Objective: The authors have investigated the characteristics of heatstroke patients transported into the emergency medical centers or emergency departments in Japan.
Methods: Five hundred and twenty-eight heatstroke patients were treated in 66 hospitals during the period from June to August in 2006. Patients' informations were collected by their family or the emergency technicians, and then their medical data were described by the medical staffs in charge according to the prearranged format and were analyzed by the heatstroke surveillance committee members of Japanese Association for Acute Medicine (JAAM).
Results: The patients' ages are distributed from 3 to 93 years with the mean age of 41.5 years. They are categorized as Grade I (mild, no need for specific treatment), Grade II (moderate, need for hospitalization for observation) and Grade III (severe, need for intensive care), consisting of 62%, 18% and 20%, respectively. Exertional heatstroke patients are divided into 2 groups. One is juvenile male patients group with the mean age of 25 years suffering in the exercise, and the other includes male muscular laborers with the mean age of 47 years. Classical heatstroke group proves to be composed of the elderly female with the mean age of 59 years. Two-hundred and eighty five cases, 56% of all with the mean age of 38 years left hospitals after such routine treatments as rapid cooling and intravenous fluid replacement in ER. The others of 221 cases, 44% of all with the mean age of 51 years needed hospitalization for advanced monitoring for cardiac, hepatic, renal and haematological dysfunctions. The worst condition was recorded on the first day for all the patients in hospital except for nonsurvivors. Thirteen Grade III patients (2.5%) died of multiple organ failure within 4 days after their admissions. Deep coma (with the point of 300 by Japan Coma Scale), shock status (with systolic arterial pressure≤90mmHg), higher body temperature(≥40°C) and acidemia with pH<7.35 have been demonstrated as the significant risk-factors accounting for fatal outcome. Especially preexisting intrinsic disorders complicated with mental illness, hypertension and diabetes have been found to be associated with classical heatstroke.
Conclusion: Acclimatization to summer heat and early recognition of signs and symptoms suggesting of heatstroke are important so as to diminish heatstroke victims.

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A 32-year-old female, who had been injured after suffering a fall, was transferred to our emergency and critical care center. She was diagnosed to have left hemothorax, left multiple rib fracture, liver injury, a lumbar fracture, and lumber spinal cord injury. Due to paraplegia in her lower limbs, she was later moved to our rehabilitation ward. Three months after suffering the trauma, she began to complain of epigastralgia. Thereafter, at four months after the trauma, the patient again complained of epigastralgia, then experienced sudden cardiac arrest and died. Emergency chest radiography and computed tomography showed an elevated diaphragm and tension gastro-colo-splenothorax in the left pleural cavity. The anatomicopathological findings showed the stomach, colon, greater omentum, and spleen to all have prolapsed into the thoracic cavity. Based on these findings, we supposed that the delayed-manifested diaphragmatic hernia should induce the tension gastro-colo-splenothorax, which most likely led the patient to develop cardiac arrest. Conclusions: we herein reported a rare case of a delayed-manifested diaphragmatic hernia, which resulted in cardiac arrest due to tension gastro-colo-splenothorax.

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[in Japanese]

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[in Japanese]

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[in Japanese]

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