than 40.6 °C (105.1 °F) due to 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.

Treatment involves rapid physical cooling.

Sign and symptoms[edit source | edit]

Heat stroke presents with a hyperthermia of greater than 40.6 °C (105.1 °F) in combination with confusion and a lack of sweating.^[1]

Causes[edit source | edit]

Substances that inhibit cooling and cause dehydration such as alcohol, caffeine, stimulants, medications, and age-related physiological changes predispose to so-called "classic" heat stroke. Exertional heat stroke can happen in young people without health problems or medications, most often in athletes and military recruits.

Children and pets in cars[edit source | edit]

Children, elderly adults, or disabled individuals left alone in a vehicle are at particular risk of succumbing to heat stroke, even with windows partially open. As these groups of individuals may not be able to express discomfort verbally (or audibly, inside a closed car), their plight may not be immediately noticed by others in the vicinity. A stuffed toy or other child's toy is recommended for a parent or guardian to keep with himself or herself in the front seat as a reminder that at least one child is present. For larger groups, checking the van or bus for stragglers at the end of the trip is essential, complemented by other procedures such as a head count.^[2]

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. Non-guide dogs are prohibited from being brought into many establishments, and opening a vehicle window sufficiently may present an escape opportunity or bite hazard. Leaving the pet at home with plenty of water on hot days is recommended instead, or, if a dog must be brought along, tied up outside the destination and provided with a full water bowl.^[3]

Between 1998 and 2011, at least 500 children in the United States died from being inside hot cars, and 75% of them were less than 2 years old. When the outside temperature is 70 degrees Fahrenheit (21.1°C), the temperature inside the car can exceed 120 degrees (48.8°C), even when the windows are partially open.^[4]

Legal prosecution of parents in this situation varies greatly. In separate incidents, a college professor in California forgot his son in a hot car and a horse trainer in Florida deliberately left his daughter in a hot car. Each resulted in the unintentional death of a child, but the college professor was never prosecuted, while the horse trainer was sentenced to 20 years in prison.^[5]

Among all child deaths in hot cars, slightly more than half occur because parents forget that the child is in the car, 18% happen after parents intentionally leave the child in a car without understanding how hot it can get, and 30% happen after the child had climbed into the car to play.^[6]

Forgotten baby syndrome[edit source | edit]

Forgotten baby syndrome (FBS) is a pseudo-medical term for the danger of adult caregivers forgetting about the presence of a 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.^[7]^[8]

Prevention[edit source | edit]

The risk of heatstroke can be reduced by observing precautions to avoid overheating and dehydration. Light, loose-fitting clothing will allow perspiration to evaporate and cool the body. Wide-brimmed hats in light colours keep the sun from warming the head and neck and block the powerful radiation from hurting the eyes; vents on a hat will allow perspiration to cool the head. Strenuous exercise should be avoided during daylight hours in hot weather; so should remaining in enclosed spaces (such as automobiles). The temperature inside cars can reach 200°F (c. 93°C) at the right exterior temperature, sunlight, color of vehicle, and type of vehicle.^[9] Temperatures that high, without proper cooling, could be dangerous and even fatal, especially with young children and pets.^[10]

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 lose heat by evaporation. In such environments, it helps to wear light clothing such as cotton in light colors, that is pervious to sweat but impervious to radiant heat from the sun. This minimises the gaining of radiant heat, while allowing as much evaporation to occur as the environment will allow. Clothing such as plastic fabrics that are impermeable to sweat and thus do not facilitate heat loss through evaporation can actually contribute to heat stress.^[11]

In hot weather people need to drink plenty of liquids to replace fluids lost from sweating. Thirst is not a reliable sign that a person needs fluids.^[12] A better indicator is the color of urine. A dark yellow color may indicate dehydration. The Occupational Safety and Health Administration in the United States publishes a heat stress Quick Card ^[13] that contains a checklist designed to help prevent heat stress. This list, known as the KBUDWA list, includes:

Know signs/symptoms of heat-related illnesses
Block out direct sun or other heat sources
Use air-conditioning; rest regularly
Drink sufficient, cold water and drinks
Wear lightweight, light colored, loose-fitting clothes
Avoid alcohol, caffeinated drinks, or heavy meals

Treatment[edit source | edit]

Treatment involves rapid mechanical cooling along with standard resuscitation measures.^[14]

The body temperature must be lowered immediately. The patient 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 may be used: The person is bathed in cool water or a hyperthermia vest can be applied. However, wrapping the patient 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 patient into a bathtub of cool (but not cold) water (immersion method) is a recognized method of cooling. This method requires the effort of 4-5 people and the patient should be monitored carefully during the treatment process. Immersion should be avoided for an unconscious patient, but if there is no alternative, the patient's head must be held above water. Immersion in very cold water is counterproductive, as it causes vasoconstriction in the skin and thereby prevents heat from escaping the body core.

This hypothesis however has been challenged in experimental studies,^[15]^[16] as well as by systematic reviews of the clinical data^[17]^[18] indicating that cutaneous vasoconstriction and shivering thermogenesis do not play a dominant role in the radiant decrease in core body temperature brought on by cold water immersion. This effect can be seen in the effect of (non-therapeutic) 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, 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 heatstroke,^[19] showing a lack of endogenous thermogenic response to cold water immersion. Thus, aggressive ice-water immersion remains the gold standard for life-threatening heatstroke.^{[citation needed]}

Hydration is of paramount importance in cooling the patient. In mild cases of concomitant dehydration, this can achieved by drinking water, or commercial isotonic drinks may be used as a substitute. In exercise- or heat-induced dehydration, electrolyte derangement can result, and may actually result in worsened by excess consumption of water. Hyponatremia can be corrected by intake of hypertonic fluids. Absorption is rapid and complete in most patients, but if the patient is confused, unconscious, or unable to tolerate oral fluid, intravenous rehydration & electrolyte replacement (via a drip) may be necessary.

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

Prognosis[edit source | edit]

It is widely believed that heat stroke leads only rarely to permanent deficits and the convalescence is almost complete. American researchers from the University of Chicago Medical Centre followed 58 subjects chosen from more than 3,000 patients with heat-related conditions who were admitted to Chicago area hospitals between July 12 and July 20, 1995 during the 1995 Chicago heat wave. All 58 subjects experienced symptoms of near-fatal heat stroke. Each was interviewed at the time of their discharge from the hospital, with a follow up interview scheduled one year later. Subjects ranged in age from 25 to 95, with the average age of the group being around 67. The study also recognized the fact that because of overcrowded conditions in all of the participating hospitals during this crisis, the immediate care – which is critical – was not as comprehensive as it should have been, underlining how important it is to quickly seek medical attention when the first signs occur.

However, in addition to the pre-hospital deaths, nearly half of the patients admitted to Chicago-area ICUs for heat stroke died within a year—21 percent before discharge and another 28 percent after release from the hospital. Many of the survivors suffered permanent loss of independent function; one-third had severe functional impairment at discharge, and none of them had improved after one year.^[20]

References[edit source | edit]

^ McGugan, Elizabeth A (2001). "Hyperpyrexia in the emergency department". Emergency Medicine Australasia 13 (1): 116–20. doi:10.1046/j.1442-2026.2001.00189.x. PMID 11476402.
^ Extreme Heat Guide, Centers for Disease Control and Prevention (CDC)
^ http://www.paw-rescue.org/PAW/PETTIPS/DogTip_HotCars.php^{[full citation needed]}
^ Heat danger: 500th child dies in a hot car, Consumer Reports, June 3, 2011
^ Court outcomes vary when kids die in hot cars, Associated Press, 2011
^ More kids die in hot cars, half because parents forget them, USA Today, June 30, 2010
^ Weingarten, Gene (March 8, 2009). "Forgetting a child in the back seat of a hot, parked car is a horrifying, inexcusable mistake. But is it a crime?". The Washington Post. Retrieved May 2, 2010.
^ "The Last Word: Forgotten Baby Syndrome". The Week. March 26, 2009.
^ http://phoenix.about.com/od/car/a/summercar.htm
^ "Avoiding Classic Heat Stroke", Institute for Good Medicine at the Pennsylvania Medical Society
^ Guyton, Arthur. (1976) Textbook of Medical Physiology. (5th ed). Philadelphia: W.B. Saunders.^{[page needed]}
^ Working in Hot Environments. National Institute for Occupational Safety and Health, 1992. NIOSH Publication No. 86-112. Accessed May 21, 2009.
^ http://www.osha.gov/Publications/osha3154.pdf^{[full citation needed]}
^ 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): 1317–23. doi:10.1152/japplphysiol.00541.2002 (inactive July 31, 2012). PMID 12626467.
^ 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. doi:10.4085/1062-6050-44.1.84. PMC 2629045. PMID 19180223.
^ 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): 439–44. doi:10.4085/1062-6050-45.5.439. PMC 2938313. PMID 20831387.
^ Hausfater, Pierre (2004). "Dantrolene and heatstroke: A good molecule applied in an unsuitable situation". Critical Care 9 (1): 23–4. doi:10.1186/cc2939. PMC 1065093. PMID 15693976.
^ "Classic heat stroke during Chicago 1995 heat wave". University of Chicago Medicine. August 1, 1998. Retrieved 2012-07-22.

External links[edit source | edit]

Heat stroke on Medicine.net

UpToDate Contents

全文を閲覧するには購読必要です。 To read the full text you will need to subscribe.

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

Cytoprotection of human endothelial cells against oxidative stress by 1-[2-cyano-3,12-dioxooleana-1,9(11)-dien-28-oyl]imidazole (CDDO-Im): Application of systems biology to understand the mechanism of action.

Wang X1, Bynum JA2, Stavchansky S3, Bowman PD4.Author information 1Department of Pharmaceutical Sciences, School of Pharmacy, Philadelphia College of Osteopathic Medicine-Georgia Campus, 625 Old Peachtree Road NW, Suwanee, GA 30024-2937, USA. Electronic address: xinyuwa@pcom.edu.2US Army Institute of Surgical Research, Fort Sam Houston, TX 78234, USA; Division of Pharmaceutics, College of Pharmacy, University of Texas at Austin, TX 77812, USA.3Division of Pharmaceutics, College of Pharmacy, University of Texas at Austin, TX 77812, USA.4US Army Institute of Surgical Research, Fort Sam Houston, TX 78234, USA. Electronic address: phillip.d.bowman4.vol@mail.mil.AbstractCellular damage from oxidative stress, in particular following ischemic injury, occurs during heart attack, stroke, or traumatic injury, and is potentially reducible with appropriate drug treatment. We previously reported that caffeic acid phenethyl ester (CAPE), a plant-derived polyphenolic compound, protected human umbilical vein endothelial cells (HUVEC) from menadione-induced oxidative stress and that this cytoprotective effect was correlated with the capacity to induce heme oxygenase-1 (HMOX1) and its protein product, a phase II cytoprotective enzyme. To further improve this cytoprotective effect, we studied a synthetic triterpenoid, 1-[2-cyano-3,12-dioxooleana-1,9(11)-dien-28-oyl]imidazole (CDDO-Im), which is known as a potent phase II enzyme inducer with antitumor and anti-inflammatory activities, and compared it to CAPE. CDDO-Im at 200nM provided more protection to HUVEC against oxidative stress than 20μM CAPE. We explored the mechanism of CDDO-Im cytoprotection with gene expression profiling and pathway analysis and compared to that of CAPE. In addition to potent up-regulation of HMOX1, heat shock proteins (HSP) were also found to be highly induced by CDDO-Im in HUVEC. Pathway analysis results showed that transcription factor Nrf2-mediated oxidative stress response was among the top canonical pathways commonly activated by both CDDO-Im and CAPE. Compared to CAPE, CDDO-Im up-regulated more HSP and some of them to a much higher extent. In addition, CDDO-Im treatment affected Nrf2 pathway more significantly. These findings may provide an explanation why CDDO-Im is a more potent cytoprotectant than CAPE against oxidative stress in HUVEC.
European journal of pharmacology.Eur J Pharmacol.2014 Apr 3. pii: S0014-2999(14)00239-8. doi: 10.1016/j.ejphar.2014.03.033. [Epub ahead of print]
Cellular damage from oxidative stress, in particular following ischemic injury, occurs during heart attack, stroke, or traumatic injury, and is potentially reducible with appropriate drug treatment. We previously reported that caffeic acid phenethyl ester (CAPE), a plant-derived polyphenolic compoun
PMID 24703885

The implementation of a protocol for the prevention and management of exertional heat illness in sport.

Broman D1, Fearn R, Wittenberg M.Author information 1Maccabi Great Britain, London, United Kingdom.AbstractBACKGROUND: The risk of heat-related illness in sport is significant. It can range from minor symptoms, through heat exhaustion to heat stroke, coma and possible death. Early recognition and cooling can reduce morbidity and mortality associated with exertional heat illness (EHI).
British journal of sports medicine.Br J Sports Med.2014 Apr;48(7):573. doi: 10.1136/bjsports-2014-093494.37.
BACKGROUND: The risk of heat-related illness in sport is significant. It can range from minor symptoms, through heat exhaustion to heat stroke, coma and possible death. Early recognition and cooling can reduce morbidity and mortality associated with exertional heat illness (EHI).OBJECTIVE: The aim o
PMID 24620078

Panophthalmoplegia and vision loss after cosmetic nasal dorsum injection.

Kim SN1, Byun DS1, Park JH1, Han SW2, Baik JS1, Kim JY1, Park JH1.Author information 1Department of Neurology, Sanggye Paik Hospital, Inje University College of Medicine, 761-1 Sanggye 7, Nowon-gu, Seoul 139-707, South Korea.2Department of Neurology, Sanggye Paik Hospital, Inje University College of Medicine, 761-1 Sanggye 7, Nowon-gu, Seoul 139-707, South Korea. Electronic address: swhan@paik.ac.kr.AbstractWe report a case of unilateral blindness and panophthalmoplegia after hyaluronic acid injection into the dorsum of the nose in a healthy young woman. Microspheres of hyaluronic acid are popular fillers for facial rejuvenation. While ocular side effects from injections in the nose and face have been reported following turbinate injection, rhinoplasty and infraorbital nerve block, ocular side effects from injection into the dorsum of the nose are extremely rare. We presume that the symptoms were due to obstruction of the branches of the ophthalmic artery. Under high injection pressure, the microspheres travelled to the ophthalmic artery and were propelled by the blood flow to the central retinal artery and the anterior and posterior long ciliary arteries, leading to her symptoms. Alternatively, there are several arterio-venous anastomotic channels in the nasal mucosa that aid heat exchange. These may have been the conduit for reflux of the filler into the arterial side of the regional circulation. Physicians must remain aware of serious complications during cosmetic injections to this region.
Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia.J Clin Neurosci.2014 Apr;21(4):678-80. doi: 10.1016/j.jocn.2013.05.018. Epub 2013 Aug 9.
We report a case of unilateral blindness and panophthalmoplegia after hyaluronic acid injection into the dorsum of the nose in a healthy young woman. Microspheres of hyaluronic acid are popular fillers for facial rejuvenation. While ocular side effects from injections in the nose and face have been
PMID 24210801

Japanese Journal

熱中症対策の効果 : 自治体の取り組み

日本建築学会環境系論文集 80(716), 993-1000, 2015-10
NAID 40020612110

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

熱中症のため刑事責任なしとされた傷害事件の無罪判決が取り消された控訴審における医学的見解の重要性

賠償科学 = Journal of compensation science : 日本賠償科学会雑誌 (43), 84-88, 2015-06
NAID 40020526870

Related Pictures

★リンクテーブル★

リンク元

「熱射病」

Heat stroke
	Classification and external resources
ICD-10	T67.0
ICD-9	992.0
DiseasesDB	5690
MedlinePlus	000056
eMedicine	med/956
MeSH	D018883

　　[★]

英: heatstroke, thermic fever, heat apoplexy, heat hyperpyrexia
同: ~~うつ熱症 heat retention~~、~~日射病？ sun stroke？~~
関: 熱中症

熱中症のなかで最重症型
臓器障害を来しうる。
病型：

古典的熱射病 classic heat stroke：幼小児や老人に多い。
労作性熱射病 exertional heat stroke：高温環境下での激しい身体活動を行った際に発症。

治療

冷却：体温が38℃以下になるまで速やかに冷却　←　38℃以下に冷やすと、冷やしすぎるため、らしい。持続的に冷却し深部体温が38℃に達する頃には体表温度はもっと下がっており、やがて深部と平衡に達して適切な体温に達する、のかもしれない。

外部冷却：氷嚢による鼠径部、腋窩、上胸部、頚部の冷却。冷水吹きつけによる蒸発冷却
内部冷却：胃、膀胱、直腸の冷水による洗浄

[1] McGugan, Elizabeth A (2001). "Hyperpyrexia in the emergency department". Emergency Medicine Australasia 13 (1): 116–20. doi:10.1046/j.1442-2026.2001.00189.x. PMID 11476402.

[2] Extreme Heat Guide, Centers for Disease Control and Prevention (CDC)

[3] ttp://www.paw-rescue.org/PAW/PETTIPS/DogTip_HotCars.php^{[full citation needed]}

[4] Heat danger: 500th child dies in a hot car, Consumer Reports, June 3, 2011

[5] Court outcomes vary when kids die in hot cars, Associated Press, 2011

[6] More kids die in hot cars, half because parents forget them, USA Today, June 30, 2010

[7] Weingarten, Gene (March 8, 2009). "Forgetting a child in the back seat of a hot, parked car is a horrifying, inexcusable mistake. But is it a crime?". The Washington Post. Retrieved May 2, 2010.

[8] "The Last Word: Forgotten Baby Syndrome". The Week. March 26, 2009.

[9] ttp://phoenix.about.com/od/car/a/summercar.htm

[10] "Avoiding Classic Heat Stroke", Institute for Good Medicine at the Pennsylvania Medical Society

[textbookofmedicalphysiology5thed-11] Guyton, Arthur. (1976) Textbook of Medical Physiology. (5th ed). Philadelphia: W.B. Saunders.^{[page needed]}

[12] Working in Hot Environments. National Institute for Occupational Safety and Health, 1992. NIOSH Publication No. 86-112. Accessed May 21, 2009.

[13] ttp://www.osha.gov/Publications/osha3154.pdf^{[full citation needed]}

[14] Tintinalli, Judith (2004). Emergency Medicine: A Comprehensive Study Guide (6th ed.). McGraw-Hill Professional. p. 1188. ISBN 0-07-138875-3.

[15] 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.

[16] Proulx, CI; Ducharme, MB; Kenny, GP (2003). "Effect of water temperature on cooling efficiency during hyperthermia in humans". Journal of Applied Physiology 94 (4): 1317–23. doi:10.1152/japplphysiol.00541.2002 (inactive July 31, 2012). PMID 12626467.

[17] 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. doi:10.4085/1062-6050-44.1.84. PMC 2629045. PMID 19180223.

[18] 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): 439–44. doi:10.4085/1062-6050-45.5.439. PMC 2938313. PMID 20831387.

[19] Hausfater, Pierre (2004). "Dantrolene and heatstroke: A good molecule applied in an unsuitable situation". Critical Care 9 (1): 23–4. doi:10.1186/cc2939. PMC 1065093. PMID 15693976.

[UC1998-20] "Classic heat stroke during Chicago 1995 heat wave". University of Chicago Medicine. August 1, 1998. Retrieved 2012-07-22.

匿名

検索

案内

案内

heatstroke