Heatstroke is an acute pathological condition characterized by rapid development with increasing symptoms. It is due to the general critical overheating of the body. Sunstroke is a direct consequence of prolonged and / or very intense exposure to sunlight on an unprotected scalp.

Note:sunstroke (apoplexia solaris) in official medicine denoted by the term "heliosis".

At high temperature environment the human body it becomes difficult to maintain a stable body temperature. A gradual decrease in the ability to normal thermoregulation leads to serious disturbances. People with chronic pathologies of cardio-vascular system hyperthermia can cause serious consequences. In particular, cardiac arrest is not excluded.

Why does heatstroke develop?

Overheating of the body is often the result of significant physical exertion. This condition often develops against the background of active dynamic exercise. Heatstroke is also possible in people whose professional activity associated with being in a hot and stuffy room (for example, a hot workshop).

"Classic" heatstroke is more often diagnosed in children and the elderly with a sufficiently long stay outside (including in transport) in hot weather.

note: Pathological conditions caused by hyperthemia are not uncommon among visitors to baths and saunas.

At high ambient temperatures, sweat increases. Moisture evaporates from the surface of the skin to cool the body. In an hour, a person loses up to 1 liter of liquid with sweat (with normal functioning of the glands).

Factors influencing the level and effectiveness of sweating:

• air temperature;
• air humidity;
• condition of the skin and sweat glands;
• individual ability of the body to adapt;
• the level of fluid intake.

If the drinking regime is not observed (inadequately low fluid intake), dehydration (dehydration) gradually develops, as a result of which sweating decreases.

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Important:a person needs to drink at least one and a half liters of liquid per day (preferably - pure water). In hot weather, and with increased physical activity, it is recommended to increase consumption to 2.5-3 liters per day.

Significant fluid loss can result from taking diuretics, as well as coffee and alcoholic beverages which also have diuretic properties.

Increased sweating with insufficient fluid intake leads to a violation of the water-electrolyte balance and thickening of the blood. The deterioration of the rheological properties of blood becomes the cause of the difficulty of blood circulation and hypoxia of tissues and organs.

The body is able to release excess heat due to the expansion of peripheral blood vessels.

If you do not provide a person who has received heatstroke with timely and adequate assistance, complications of the condition can pose a significant threat to health and even life.

Note:heatstroke that develops against the background of active physical exertion, much more often becomes the cause of the development severe complications, in comparison with the pathological condition resulting from prolonged exposure to the sun.

Heatstroke symptoms

Overheating may result in the following clinical forms heatstroke:

• hyperthermic;
• asphytic;
• cerebral;
• gastroenteric.

The main manifestation of the hyperthermic variety is the high (pyretic) body temperature of the victim reaches 40-41 ° C.

With an asphytic form of heatstroke, the dominant clinical symptom is a violation of the respiratory function. The patient's body temperature is within the febrile range (38-39 ° C).

The cerebral variety is characterized by a predominance of neuropsychiatric disorders.

With the gastroenteric form of heatstroke, disturbances in the digestive function (dyspeptic disorders) come to the fore.

With this pathological condition, a rather characteristic symptomatology develops.

The clinical manifestations of heatstroke are:

Severe cases are characterized by:

• disorientation in space;
• rave;
• psychomotor agitation;
• the appearance of seizures;
• hallucinations;
• cyanosis (cyanosis of the skin);
• bleeding in the digestive tract.

It is also possible involuntary defecation and urination.

In some cases, development is possible liver failure, manifested by encephalopathy, jaundice and hypoglycemia. Some heatstroke sufferers have acute symptoms kidney damage, which are characterized by a change in the color of urine and a pronounced decrease in urine output.

Complications such as increased intracranial pressure and seizures are rare.

With sunstroke, the same clinical manifestations, as with the classic heat, but the symptoms are more pronounced. Sunstroke is more common in children.

Diagnostics

The diagnosis is usually not difficult even for young professionals. A doctor or paramedic makes a diagnosis based on the history, general condition of the victim and the presence of certain clinical manifestations in him.

Pathologies with which differential diagnosis is carried out:

• encephalopathy (uremic or hepatic);
• ("delirium tremens");
• (thyroid disease);
• tetanus;
• cocaine poisoning.

First aid for heatstroke

At the first sign of heat (solar) stroke, you need to call an ambulance team or ensure the transportation of the victim to the nearest hospital.

First aid

First of all, it is necessary to cool the body and replenish the volume of fluid (give a drink of cool clean water). The patient should be moved to the shade and provided with peace. If a person feels weak and nauseous, then his body needs to be given a horizontal position (lying on his back with raised legs), but if vomiting begins, then it is necessary to turn him to one side to avoid aspiration of vomit. Cold compresses should be applied to the head (in the frontal and occipital region).

Any clothing that may constrict breathing should be removed or unbuttoned.

Important:if you have a driver's first-aid kit at hand, instead of compresses, it is advisable to use special hypothermic bags.

If possible, it is advisable to place the patient in an air-conditioned room and wrap a wet sheet over his entire body. Rapid cooling can be achieved by rubbing with alcohol, vodka or ether. The temperature is needed in as soon as possible reduce to numbers less than 39 ° C.

Important:conventional antipyretics (paracetamol and acetylsalicylic acid) with hyperthermia against the background of heatstroke are ineffective. On the contrary, they can be dangerous because they put additional stress on the liver.

In the room, the patient needs to provide an inflow fresh air for additional cooling and easier breathing. If possible, it is recommended to periodically douse the body with cool water (17-20 ° C), and if the general condition allows the victim to move, then you can put him in a cold bath (you can even add ice to the water). If confusion or loss of consciousness occurs, inhale ammonia vapor.

In case of cardiac arrest, an urgent need to start indirect massage heart and give the victim artificial respiration.

Medical tactics

In most cases, hospitalization of the patient is indicated. When breathing stops and acute violation cardiac activity, a complex of resuscitation measures is carried out.

The patient is given intravenous infusion chilled saline to reduce body temperature and eliminate dehydration.

Important:if adequate assistance is not provided to the victim within an hour after the appearance characteristic symptoms, the body may begin irreversible processes... Defeat nervous system often leads to disability of the patient.

To stimulate cardiac activity, an injection of a solution of sodium caffeine-benzoate (10%, 1 ml subcutaneously) is made. Intravenous 30-40 ml of 10% glucose solution is injected. In case of breathing disorder, it is indicated intramuscular injection stimulant reflex action- lobeline hydrochloride (1%, 0.5 ml).

In severe cases, after stabilization of the patient's condition, a number of tests are performed and additional research in order to exclude possible complications. The patient is referred for analysis of blood, urine and cerebrospinal fluid. To identify possible damage to the central nervous system, computed tomography or MRI is performed. An electrocardiogram is prescribed to assess the condition of the heart.

At-risk groups

Heat (sun) stroke represents greatest danger for young children, since they do not have a perfect thermoregulation system of the body. Severe consequences(up to death) can develop in people with pathologies of the cardiovascular system.

The risk group also includes persons with dermatological diseases... With extensive skin lesions, the functional activity of the sweat glands is often reduced. People with overweight(obesity), as well as in persons suffering from organ diseases endocrine system(in particular - the thyroid gland).

Note:some experts predict an annual increase in heatstroke as a result of global warming.

Heat stroke prevention

To prevent the development of this acute condition you need to work in a room with good ventilation. If you need a long stay in conditions elevated temperature periodic douches, wipes, or cool showers are recommended. In hot weather, it is advisable to postpone the main meal (up to 40% of the daily diet) to the evening. During physical exertion, as well as while relaxing on the beach, it is better not to drink plain water, and a decoction of berries, kvass or slightly acidified tea. Drinking coffee and alcohol should be avoided to avoid additional dehydration. You should also avoid overusing sugary soda with synthetic additives. Avoid prolonged sun exposure without a hat or beach umbrella!

Plisov Vladimir, medical columnist

• What is Heatstroke
• What provokes Heatstroke
• Heatstroke symptoms
• Heatstroke Treatment

What is Heatstroke

Heatstroke- a dangerous rapidly developing form of damage to the body when the body temperature rises above 40 ° C.

What provokes Heatstroke

Heatstroke sometimes occurs among sailors in the tropics, among workers in hot shops, during agricultural work, among those who enjoy excessive sun tanning. Sometimes heatstrokes occur during marches of military personnel on hot days, during hiking trips with improper organization and insufficient training of participants. The occurrence of heatstroke is promoted by air humidity, irrational clothing, and individual sensitivity to temperature rise. People suffering from vegetative-vascular insufficiency, cardiovascular diseases, obesity and other metabolic disorders (in particular, with endocrine diseases). Mortality in heatstroke reaches high numbers. So, when the body temperature rises above 41 ° C, up to half of the victims die.

Pathogenesis (what happens?) During Heatstroke

The leading links of pathogenesis are disorders of water-electrolyte balance due to impaired sweating and the activity of the hypothalamic center of thermoregulation. With heatstroke, a fatal outcome often occurs against the background of the development of a collapse. Contributes to circulatory disorders toxic effect on the myocardium of excess potassium in the blood, released from erythrocytes. Heatstroke also affects the regulation of respiration, kidney function, different kinds metabolism (protein, carbohydrate, fat).

Pathomorphological examination of the central nervous system in persons who died from heatstroke reveals hyperemia and edema of the membranes and brain tissue, multiple hemorrhages in them. Histological examination reveals perivascular edema of the membranes and brain tissue, changes nerve cells type acute illness Central nervous system, and in some cells - severe hydropic changes.

Heatstroke symptoms

Distinguish between light, moderate and severe heatstroke. The onset is usually acute. There is an increase in breathing and heart rate, flushing of the skin, an increase in body temperature, sometimes reaching high numbers.

At mild form heatstroke disorders are limited to headache, nausea, and general weakness.

With heat injury moderate more severe muscle weakness, severe headache, nausea and vomiting develop. Some general lethargy, staggering when walking, and sometimes fainting are noted. Breathing and pulse are sharply increased. Observed increased sweating... The body temperature rises to 40 ° C.

Severe form heatstroke develops suddenly. Motor excitement is often noted, sometimes - mental disorders(hallucinations, delusions). Breathing quickened, shallow, its rhythm is often broken. The pulse is accelerated to 120 or more beats per minute, weak. Heart sounds are muffled. The skin is pale, covered with sticky sweat. The body temperature rises to 41-43 ° C. Diuresis is sharply reduced. In the blood, the content of nitrogen and urea increases with a decrease in the amount of chlorides. Against the background of pronounced vegetative-vascular disorders, disorders of consciousness of varying depth and duration develop. Neurological examination reveals anisocoria, inhibition of the reaction of the pupils to light and corneal reflexes, as well as reflexes on the limbs. Motor excitement, vomiting, clonic-tonic convulsions, coma are often observed, against the background of which, in the most severe cases, fatal respiratory and cardiac disorders can develop.

Heatstroke Treatment

It is necessary to take measures to lower the body temperature: transfer the patient to the shade, free him from embarrassing clothing, put cold on his head, the region of the heart and large vessels. It is necessary to provide an introduction enough liquids. In case of preservation of consciousness, they give cold water, tea, coffee. When excited, aminazine, diphenhydramine are administered, for seizures - anticonvulsants - sibazon (seduxen), chlorpromazine, phenobarbital, etc. When cardiac activity falls, cardiac drugs (cordiamine, caffeine, strophanthin) are used. With an increase in intracranial pressure, unloading lumbar punctures are shown. When oxygen is inhaled, it is recommended to add carbon dioxide. With the subsequent treatment of an asthenic state, B vitamins, iron and calcium preparations are prescribed.

Which doctors should you contact if you have Heatstroke?

Neurologist

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Summer is a time of vacations, relaxing on the beach and, in general, sheer pleasure. But this pleasure can be overshadowed by sunbathing uncontrollably. Of course, you want to soak up the sun, and at the same time give your skin a beautiful dark chocolate shade, which will remind you of hot summer days even in autumn. But along with a sunburn, you can inadvertently get heatstroke, and then part of the vacation will have to be spent not on entertainment, but on the treatment of heatstroke. But even if you are always careful and careful about your health, it is better to learn the basic first aid for heatstroke in advance. God forbid, but someone close to you may need it. The treatment of heatstroke in children requires special attention, because children's organism much weaker and less resistant to overheating. Therefore, we suggest that you learn and / or brush up on ways to treat and prevent heatstroke.

What is heatstroke?
Thermal shock is, in fact, overheating, or rather, a reaction to too high an ambient temperature. As a rule, it does not happen immediately, but after a while in the open sun. How much time must pass so that the body can no longer independently provide thermoregulation depends on the state of health, age, weight and some other factors. But sooner or later, in the heat, almost any person becomes ill, and for those who suffer from diseases of the cardiovascular system, overheating can even be deadly.

Heatstroke develops in successive stages:
You can help a person who has just started to overheat on your own. To do this, you need to notice his condition in time. Always pay attention to such outward signs heatstroke:

• redness of the face and body, unhealthy blush;
  
• dryness and fever of the skin;
  
• shortness of breath or shortness of breath;
  
• "Midges" and / or darkening before the eyes, dizziness;
  
• muscle weakness, spasms;
  
• nausea and / or vomiting;
  
• involuntary urination.
  

Heatstroke symptoms are listed in order of worsening physical condition the affected person. They can be accompanied by an increase and decrease in the pulse, visual hallucinations and even loss of consciousness. Usually they can be seen even on initial stages and take the necessary action, as opposed to sudden sunstroke. Thus, sunstroke is a particularly severe form of heatstroke. In this case, overheating is aggravated by the action of ultraviolet radiation on the bare head and brain. Sunstroke is often accompanied by vomiting, fainting, even coma, and in 20% of cases ends in the death of the patient. Therefore, it is important to provide first aid as soon as you notice initial symptoms heatstroke to prevent it from developing into sunstroke.

First aid for heatstroke
Heatstroke in children, the elderly and those whose body is weakened for one reason or another (alcohol intoxication, low-calorie diet, food poisoning etc.) happens more often than in healthy active people... Those who are at risk need to go out under the scorching sun less often and spend more time in the shade, coolness, be sure to protect themselves with hats and clothes made of natural fabrics of light shades. If these precautions were ignored or did not help, you need to help the victim as soon as possible by such actions:

1. If you feel that you are overheated, immediately go to the shade, but better - to a cool room. If you notice symptoms of overheating in someone else, hide it from the sun immediately in the same place.
   
2. Once you're in a cool and / or shady place, try to relax and breathe deeply, calmly. Provide free air circulation, turn on a fan or air conditioner, but do not sit in a draft, because the body is weakened by overheating and gets cold easily. Sometimes even simple fanning or magazine fanning plays an important role.
   
3. Remove tight and tight clothing, accessories or jewelry. Take a cool bath or refreshing shower. Get into a comfortable sitting or lying position, in which the body is not subjected to stress and pressure.
   
4. The next task is to restore water balance... To do this, drink a lot of clean or mineral table cool (not cold!) Water without gas, which can be acidified with natural lemon juice... In addition to drinking, eat juicy and watery fruits and vegetables: cucumbers, watermelon, citrus fruits. All of them contain potassium and fiber, which are necessary for the normalization of water-salt metabolism.
   
5. All of the previous tips were for a mild form of heatstroke in which you can help yourself. But if the situation is more complicated, then you need to help the victim by transferring him to a cool room, undressing and laying on his back.
   
6. Then wipe the body with a sponge soaked in cool water and let it drink. At severe dehydration you may need a special drug (for example, Rehydron or an analogue) to restore the level of minerals and water balance.
   
7. It is useful to wrap the palms and feet of the victim with cold wet towels to cool their surface and large arteries. Another towel can be placed on your chest. In this case, it is advisable to fan it and / or turn on a fan nearby.
   
8. Apply cold compresses to the back of your head (under your head) and forehead. They can also be made from towels or use special bags that are included in the standard kit (the so-called "hypothermic bag").
   
9. It doesn't hurt to wrap or cover your body from legs to neck with a wet, cold sheet.
   
10. If a sunstroke victim starts to vomit, take care not to choke. To do this, you need to maintain it and temporarily change the supine position to a more comfortable one.
    
11. In case of loss of consciousness, you can bring a bottle of ammonia to your face, the vapors of which, when inhaled, bring you out of fainting.
    
12. If all of the above methods did not help you or another person, you need to call ambulance... Continue cooling the victim until the physician arrives, and then handing over to the physician.
    
13. Call an ambulance immediately if heatstroke manifests itself with convulsions, severe tachycardia(more than 150 heart beats per minute), pain in the abdomen and other parts of the body, cough, fear of light and fever above 39 ° C.
    
14. The patient can be taken to the hospital, where they will be treated for heatstroke after accurate diagnosis... Depending on the severity of heatstroke, oral, intramuscular, and / or intravenous medications will be prescribed, especially if seizures are present.
    
15. In a clinic, heatstroke is treated with solutions of glucose (intravenous) and sodium chloride (subcutaneous). Caffeine-sodium benzoate is also administered subcutaneously if the heart muscle has weakened from overheating.
    
16. The severity and duration of overheating affects the duration recovery period after heatstroke treatment. It may take several days bed rest... During this period, body temperature can still rise and fall sharply.
    
17. Until the symptoms of heatstroke disappear completely, the patient is shown special diet... It involves reducing the amount of carbohydrates in the diet and increasing - plant products rich dietary fiber and minerals. Necessary plentiful drink consisting of mineral water, herbal decoctions, natural compote, bread kvass, acidified tea, etc.
    
18. While recovering from heatstroke, it is beneficial to eat buttermilk. It is taken by a glass twice or three times a day during treatment and rehabilitation.
    
19. Alcohol, cigarettes, and physical activity are prohibited during and after heatstroke. It is also better to exclude coffee and strong tea from the menu.
    

These are basic tips on when it is permissible and how to treat heatstroke on your own, and when it is necessary to call qualified medical help. Hopefully, you won't need them or only need the first points of the above list. With correct and timely first aid, heatstroke passes quickly enough and without consequences. Although it is better, of course, just to prevent its development, by taking reasonable and uncomplicated preventive measures. Take care of yourself and be healthy!

Heatstroke is a sharp disorder in the activity of the central nervous system (loss of consciousness, drop in blood pressure, sometimes vomiting and convulsions, respiratory failure, etc.) due to a rapid rise in body temperature.

When heatstroke hits

Heat stroke is most often observed when physical activity in conditions high temperature and high humidity. Cases of heatstrokes have been repeatedly described among soldiers on the march in hot weather, among drivers of armored vehicles, stokers, and workers in hot shops. In addition to the climatic conditions of the weather, clothing, lack of drinking, etc., in the development of heatstroke, the individual characteristics of the organism are of significant importance - its ability to adapt to the effects of unfavorable meteorological conditions. The elderly, children, people suffering from heart disease, vasomotor disorders, obesity and hyperthyroidism, as well as alcoholics are more prone to heatstroke. The development of heatstroke is usually preceded by prodromal phenomena - headache, weakness, increased thirst, increased body temperature, sharp redness of the skin. In some cases, the prodromal period is absent and a severe coma occurs suddenly.

Heatstroke symptoms

With heatstroke, the central nervous system and a number of other important organs and systems are primarily and most affected.

Patients complain about headache, dizziness, severe muscle weakness, drowsiness, apathy, flickering in the eyes, hearing disorders, discomfort in the heart, nausea, thirst, sometimes vomiting and diarrhea.

During the examination, there is a significant increase in body temperature (often above 40 °), skin hyperemia, and sometimes cyanosis of the lips. Severe asthenization is often noteworthy.

Pulse and breathing are quickened, blood pressure is lowered.

Severe changes may occur on the part of the central nervous system and circulatory apparatus (speech disorder, delirium, hallucinations, darkening of consciousness, coma, collapse). In severe cases, breathing becomes uneven (over 50 per minute), chain-Stokes breathing can be observed, reflexes disappear.

Sometimes pulmonary edema develops.

In some cases, heatstroke is accompanied by acute gastrointestinal disorders... Prognostically unfavorable are cases that are accompanied by a very high rise in body temperature (above 41 °) and severe mental disorders.

It must be remembered that in isolated cases the clinical phenomena of heatstroke may develop some time after overheating.

Acute overheating of the body can also occur in the form convulsive disease, the development of which is associated primarily with a sharp violation of water-salt metabolism and progressive dehydration of tissues. In these cases, along with the above-described phenomena characteristic of heatstroke, in the foreground in clinical picture convulsions appear. Body temperature with a convulsive form usually rises slightly. There are clonic and tonic cramps in the muscles of the limbs and trunk (most often the calves). Patients complain of sharp muscle soreness during seizures.

In severe cases exterior view the patient changes dramatically: the cheeks fall in, the nose sharpens, the eyes are surrounded by dark circles and sink, the lips are cyanotic. The skin is pale, dry and cold to the touch. Heart sounds are muffled, pulse up to 10-120 beats per minute, sometimes threadlike, blood pressure is low. The picture sometimes resembles epileptiform seizures. In some cases, hemiplegia or bulbar symptoms are noted.

Most often, heatstroke after the termination of overheating, especially if they were carried out in a timely manner therapeutic measures, ends with recovery. In some cases, recovery is slow: there are subsequent prolonged febrile states, neuropsychiatric disorders. After recovery, there may be re-development clinical phenomena from the central nervous system.

Pathogenesis and pathological anatomy of heatstroke

By modern ideas heatstroke is the result of pronounced overheating of the body, which, causing changes in the most important organs and systems (primarily the higher brain centers), leads to severe metabolic disorders and, ultimately, to oxygen starvation of cells.

Pathomorphological examination reveals mainly changes in the central nervous system: cerebral hyperemia, punctate hemorrhages in the brain.

First aid for heatstroke

The patient should be immediately removed from conditions that cause or contribute to overheating of the body, placed in a shade or cool room and removed from his clothes. Then the victim needs to be drunk cold water, tea or coffee. Good effect give cooling procedures: an ice pack on the head, neck, spine, wrapping in cool water (temperature 25-26 °) and squeezed sheets. Rapid significant total cooling should not be used. The early appointment of agents that stimulate respiration and cardiovascular activity (camphor, caffeine, cardiazole, lobelia), which help to overcome secondary oxygen deficiency, especially in the central nervous system, are important.

The phenomenon of overheating, however, does not always go away after a decrease in body temperature. Severe cases overheating with significant dysfunction of the higher parts of the central nervous system sometimes ends fatally after a few hours or days. In some cases, the residual phenomena of the disorder of the higher nervous activity can remain for a long time.

With cyanosis, tense pulse, convulsions and delirium, bloodletting (300-500 ml and more) or leeches on the area of ​​the mastoid processes is indicated. It should be remembered that low filling and pulse voltage, low blood pressure are contraindications to bloodletting. In cases where intracranial pressure increased (neck stiffness, Kernig's symptom, slow and tense pulse), do spinal tap... If indicated, artificial respiration and heart massage, subcutaneous or intravenous administration of adrenaline can be used.

In the convulsive form of overheating, rest and warmth (at subnormal body temperature), subcutaneous administration of saline (up to 1 liter), intravenous administration of glucose, food rich in salt are recommended. With a weakening of cardiac activity, injections of camphor and caffeine are prescribed.

Persons who have suffered from heat and sunstroke require further careful medical supervision.