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Heatstroke occurs when the body heats up when the surrounding temperature rises, so if the heat is not lowered, it can be life-threatening.
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|Human body temperature classification|
heatstroke(heatstroke,British: hyperthermia[Note 1]) IsHeatIn the environmentA humanBodyAdaptationIt is a general term for the conditions caused by the disorder of.. Non-humanAnimalBecomes the same state ("Non-human example"reference).
In essence,Dehydrationbybody temperatureOrgans associated with elevation, dehydration and elevated body temperatureBlood flowWith declineMultiple organ failureで, The main superficial symptoms aredizzy,syncope,headache,nausea, Strong drowsiness, feeling unwell, abnormally elevated body temperature, abnormalsweating(Or stop sweating). Also, due to heat strokeDeathThere are also things to do. In particular, there is a statistic that the fatality rate reaches 30% in the case of heat stroke of degree III, and it is said that appropriate measures need to be taken regardless of the degree of onset. Even if he does not die, especially in severe cases, brain dysfunction andKidney damage OfSequelaeMay be left.
High temperature, indoors or outdoorsHumidityCan be caused by.Wet bulb black ball temperature21 - 25℃Be careful from around.Japan OfNational Institutes of HealthAccording to the document, the number of patients develops at around 25°C (increasing in stages), and increases sharply above 31°C.
"Heat index" and "heat stroke alert"
This wet-bulb globe temperature is called the "heat index" in Japan, and the day when it is expected to reach 33 or higher isMinistry of the EnvironmentとJapanese Meteorological AgencyHas issued heat stroke alerts on a prefectural basis, and some local governments have called for refraining from going out in the areas where they have been issued..
Severity classification of heat stroke
|Sort||symptom||Correspondence example||Conventional classification|
|Darkness in front of me, feeling unwell, limbsNumbness|
limb·Abs Of痉挛,Crouching, Muscle pain, stiffness
Lower blood pressure, Skin pallor
|Rest in the shade|
Loosen clothes and cool the body
|Heat cramps, fainting|
Weakness, large amountsweating,Tachycardia,dizzy,diarrhea
|Treatment at medical institutions (Infusion),management||Thermal fatigue|
|Core body temperatureRise|
Confusion of consciousness due to brain dysfunction,譫妄State, unconsciousness[Note 2]
Liver dysfunction・Kidney dysfunction
|Transport and treat by ambulance to medical facilities that provide life-saving medical care||Heat stroke|
The diagnostic criteria for degree III heat stroke are:
- There is exposure to heat.
- Deep body temperature 40°C or higher orAxillabody temperature38°C or higher.
- Abnormal signs are present in any one of brain function, liver function, kidney function, and blood coagulation.
Satisfying the three. Blood coagulation is caused by an excessive increase in body temperature.proteinIs brokenInternal bleedingAs a result, the blood clots to stop internal bleeding. In other words, it is a symptom that occurs after getting heat stroke.
Type of heat stroke (international classification)
|Thermal fatigue||Ⅱ degree||正常||~ 39 ℃||cold||(+)|
|Heat stroke||Ⅲ degree||Advanced disability||40 ℃ ~||high temperature||(-)|
PathophysiologyThe following terms are used in the international classification based on.
Syncope(Netsshinshin, English: heat syncope).
- It occurs for a long time in direct sunlight or in a hot and humid room. Due to sweatingDehydrationIt occurs when blood circulation to the brain is diminished due to dilation of terminal blood vessels.
- Sudden loss of consciousnessDevelops in.body temperatureAre often normal, sweating is seen,pulse TheBradycardiaPresent.
- InfusionAnd do cold therapy.
- I degree
Passionate(Netsurei, English: heat cramps).
- Sudden involuntary pain痉挛とRigidityOccurs in. Body temperature is often normal and sweating is seen.
- Oral rehydration solution(For 1 liter of watersugar40g,Salt 3g) andPhysiological salineAdminister saline solution (~ 0.9%) at the following concentration.
- I degree
Thermal fatigue(Netsuhiro, English: heat exhaustion).
- Replenishment of water and salt cannot keep up with a large amount of sweat,DehydrationIt occurs when it becomes.
- Symptoms vary,Rectal temperatureRises to about 39°C,皮膚Is cold and sweating is seen.
- InfusionAnd do cold therapy.
- II degree
Heat stroke(Neshabyo, English: heat stroke).In the past, "heat stroke" occurred in a hot and humid work environment, and "heat stroke" occurred in direct sunlight.sunstroke(Nisshabyo, English:sun stroke) ”.The onset mechanism is exactly the same, and recently it is being unified into "heat stroke".
- HypothalamusIt is caused by the loss of the thermoregulatory function when the heat center of is damaged.
- AdvancedConsciousness disorderOccurs, the body temperature rises above 40°C, no sweating is seen, and the skin is dry.
- It is an emergency situation with a risk of death, and prompt cooling treatment with emergency hospitalization,dialysis, Infuse.
- III degree
- The day when the temperature suddenly increased from the previous day.
- Even if the temperature is not so high, it is likely to occur if the humidity is high (because perspiration cannot be evaporated and heat in the body cannot be dissipated).
- A person who was in a cool room suddenly went outside to work (because he was not used to the heat).
- The first day of the work schedule-several days tend to occur.
- Construction site, manufacturing industry, disaster relief site, etc. where it is difficult to wear light clothes for safety reasons, Long outdoor sports and activities, indoors with armor and heavy clothing.
- Time zone-The statistically easy time zone is high in the morning around 10 o'clock and in the afternoon around 1 to 2 o'clock,
- Season- rainy seasonAfter dawn, it is often in July, and especially in August. However, heat stroke occurs even in a "cool environment", "a short time after starting exercise" and "light exercise".
- The sum of water temperature and temperature exceeds 65℃Pool.
- Parental negligence-likely to heat a child for some reasonAutomobileThere are cases in which the disease develops when it is left in the car. in JapanPachinko parlorAttention is paid to examples of leaving behind in parking lots, etc.But,The United States of AmericaHowever, there are quite a few cases of heat stroke death due to forgetting that the guardian had a child on board..
- Suspension of air-conditioning equipment due to wide-area large-scale power outage that is difficult to restore on a hot day.
- It is said that even if you live with a mask on, you will suffer from heat stroke..
- Roads are in a harsh environment due to the reflection of sunlight and heat storage.In particular, heat-shielding paved roads reflect heat and do not raise the road surface temperature, but the reflected heat creates a harsh environment for pedestrians, increasing the risk of heat stroke..
- Under 10 years oldchildren
- Over 65 years oldSenior citizens
- obesityA person
- People who tend to dehydrate (diarrheaWait)
- FeverSomeone with
- Congenital painless anhidrosisPeople whose body temperature cannot be lowered due to poor sweating
- People with cold heads...legThe bottom is cold, and the core of the body is completely cold without knowing, and it is not possible to control the body temperature by sweating,Upper bodyBecomes hot,Brain cellsWill not function at temperatures above 40°C and will collapse due to heat stroke.
- Lack of sleep
- Genetic predisposition: Energy called "CPT-2"metabolism.Related to production酵素To a certainSNPEnergy metabolism at high body temperature of 40 ℃ or more (ATPProduction) will not work well and will lead to cell dysfunction.Influenza encephalopathyIs likely to develop with similar SNP.
- There are also fatal accidents due to insufficient knowledge about preventive measures.
Number of casualties by occupation due to heat stroke
According to data from the Ministry of Health, Labor and Welfare, the number of casualties by occupation due to heat stroke (2015-2019 total)The number of construction and manufacturing industries is remarkably increasing as follows.
|Cleaning and slaughter||234|
Under school control
- Tokyo Metropolitan Board of EducationAccording to the document, under school management,Sports Department72.1% was the most activity-related activity, followed by 12.9% for "physical events".. Extracurricular activities for lower grade elementary school students (explained later) under hot weather.
- Unlike older people and adults, low-school children of short stature are more likely to experience radiant heat exposure in the hot sun and fatigue sooner.
- Focusing on the type of sports, athletic club activities under school managementbaseballMost, Thenサ ッ カ ー,TennisIt was said that there were many in order of.. By gender, baseball, soccer, and tennis are in order for boys, but tennis is the most common for girls, followed bybasketball, And thenvolleyballとsoft ballAre lined up.Baseball has the highest number of fatal accidents,rugbyand soccer.
- School BusThere have also been incidents of infants left behind dying of heatstroke.
Cases of onset in school club activities
- 2000 years(Heisei12 years) August,KanagawaKawasaki City OfJunior high schoolFatal accident in the baseball club.
- August 2007 (Heisei 19),HyogoTatsuno CityA sophomore member collapsed while practicing running at a high school women's tennis club, and was bedridden due to hypoxic encephalopathy.
- August 2009 (Heisei 21),OitaTakeda,IbarakiMito Ofhigh school OfkendoOne after another, a fatal accident.
- August 2018 (Heisei 30),AichiToyota City Ofprimary schoolFatal accident after studying outside of school.
- 22 (Wa) 2010 Claim for damages March 222, 25 Oita District Court
- Case number 26 (Ne) 2014 No. 668 January 27, 2015 Osaka High Court
- Claim for damages Case number 25 (wa) 2013] May 5530, 28 Osaka District Court[Note 3]
Fundamentally, the environmental temperature is set to a temperature below the temperature at which heat stroke develops. However, when spending in a temperature environment where there is a risk of developing heat stroke, it is necessary to take measures against people.
Drink cold drinks, especially when exercising, avoid extreme exercise, and take a cool bathShower, Water your body, loose clothing in bright colors, avoid direct sunlight during hot hours, avoid drinking too much alcohol.
When the outside temperature exceeds 35 degrees, heat will come in from the outside... Drinking water means that humans are sweating and adjusting their body temperature, so they need water..28 degreesBecause to the lastIndoor temperature referenceAndAir conditionNot the set temperature of, The temperature may not reach the set temperature, and the sun may be hot even at 28 degrees.
- Avoid the heat.
- Indoors,Fan, Adjust the room temperature to 28℃ or less with the air conditioner.
- Blackout curtains, blinds (Sneaker),Sprinkling waterReduce the heat that enters the room.
- Outdoors (when going out)parasol,HatUse of.
- Wear breathable, hygroscopic and quick-drying clothing.
- Suppress going out during high-risk hours.
- ice packCool yourself with water, cold towel, etc.
- Frequently replenish water and salt.
- Even if you do not feel thirsty indoors or outdoors, water, salt,Oral rehydration solutionAnd replenish. As an example of a salt supplement source,Plum kelp tea,Miso Soup,Salted plum,Rice crackers, Including saltcandySuch. However,ElectrolyteWhen replenishing only water that does not containHyponatremiaMay cause.The upper limit of the concentration of salt water to be ingested is about physiological saline (1 liter of water, 9 grams of salt).
As a preventive measure during exerciseJapan Athletic AssociationAccording to the table, "Exercise guidelines for the prevention of heat stroke" are listed below.
|Wet bulb black ball temperature|
|Wet bulb temperature|
|Dry bulb temperature|
|Exercise guidelines for the prevention of heat stroke|
|31 -||27 -||35 -||Exercise is canceled in principle||Prohibited except in special cases.|
Especially for children, it should be discontinued.
|28 - 31||24 - 27||31 - 35||Strict caution|
|Avoid strenuous exercise or endurance running.|
Actively take breaks and rehydrate.
Exercise is discontinued for those who are not physically fit and who are not accustomed to the heat.
|25 - 28||21 - 24||28 - 31||Vigilance|
|Actively take a rest and rehydrate.|
During intense exercise, rest every 30 minutes.
|21 - 25||18 - 21||24 - 28||Notes|
|A fatal accident may occur.|
Watch for signs of heat stroke. Replenish water and salt between exercise sessions.
|The risk of heat stroke is usually low, but hydration should be provided as appropriate.|
Even in this condition, be careful in citizen marathons.
- The heat index (WBGT) is desirable for assessing environmental conditions.
- Be careful of humidity when using dry-bulb temperatures. If the humidity is high, the exercise guideline of the environmental condition that is one rank severe is applied.
- Do not ingest anything that has a diuretic effect.
- TeabeerHas a diuretic effect, so if you take too much of these, you will be excreted frequently, which can easily lead to lack of water..
Acclimation to heat
As mentioned above, in addition to preventing the ambient temperature and body temperature from rising excessively on the spot, and keeping in mind hydration and rest, acclimatize the body to the heat for the summer. "(Acclimation to heat) Is also valid.Specifically, by continuing a slightly tight exercise for about 30 minutes every day for several days to 2 weeks, it becomes easier to release heat in the body by sweating..
Understanding dehydration by urine color
|Status||Water intake behavior|
|No problem||Water intake as usual|
|No problem||Intake a glass of water|
|Dehydration||Ingest 1 ml of fluid within 250 hour|
Ingest 500 ml of fluid outdoors or when sweating
|Dehydration||Ingest 250 ml of water now|
Ingest 500 ml of fluid outdoors or when sweating
|Dehydration||Ingest 1000 ml of water now|
Immediately go to a medical institution if it is darker than this color, or if "red" or "brown" is mixed.
* Refer to the description on the Ministry of Health, Labor and Welfare workplace safety site "Check for dehydration by urine color" (color tone varies depending on the display environment).
- Environmental improvement (cooling) and rest The important thing is to cool the body. If you report a complaint in a place exposed to direct sunlight, immediately move to a nearby air-conditioned room, car, shade, or shade to loosen your clothes and keep it at rest... Effective cooling of the neck with thick blood vessels, both sides, and the base of the foot.. There is also a method of lowering the body temperature by applying water to the body surface and using the heat of vaporization..
- Replenishing water and salt If consciousness is clear, about 0.5-0.9% saline solution,Oral rehydration solution,Sports Drink Rehydrate with such as. A saline solution of about 0.9% does not cause much damage to the body even if it is rapidly replenished without diluting the salt concentration of the blood.However, 0.1-0.2% salt water is desirable for normal prophylactic administration against sweating because the salt content becomes excessive with respect to the amount of sweating water.Sports drinks are high in sugar and lack electrolytesOften. Also, if you are unconscious,trachea-lungThere is a risk of entering, so cancel.. Furthermore, it is a sports drink style with a lot of sugarSoft drinkIf you drank too much,PET bottle syndromeRisk of developing.
- If you have convulsions, unconsciousness or cloudy symptoms, call an ambulance immediately... If you are conscious, take the above first-aid measures, but if you cannot rehydrate yourself, you need to see a medical institution..
- If symptoms such as numbness of the limbs, nausea, and tiredness do not disappear even after self-replenishment of water, medical examination is recommended..
What needs attention as a disease that requires differentiationDiabetes mellitus,High blood pressureIf you have a history ofHypoglycemic attack,Myocardial infarction,cerebral infarctionIt has been reported that proper response is delayed due to misidentification of vascular infarction symptoms such as.
Treatment at medical institutions
The whole body is cooled. As a first aid, cooling infusion, ice sac and evaporative cooling to reduce body surface temperature,Gastric lavageEtc. are used.Infusion to correct dehydration and desalination at the same time and normalize the electrolyte balance in the blood,dialysisIs also done.
2015 (Heisei 27) from the Japanese Society of Emergency Medicine “Guideline for heat stroke treatment 2015”Will be announced and treatment will be performed according to the guidelines. The above-mentioned “Severity classification of heat stroke” Tables II and III are hospitalized if they are treated in the medical field and show organ disorders such as central nervous system symptoms, liver/renal dysfunction, and blood coagulation abnormalities. Is required.. Furthermore, the treatment policy is determined from various viewpoints such as a history of basic diseases, medication history, consciousness level, whether or not to walk on its own, and food intake. Especially in severely severe III patients, it is necessary to lower the core body temperature to normal body temperature in a short time.Gelpad,Cardiac arrestDevice for hypothermia used for treatment of post-syndrome, intravascular coolingcatheterIs used, Effectiveness has been reported.
When severe heat stroke occurs, brain cells gradually die when the core body temperature rises to a high fever state. Even if I could save my life,Diencephalon OfHypothalamusThere may be permanent damage to existing. If the thermoregulatory center remains impaired, the resistance to extreme high and low temperatures will decrease thereafter. Other than this, hallucinations,Low vision,Dysarthria(stutter, Ritsu does not turn),Movement disorder,Consciousness disorder, Decreased liver function, convulsions, etc.SequelaeIn some cases.. Since the brain cells that have once died do not regenerate, there is almost no hope of complete recovery.
In Japan, it is increasing year by year.Fire departmentAccording to the report, due to heat stroke from April 2018 to September 30, 4 for about 30 monthsFirst aidThe number of carriers was 9, the highest number ever.
- The number of deaths in 2007 was 19.However, it has been reported that there are variations in the figures depending on the organization conducting the survey..
- Number of emergency carriers due to heat stroke in June-September (nationwide)
- 2010 (Heisei 22): 56,119
- 2013 (Heisei 25): 58,729
Looking at the onset by age group, more than half of people are 65 years of age or older, and the older the age, the higher the incidence rate..
The places (characteristic places) that frequently occur according to age group are as follows.
- 7-18 years old: school (especially during exercise)
- Ages 19-39 and 40-64: Occurring in relatively diverse places, mainly during outdoor work
- 65 years old and over: Home (living room)
Dog(Dog)Sweat glandsIn Japan, heat stroke is more likely to occur, especially since May to October... Be careful when walking because the distance from the ground to your body is closer than that of people and the reflected heat from the paved road has a large impact on the dog..
In 1977Yoichi FukunagaIn combination withSatsuki AwardWonRacehorseHard bargeAfter participating in a harsh horse show in his later years as a causative horse for three weeks in a row, he lost weight rapidly and died of sunbeams while grazing on a ranch in July 3. 1987 years old died.The end of the hard barge was taken up in a newspaper article, which gave an opportunity to think about the remaining life of a famous horse, and eventually a racehorse nursing facility and a subsidy system (Merit horse connection exhibition business) Was created.
- ^ heat stroke or sun stroke Often called.
- ^ As related itemsConsciousness disorderSee also.
- ^ womanbadmintonJunior high school students in club activities suffered from heat strokecerebral infarctionOf mild left half of the bodySequelaeBear A case in which the junior high school principal acknowledged the fault as "the plaintiff developed heat stroke as a result of the advisor's teacher not being able to respond according to the temperature."
- ^ Marx, John (2006). Rosen's emergency medicine: concepts and clinical practice. Mosby / Elsevier. P. 2239. ISBN 978-0-323-02845-5.
- ^ Karakitsos D, Karabinis A (September 2008). "Hypothermia therapy after traumatic brain injury in children". N. Engl. J.Med. 359 ( two:10.1056 / NEJMc081418. PMID 18788094.
- ^ a b Axelrod YK, Diringer MN (May 2008). "Temperature management in acute neurologic disorders". Neurol. Clin. 26 (2): 585–603, xi. two:10.1016 / j.ncl.2008.02.005. PMID 18514828.
- ^ a b Laupland KB (July 2009). “Fever in the critically ill medical patient”. Crit. Care Med. 37 (7 Suppl): S273–8. two:10.1097 / CCM.0b013e3181aa6117. PMID 19535958.
- ^ Grunau BE, Wiens MO, Brubacher JR (September 2010). "Dantrolene in the treatment of MDMA-related hyperpyrexia: a systematic review". CJEM. 12 ( PMID 20880437.
Dantrolene may also be associated with improved survival and reduced complications, especially in patients with extreme (≥ 42 ° C) or severe (≥ 40 ° C) hyperpyrexia
- ^ Sharma HS, ed. (2007). Neurobiology of Hyperthermia (1st ed.). Elsevier. Pp. 175–177, 485. ISBN 9780080549996.Retrieved January 2016, 11.
Despite the myriad of complications associated with heat illness, an elevation of core temperature above 41.0 ° C (often referred to as fever or hyperpyrexia) is the most widely recognized symptom of this syndrome.
- ^ "JMA Magazine" 2012; 141 (2): pp.259-263.
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- ^ (PDF) Modify
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- ^ Yasuo Fujisawa "Study on health and hygiene management of swimming pool in schoolThesis (2010/3) Hyogo University of Education
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- ^ ""Remove the mask outdoors" Ministry of Health, Labor and Welfare calls for heat stroke prevention”. Sankei News (February 2022, 6). April 2022, 6Browse.
- ^ Kazuo Nagano, Kyoko Shimura, Manami Mishima, Tsukasa Inoue, Kazuya Kiriyama, Mine Sudo, Tetsumi Horikoshi "Effects of Various Asphalt Road Pavement Materials on Heat Stress of Pedestrians", Journal of the Japanese Society of Biometeorology, Vol. 57, No. 2. , Japanese Society of Biometeorology, 2020, pp. 81-94, two:10.11227 / seikisho.57.81.
- ^ Hiiragi Yoda, Akihisa Nomoto, Yoshito Takahashi, Takeyuki Ogata, Shinichi Tanabe "Proceedings of the First Year of Reiwa (Sapporo) Academic Lectures Vol. , Air Conditioning and Sanitary Engineering Society, 2019, pp. 85-88, two:10.18948 / shasetaikai.2019.6.0_85.
- ^ Yoshiharu Endo “This is the true guidebook for “Chilling”: Aizou version” ISBN 4569829767 P.99
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- ^ Jun Oda, Tetsuo Yukioka, Hiroshi Kido and othersHeat-labile phenotype as a new risk factor for heat stroke"Journal of the Japanese Society of Emergency Medicine, 2011, Volume 22, Issue 7, p.350-351, two:10.3893 / jjaam.22.350
- ^ Occurrence of casualties due to heat stroke in the workplace
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- Oral rehydration solution
- Emergency medical care
- Heat island
- Wet bulb black ball temperature(WBGT)
- Heat acclimation
- Heatstroke alert alert
- Abnormal weather early warning information
- High temperature caution information
- Heat stroke related information Ministry of Health, Labor and Welfare
- Information and materials site for heat stroke prevention Ministry of Health, Labor and Welfare
- Heat stroke prevention information site Ministry of the Environment
- Heat stroke prevention call project Ministry of the Environment
- To protect yourself from heat stroke Japanese Meteorological Agency
- Zero heat stroke Japan Weather Association
- heatstroke Japanese Red Cross
- Let's prevent heat stroke Japan Sports Association
- Let's prevent heat stroke-enlightenment materials Japan Sports Promotion Center
- Save children from heat stroke and injury Save Our Kids
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- Overview of heat stroke - MSD Manual