Severe heat stroke in children can lead to death, don't underestimate this disease

time:2022-11-27 author:Common phenomenon
Severe heat stroke in children can lead to death, don't underestimate this disease

*For reference only for medical professionals

I am very fortunate that the two children sent by 120 are only mild heatstroke

"Dr. Tian, ​​two patients sent by 120!" I Hearing the nurse's call, he hurried to the emergency room and saw two students in camouflage clothes lying on the stretcher. He quickly ordered the nurse to monitor the patient's ECG, and asked about the medical history while checking. The escort was a teacher of the school. After inquiries, I learned that the two students were students of a vocational high school. They were in military training today. The temperature was a bit high at noon. They had been training outdoors in the morning, and suddenly fainted. Huoxiangzhengqi water. Through the examination, the two patients were clearly conscious, answered the question correctly, had no fever, stable vital signs, no obvious abnormality in blood routine and biochemical examination, and considered the possibility of heat stroke in combination with the patient's medical history and related examinations. Recent news has repeatedly mentioned cases of death due to severe heat stroke (ie, heat stroke), and there have also been reports of a 10-year-old boy suffering from severe heat stroke leading to systemic multiple organ failure and shock. I am very fortunate that the two children sent by 120 only had mild heat stroke. With the opening of schools in recent days, military training is also in full swing. However, because the temperature has picked up in recent days, children with heat stroke will be sent to the pediatric clinic from time to time for rescue. Heat stroke seems to be a minor illness, but it is known that severe heat stroke can cause serious consequences such as shock, liver and kidney failure, so the disease of heat stroke should not be underestimated. Definition of heat stroke Heat stroke refers to a heat injury disease mainly manifested by central nervous system and cardiovascular dysfunction caused by excessive loss of water and electrolytes in the human body in a high temperature and high humidity environment. Classification and manifestations of heatstroke 1. Mild heatstroke: refers to at least one of the following symptoms or signs that cannot be explained by other diseases after being exposed to a high temperature (high humidity) environment and/or strenuous exercise for a certain period of time: ① Dizziness , headache, decreased reaction, inattention, uncoordinated movements; ② thirst, palpitations, pulse rate, blood pressure drop, syncope; ③ nausea, vomiting, diarrhea, oliguria or no urine; ④ profuse or no sweat, complexion Flushing or pale, hot or clammy skin, myalgia, convulsions; ⑤ fever. 2. Moderate heat stroke: that is, heat exhaustion. Decompensated manifestations of organ insufficiency are often characterized by hypovolemia, such as clammy and cold skin, pale complexion, marked increase in heart rate, drop in blood pressure, oliguria, etc. There was no obvious neurological damage. 3. Severe heat stroke: heat stroke. It refers to any one of the following clinical manifestations after exposure to high temperature (high humidity) environment and/or strenuous exercise for a certain period of time, which cannot be explained by other reasons: ① The manifestations of damage to the central nervous system (such as coma, generalized convulsions, Delirium, abnormal behavior, etc.); ② Core temperature ≥ 40°C; ③ Multi-organ (≥ 2) dysfunction manifestations (liver, kidney, striated muscle, gastrointestinal, circulatory, respiratory dysfunction, etc.); ④ Severe coagulation dysfunction or diffuse Intravascular coagulation. There is a certain relationship between heat stroke and the body's own ability to withstand heat stroke. Some special occupations, such as soldiers and miners, work under high temperature conditions for a long time and are prone to heat stroke. Students participating in military training are prone to heat stroke if they have relatively little training and poor physical fitness. In addition, the elderly, children and patients with chronic diseases are at high risk. Children, in particular, have a larger ratio of body surface area to body mass, a higher rate of heat absorption, lower thermal conductivity, and less perspiration, making it easier for heat to accumulate in the body. In addition, children's thermoregulation center is underdeveloped, blood circulation is insufficient, sweat glands are smaller, and the amount of sweating is lower than that of adults, so the thermoregulation ability of children is not as good as that of adults, and they are more prone to heat stroke. First aid for heat stroke 1. Immediately remove the patient from the high temperature site and move it to a ventilated, cool and dry place, such as a corridor and an air-conditioned room. The temperature should be kept at 22℃~25℃, not too low. 2. Lay the patient supine and unbutton the clothes button and belt, loosen or take off the clothes to facilitate breathing and heat dissipation, and replace the clothes soaked by sweat. 3. Wipe the head, neck, armpits and groin with cold water to dissipate heat until the body temperature drops below 38°C. 4. People with heat stroke sweat more and need to add salty water. However, it should be noted that it is not advisable to add a lot of water. Drinking too much water at one time will cause or aggravate nausea, vomiting, headache and other uncomfortable feelings, which will aggravate the symptoms of heat stroke. 5. For those with severe heatstroke, they must immediately call the rescue phone, and turn the patient's head to one side during the rescue to avoid aspiration. If cardiac and respiratory arrest occurs, immediately perform cardiopulmonary resuscitation. During the transfer process, a stretcher should be used to make the patient supine, and it is best to use an air-conditioned vehicle for transfer. Oxygen inhalation, intravenous infusion of 5% dextrose saline or normal saline, etc. were given, and ice pillows were placed on the ice pillow during transportation, and ice cubes were placed at the passage of large blood vessels such as the neck, armpit, and groin to continue physical cooling. Prevention of heat stroke 1. Drink plenty of water. In hot weather, be sure to drink enough water. For those exposed to the scorching sun, due to the large amount of sweat, the body will lose a lot of salt and minerals, which can be replenished by drinking warm salt water or sports drinks; avoid drinking too cold ice drinks to avoid stomach cramps. 2. Reduce outdoor activities When the temperature is too hot and humid, reduce the time you spend working and exercising outdoors. 3. Do a good job of protection when going out. It is best to wear cotton, linen, silk and other well-ventilated clothing when going out in summer, so as not to be unable to dissipate heat in time when sweating a lot; it is best to wear umbrellas, sun hats and sunglasses when going out. Carry heatstroke prevention and cooling items with you, such as drinking water, wind oil, etc. 4. Ensure adequate sleep In hot weather, ensure adequate rest and sleep to prevent excessive fatigue, so as not to reduce the body's resistance. The room should be ventilated, and the temperature difference between the indoor and outdoor air conditioners should not be too large. 5. A first aid kit should be prepared at the work site for drug prevention, which contains Huoxiangzhengqi oral liquid, cooling oil, wind oil essence and other heatstroke prevention items; if you need to go out for a long time in high temperature weather, you can use wind oil essence or cooling oil on the forehead and temples , or take Chinese patent medicines with less side effects such as Huoxiangzhengqi water (pills) under the guidance of a doctor to prevent heat stroke; but Huoxiangzhengqi water contains alcohol, before driving, people allergic to alcohol, children and patients who are taking anti-inflammatory drugs, It should be avoided. Alcohol-free dosage forms are available. To sum up, heat stroke is common in high temperature and humid environments. Early detection and timely medical treatment should be done to reduce the disability rate and fatality rate of severe heat stroke. Taking reasonable measures can effectively prevent the occurrence of heat stroke. References: [1] Li Ting, Li Jun, Wang Fan, Xu Wen. New cognition on the concept of heatstroke prevention and diagnosis criteria for heatstroke [J]. China Health Standards Management, 2016,7(36):8-9. [2] Bian Ji. Beware of heat stroke in high temperature weather [J]. New Countryside, 2022(08): 42. [3] Yu Biao. How to carry out pre-hospital first aid treatment for patients with heat stroke? [J]. Everyone Health, 2020 (05):97.[4]Su Xiaowen.Heatstroke Prevention and On-site Rescue[J].Modern Medicine and Health, 2011,27(16):2512-2513. This article was first published: Pediatrics Channel of the Medical Community The author of this article: Peking University Shougang Hospital Pediatrics Tian Mingda Wu Jun editor in charge: Xiang Yu has the Pediatric Clinical Knowledge Doctor Station App you want to see👇1. Scan the QR code below 2. 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