Exertional heat stroke: A lucky bunch of overly motivated policemen!

Abstract

Introduction: Exertional heat stroke is a true medical emergency resulting from thermoregulatory failure. The risk of death is related directly to the peak temperature, duration of exposure and acclimatisation period. This case report illustrates the management of multiple casualties of heat stroke in the emergency department and their outcomes. Clinical feature: Nine policemen arrived in the emergency department in semiconscious state after being retrieved from a group of policemen who were loaded into a bus without proper ventilation during a selection program. All of them presented with hyperpyrexia, hypotension, tachycardia and altered sensorium. Treatment: Immediate evaporative cooling with support of organ-system dysfunction was commenced. Six patients were intubated and admitted to the intensive care unit. One patient was monitored in high dependency ward while the other two were admitted to the general medical ward. Outcome: All patients were extubated within 48 hours. None of them had residual neurological dysfunction. One patient developed coagulopathy which required blood product transfusion. Three patients were discharged in less than one week and the rest were observed in the general ward in stable condition for liver profile monitoring.