Rittblat Mor, Katabi Shiran, Kotovich Dmitry, Cahan Stav S, Langer Ysh-Ia
Israeli Defense Forces Medical Corps, Tel Hashomer, Ramat Gan, Israel.
Department of Plastic and Reconstructive Surgery, Burn and hand units, Hadassah Hebrew University Medical Center, Jerusalem, Israel.
JPRAS Open. 2025 Jul 18;45:386-389. doi: 10.1016/j.jpra.2025.07.009. eCollection 2025 Sep.
Heatstroke is a life-threatening medical emergency characterized by a core body temperature exceeding 40 °C (104°F). Prompt and effective cooling is critical to prevent multiorgan failure and death. However, aggressive cooling techniques, if improperly applied, may lead to iatrogenic complications. We present a pediatric case of severe frostbite injury resulting from direct ice pad application during emergency treatment for heatstroke.
A 22-month-old infant was found unconscious after being left unattended in a parked car and was diagnosed with severe heatstroke. During prehospital care, direct ice packs were applied per emergency protocol. On admission, erythematous skin lesions were noted on both anterior thighs, which progressed to full-thickness eschars. The plastic surgery team later confirmed these as frostbite injuries. The patient underwent surgical debridement and autologous skin grafting, followed by successful recovery without long-term sequelae.
This case underscores the potential risks associated with rapid cooling interventions, particularly in pediatric patients with more delicate skin. While immediate temperature reduction is vital in treating heatstroke, cooling methods must be carefully selected and monitored. This report highlights the need for pediatric-specific protocols that prioritize both efficacy and safety, and emphasizes the importance of thorough communication between prehospital and in-hospital providers.
中暑是一种危及生命的医疗急症，其特征为核心体温超过40°C（104°F）。迅速有效的降温对于预防多器官功能衰竭和死亡至关重要。然而，积极的降温技术若应用不当，可能会导致医源性并发症。我们报告一例小儿严重冻伤病例，该病例是在中暑急诊治疗期间直接应用冰垫所致。
一名22个月大的婴儿被独自留在一辆停着的车内，被发现时已昏迷，被诊断为严重中暑。在院前护理期间，按照急诊方案直接应用了冰袋。入院时，双侧大腿前部出现红斑性皮肤损伤，随后发展为全层焦痂。整形外科团队后来证实这些为冻伤。患者接受了手术清创和自体皮肤移植，随后成功康复，无长期后遗症。
该病例强调了快速降温干预相关的潜在风险，尤其是对于皮肤更为娇嫩的儿科患者。虽然立即降温对于治疗中暑至关重要，但必须仔细选择和监测降温方法。本报告强调了制定针对儿科的方案的必要性，这些方案应兼顾疗效和安全性，并强调了院前和院内医护人员之间进行充分沟通的重要性。
