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“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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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 Windows”

Dave Barry, American Writer


Heat stroke victim

Heat Stroke Victim


Recovery from heat stroke

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.


Heat stroke victim

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


Risk factors

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


Heat stroke victim

Signs and Symptoms


Heat stroke victim

Carter: Current Sports Medicine Reports, 2008


Heat stroke victim

Carter: Current Sports Medicine Reports, 2008


Heat tolerance testing biomarkers

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.


Heat tolerance testing biomarkers1

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)


Heat tolerance exercise

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


Heat tolerance testing

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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