Heat stroke - Heat emergencies

Japanese: 熱中症 - ねっちゅうしょう（英語表記）Heat emergencies

What kind of disability is it?

Heatstroke is a general term for physical disorders caused by exercise or heat. Heat stroke ( Nesshabyo ) or sunstroke ( Nisshabyo ) This is called severe heat stroke.

Medically speaking, heat stroke is Hypothalamus ( Turnip ) This is an extremely urgent condition in which the body's ability to maintain normal body temperature is weakened, sweating stops, and the body temperature exceeds 40°C, leading to death if left untreated. Of these, heatstroke, which is caused in part by sunlight, is called heatstroke.

What is the cause?

The human body lowers its temperature by losing heat through the skin and by sweating, but when the outside air is above skin temperature or when the humidity is very high, it becomes difficult to lose heat or sweat, which can lead to heatstroke.

Elderly people with underlying diseases, obese people, people with diabetes, and people with alcoholism are more likely to suffer from heat stroke. There have been reports of many elderly people suffering from heat stroke in years when there was an abnormal heat wave. Drunk ( Deisu ) Then in the sauna coma ( Today ) There have been reports of people falling into a trap and small children being locked in cars, but usually Scorching Hot ( Heat ) It occurs when you continue exercising or working in an environment that is too harsh.

On the other hand, there is a theory that the most severe form of heatstroke, which can be fatal, is related to predisposing factors (original constitution).

The reasoning is that heat stroke can occur even with thorough training and management thanks to advances in sports medicine, and that heat stroke is very similar in pathology to malignant hyperthermia, an abnormally high body temperature caused by anesthesia. Sarcoplasmic reticulum ( Coin ) It is caused by an abnormality in calcium metabolism in the body, and there is evidence that there is a familial predisposition to it.

How symptoms manifest

Heat stroke can be classified into mild heat cramps and moderate heat stroke. Heat exhaustion ( Heat recovery ) and severe heat stroke.

Symptoms range from headaches and fatigue to what is commonly known as "heatstroke," heat cramps that cause muscle cramps, heat exhaustion that is mainly caused by dehydration and leads to headaches and nausea, and the most severe form of heat stroke, in which the body temperature exceeds 40°C and consciousness is lost.

Treatment methods

1. Heat convulsions

This is likely to occur when excessive sweating is caused by only replacing fluids, and is believed to be due to a relative lack of salt. For this reason, saline or lactated Ringer's solution is administered intravenously.

②Heat exhaustion

Although this is a type of dehydration, because the body's thermoregulatory function remains, sweating continues and the body temperature does not rise significantly. Intravenous infusion of saline or lactated Ringer's solution and administration of analgesics are effective, but since correcting dehydration takes time, treatment is required after hospitalization.

3) Heat stroke

The function of the body temperature center in the hypothalamus and sweat glands declines, causing the core body temperature to rise above 40°C, creating a highly urgent condition.

Hematologically, consumption coagulation disorder (clotting factors are consumed, resulting in bleeding tendency) is observed, and even in survivors, Acute renal failure ( Emergency person ) This leads to:

The patient was admitted to the intensive care unit and given 1) cooling, 2) fluid and electrolyte adjustment, 3) anticonvulsants, Muscle relaxants ( Kinkikan ) 4) Treatment for consumption coagulopathy, and 5) other symptomatic treatments are intensively performed.

How to provide first aid

There are three basic steps:

1) Rest

Loosen your clothing and rest to help cool your body.

② Cooling

Let it rest in a cool place. Move it to a shady, air-conditioned room with good ventilation.

Also, Ice pack ( Hyono ) , ice blocks, etc. Armpit ( Armpit ) It cools areas such as under the legs, around the neck, and at the base of the legs, and helps cool body temperature quickly through blood circulation.

3) Hydration

If the person is conscious, rehydrate them (with a sports drink). If they are unconscious or nauseous, they will need to be given fluids at a medical institution and an ambulance will be called to transport them to an emergency medical facility.

Toshiharu Yoshioka

Source: Houken “Sixth Edition Family Medicine Encyclopedia” Information about the Sixth Edition Family Medicine Encyclopedia

Japanese:

どんな障害か

　熱中症は、運動や暑熱から起こる体の障害の総称です。熱射病(ねっしゃびょう)や日射病(にっしゃびょう)と呼ばれているものは、重症の熱中症のことです。

　医学的にいう熱射病は、視床下部(ししょうかぶ)の体温を正常に保とうとする機能が低下して、汗がとまってしまい、体温が40℃を超えて、そのままでは死に至る極めて緊急性の高い状態を指します。このうち、太陽光がその一因となるものを日射病といいます。

原因は何か

　人間の体は、皮膚からの放熱や発汗によって体温を下げますが、外気が皮膚温以上の時や湿度が非常に高いと、放熱や発汗ができにくくなり、熱中症を引き起こします。

　基礎疾患のある高齢者や肥満、糖尿病の患者さん、アルコール依存症の患者さんは、熱射病に陥りやすいとされています。異常な熱波に見舞われた年に多くの高齢者に発生したという報告や、泥酔(でいすい)してサウナで昏睡(こんすい)に陥った人、車内に閉じこめられた幼児の報告もありますが、通常は灼熱(しゃくねつ)環境下での運動や作業を無理に続けた時に発生します。

　一方、死に至ることもある最重症の熱射病には、素因（もともとの体質）が関係するとする考え方があります。

　その論拠は、スポーツ医学の発達で指導管理を徹底しても熱射病が発症すること、また熱射病は、麻酔により異常な高体温となる悪性高熱症と、その病態がよく似ていることにあります。悪性高熱症は、骨格筋の筋小胞体(きんしょうほうたい)におけるカルシウム代謝の異常が原因で、家系的な素因のあることが証明されています。