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Heat, cold and electrical trauma
Published in Jason Payne-James, Richard Jones, Simpson's Forensic Medicine, 2019
Jason Payne-James, Richard Jones
Hyperthermia, a condition where the core body temperature is greater than 40°C (100°F), occurs when heat is no longer effectively dissipated, leading to excessive heat retention. Its development may be associated with those who have taken prescribed drugs including some anti-psychotics and those who have taken illicit stimulants including cocaine and amphetamine and some novel psychoactive substances. These appear to elevate metabolic rate/heat production or reduce sweating. It may also occur in those with medical conditions (e.g., hyperthyroidism), or in those who are resisting restraint. It may occur in those exposed to high ambient temperatures (heat stroke) and has a high risk of mortality or morbidity, which can occur in the young and fit (exertional heat stroke) as well as the elderly and infirm (non-exertional heat stroke). Other examples may include children trapped in hot cars. Exertional heat illness is recognised within military training programmes. Autopsy findings in such cases are non-specific but can include diffuse petechial haemorrhages of serosal membranes and lung congestion as well as features in keeping with ‘shock’ and multiple organ failure in those who survive for a short period, if resuscitative measures are ineffective.
Age-Related Changes in the Autonomic Nervous System
Published in David Robertson, Italo Biaggioni, Disorders of the Autonomic Nervous System, 2019
Sheila M. Ryan, Lewis A. Lipsitz
Sweating and vasodilatation normally occur in response to elevations in environmental temperature to prevent an excessive rise in the core temperature. Epidemiological studies suggest that elderly individuals are more vulnerable to heat stroke. Skin atrophy which accompanies normal aging results in a loss of sweat glands. As a result, elderly individuals exhibit reduced sweating in response to heat and neurochemical stimulation (Foster et al., 1976). In addition, the elderly have a higher core temperature threshold for the onset of sweating and vasodilatation. Vasodila-tory responses to radiant heat on the forearm have been investigated using doppler skin blood flow measurements (Richardson, 1989). Young subjects demonstrated an increased forearm cutaneous blood flow in response to heat, measured as the increase in velocity and volume of blood cells flowing through the vessels. This response may result from the combination of increased blood flow through dilated veins, and from the opening of capillary vessels that increase the cutaneous vascular bed. Elderly subjects showed attenuated cutaneous blood flow responses to local heat, although it is not clear if this is secondary to reduced vasodilatation or less recruitment of capillary vessels. When the effect of age, cholesterol and plasma glucose on cutaneous blood flow response to ambient heat was investigated, age was the most important variable (Richardson, 1989).
Basic Thermal Physiology: What Processes Lead to the Temperature Distribution on the Skin Surface
Published in Kurt Ammer, Francis Ring, The Thermal Human Body, 2019
Prolonged failure of heat defence mechanisms leads to heat stroke, which is a severe illness characterized by a core temperature >40°C and central nervous system abnormalities such as delirium, convulsions, or coma resulting from exposure to environmental heat (classic heat stroke) or strenuous physical exercise (exertional heat stroke).
Immersive Cooling in the Prehospital Setting for Heat Stroke: A Case Report
Published in Prehospital Emergency Care, 2023
Douglas Young, Bryan Everitt, Brandon Fine, David Miramontes
Heat stroke is a well-defined emergent medical condition characterized by core body temperature >40 °C (104 °F) and end-organ dysfunction, typically manifested as alteration of the central nervous system (1). Standard care for these patients includes evaporative and convective cooling techniques and immersive cold water/ice water cooling, which has been shown to decrease body temperature the quickest of all methods (2). Immersive cooling techniques have been used in the emergency department to cool patients with heat-related illnesses (3). However, these techniques can be challenging to achieve with limited resources in the prehospital setting. Using body bags to cool individuals safely is a cost-effective and readily available solution to allow immersive cooling in an austere environment. Immersive cooling initiated in the prehospital setting remains rare, with some of the first cases being described by Jacobsen et al. in a five-case series published in Nov 2022 (4). This report describes a case of immersive cooling being applied for an elderly heat stroke patient via immersion in ice water within a body bag.
SIRT1-mediated p53 deacetylation inhibits ferroptosis and alleviates heat stress-induced lung epithelial cells injury
Published in International Journal of Hyperthermia, 2022
Hui Chen, Xiaoping Lin, Xiaohong Yi, Xiaofeng Liu, Ranghui Yu, Wenhao Fan, Yaping Ling, Yanan Liu, Weidang Xie
The global incidence of heat stroke (HS) has increased in recent years and is associated with high morbidity and mortality [1]. Acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) are widely acknowledged as common complications in critically ill patients, responsible for significant morbidity, mortality, and related healthcare costs [2]. It is well-recognized that ALI/ARDS is a common complication of heat stroke [3]. Although mechanisms involved in HS-induced ALI remain largely unknown, which seems to be associated with the results of inflammatory injury and hypoxemia, oxidative stress, and apoptosis [4]. Our previous study has demonstrated that heat stress could induce RIP1/RIP3-dependent necroptosis in pulmonary vascular endothelial cells, which may cause or exacerbate ALI induced by HS [5]. Additionally, one recent study has indicated that inhibiting lung epithelial ferroptosis can significantly improve intestinal ischemia/reperfusion (I/R)-induced lung injury [6]. It is believed that ferroptosis contributes to rhabdomyolysis development following exertional heat stroke (EHS) [7]. Therefore, the precise roles of lung epithelial ferroptosis in ALI induced by HS remains to be determined.
Enhanced intestinal permeability and intestinal co-morbidities in heat strain: A review and case for autodigestion
Published in Temperature, 2021
Anthony A. Fung, Andy Zhou, Jennifer K. Vanos, Geert W. Schmid-Schönbein
Heat stroke is multi-step, life-threatening, and can have long-term consequences to survivors due to SIRS. Significant gaps remain in understanding the pathophysiology of heat stroke. This literature summary examines a possible relationship between heat stress and autodigestion co-morbidities and interrogates its trends in a large body of scientific literature. An unbiased machine-based search of the literature indicates that heat illness and autodigestion have not been discussed in the literature to any extend. The presence of a concomitant intestinal permeability related topical class indicates that heat stress-mediated organ injury may depend on a pathway involving the small intestine barrier and an elevation of its mucosal epithelial permeability to molecules the size of digestive enzymes. The leakage of these enzymes from the intestinal tract into the systemic circulation may be related to SIRS and sepsis (Figure 14). The current evidence outlined in the two literature summaries presented here is compatible with this possibility, yet critical elements of the hypothesis remain to be tested.