Heat production, mainly from muscles, during intense exercise is – times greater than at rest, and is sufficient to raise body core temperature by.F each min without thermoregulatory heat loss adjustments. When the rate of heat production exceeds that of heat loss for a sufficient period of time, severe hyperthermia occurs.
Heatstroke is the most serious of the syndromes associated with excess body heat. It is defined as a condition in which body temperature is elevated to a level that causes damage to the body’s tissues, giving rise to a characteristic clinical and pathological syndrome affecting multiple organs. After races, adult core rectal temperatures above .C .F have been reported in conscious runners, and -C F in collapsed runners. Sweating is usually present in runners who experience exertional heatstroke.
Strenuous physical exercise in a hot environment has been notorious as the cause of heatstroke, but heatstroke also has been observed in cool-to-moderate [-C -F] environments, suggesting variations in individual susceptibility. Skin disease, sunburn, dehydration, alcohol or drug use/abuse, obesity, sleep loss, poor physical fitness, lack of heat acclimatization, advanced age, and a previous heat injury all have been theoretically linked to increased risk of heatstroke. The risk of heatstroke is reduced if runners are well-hydrated, well-fed, rested, and acclimatized. Runners should not exercise if they have a concurrent illness, respiratory infection, diarrhea, vomiting, or fever. For example, a study ofheat casualties at a -km race showed that reported a recent gastrointestinal or respiratory illness, whereas a study of military heatstroke patients reported that three had a fever or disease and six recalled at least one warning sign of impending illness at the time of their heatstroke.
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Appropriate fluid ingestion before and during prolonged running can minimize dehydration and reduce the rate of increase in body core temperature However, excessive hyperthermia may occur in the absence of significant dehydration, especially in races of less than km, because the fast pace generates greater metabolic heat.
The mortality rate and organ damage due to heatstroke are proportional to the length of time between core temperature elevation and initiation of cooling therapy. Therefore, prompt recognition and cooling are essential A measurement of deep body temperature is vital to the diagnosis, and a rectal temperature should be measured in any casualty suspected of having heat illness or hypothermia. Ear tympanic, oral, or axillary measurements are spuriously affected by peripheral skin and environmental temperatures and should not be used after exercise. When cooling is initiated rapidly, most heatstroke patients recover fully with normal psychological status, muscle energy metabolism, heat acclimatization, temperature regulation, electrolyte balance, sweat gland function, and blood constituents.
Many whole-body cooling techniques have been used to treat exertional heatstroke, including water immersion, application of wet towels or sheets, warm air spray, helicopter downdraft, and ice packs to the neck, underarm, and groin areas. There is disagreement as to which modality provides the most efficient cooling, because several methods have been used successfully. However, the fastest whole-body cooling rates and the lowest mortality rates have been observed during cool and cold water immersion. Whichever modality is utilized it should be simple and safe, provide great cooling power, and should not restrict other forms of therapy cardiopulmonary resuscitation, defibrillation, IV cannulation. The advantages and disadvantages of various cooling techniques have been discussed.
Heatstroke is regarded as a medical emergency that might be fatal if not immediately diagnosed and properly treated. Early diagnosis is of utmost importance and time-consuming investigation should be postponed until body temperature is corrected and the patient is evacuated to a nearby medical facility that is aware of such conditions.
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