Heat Stroke in Emergency Department: Diagnosis and Management
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Abstract
Background: Heat stroke is a severe health concern with the potential for multi-organ failure, necessitating rapid and effective management. With rising global temperatures, there is increasing concern regarding the vulnerability of populations in high-heat areas, notably in Saudi Arabia, especially during the annual Hajj pilgrimage.
Objective: This paper aims to review the epidemiology, evaluation and management techniques of heat stroke, emphasizing the situation during Hajj pilgrimages in Saudi Arabia, and to outline the best practices for emergency management.
Methodology: A comprehensive review of literature and studies related to heat stroke, both globally and specific to Saudi Arabia, was undertaken. An in-depth analysis of emergency management, including initial assessment, cooling methods, organ support, medication, and prevention strategies, was conducted.
Results: Heat stroke remains a significant cause of emergency department visits, with specific groups, such as men and the elderly, being more susceptible. During the Hajj in 2016, 267 patients were diagnosed with heat-related illnesses, with heatstroke accounting for 29% of these cases. With the threat of global warming, studies indicate a potential tenfold increase in heat stroke risk with a 2°C rise in temperatures. Swift and comprehensive cooling is pivotal for recovery. Management emphasizes rapid recognition, assessment, and varied cooling methods, along with targeted treatments for organ dysfunctions. Prevention strategies play a vital role, given the higher efficacy and practicality over treating organ dysfunctions.
Conclusion: Heat stroke is a pressing health challenge, particularly in high-risk environments like Saudi Arabia during the Hajj pilgrimage. While effective emergency management protocols exist, an emphasis on prevention is crucial. It is imperative to incorporate a comprehensive approach to address both the immediate threat and long-term risks of heat stroke, especially with the looming challenge of global warming.
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References
Bouchama A, Knochel JP. Heat stroke. New England Journal of Medicine. 2002;346(25):1978-88.
Watts N, et al. The 2019 report of The Lancet Countdown on health and climate change: ensuring that the health of a child born today is not defined by a changing climate. The Lancet. 2019;394(10211):1836-78.
Glazer JL. Management of heatstroke and heat exhaustion. American Family Physician. 2005;71(11):2133-40.
Becker JA, Stewart LK. Heat-related illness. American Family Physician. 2011;83(11):1325-30.
O’Connor FG, Casa DJ. Exertional heat illness in adolescents and adults: epidemiology, thermoregulation, risk factors, and diagnosis. UpToDate. 2021.
Bouchama A, et al. Pathophysiology of heatstroke: a multisystemic endotype-based approach. Annals of the New York Academy of Sciences. 2018;1435(1):4-18.
Epstein Y, Roberts WO. The pathophysiology of heat stroke: an integrative view of the final common pathway. Scandinavian Journal of Medicine & Science in Sports. 2011;21(6):742-48.
Costrini A. Emergency treatment of exertional heatstroke and comparison of whole body cooling techniques. Medicine and Science in Sports and Exercise. 1990;22(1):15-18.
Casa DJ, et al. Survival strategy: acute treatment of exertional heat stroke. Journal of Athletic Training. 2005;40(3):117-120.
Smith JE. Cooling methods used in the treatment of exertional heat illness. British Journal of Sports Medicine. 2005;39(8):503-507.
Budd GM. Wet-bulb globe temperature (WBGT)—its history and its limitations. Journal of Science and Medicine in Sport. 2008;11(1):20-32.
Oke TR. The energetic basis of the urban heat island. Quarterly Journal of the Royal Meteorological Society. 1982;108(455):1-24.
Casa DJ, et al. Exertional heat stroke in competitive athletes. Current Sports Medicine Reports. 2005;4(6):309-317.
Pandolf KB. Time course of heat acclimatization and its decay. International Journal of Sports Medicine. 1998;19(S 2):S157-S160.
Kenny GP, et al. Heat exposure: health threats and remedies. Annual Review of Public Health. 2020;41:15-34.
Jessen C. The role of body temperature in the regulation of energy metabolism. Proceedings of the Nutrition Society. 1980;39(3):205-214.
Kenney WL, Munce TA. Aging and human temperature regulation. Journal of Applied Physiology. 2003;95(6):2598-2603.
Morris A, Patel G. Heat Stroke. [Updated 2023 Feb 13]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK537135/
Gaudio FG, Grissom CK. Cooling Methods in Heat Stroke. J Emerg Med. 2016 Apr;50(4):607-16.
Pease S, Bouadma L, Kermarrec N, Schortgen F, Régnier B, Wolff M. Early organ dysfunction course, cooling time and outcome in classic heatstroke. Intensive Care Med. 2009 Aug;35(8):1454-8
Wu, X., Brady, J. E., Rosenberg, H., & Li, G. (2014). Emergency Department Visits for Heat Stroke in the United States, 2009 and 2010. Injury epidemiology, 1(1), 8. https://doi.org/10.1186/2197-1714-1-8
Khogali M. (1983). Epidemiology of heat illnesses during the Makkah Pilgrimages in Saudi Arabia. International journal of epidemiology, 12(3), 267–273. https://doi.org/10.1093/ije/12.3.267
Abdelmoety, D. A., El-Bakri, N. K., Almowalld, W. O., Turkistani, Z. A., Bugis, B. H., Baseif, E. A., Melbari, M. H., AlHarbi, K., & Abu-Shaheen, A. (2018). Characteristics of Heat Illness during Hajj: A Cross-Sectional Study. BioMed research international, 2018, 5629474. https://doi.org/10.1155/2018/5629474
Saeed, F., Schleussner, C.-F., & Almazroui, M. (2021). From Paris to Makkah: heat stress risks for Muslim pilgrims at 1.5 °C and 2 °C. Environmental Research Letters, 16(2), 024037. https://doi.org/10.1088/1748-9326/abd067
Soomaroo L., Murray V. Weather and environmental hazards at mass gatherings. PLoS Currents. 2012 doi: 10.1371/4fca9ee30afc4.
Shafi S., Dar O., Khan M., et al. The annual Hajj pilgrimage—minimizing the risk of ill health in pilgrims from Europe and opportunity for driving the best prevention and health promotion guidelines. International Journal of Infectious Diseases. 2016;47:79–82. doi: 10.1016/j.ijid.2016.06.013
SMR A. l., Asmidar A. B., Yussof S. Determining the types of diseases and emergency issues in Pilgrims during Hajj: a literature review. International Journal of Advanced Computer Science and Applications. 2016;7(10):86–94
Galal M. S., Salem K. A. Pattern of heat stroke and heat exhaustion among pilgrims . Over 20 years (1982-2001) The Egyptian Journal of Community Medicine. 2003;21(3)
Mackowiak, P. A. (1998). Concepts of fever. Archives of Internal Medicine, 158(17), 1870-1881.
Casa, D. J., DeMartini, J. K., Bergeron, M. F., Csillan, D., Eichner, E. R., Lopez, R. M., ... & Yeargin, S. W. (2015). National Athletic Trainers' Association position statement: exertional heat illnesses. Journal of Athletic Training, 50(9), 986-1000.
Hall, D. M., Baumgardner, K. R., Oberley, T. D., & Gisolfi, C. V. (1999). Splanchnic tissues undergo hypoxic stress during whole body hyperthermia. American Journal of Physiology-Gastrointestinal and Liver Physiology, 276(5), G1195-G1203.
Leiva DF, Church B. Heat Illness. [Updated 2023 Apr 10]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK553117/
Sharma, V. M., Sridharan, K., Pichan, G., & Panwar, M. R. (1986). Influence of heat-stress induced dehydration on mental functions. Ergonomics, 29(6), 791-799.
Leon, L. R., & Helwig, B. G. (2010). Heat stroke: role of the systemic inflammatory response. Journal of Applied Physiology, 109(6), 1980-1988.
Savioli, G., Zanza, C., Longhitano, Y., Nardone, A., Varesi, A., Ceresa, I. F., Manetti, A. C., Volonnino, G., Maiese, A., & La Russa, R. (2022). Heat-Related Illness in Emergency and Critical Care: Recommendations for Recognition and Management with Medico-Legal Considerations. Biomedicines, 10(10), 2542. https://doi.org/10.3390/biomedicines10102542
Morris A, Patel G. Heat Stroke. [Updated 2023 Feb 13]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK537135/
Hifumi, T., Kondo, Y., Shimizu, K., & Miyake, Y. (2018). Heat stroke. Journal of intensive care, 6, 30. https://doi.org/10.1186/s40560-018-0298-4
Hausfater P, Megarbane B, Dautheville S, Patzak A, Andronikof M, Santin A, Andre S, Korchia L, Terbaoui N, Kierzek G, Doumenc B, Leroy C, Riou B. Prognostic factors in non-exertional heatstroke. Intensive Care Med. 2010;36:272–280. doi: 10.1007/s00134-009-1694-y.
Argaud L, Ferry T, Le QH, Marfisi A, Ciorba D, Achache P, Ducluzeau R, Robert D. Short- and long-term outcomes of heatstroke following the 2003 heat wave in Lyon, France. Arch Intern Med. 2007;167:2177–2183. doi: 10.1001/archinte.167.20.ioi70147.
Misset B, De Jonghe B, Bastuji-Garin S, Gattolliat O, Boughrara E, Annane D, Hausfater P, Garrouste-Orgeas M, Carlet J. Mortality of patients with heatstroke admitted to intensive care units during the 2003 heat wave in France: a national multiple-center risk-factor study. Crit Care Med. 2006;34:1087–1092. doi: 10.1097/01.CCM.0000206469.33615.02
Rublee, C., Dresser, C., Giudice, C., Lemery, J., & Sorensen, C. (2021). Evidence-Based Heatstroke Management in the Emergency Department. The western journal of emergency medicine, 22(2), 186–195. https://doi.org/10.5811/westjem.2020.11.49007
Smith JE. Cooling methods used in the treatment of exertional heat illness. British Journal of Sports Medicine. 2005;39(8):503-507.
Kenney WL, Munce TA. Aging and human temperature regulation. Journal of Applied Physiology. 2003;95(6):2598-2603
Epstein, Y., & Yanovich, R. (2019). Heatstroke. New England Journal of Medicine, 380(25), 2449-2459
Hifumi, T., Kondo, Y., Shimizu, K., & Miyake, Y. (2018). Heat stroke. Journal of intensive care, 6, 30. https://doi.org/10.1186/s40560-018-0298-4
Casa, D. J., et al. (2015). Intravenous versus oral rehydration during a brief period: responses to subsequent exercise in the heat. Medicine & Science in Sports & Exercise, 47(1), 50-59.
Roberts, W. O. (2006). Exertional heat stroke during a cool weather marathon: a case study. Medicine & Science in Sports & Exercise, 38(7), 1197-1203 5
Dematte, J. E., et al. (1998). Near-fatal heat stroke during the 1995 heat wave in Chicago. Annals of Internal Medicine, 129(3), 173-181
Leon, L. R., & Bouchama, A. (2015). Heat stroke. Comprehensive Physiology, 5(2), 611-647.
Armstrong, L. E., & Maresh, C. M. (1991). The induction and decay of heat acclimatisation in trained athletes. Sports Medicine, 12(5), 302-312.
Casa, D. J., et al. (2007). American College of Sports Medicine roundtable on hydration and physical activity: consensus statements. Current Sports Medicine Reports, 6(3), 115-127.
Peiris AN, Jaroudi S, Heat Stroke NR. JAMA. 2017;318:2503. doi: 10.1001/jama.2017.18780