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Exertional Heat Stroke Definition & Epidemiology

Exertional Heat Stroke Definition & Epidemiology. William O Roberts MD, MS, FACSM St Johns Family Medicine Residency Department of Family Medicine University of Minnesota Medical School. Definition of EHS – Part 1. Hyperthermia during physical activity Rectal (core) temperature > 40-42 º C

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Exertional Heat Stroke Definition & Epidemiology

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  1. Exertional Heat StrokeDefinition & Epidemiology William O Roberts MD, MS, FACSM St Johns Family Medicine Residency Department of Family Medicine University of Minnesota Medical School

  2. Definition of EHS – Part 1 • Hyperthermia during physical activity • Rectal (core) temperature > 40-42 ºC • Due to • Impaired dissipation of endogenous metabolic heat • Exogenous heat gain • Extreme heat conditions

  3. Definition of EHS – Part 2 • Associated with organ system dysfunction or failure • Brain (CNS dysfunction) • CNS status impaired • Loss of lower limb function • Heart, liver, kidney, muscle

  4. EpidemiologyLearning from Experience • Construction sites, war, road racing, football, & military training provide “heat labs” • Falmouth Road Race • 1-2 EHS per 1000 finishers • Twin Cities Marathon 24 year average • 1 EHS per 10,000 finishers • 2007 – 12 per 10,000 • 2007 Grandma’s Marathon • 28 per 10,000 finishers • Death reviews provide prevention & treatment “failure” data

  5. EHS Mortality Bands(Keatinge) • Mortality higher at lower temp range in higher latitudes • Higher temps as mean summer temps rise • Acclimatization from living in area

  6. TCM 2007 Outcomes • Start WBGT 72ºF, 4 hr WBGT 81ºF • Starters = 8093 • Finishers = 7226 • Unsuccessful starters (DNF) = 867 • Medical encounters = 291 • Medical encounters/1000 finishers = 40 • Unsuccessful participants/1000 finishers = 160 • EHS = >12/10,000 finishers • MCI criteria surpassed

  7. >12 per race 4-5 per race 0-1 per race Unpublished data, W Roberts

  8. >103 Unpublished data, W Roberts

  9. Unrecognized, Untreated EHS is Fatal(Rae, 2008) • 5 bikers died in same bicycle race • Not diagnosed on site • Delays probably caused deaths • EHS victims do not cool to safe levels spontaneously • Cooling essential

  10. Football Experience • Most fatal heat stroke in first 1-4 days • Implies role of acclimatization • Early season heat related HS & youth football deaths • 2006 – 5 • 2007 – 5 • 2008 – 4-5 • Heat “capacitance” • Large players

  11. Heat Balance Equation Initial Body Temperature Sleep & Air conditioning Illness Intensity & duration + Metabolic Heat Produced Environmental Heat Absorbed Env temp > Body temp Radiant heat + Body Heat Removed Sweat Heat transport Heat transfer Acclimatization Insulation - Final Body Temperature

  12. Thank You! rober037@umn.edu

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