新人999中暑后如何治疗配图，仅供参考
On-site emergency treatmentsThe keys to on-site treatment for HS patients are:1) rapid,effective and continuous cooling;2) rapid rehydration;3) effective control of restlessness and convulsions. Among these measures,the first point is the most important. In view of the critical condition and rapid progression,continuous cooling and evacuation should be implemented at the same time during the initial hours following heat stroke on-site treatment. If there is a conflict between continuous cooling and evacuation,on-site cooling should take precedence. Due to limited resources and extreme conditions on site,the following six critical treatment steps should be implemented to the best.
(1) Immediate removal from the heat. Whether affected by EHS or CHS,the patient should be quickly removed from the hot and humid environment (trainees should stop training immediately) and be transferred to a cool and ventilated location. The patient’s clothing should be removed as soon as possible to facilitate heat dissipation. If conditions allow,the patient should be transferred to an air-conditioned room with a room temperature of 16-20 ?C.
(2) Quick measurement of body temperature. Fast and accurate measurement of body temperature is a prerequisite for effective cooling. Core temperature,instead of body surface temperature,should be measured on site because of the potential dissociation between the two in critically ill patients. Rectal temperature should be preferred; it can be measured by inserting a flexible rectal thermometer to a depth of at least 15 cm . If core temperature (rectal temperature) cannot be measured on site,surface temperature (axillary or tympanic temperature) can be measured as a reference. HS cannot be excluded even if the axillary or tympanic temperature is below the diagnostic threshold; furthermore,body temperature should be measured every 10 min or monitored continuously.
(3) Active and effective cooling. Because the mortality rate is closely related to the degree and duration of hyperthermia,rapid,effective and continuous cooling is the primary treatment for HS patients. If initial cooling is delayed by 30 min,internal damage will continue even if the body temperature reaches the target. Previous studies have indicated that patients may not die if their core temperature is reduced to below 40.0 ?C within 30 min . This consensus recommends that the core temperature should be reduced below 39.0 ?C within 30 min and below 38.5 ?C within 2 h. The cooling methods should be adapted to the local conditions and selected flexibly according to availability. Multiple methods can be used together. We recommend stopping the cooling measures or reducing the cooling intensity when the core temperature drops to 38.5 ?C and maintaining a rectal temperature of 37.0-38.5 ?C,in order to avoid hypothermia . The cooling measures should be restarted if the body temperature increases again. The following cooling methods,but not limited to those listed,can be used on site . 1) Cooling by evaporation: Effective cooling can be achieved by spraying the individual with cold water or misting the skin with water while applying air with a fan. A maximum cooling effect can be reached by maintaining the water temperature at 15-30 ?C and the fan air at 45 ?C,which prevents vasoconstriction by keeping the skin temperature at 30-33 ?C. If conditions are limited,the patient’s skin can be covered as much as possible with gauze cloth (the patient should lie on his or her side to avoid aspiration),and room temperature water can be applied intermittently to the gauze so that the skin temperature is maintained at 30-33 ?C,while fanning continuously. A moist towel or diluted alcohol can also be used to wipe the entire body while fanning continuously. In most circumstances,reducing temperature by evaporation is the easiest option suitable for both CHS and EHS patients and can be used as the primary option. 2) Immersion in cold water: This method is mainly applied to EHS patients. Based on the principle of conduction cooling,the patient can be immersed,below the neck,in cold water (2-20 ?C) using large containers (such as bath tubes,tarpaulins and sinks); this can be the most effective on-site cooling method. The cooling rate is 0.13-0.19 ?C ?C/min,and there is no significant difference in cooling effects of cold water at different temperatures. If cold water is not available,room temperature water (e.g.,water at 26 ?C) can be used for immersion. Special care should be taken to ensure that the patient’s head does not enter the water,and the respiratory tract should be protected to prevent aspiration and drowning. Adverse reactions of cooling by immersion in cold water include chills and restlessness,which usually occur after 9-10 min. In theory,chills and the accompanying skin vasoconstriction may reduce the effect of conduction cooling,but in reality,effective cooling can still be achieved. 3) Cooling by ice: Using the principle of conduction cooling,the patient can wear an ice cap or use an ice pillow,and ice packs wrapped in gauze can be placed at places with abundant blood vessels and rapid heat dissipation,such as the neck,groin (the scrotum should be protected) and armpit. The ice packs should not be in place for more than 30 min each treatment. When applying ice,changes in local skin color should be monitored to avoid frostbite. Because this method leads to vasoconstriction in the skin,the skin should be massaged intensely while applying the ice. In fact,the effect of ice cooling is not ideal; the cooling rate is approximately 0.034 ?C/min. 4) Cooling in vivo: Body temperature can be reduced by stomach tube irrigation with normal saline at 4-10?C (rapid injection (total volume of 10 ml/kg within 1 min) through the gastric tube followed by aspiration after 1 min; the procedure can be repeated multiple times) or by rectal lavage (total volume of 200-500 ml injected at the rate of 15-20 ml/min at a depth of no less than 6 cm; it can be release after being placed for 1-2 min,and the procedure can be repeated multiple times.) The injection speed should not be too high during rectal lavage. Rapid intravenous injection of cold saline at 4 ?C can also result in effective cooling,which is especially suitable for dehydrated EHS patients and is commonly used as a part of comprehensive treatment. Based on relevant literature,this consensus recommends infusion of normal saline at 4 ?C at 25 ml/kg or a total volume of 1000-1500 ml within 60 min. The key to this method is to maintain a rapid infusion velocity; otherwise,the cooling effect cannot be reached. Core temperature should be monitored and should not decrease below 38.5 ?C. If cold saline is not available on site,normal saline at room temperature can also be used for cooling. 5) Cooling by medication: Due to thermoregulatory center dysfunction in the early stage of HS,the use of drugs,including nonsteroidal drugs and artificial hibernation compounds,to reduce body temperature during treatment on site is not recommended.
(4) Rapid fluid recovery: Venous access should be established quickly on site,preferably via thick peripheral veins. Establishment of a peripheral two-channel fluid path using a trocar instead of a steel needle is recommended because the latter is not easy to fix. A medullary ducts can also be established if available. Sodium-containing fluid (such as normal saline or Ringer’s solution) is preferred for infusion,which can replenish lost salt while rehydrating. This consensus recommends infusion of 30 ml/kg or a total volume of 1500-2000 ml within the first hour on site (if cooling by cold saline is initiated,the amount should be included in the total volume calculation). The infusion rate should be adjusted according to the patient response (such as blood pressure,pulse and urine volume) after the first hour so that the urine volume of patients without renal failure is maintained at 100-200 ml/h while avoiding fluid overload. Infusion of a large amount of glucose should be avoided to prevent a rapid reduction in blood sodium in a short period of time that may aggravate nerve damage .
(5) Airway protection and oxygen therapy: The head of a patient in a coma should be turned to one side to keep the airway open. Airway secretions should be cleared in a timely manner to prevent vomiting and aspiration. Water should not be provided to unconscious patients. If vomiting has occurred,the oral secretions should be cleaned as soon as possible. Tracheal intubation should be performed as soon as possible for HS patients who require airway protectio n. If intubation is not available on site,the airway should be kept open/be continuously opened by hand,orapharyngeal/nasopharynx airway,and then,call for support as soon as possible. Pulse oximetry (SpO2) should be monitored continuously during on-site treatment if conditions permit. Nasal cannula oxygenation should be used to maintain SpO2 ≥ 90% . If the nasal cannula fails to meet the oxygen level,a mask should be used for oxygenation.
(6) Control of convulsions: Convulsions and restlessness not only interfere with cooling treatments but also increase heat production and oxygen consumption,which aggravates damage to the nervous system. It is extremely important to control convulsions and restlessness on site. Sedative drugs can be given to keep the patient in a sedated state and prevent accidental injuries,such as tongue biting. Restless patients can be injected with 10-20 mg of diazepam intravenously within 2-3 min. If intravenous injection is difficult,diazepam can be injected intramuscularly. If the convulsions are not ameliorated after the first dosage,10 mg of diazepam can be injected intravenously after 20 min; total dose within 24 h should not exceed 40-50 mg. If convulsions are not controlled properly,intramuscular injection of 5-8 mg/kg phenobarbital can be used in addition to diazepam.","department":"
