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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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“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


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.


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

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


Signs and Symptoms


Carter: Current Sports Medicine Reports, 2008


Carter: Current Sports Medicine Reports, 2008


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 + 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

  • 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

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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