Savić Slobodan, Pavlekić Snezana, Alempijević Djordje, Dragan Jecmenica
Srp Arh Celok Lek. 2014 May-Jun;142(5-6):360-4. doi: 10.2298/sarh1406360s.
Heat stroke is the most dangerous among numerous disorders caused by elevated environmental temperature. It is characterized by an increased body temperature of over 40 degrees C, the dysfunction of the central nervous system and the development of multiple organ failure. The aim of this paper was to highlight problems in the clinical and post-mortal diagnosis of fatal heat stroke.
A 20-year-old male was found unconscious on the street; on admission at the Emergency Center, Clinical Center of Serbia, Belgrade, he was in a coma. The body temperature of 40 degrees C was maintained despite the applied therapy, meningeal signs were negative, tachycardia with gallop rhythm, hypotension, bleeding from the nose and mouth, and presence of skin bruises.
highly elevated LDH and creatine kinase, elevated serum creatinine, AST, and signs of DIC. Lethal outcome occurred 6 hours after admission, and the case remained clinically unsolved. Autopsy showed signs of hemorrhagic diathesis, brain and pulmonary edema, and microscopic examination revealed general congestion, internal bleeding in various organs, cerebral edema, massive blood aspiration and pulmonary edema. Toxicological and bacteriological examinations were negative. Based on these findings and subsequently obtained data on the conditions at the workplace where the young man had a part-time job, it was concluded that the violent death was caused by heat stroke.
Since heat stroke is associated with a high mortality rate and high incidence of serious and permanent organ damage in survivors, it is important to make the diagnosis of heat stroke as quickly as possible and apply appropriate treatment. Misdiagnosis of heat stroke, and consequently inadequate treatment, with a potential fatal outcome for the patient, can be the reason for blaming doctors for the legal offense of medical malpractice in failing to administer first aid.
中暑是环境温度升高引发的众多病症中最危险的一种。其特征为体温超过40摄氏度、中枢神经系统功能障碍以及多器官功能衰竭。本文旨在强调致命性中暑临床及尸检诊断中的问题。
一名20岁男性被发现昏迷于街头；在塞尔维亚贝尔格莱德临床中心急诊室入院时，他处于昏迷状态。尽管进行了治疗，体温仍维持在40摄氏度，脑膜刺激征阴性，存在奔马律心动过速、低血压、口鼻出血以及皮肤瘀斑。
乳酸脱氢酶和肌酸激酶大幅升高，血清肌酐、天门冬氨酸氨基转移酶升高，并有弥散性血管内凝血迹象。入院6小时后患者死亡，该病例临床诊断未明确。尸检显示有出血素质、脑和肺水肿迹象，显微镜检查发现全身充血、各器官内出血、脑水肿、大量血液吸入及肺水肿。毒理学和细菌学检查均为阴性。基于这些发现以及随后获取的该年轻人兼职工作场所的情况数据，得出结论：暴力死亡系中暑所致。
由于中暑与高死亡率以及幸存者中严重且永久性器官损伤的高发生率相关，尽早诊断中暑并采取适当治疗至关重要。中暑的误诊以及由此导致的治疗不当，可能给患者带来潜在致命后果，这可能成为指责医生因未能实施急救而构成医疗事故法律罪行的原因。
