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Heat Stroke Victim

“If you asked me to name the three scariest threats facing the human race, I would give the same answer that most people would: nuclear war, global warming and W i n d o w s ” Dave Barry, American Writer. Heat Stroke Victim. Recovery from Heat Stroke?. Physiological Responses

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Heat Stroke Victim

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  1. “If you asked me to name the three scariest threats facing the human race, I would give the same answer that most people would: nuclear war, global warming and Windows” Dave Barry, American Writer

  2. Heat Stroke Victim

  3. Recovery from Heat Stroke? Physiological Responses To Exercise Heat Stress Organ / Tissue Responses Robert Carter, Ph.D., M.P.H., F.A.C.S.M.

  4. Understanding EHI/HYPO Case Reports Epidemiological Studies Risk Factors i.e., Local Injury Population Organism Tissue/Cellular Gene Expression Genetic Factors Gene-Environment i.e., Sickle Cell Trait Body Temp Heart Rate Blood Markers Environmental Acutely altered physiological factors

  5. Risk Factors Exertional Heat Illness • Male Soldier (21 yr) • Heat acclimation protocol (100 min on treadmill, 3.5 mph, 4% grade, 40ºC, 20% rh) • Developed heel blister Day 2 • Initial exam following Day 3 showed local heel swelling & clear discharge • Follow-up exam confirmed cellulitis (2-wks antibiotic therapy) • Day 4 walk 5 days after treatment Carter et al, Sports Sci Exch, 2006 Carter et al, J. Sports Rehab, 2007

  6. Signs and Symptoms

  7. Carter: Current Sports Medicine Reports, 2008

  8. Carter: Current Sports Medicine Reports, 2008

  9. Heat Tolerance Testing + Biomarkers? • Heat Tolerance Test (HTT) • 120 min walk 5 km/h at 2% grade in 40oC, 40% RH • Steady-State Core Temperature <38.5oC • Assumes Heat Stroke recovery related to gross heat exchange • Modest Compensable Heat Stress • 70 kg, 1.92 m2 Soldier have Ereq/Emax = ~45% (223/485 w/m2) • Large Core-to-Skin Temperature Gradient (~4oC), so low skin blood flow & compensatory vasoregulatory requirement • No sophisticated thermoregulatory control evaluation & no pre-injury baseline • No profile of organ injury • Best criteria for return? • Issue is Multi-Organ Dysfunction, NOT gross heat exchange • Wallace et.al. (Science Direct 2007) – Soldiers hospitalized for heat stroke subsequently had increased mortality (30 years) from cardiovascular, liver, renal & GI diseases.

  10. Heat Tolerance Testing + Biomarkers? • John Bowen – PA at TMC 14, Camp MacKall, MC • Heat Stroke Return for Special Force Qualification Course • “Best Guess from Experience” • Clean Clinical Picture • 30 days – P3(T) Profile (limit of 15 min vigorous exercise) • 30 days – P3 Profile (limit maximal exercise & MOPP) • 30 days – PT & Training (ramp & observation) • “USARIEM Twist” (core temperature telemetry & blood analyses) • Clean Clinical Picture • 30 days – Observe & walk / jog to Tc to 38.5oC (PT Uniform) • 30 days – Observe & ramp military activities to Tc to 38.5oC (ACU) • 30 days – Observe & ramp military activities to Tc to 39.5oC (no restrictions)

  11. Heat Tolerance + Exercise • Exercise promotes early recovery of • skeletal muscle • Avoids development of fibrosis • May better tolerance (muscle injury, heat stress?) • Promotes muscle mass • Inactivity significant MM losses

  12. Heat Tolerance Testing Summary • Addition information such as repeated laboratory values, biomarkers of tissue damage, ??? may be needed. • Progress responses to exercise heat stress • Repeated Exercise Bouts • Start mild exercise to “speed up” recovery • Adequate Surveillance for Follow-up

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