Exertional Heatstroke, Asesmen Cepat Dan Penatalaksanaan Tepat: Laporan Kasus

Abstract

Heatstroke is the most severe heat illness which homeostatic thermoregulatory mechanism is failed, characterized by an elevation of the core body temperature above 40 oC, central nervous system dysfunction, and possible multi-organ failure. Heatstroke is the third leading cause of death among athletes. Exertional heatstroke (EHS) is exercise-induced; usually affects young healthy people during strenuous physical activity and have not acclimatized to environmental heat stress. Frequently encountered complications include encephalopathy, acute respiratory distress syndrome, myocardial injury, acute kidney injury, hypoglycemia, intestinal ishemia or infarction, pancreatic injury, rhabdomyolysis, disseminated intravascular coagulation (DIC), hypocalcemia, lactic acidosis, and hepatic failure. Immediate cooling is the cornerstone of treatment which evaporative cooling is preferred. Aspiration and seizure are common; airway management, oxygenation, and ventilation have to be adequately maintained. Crystalloid-fluid resuscitation is essential, averaging 1200 mL in first 4 hours. Systemic complications of heatstroke should be well-managed to prevent worse outcome. A case of 32-years-old man with no significant medical history was brought to emergency department after collapsing while running into the 20-kilometres marathon. He was unresponsive (GCS E1V2M1), had serial generalized seizure and hematemesis-melena. On primary survey, the patient was shocked (BP 67/24 mmHg, HR 165 bpm, cold extremity), tachypnea (41/min), hyperthermia (40.5oC rectally), SpO2 95% on simple mask 10 L/min. His laboratory results showed full-blown complications of heatstroke. Immediate rehydration therapy using saline solution and colloid solution intravenously was started, followed with blood or blood component transfusion. Tracheal intubation and mechanical ventilation were performed. During the intensive treatment, he became fully conscious and was extubated on hospital day 7. He was hemodynamically stable without any support, but developed multi-organ failure. Unfortunately, on twentieth day, he was cardiac arrest during hemodialysis and died four days later.

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