[Take health home] High temperature strike, be alert to thermal shooting disease

Author:Shenyang hygiene Time:2022.07.22

【Introduction】

Summer is approaching, and high temperature weather is generally ushered in all over the country, especially in the south. High temperature can lead to heat stroke, and many cases of rescue death have occurred due to heat irritation.

During the heat stroke season, in the high temperature and (or) high humidity environment, the central function disorder is regulated by body temperature, the dysfunction of sweat glands, and the loss of hydroladia is characterized by too much. Severing heatstroke is divided into three types: heat spasm, heat failure, and thermal ejection disease. Thermal radiation disease is the most serious type of heat stroke. It is fatal emergency, with very high mortality. There are often behavioral abnormalities, high thermal (core temperature greater than equal to 41 ° C), consciousness or coma, multi -organ dysfunction, etc.

1. Typical thermal radiation disease is divided into two categories

1. Labor fever: It is more common in healthy young people and often occurs during physical labor, sports or military training. His manifestations of high fever, convulsions, coma, sweat or sweatless. Fast heart rate (160-180 times/each), and pulse pressure increases. Such patients often die in MODS or MOF.

2. Non -labor fever (also known as classic thermal radiation disease), which is more common in patients who are weak and chronic diseases. The living environment is poor and urban residents are more common. Beginning shows that delirium, epileptic seizures, and various behaviors are abnormal, and then high fever, coma, dry skin, heat and sweating, pupils are symmetrically reduced, hypotension, arrhythmia, heart failure, shortness of breath And pulmonary edema died about 24 hours after the onset.

2. How to diagnose fever?

Based on the "Consensus and Treatment Experts of Hematology and Emergency Diagnosis and Treatment in 2021".

(1) Medical history

1. Exposed to high temperature and high humidity environment.

2. High -intensity exercise.

(2) Clinical manifestations

1. The manifestation of the central nervous system dysfunction (such as coma, convulsions, delirium, abnormal behavior, etc.).

2. Core temperature, the rectal temperature exceeds 40 degrees Celsius.

3. Multi -organ (more than equal to two or more organs) functional damage manifestations (liver, kidney, diarrhea, gastrointestinal, etc.).

4. Severe coagulation dysfunction or DIC.

There is any one in the medical history information, coupled with any clinical manifestations and cannot be explained in other reasons, the diagnosis of thermal ejection disease should be considered.

It is necessary to be highly questioned when diagnosing fever, because many symptoms and signs are non -specific, and the composite syndrome or malignant hypertext caused by the central nervous system infection, purulent disease, and neuroplasm (after the treatment of anesthesia).

Body temperature is one of the most important indicators for evaluating thermal radiation disease, but the core temperature cannot be greater than 40 degrees as a necessary condition for clinical diagnosis. If patients are in accordance with the patient from history to clinical manifestations, they cannot be excluded because the core temperature does not exceed 40 degrees Celsius.

3. How to treat thermal radiation disease?

Early treatment of thermal radiation is the key to determining prognosis. The treatment must seize the two principles, three key points, ten morning and one forbidden.

(1) Two principles

1. First maintain the stability of life signs, reduce unnecessary transfer, move and creative inspections.

2. Complete laboratory examinations, evaluate the condition, multi -disciplinary club, and transfer to the intensive care room as soon as possible.

(2) Three key points

1. Quickly reduce the core temperature.

2. Blood purification.

3. Control DIC.

(3) Ten morning

1. Early cooling: The core temperature is required to quickly drop to below 39 ° C within 30 minutes, and to below 38.5 ° C within two hours. The core temperature is reduced, not the body surface temperature.

2. Early expansion: Quick vein infusion (input 25 ml/kg or total 1000 to 1500 ml within 60 minutes (input 25 ml/kg or total 1000 to 1500 ml) 4 ° C to cool down. It is not recommended to cool down early drugs.

3. Early blood purification.

4. Early calm: convulsions and restlessness not only interfere with cooling treatment, but also increase heat production and oxygen consumption, exacerbate damage to the nervous system.

5. Puppetth pipe intubation.

6. Early supplemental anticoagulation.

7. Early anti -inflammatory.

8. Early intestinal nutrition.

9. Early dehydration.

10. Purakins of immunization.

(4) One ban

Surgery is prohibited during coagulation disorders.

When the early coagulation dysfunction of patients with heat irritation, if there is a creative operation, it will often aggravate bleeding and even endanger life. Therefore, some necessary operations such as blood purification and pipes and central vein tubes are recommended. Compression of bleeding time, and other urgent rescue measures, it is not recommended to perform early surgery, such as bronchylotomy and fascia.

Fourth, how to prevent the occurrence of heat irritation?

The key to reducing the mortality of thermal radiation disease is prevention. The most effective prevention measures are to avoid high temperature, high humidity, and non -ventilation environment, reduce and avoid dangerous factors of heat stroke, ensure sufficient rest time, and avoid the occurrence of dehydration, thereby reducing the incidence and mortality of thermal radiation.