Heat stroke and the elderly

Recently, the heat stroke in the elderly who often remains at home during the day increases due to high temperatures in summer by urban heat island effect. We have examined how the elderly were influenced by the high summer temperatures. We explained the patients or the caregivers at home while showing the checklist of six items. In addition, we checked and interviewed time of visits, patients' room temperature, with or without air conditioning fan etc., and filled out their histories of summer heat. If some items of the checklist were not improved, we explained the care points again every time we visited. 10 people out of the 72 patients were identified as summer heat illness at home. We need to work together with medical cares and welfare services and the other organizations of each region.     

Heat stroke: a comprehensive review

Heat stroke (HS) is a serious and potentially life-threatening condition defined as a core body temperature >40.6 degrees C. Two forms of HS are recognized, classic heat stroke, usually occurring in very young or elderly persons, and exertional heat stroke, more common in physically active individuals. An elevated body temperature and neurologic dysfunction are necessary but not sufficient to diagnose HS. Associated clinical manifestations such as extreme fatigue; hot dry skin or heavy perspiration; nausea; vomiting; diarrhea; disorientation to person, place, or time; dizziness; uncoordinated movements; and reddened face are frequently observed. Potential complications related to severe HS are acute renal failure, disseminated intravascular coagulation, rhabdomyolysis, acute respiratory distress syndrome, acid-base disorders, and electrolyte disturbances. Long-term neurologic sequelae (varying degrees of irreversible brain injury) occur in approximately 20% of patients. The prognosis is optimal when HS is diagnosed early and management with cooling measures and fluid resuscitation and electrolyte replacement begins promptly. The prognosis is poorest when treatment is delayed >2 hours.     

Heat stroke in a subtropical country

In Taiwan, a subtropical country without any history of heat waves, heat stroke has been considered a rare disease. However, after seeing several cases of the classic type of heat stroke at the end of the summer of 1998 (an unusual event) we began to review and collect cases of suspected heat stroke (hyperthermia (>40.6 degrees C) in the presence of altered mental status and anhidrosis) and tried to explore the possible cause of this unusual phenomenon. Through a emergency department (ED) chart review, case retraction from International Classification of Diseases (ICD) code, and ED conferences, six patients were found for the period from June to August (the hottest months in Taiwan) 1998. We found that the most common comorbid conditions were hypertension (4/6) and preexisting mental problems (3/6). All patients lived in the inner part of an urban area, were middle class, and were not socially isolated. Most of our patients felt unhealthy being exposed to the cold and avoided staying in air-conditioned rooms. Laboratory abnormalities and clinical presentations, except for a high fever and conscious change, seemed to be nonspecific. All cases occurred during two periods of sustained hotter-than-average weather and, to our surprise, we found that three episodes occurred around the day of the highest weather temperature (38.1 degrees C). However, the higher temperatures (around 30 degrees to 31 degrees C and 32 degrees to 33 degrees C) did not reach the criteria of a heat wave. Compared with the other study, our patients seemed to have initial worse outcomes. Because of special environment and social factors, classic heat stroke may occur occasionally in subtropic regions, without previous history of heat waves and where heat stroke rarely occurs, during periods of the persistently high temperatures. Prevention of heat stroke in an area with a low incidence includes early health organizations' issue of advisories or warnings through the media and reminding or teaching emergency physicians about heat stroke during sustained hot weather, especially when record temperatures are set.     

Heat stroke and related heat stress disorders

Medical disorders related to environmental heat exposure are exceptionally common in persons who perform hard work in hot climates. They are also common in competitive athletes as well as in persons who participate in casual exercise to maintain health. The important issue of salt and water disturbances consequent to heavy sweating in hot climates is discussed in detail as are mechanisms of potassium deficiency and its implications. The major forms of environmental heat illness including heat syncope, heat cramp, heat exhaustion, and heat stroke are presented in detail with relevant clinical examples. A discussion of the differential diagnosis of hyperthermia and rhabdomyolysis follows. Because of the difference in treatment and complications, heat stroke is subdivided into the classic variety that affects the elderly and very young and that form that follows heavy physical work and is always associated with rhabdomyolysis. Because severe heat exhaustion and heat stroke are life-threatening disorders, the chapter includes a detailed discussion of complications and plans for treatment.     

Heat stroke death as a cause of death

Tokyo Medical Examiner's Office has approximately 13,000 inquest cases and 3,000 autopsies per year. Usually the winter season has much number of inquest cases owing to the elder' s death. In summer of 2007 and 2010, however, a number of inquest and autopsy cases increased rapidly and conspicuously. The cause was the increase of heat stroke death caused by intense heat. We often appealed "the prevention of the heat stroke" for the ministries and agencies from the standpoint of medical examiners. In the present paper, the situation of heat stroke deaths in Tokyo metropolitan area and the findings and diagnosis of heat stroke death were introduced.     

Heat stroke: helping patients keep their cool

Heat stroke is a life-threatening illness that requires prompt diagnosis and treatment. Early vital sign assessment and history gathering are key to identifying this disorder.     

Heat stroke and multi-organ failure with liver involvement in an asylum-seeking refugee

Heat stroke is the result of exposure to high environmental temperature and strenuous exercise representing a medical emergency characterized by an elevated core body temperature and central nervous system disorders. Slightly elevated liver enzymes, lacking clinical significance, seem to be frequent in heat stroke, whereas severe, clinically relevant, hepatocellular injury has been observed in only a minority of cases. In the present report we describe the case of an otherwise healthy young asylum-seeking refugee from East Timor, who developed severe heat stroke during his transportation to Greece in a closed container on a ship under unusually high temperatures. He was admitted to the hospital with severe multi-organ failure. After a short period of initial improvement, he developed severe hepatocellular injury and hepatic encephalopathy. Other causes of liver damage were excluded. The patient completely recovered.     

Heat stroke at the Mekkah pilgrimage: clinical characteristics and course of 30 patients

The clinical picture and the final outcome of 30 patients with heat stroke during the Mekkah pilgrimage 1404 (September 1984) were analysed. Rapid cooling by the 'evaporative method' was achieved in a mean time of 59 min (range 15-135). An initial temperature above 42 degrees C and a cooling time of more than 1 h indicated a poor prognosis. Acute hepatic failure, 'adult respiratory distress syndrome' and decerebrate convulsions were among the fatal complications occurring in three patients. In the final outcome three patients (10 per cent) died, two patients (7 per cent) recovered but developed myocardial infarction and cerebellar ataxia respectively. Twenty-five patients (83 per cent) made an uncomplicated recovery.     

Preventable stroke and stroke prevention

Stroke is a major cause of death and disability in the world. The main causes of stroke are atherothromboembolism and cardiogenic embolism. The main causal and treatable risk factors for atherothromboembolic ischemic stroke are increasing blood pressure (BP), increasing cholesterol, cigarette smoking and diabetes; and the main risk factors for cardiogenic ischemic stroke are atrial fibrillation (AF) and ischemic heart disease. Strategies to reduce the incidence of stroke include prevention of first-ever and recurrent stroke, and treatment of patients with acute stroke to reduce death and disability. The two main strategies of stroke prevention are the 'population' (or 'mass') approach and the 'high risk' approach. The 'population' approach aims to reduce stroke by lowering the prevalence and mean level of causal risk factors in the community, by means of public education and government legislation. The 'high risk' approach aims to reduce stroke by identifying individuals at high risk of stroke, and lowering their risk by means of optimal medical therapies. Level 1 evidence from randomized controlled trials indicates that effective treatments for high risk patients include control of causal risk factors (lowering BP, lowering blood cholesterol), antithrombotic therapy (antiplatelet therapy with aspirin, clopidogrel, or the combination of aspirin and dipyridamole for patients in sinus rhythm, and anticoagulation with warfarin or ximelagatran for patients in AF) and, where appropriate, carotid revascularization for patients with severe carotid stenosis.     

Life experiences after stroke among Iranian stroke survivors

DALVANDI A., HEIKKILÄ K., MADDAH S.S.B., KHANKEH H.R. & EKMAN S.L. (2010) Life experiences after stroke among Iranian stroke survivors. International Nursing Review 57 , 247–253 Background: Stroke is a major cause of disability worldwide. It is a life‐threatening and life‐altering event, which leaves many physical and mental disabilities, thus creating major social and economic burdens. Experiencing a stroke and its aftermath can be devastating for patients and their families. In Iran, many services are not available for those who lack property; this may result in many difficulties and long‐term problems for stroke survivors and their family members who are usually the main caregivers in Iranian cultural. Despite its effect on their lives, little is known about how the survivors perceive stroke in the Iranian context, therefore, knowing more about this process may enhance problem identification and problem solving. Aim: To illuminate how stroke survivors experience and perceive life after stroke. Method: A grounded theory approach was recruited using semi‐structured interviews with 10 stroke survivors. Findings: The survivors perceived that inadequate social and financial support, lack of an educational plan, lack of access to rehabilitative services, physical and psychological problems led them to functional disturbances, poor socio‐economical situation and life disintegration. The core concept of life after stroke was functional disturbances. Conclusions: The study shows the need to support the stroke survivors in their coping process with their new situation by providing appropriate discharge plans, social and financial support, social insurances and training programmes for the stroke survivors and their families.     

Ischemic stroke

Atherosclerosis in the large carotid and cerebral vessels resulting in insufficient blood supply to the brain is the most common cause of ischemic stroke. Certain risk factors (ie, male sex and advanced age) cannot be changed. However, others (ie, hypertension, hyperlipidemia, and smoking) may be modified. Dr Bundlie describes the present state of research on preventing a first stroke by controlling these risk factors.