Exertional heat stroke in an amateur runner – Challenges in diagnostics and the role of unhealthy competition

AbstractThe active participation of skeletal muscles is a unique characteristic of exertional heat stroke. Nevertheless, the only well-documented link between skeletal muscle activities and exertional heat stroke pathophysiology is the extensive muscle damage (e. g., rhabdomyolysis) and subsequent leakage of intramuscular content into the circulation of exertional heat stroke victims. Here, we will present and discuss rarely explored roles of skeletal muscles in the context of exertional heat stroke pathophysiology and recovery. This includes an overview of heat production that contributes to severe hyperthermia and the synthesis and secretion of bioactive molecules, such as cytokines, chemokines and acute phase proteins. These molecules can alter the overall inflammatory status from pro- to anti-inflammatory, affecting other organ systems and influencing recovery. The activation of innate immunity can determine whether a victim is ready to return to physical activity or experiences a prolonged convalescence. We also provide a brief discussion on whether heat acclimation can shift skeletal muscle secretory phenotype to prevent or aid recovery from exertional heat stroke. We conclude that skeletal muscles should be considered as a key organ system in exertional heat stroke pathophysiology.

Download Full-text

A Case of Exertional Heat Stroke Complicated by Hypoxic Hepatitis

Case Reports in Emergency Medicine ◽

10.1155/2020/8724285 ◽

2020 ◽

Vol 2020 ◽

pp. 1-4

Author(s):

Bertram K. Woitok ◽

Shawki Bahmad ◽

Gregor Lindner

Keyword(s):

Supportive Care ◽

Liver Failure ◽

Acute Liver Failure ◽

Multiorgan Failure ◽

Heat Stroke ◽

Exertional Heat Stroke ◽

Hypoxic Hepatitis ◽

Threatening Condition ◽

Life Threatening ◽

Delayed Referral

Background.Exertional heat stroke is a life-threatening condition often complicated by multiorgan failure. We hereby present a case of a 25-year-old male presenting with syncope after a 10 km run in 28°C outside temperature who developed acute liver failure. Case Presentation. Initial temperature was found to be 41.1°C, and cooling measures were rapidly applied. He suffered from acute renal failure and rhabdomyolysis and proceeded to acute liver failure (ASAT 6100 U/l and ALAT 6561 U/l) due to hypoxic hepatitis on day 3. He did not meet criteria for emergency liver transplantation and recovered on supportive care. Conclusions. Acute liver failure due to heat stroke is a life-threatening condition with often delayed onset, which nevertheless resolves on supportive care in the majority of cases; thus, a delayed referral to transplant seems to be reasonable.

Download Full-text

Exertional Heat Stroke Knowledge and Management among Emergency Medical Service Providers

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18095016 ◽

2021 ◽

Vol 18 (9) ◽

pp. 5016

Author(s):

Rebecca Hirschhorn ◽

Oluwagbemiga DadeMatthews ◽

JoEllen Sefton

Keyword(s):

Service Providers ◽

Heat Stroke ◽

The United States ◽

Knowledge Assessment ◽

Years Of Experience ◽

Exertional Heat Stroke ◽

Emergency Medical ◽

Previously Treated ◽

Stroke Knowledge ◽

Cooling Methods

This study evaluated emergency medical services (EMS) providers’ knowledge of exertional heat stroke (EHS) and assessed current EMS capabilities for recognizing and managing EHS. EMS providers currently practicing in the United States were recruited to complete a 25-item questionnaire. There were 216 questionnaire responses (183 complete) representing 28 states. On average, respondents were 42.0 ± 13.0 years old, male (n = 163, 75.5%), and white (n = 176, 81.5%). Most respondents were Paramedics (n = 110, 50.9%) and had ≥16 years of experience (n = 109/214, 50.9%) working in EMS. Fifty-five percent (n = 99/180) of respondents had previously treated a patient with EHS. The average number of correct answers on the knowledge assessment was 2.6 ± 1.2 out of 7 (~37% correct). Temporal (n = 79), tympanic (n = 76), and oral (n = 68) thermometers were the most prevalent methods of temperature assessment available. Chemical cold packs (n = 164) and air conditioning (n = 134) were the most prevalent cooling methods available. Respondents demonstrated poor knowledge regarding EHS despite years of experience, and over half stating they had previously treated EHS in the field. Few EMS providers reported having access to an appropriate method of assessing or cooling a patient with EHS. Updated, evidence-based training needs to be provided and stakeholders should ensure their EMS providers have access to appropriate equipment.

Download Full-text

Prehospital management of exertional heat stroke at sports competitions: International Olympic Committee Adverse Weather Impact Expert Working Group for the Olympic Games Tokyo 2020

British Journal of Sports Medicine ◽

10.1136/bjsports-2020-103854 ◽

2021 ◽

pp. bjsports-2020-103854

Author(s):

Yuri Hosokawa ◽

Sebastien Racinais ◽

Takao Akama ◽

David Zideman ◽

Richard Budgett ◽

...

Keyword(s):

Rectal Temperature ◽

Working Group ◽

Olympic Games ◽

Heat Stroke ◽

International Olympic Committee ◽

Exertional Heat Stroke ◽

Weather Impact ◽

Prehospital Management ◽

Adverse Weather ◽

Expert Working Group

ObjectivesThis document aimed to summarise the key components of exertional heat stroke (EHS) prehospital management.MethodsMembers of the International Olympic Committee Adverse Weather Impact Expert Working Group for the Olympic Games Tokyo 2020 summarised the current best practice regarding the EHS prehospital management.ResultsSports competitions that are scheduled under high environmental heat stress or those that include events with high metabolic demands should implement and adopt policy and procedures for EHS prehospital management. The basic principles of EHS prehospital care are: early recognition, early diagnosis, rapid, on-site cooling and advanced clinical care. In order to achieve these principles, medical organisers must establish an area called the heat deck within or adjacent to the main medical tent that is optimised for EHS diagnosis, treatment and monitoring. Once admitted to the heat deck, the rectal temperature of the athlete with suspected EHS is assessed to confirm an elevated core body temperature. After EHS is diagnosed, the athlete must be cooled on-site until the rectal temperature is below 39°C. While cooling the athlete, medical providers are recommended to conduct a blood analysis to rule out exercise-associated hyponatraemia or hypoglycaemia, provided that this can be safely performed without interrupting cooling. The athlete is transported to advanced care for a full medical evaluation only after the treatment has been provided on-site.ConclusionsA coordination of care among all medical stakeholders at the sports venue, during transport, and at the hospital is warranted to ensure effective management is provided to the EHS athlete.

Download Full-text