Tucker Lucy, Evans Emily
Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.
Adv Emerg Nurs J. 2023;45(3):210-216. doi: 10.1097/TME.0000000000000470.
Heat-related illnesses, namely, heatstroke is on the rise and is a public health concern nationally and internationally. Heatstroke is generally considered to be a core body temperature greater than 40 °C (104 °F) with dry, hot skin, and central nervous system manifestations. Heatstroke is characterized by a systemic inflammatory response that leads to multiple-organ dysfunction and ultimately death if not treated in a timely manner. Rapid recognition and cooling are imperative, as mortality is high, especially in the elderly. There are many cooling methods that have been studied that include cold-water immersion, tarp-assisted cooling with oscillation (TACO), evaporative cooling (misting/fanning), commercial ice packs, cooling vests and jackets, cold showers, and ice sheets. Although cold-water immersion is the fastest method for cooling, it is not usually feasible in an emergency department (ED). TACO is the most feasible and effective cooling method for EDs. It is vital that EDs have a specific plan in place before implementing TACO, as it requires 30-40 gallons of ice water, a tarp or waterproof sheet, core temperature monitoring, and an ample number of ED staff members to oscillate the water over the patient. Further research is needed to study TACO in the ED setting. As the incidence of heatstroke is expected to increase in the coming years, EDs must have a plan in place to rapidly recognize and treat patients with heatstroke so that patients will have improved outcomes and reduced mortality.
与热相关的疾病，即中暑，正在增加，是国内外的一个公共卫生问题。中暑通常被认为是核心体温高于40°C（104°F），伴有皮肤干燥、发热以及中枢神经系统表现。中暑的特征是全身性炎症反应，若不及时治疗会导致多器官功能障碍并最终死亡。快速识别和降温至关重要，因为死亡率很高，尤其是在老年人中。已经研究了许多降温方法，包括冷水浸泡、振荡式防水布辅助降温（TACO）、蒸发降温（喷雾/扇风）、商用冰袋、降温背心和夹克、冷水淋浴以及冰毯。虽然冷水浸泡是最快的降温方法，但在急诊科通常不可行。TACO是急诊科最可行且有效的降温方法。在实施TACO之前，急诊科制定具体计划至关重要，因为这需要30 - 40加仑的冰水、一块防水布或防水床单、核心体温监测，以及足够数量的急诊科工作人员在患者身上振荡水。需要进一步研究在急诊科环境中使用TACO的情况。由于预计未来几年中暑的发病率会增加，急诊科必须制定计划以快速识别和治疗中暑患者，从而使患者有更好的预后并降低死亡率。
