Approach to heat-related illness.

OBJECTIVE: To describe heat-related illness and provide approaches for treatment in family practice. SOURCES OF INFORMATION: The MeSH terms heat-related illness and primary care were searched in PubMed. Clinical trials, practice reviews, and systematic reviews were included in this review. Reference lists were reviewed for additional articles. MAIN MESSAGE: Extreme heat events are increasing in frequency due to climate change and can directly result in heat exhaustion, heat stroke, or death. Exposure to extreme heat also exacerbates underlying health conditions. Patients may be at increased risk of heat-related illness because of underlying sensitivity to heat, increased exposure to heat, or barriers to resources. CONCLUSION: Family physicians can help prevent heat-related illness by identifying and counselling patients who are at increased risk and by advocating for interventions that reduce the chance of heat-related illness.

Aborder les troubles liés à la chaleur.

OBJECTIF: Décrire les troubles liés à la chaleur et présenter des stratégies de traitement en pratique familiale. SOURCES DE L'INFORMATION: Une recension à l'aide des expressions MeSH en anglais heat-related illness et primary care a été effectuée dans PubMed. Les essais cliniques, les évaluations de la pratique et les revues systématiques ont été inclus dans la présente révision. Les listes de références ont été examinées pour trouver des articles additionnels. MESSAGE PRINCIPAL: Les épisodes de canicule augmentent en fréquence en raison du changement climatique et peuvent directement causer un épuisement dû à la chaleur, un coup de chaleur ou la mort. L'exposition à la chaleur extrême peut aussi exacerber les problèmes de santé sous-jacents. Les patients peuvent être à risque accru d'un trouble lié à la chaleur à cause d'une sensibilité sous-jacente ou d'une plus grande exposition à la chaleur, ou encore en raison d'obstacles pour accéder aux ressources. CONCLUSION: Les médecins de famille peuvent aider à prévenir les troubles liés à la chaleur en identifiant les patients qui sont à risque plus élevé et en plaidant en faveur d'interventions qui réduisent le risque de tels troubles.

[Heat-related illnesses: advice for clinicians and healthcare professionals]. / Maladies liées à la chaleur : conseils aux médecins et professionnels de santé.

The increase in heatwaves, a significant consequence of global warming, represents a major public health issue and is the main cause of death related to hyperthermia. The seriousness of such exposure to extreme ambient temperature lies in the difficulty to the general population to identify the warning signs and take appropriate protective measures. This article therefore presents guidelines for the prevention, recognition and treatment of heat-related illnesses, and thus arms clinicians and healthcare professionals who are on the front line in protecting the general population from this 'silent killer'.

L'augmentation des épisodes de canicule, conséquence notable du changement climatique, constitue un enjeu majeur de santé publique et représente la principale cause de mortalité liée à l'hyperthermie. La gravité de ces épisodes de chaleur extrême réside dans la difficulté pour la population générale d'identifier les signes avant-coureurs et de mettre en place des mesures de protection adéquates. Cet article présente des directives pour la prévention, la reconnaissance et le traitement des maladies liées à la chaleur, afin d'équiper les médecins et professionnels de santé qui sont en première ligne pour protéger la population générale de ce « tueur silencieux ¼.

Heat-Related Illness in Athletes.

This JAMA Insights discusses heat-related illness in athletes, including risk factors, prevention, symptoms, and management.

Heat-Related Illnesses.

There is a growing incidence of heat-related illnesses due to rising global temperatures. Heat-related illnesses range from mild to severe, with heat stroke being the most critical. The wet bulb global temperature index considers humidity and solar intensity; its use is recommended to estimate heat stress on an individual and mitigate risk. Efficient cooling methods, such as cold water immersion, are essential in severe cases. Prevention is through hydration, appropriate clothing, recognition of high risk medications, and awareness of environmental conditions. Recognizing heat-related illnesses early in the clinical course and implementing rapid cooling strategies reduces morbidity and mortality.

Management of Heat-Related Illness and Injury in the ICU: A Concise Definitive Review.

OBJECTIVES: The increasing frequency of extreme heat events has led to a growing number of heat-related injuries and illnesses in ICUs. The objective of this review was to summarize and critically appraise evidence for the management of heat-related illnesses and injuries for critical care multiprofessionals. DATA SOURCES: Ovid Medline, Embase, Cochrane Clinical Trials Register, Cumulative Index to Nursing and Allied Health Literature, and ClinicalTrials.gov databases were searched from inception through August 2023 for studies reporting on heat-related injury and illness in the setting of the ICU. STUDY SELECTION: English-language systematic reviews, narrative reviews, meta-analyses, randomized clinical trials, and observational studies were prioritized for review. Bibliographies from retrieved articles were scanned for articles that may have been missed. DATA EXTRACTION: Data regarding study methodology, patient population, management strategy, and clinical outcomes were qualitatively assessed. DATA SYNTHESIS: Several risk factors and prognostic indicators for patients diagnosed with heat-related illness and injury have been identified and reported in the literature. Effective management of these patients has included various cooling methods and fluid replenishment. Drug therapy is not effective. Multiple organ dysfunction, neurologic injury, and disseminated intravascular coagulation are common complications of heat stroke and must be managed accordingly. Burn injury from contact with hot surfaces or pavement can occur, requiring careful evaluation and possible excision and grafting in severe cases. CONCLUSIONS: The prevalence of heat-related illness and injury is increasing, and rapid initiation of appropriate therapies is necessary to optimize outcomes. Additional research is needed to identify effective methods and strategies to achieve rapid cooling, the role of immunomodulators and anticoagulant medications, the use of biomarkers to identify organ failure, and the role of artificial intelligence and precision medicine.

Exertional Heat Illness-From Identifying Heat Rash to Treating Heat Stroke.

Heat-related illness commonly affects adolescent patients, especially as summer approaches and global temperature extremes worsen. Basic counseling on sunburn prevention can decrease the risk for future malignancies, and rapidly preventing, identifying, and treating heat stroke can prevent severe morbidity and mortality. This article will review the epidemiology of exertional heat-related illness and the variations in presentations and pathology, from heat rash and sunburn to heat exhaustion and heat stroke. By the end of this review clinicians should be able to identify and treat different heat-related illnesses in adolescents and potentially save a life. [Pediatr Ann. 2024;53(1):e17-e21.].

[Heat illness]. / Hitteziekte.

Thermoregulation keeps the normal body temperature of humans at approximately 37 °C. However, as a result of heat load - both endogenous and exogenous heat - it can occur that the body is unable to dissipate excess heat, leading to an increase in the core body temperature. This can result in various heat illnesses, ranging from mild, non-life-threatening conditions, such as heat rash, heat edema, heat cramps, heat syncope and exercise associated collapse to life-threatening conditions, namely exertional heatstroke and classic heatstroke. Exertional heatstroke is the result of strenuous exercise in a (relatively) hot environment, whereas classic heatstroke is caused by environmental heat. Both forms result in a core temperature of > 40 °C in combination with a lowered or altered consciousness. Early recognition and treatment are critical in reducing morbidity and mortality. Cornerstone of treatment is cooling.

Management of a Special Warfare Trainee With Repeat Exertional Heat Stroke: A Case Study.

CONTEXT: Exertional heat stroke (EHS) is the most deadly form the exertional heat illness with a higher incidence among active duty US military members than in the general population. Current guidelines on EHS recovery timelines and return to duty vary among the military branches. In some cases, individuals experience prolonged heat and exercise intolerance with repeat exertional heat illness events, which can complicate the recovery process. Management and rehabilitation of such individuals is unclear. CASE PRESENTATION: This manuscript addresses the case and management of a US Air Force Special Warfare trainee who experienced 2 episodes of EHS, despite early recognition, gold standard treatment, and undergoing 4 weeks of a stepwise recovery after an initial EHS. MANAGEMENT AND OUTCOMES: After the second episode, a 3-step process was utilized, consisting of a prolonged and personalized recovery period, heat tolerance testing using Israeli Defense Force advanced modeling, and stepwise reacclimatization. This process allowed the trainee to successfully recover from repeat EHS and return to duty, and set a framework for future repeat EHS treatment guidelines. CONCLUSIONS: In individuals with repeat EHS, a prolonged recovery period followed by heat tolerance testing can be used to demonstrate appropriate thermotolerance and safely clear an individual to begin stepwise reacclimatization. Overall, patient care and military readiness may be improved by unified Department of Defense guidelines for return to duty after EHS.

ACSM Expert Consensus Statement on Exertional Heat Illness: Recognition, Management, and Return to Activity.

ABSTRACT: Exertional heat stroke is a true medical emergency with potential for organ injury and death. This consensus statement emphasizes that optimal exertional heat illness management is promoted by a synchronized chain of survival that promotes rapid recognition and management, as well as communication between care teams. Health care providers should be confident in the definitions, etiologies, and nuances of exertional heat exhaustion, exertional heat injury, and exertional heat stroke. Identifying the athlete with suspected exertional heat stroke early in the course, stopping activity (body heat generation), and providing rapid total body cooling are essential for survival, and like any critical life-threatening situation (cardiac arrest, brain stroke, sepsis), time is tissue. Recovery from exertional heat stroke is variable and outcomes are likely related to the duration of severe hyperthermia. Most exertional heat illnesses can be prevented with the recognition and modification of well-described risk factors ideally addressed through leadership, policy, and on-site health care.

Hypothermia following cold-water immersion treatment for exertional heat illness.

Cold-water immersion (CWI) is the gold standard therapy for exertional heat illness (EHS), and it is critical to perform CWI expeditiously when the core temperature exceeds 40°C; however, the treatment comes with risks, most notably hypothermia. Following a major marathon, three runners presented to our emergency department (ED) with symptomatic mild hypothermia requiring re-warming. Prior to developing hypothermia, all three were treated at the racecourse with CWI for EHS. During CWI, there are monitoring methods to determine appropriate cessation: continuous temperature measurement, regular temperature checks, using an equation to predict immersion time, and symptom observation. There is no consensus on the best system, but a monitoring method should be used to prevent over-cooling. This case series illustrates the importance of proper CWI execution in order to avoid harm.

Consistency and applicability of return to function guidelines in tactical-athletes with exertional heat illness. A systematic review.

OBJECTIVE: To assess the consistency of return to sport and occupation recommendations following EHI provided in published clinical practice guidelines, consensus statements, position statements, and practice alerts. The agreement between medical policies governing the return to duty following EHI between the branches of the United States Armed Forces and published recommendations was assessed. METHODS: Ovid MEDLINE, Web of Science, and CINAHL databases were searched for clinical practice guidelines and position statements published at any time that guided return to activity in individuals with EHI. Methodological quality was assessed, and the specific recommendations for clinical management were extracted. Consistency of recommendations was evaluated. Agreement between published guidelines and the policies governing return to activity in military tactical athletes with heat injury were also evaluated. RESULTS: Guidelines developed by two civilian sports medicine societies in the United States detailing recommendations for return to function following EHI were identified. There was consistency between guidelines regarding recommendations that addressed abstinence from activity; medical follow-up; graded resumption of activity; and return to function. Pertaining military policy, contemporary regulations published in recent years reflected the recommendations provided in the professional guidelines. The greatest incongruence was noted in older military policies. CONCLUSIONS: This systematic review highlights the need for consistent recommendations across all branches of the military and medical specialties pertaining to returning servicemembers to duty after EHI .

[Chinese foreign medical aid work should pay attention to heat stroke as a preventable disease under global warming context].

Within the global warming context, heat stroke heavily threatens human health as the most severe type of heat-related illnesses. Despite the urgent onset, severe condition and poor prognosis, heat stroke is entirely preventable and treatable. Most of the recipient countries of Chinese foreign medical aid work are concentrated in the tropical and subtropical regions. It is necessary to popularize the knowledge of heat stroke and improve the ability of diagnose and treatment among foreign medical aid members, which is critical to enhance the quality of medical service and provide better medical care for recipient countries and workers in Chinese-funded institutions. This article reviews the latest research progress in the epidemiology, pathophysiology, diagnosis, and treatment of heat stroke to provide scientific reference for actively implementing interventions and reducing morbidity and mortality.

Fermentation quality of herbal tea residue and its application in fattening cattle under heat stress.

BACKGROUND: Herbal tea residue (HTR) is generally considered to be the waste of herbal tea beverage production while it still retains rich nutrients and active substances. The main aim of the present study was to investigate the effect of fermentation technology on improving the quality of HTRs, and focus on the fermented HTR-induced alleviation of summer heat stress in fattening cattle. RESULTS: In this study, the waste HTR was fermented and then fed to a total of 45 fattening cattle that were divided into 3 groups (fermented HTR replaced 0, 15, 30% of the forage component of the diet), and the feeding experiment was lasted for 40 days. The physiological indexes, growth performance and fecal microbiota of fattening cattle were evaluated and results showed that fermented HTR could effectively reduce the respiratory rate and rectal temperature of fattening cattle under heat stress, increase the daily feed intake and daily gain, and improve the antioxidant content and blood immune index. In addition, we studied the fecal microbiota composition of 6 fattening cattle in control and 30% HTR substitution groups and found fermented HTR significantly changed the composition of fecal microbiota and increased microbial diversity, and correlation analysis suggested that the bacteria were closely related to fecal SCFA levels of fattening cattle under heat stress. CONCLUSIONS: In this study, fermented HTR replaced 30% of the forage component of the diet that can change the intestine microorganisms, maintain health and alleviate the heat stress of fattening cattle.

ACSM Expert Consensus Statement on Exertional Heat Illness: Recognition, Management, and Return to Activity.

ABSTRACT: Exertional heat stroke (EHS) is a true medical emergency with potential for organ injury and death. This consensus statement emphasizes that optimal exertional heat illness management is promoted by a synchronized chain of survival that promotes rapid recognition and management, as well as communication between care teams. Health care providers should be confident in the definitions, etiologies, and nuances of exertional heat exhaustion, exertional heat injury, and EHS. Identifying the athlete with suspected EHS early in the course, stopping activity (body heat generation), and providing rapid total body cooling are essential for survival, and like any critical life-threatening situation (cardiac arrest, brain stroke, sepsis), time is tissue. Recovery from EHS is variable, and outcomes are likely related to the duration of severe hyperthermia. Most exertional heat illnesses can be prevented with the recognition and modification of well-described risk factors ideally addressed through leadership, policy, and on-site health care.

Characteristics of Prehospital Heat Illness Cases During the Annual Heat Wave Period in Telangana, India.

OBJECTIVES: Global warming and more intense heat wave periods impact health. Heat illness during heat waves has not been studied in the prehospital setting of a low- and middle-income country (LMIC). Early intervention in the community and in the prehospital setting can improve outcomes. Hence, this paper aims to describe the characteristics of heat illness patients utilizing the ambulance service in Telangana state, India with the aim of optimizing public prevention and first aid strategies and prehospital response to this growing problem. METHODS: This retrospective observational study reviewed patients presenting to Telangana's prehospital emergency care system with heat illness symptoms during the heat wave period from March through June in 2018 and 2019. Descriptive analysis was done on the prehospital, dispatch, and environmental data looking at the patients' characteristics and prehospital intervention. RESULTS: There were 295 cases in 2018 and 230 cases in 2019 from March-June. The overall incidence of calls with heat illness symptoms was 1.5 cases per 100,000 people. The Scheduled Tribes (ST) had the highest incidence of 4.5 per 100,000 people. Over 96% were from the white income group (below poverty line) while two percent were from the pink income group (above poverty line). From geospatial mapping of the cases, the highest incidence of calls came from the rural, tribal areas. However, the time to response in rural areas was longer than that in an urban area. Males with an average age of 47 were more likely to be affected. The three most common symptoms recorded by the first responders were vomiting (44.4%), general weakness (28.7%), and diarrhea (15.9%). The three most common medical interventions on scene were oxygen therapy (35.1%), oral rehydration salt (ORS) solution administration (26.9%), and intravenous fluid administration (27.0%), with cold sponging infrequently mentioned. CONCLUSION: This descriptive study provides a snapshot of the regions and groups of people most affected by heat illness during heat waves and the heterogeneous symptom presentation and challenges with management in the prehospital setting. These data may aid planning of prehospital resources and preparation of community first responders during heat wave periods.