PBL REPORT

HEATSTROKE

Tutorial group :8
Facilitator : Cik Siti Zubaidah Binti Patuwan
MATRIC NO NAME
FS18110136 MOHD EZAM BIN TAJUDIN
FS18110079 MOHD NUR FITRIE BIN SUPIDIE
FS18110077 TUGANG ANAK ASONG
FS18110465 NUR KHAIRUNNISA’ BINTI SAZALI
FS18110276 NUR AZREEN JIHAN BINTI JOHARI
FS18110413 NUR FADZILAH BINTI USMAN
FS18110025 NUR FATIHAH BINTI HASAN

For facilitator use only

Elements of Report Total Marks Percentage

Format /9 /2
Background of Study /9 /5
Objectives and Problem Statement /9 /5
Results and Discussions /9 /20
Conclusions /9 /5
References /3 /3
CONTENT

NO. CONTENTS PAGE

1 INTRODUCTION 3

2 OBJECTIVES 4

3 PROBLEM STATEMENT 4

4 RESULT 5-8

5 DISCUSSION 9 – 12

6 CONCLUSION 12

7 REFERENCES 13 - 14

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INTRODUCTION
Heat stroke is the most severe heat-related illness and can rapidly lead to death
without prompt treatment. Heatstroke (HS), also known as sunstroke is the most
serious form of heat-related illness and is a medical emergency. It is caused by an
excessive rise in deep body temperature due to thermoregulatory failure and is
characterized primarily by hyperthermia usually with core temperature above
40.6°C (105°F), due to environmental heat exposure with lack of thermoregulation
and usually complicated with central nervous system dysfunction, metabolic
derangement, and coma. HS is the most severe form of the heat-related illnesses so
it must be distinguished from heat exhaustion, sepsis, diabetic ketoacidosis, closed
head trauma, malignant hyperthermia, encephalitis, cerebral malaria, cerebral
hemorrhage, amphetamine and cocaine toxicity, strychnine poisoning etc., This is a
distinct form of a fever, where there is a physiological increase in the temperature
set point of the body. It carries a high mortality nearly 80% if effective treatment is
not given immediately. While anhidrosis (lack of sweating) is frequently present,
especially with classic heat stroke, this is not an absolute diagnostic criterion.

This condition represents a failure of the body's ability to maintain

thermoregulatory homeostasis. Heat stroke is further classified as classic (non-
exertional) heat stroke which arises from environmental exposure to heat and is
more common in younger children who are unable to escape from hot environments
and those with underlying chronic medical conditions that impair thermoregulation
and exertional heat stroke generally occurs in young, otherwise healthy individuals
who engage in heavy exercise during periods of high ambient temperature and
humidity. Typical patients are athletes and military recruits in basic training.

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OBJECTIVES
1. To identify effective ways to decrease and prevent heatstroke cases involving
children.
2. To figure out the mechanics of car greenhouse effect.
3. To create awareness among society regarding the danger of heatstroke.

PROBLEM STATEMENT
Many accidents/cases involving fatal injury to children due to heatstroke for being
trapped in cars of parents’ negligence. So, what action should be taken to prevent
these accidents?

THREE-STEP CYCLE TABLE

What We Know What We Need to Know Summary

Children are more What caused the Children have undeveloped
vulnerable to heat stroke. vulnerability? body.
Theres no safe amount of At what period would the Heat increase the most in the
time to left infants in the amount of heat increase the first half an hour.
car. most?
Dehydration caused most How to keep babies Breastfeed and provide good
cases of heat stroke. hydrated? amount of water for them.
Heat stroke in car caused What are the concept Green-house effect is applied
by trapped heat. related that caused heat to in the inner environment of the
be trapped in the car? car.
Heat stroke caused a lot What are the health Heatstroke can lead to
of complication to babies. condition caused by hyponothermia, neurologic
heatstroke? abnormalities and etc.

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RESULT
Examples of Heatstroke Cases Among Children
Heatstroke can happen to anyone regardless their age. This includes children.
According to the safety organization Kids and Cars, an average of 37 children die
each year in hot cars. These include instances where a child has been forgotten in a
car or accidentally locks themselves in a car or trunk. There were also cases where
the child has been intentionally left in a car by their parents or guardian. For
example, in Japan, a boy collapsed when he was on his way back home from a trip.
When he referred to the hospital, it was found that the body temperature of the boy
was relatively high which then concluded that it was due to the extreme heatwave
across Japan.

As for in Malaysia, there were cases where the child was left in the car which
then caused fatality. In 2013, a three years old child passed away after being left in
a car for five hours by his mother who worked as a teacher while in 2014 a four
years old boy passed away after accidentally left by his father in the car for eight
hours. Earlier this year, 2018, the similar case happened, a two years old child
passed away after she was left by her mother in a car for several hours in a parking
area in Port Dickson, Negeri Sembilan. When the child was referred to the nearest
hospital, it was confirmed that she passed away due to heatstroke.

There were also cases of heatstroke among adults. For example, a trainee in
PULAPOL passed away while training in 2016. In Quebec Canada 2018, 33 people
reported passed away due to extreme heatwave. Most of the victim age ranged 53
– 85. As for in Japan, 80 people were reported dead due to extreme hot weather
exceeding 40 degrees Celsius while 35,000 people were referred to the hospital. In
India, there were 124 heatstroke cases across Maharashtra in March 2018 where
the first case reported was the death of a farmer. While in Pakistan, 2018, 65
people died due to heatstroke.

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Heatstroke Effects
Neurologic Abnormalities
Permanent neurologic damage is more commonly seen in little child with core
temperatures higher than 42ºC (107.6ºF) and consist of spasticity, ataxia,
dysarthria, poor coordination, impaired memory, and behavioral changes when they
are growing up. (Epstein, Y., 1993). Patients recovering from rapidly treated
exertional or classic heat stroke with core body temperatures below this level may
manifest some of these neurologic findings but typically recover fully (Royburt,
M.,1993).

Exertional heat illness such as heatstroke can affect athletes during high-intensity or
long-duration exercise and result in withdrawal from activity or collapse during or
soon after activity. These maladies include exercise associated muscle cramping,
heat exhaustion, or exertional heatstroke. While certain individuals are more prone
to collapse from exhaustion in the heat (i.e., not acclimatized, using certain
medications, dehydrated, or recently ill), exertional heatstroke (EHS) can affect
seemingly healthy athletes even when the environment is relatively cool. (Casa, D.
J.,2007). EHS is defined as a rectal temperature greater than 40ºC accompanied by
symptoms or signs of organ system failure, most frequently central nervous system
dysfunction.

Early recognition and rapid cooling can reduce both the morbidity and mortality
associated with EHS. The clinical changes associated with EHS can be subtle and
easy to miss if coaches, medical personnel, and athletes do not maintain a high
level of awareness and monitor at-risk athletes closely. Fatigue and exhaustion
during exercise occur more rapidly as heat stress increases and are the most
common causes of withdrawal from activity in hot conditions. In some cases, rectal
temperature is the only discernible difference between severe heat exhaustion and
EHS in on-site evaluations. Heat exhaustion will generally resolve with symptomatic
care and oral fluid support. Exercise associated muscle cramping can occur with
exhaustive work in any temperature range but appears to be more prevalent in hot
and humid conditions (Armstrong, L. E., 2007).

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Hyperthermia
Hyperthermia is defined as elevation of core body temperature above the normal
diurnal range of 36 to 37.5°C (96.8 to 99.5°F) due to failure of thermoregulation.
Hyperthermia is not synonymous with the more common sign of fever, which is
induced by cytokine activation during inflammation and regulated at the level of the
hypothalamus. Heat-related illnesses range from minor syndromes to life-
threatening processes. While there are many manifestations of heat-related
illnesses, all heat-related illnesses result from excessive heat stress caused by an
increased environmental heat burden, an inability of the body to dissipate
endogenous heat, or a combination of these two factors. Heat stroke is the most
severe heat-related illness and can rapidly lead to death without prompt treatment.

Hallucinations
Children that are exposed into excessive amount of heat, can experience
hallucinations. Hallucinations are sensations that appear to be real but are created
within the mind. Examples include seeing things that are not there, hearing voices
or other sounds, experiencing body sensations like crawling feelings on the skin, or
smelling odors that are not there. High fevers can also produce hallucinations in
some people. Hallucinations can accompany other psychotic symptoms such
as delusions and disconnection from reality. They can be temporary or persist over
the long term, depending upon the exact type of hallucinations and their cause.

Seizures
Seizures are caused by a sudden surge of electrical activity in the brain. A seizure
usually affects how a person looks or acts for a short time. Someone having a
seizure might collapse, shake uncontrollably, or even just stare into space. All of
these are brief disturbances in brain function, often with a loss of or change in
consciousness. Seizures can be frightening, but most last only a few minutes, stop
on their own, and are not life-threatening (Beyderman, L., October 2016).

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Physics Concept
Greenhouse Effect

Figure 1: The greenhouse effect in the car.

The greenhouse effect refers to the condition where the short wavelengths of
visible light from the sun pass through a transparent medium and are absorbed,
however the longer wavelengths of the infrared re-radiation from the heated
objects are unable to pass through that medium. The trapped long wavelength
radiation leads to more heating and a higher resultant temperature. Besides the
heating of an automobile by sunlight through the windshield has been widely used
to describe the trapping of excess heat by the rising concentration of carbon dioxide
in the atmosphere. The carbon dioxide strongly absorbs infrared and does not allow
as much of it to escape into space.

Bright sunlight will effectively warm your car on a cold, clear day by the greenhouse
effect. The longer infrared wavelengths radiated by sun-warmed objects do not
pass readily through the glass. The entrapment of this energy warms the interior of
the vehicle. The trapping of the hot air so that it cannot rise and lose the energy by
convection also plays a major role. Short wavelengths of visible light are readily
transmitted through the transparent windshield. Shorter wavelengths of ultraviolet
light are largely blocked by glass since they have greater quantum energies which
have absorption mechanisms in the glass. Even though you may be uncomfortably
warm with bright sunlight streaming through, you will not be sunburned.

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DISCUSSION
There are many cases of heat stroke that related to the children, for
instance they were locked in hot cars for a long period, like stated previously. If
parents or the others don't take action of these situation, their life are at stake.
Thus, to avoid the dangers related to the heat stroke, there are many ways and
solutions to prepare your baby for time in the car which result in the declining
number of heatstroke cases.

Primarily, the effective ways to prevent heat stroke to the babies is to keep
them always hydrated. This can be achieved by breastfeed or offer formula to them.
Although milk and formula are usually enough to starve off dehydration. At the
same boat, provide small amounts of water as well to the baby. Much like ours, the
baby’s body loses a lot of water through sweating and essential body functions so
it’s key to compensate this water loss as often as possible and water is the key of
hydration. When heading out for the day be sure to pack extra breast milk or
formula just in case and store them in a cooler bag at the car to keep them fresh.

On top of that, put up a sun shade in the window next to child so that direct
sun doesn’t hit them. They can burn easily since they can’t move. For babies in
rear-facing car seats, pull the hood forward if the seat has one. This will provide
some shade for your baby or use sunscreen formulated for babies and be mindful of
the SPF (sun protective factor). An SPF of at least 30 is recommended. One very
vital thing to remember is to be sure to apply sunscreen to the baby’s face. If
possible, park in a garage to keep your car cool before you enter it again. When
returning to a hot car, roll down the windows and wait a few minutes before
buckling in your child. If have to park outside, consider putting a sun shade up in
the windshield to block out heat waves.

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 Being especially busy or distracted from daily life even a parent or a very
loving and attentive one, can forget a child is in the back seat and effect the
increases the risk of heatstroke. Therefore, the best way to prevent this case is to
set some reminders in the car and yourself. First, always check the back seat and
make sure all children are out of the car before locking it and walking away. Besides,
avoid distractions while driving, especially cell phone use or have the child care
provider call if the child is more than 10 minutes left. Alternatively, put your cell
phone, bag, or purse in the back seat, so you will check the back seat when you
arrive at your destination. By creating a reminder like a stuffed animal or other
memento in child’s car seat when it’s empty and move it to the front seat as a
visual reminder when your child is in the back seat (Children's National, 9th July
2018).

Another safety precaution to prevent heatstroke to the infants is lock the car.
Keep the car locked when it is parked to prevent a curious child from entering when
no one is around. Overall, many hot car deaths have occurred when a child
mistakenly locks himself inside. Make sure children do not have easy access to the
car keys. Store them out of a child's reach. Furthermore, teach children that cars
are not safe places to play. Keep rear fold-down seats closed to prevent a child
from crawling into the trunk from inside the car.

Additionally, foods can also be a source to refuel and re-hydrate babies by

giving them food that contains high liquidity. Instead of giving to the baby sugary
snacks, give them fruits and vegetables such as cucumbers, pears, kiwi and
watermelon. These foods are also nutritious, have natural sweetness and work to
replenish nutrients that are lost through sweating and exertion. Not only will be
protecting the baby from potential heat stroke, but also teaching them healthy
habits and building their preference for healthy snack options. This sounds like
killing two birds in one stone to the baby, so why not give it a try.

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 Moving onto the solutions, the immediate action shoud be taken when a
person showing the symptoms of having a heatstroke is calling the emergency
hotline for medical emergency. For further actions, the first-aid treatment is crucial
while waiting for the medical team to arrive. The steps begin by first moving the
victim into cool and shaded place away from direct sunlight. Next, remove all of the
unnecessary clothing and let the victim lay on by his or her side to let as much of
the skin surface to the air as possible. In addition of giving the victim a cooling
effect, sponging or spray cold water onto the entire body surface and fan the victim
to let the body temperature down. Also, apply ice packs in each armpit and at the
back of the neck. Watch for signs of rapidly progressing heatstroke, such as seizure,
unconsciousness for longer than a few seconds, and moderate to severe difficulty
breathing (Emergency First Aid for Heatstroke, 2018). If a child has stopped
breathing, begin rescue breathing - CPR (cardiopulmonary resuscitation) is pushing
down on a person's chest and breathing into his or her mouth (Dealing With
Emergencies, 2018).

Furthermore, do not give aspirin or acetaminophen to reduce a high body

temperature that can occur with heatstroke. These medicines may cause problems
because of the body's response to heatstroke. If the victim is awake and alert
enough to swallow, give the victim fluids [1 L (32 fl oz) to 2 L (64 fl oz) over 1 to 2
hours] for hydration. You may have to help. Make sure the victim is sitting up
enough so that he or she does not choke. Most people with heatstroke have an
altered level of consciousness and cannot safely be given fluids to drink (Emergency
First Aid for Heatstroke, 2018). Avoid fluid containing alcohol or caffeine. Alcohol
consumption may lead to impaired judgment and the inability to adopt cooling
behaviors. Further, alcohol may cause peripheral vasodilatation which may permit
both heat loss and heat gain through the skin, as well as weakened cardiac
contractility which may impair the body’s ability to compensate for heat-related
stress. Caffeine may increase heart rate and metabolic rate, subsequently increasing
body temperature (Alcohol and Caffeine, 2010).

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 Finally, usually doctors or medical team will do almost the same steps above
which can be simplify into four techniques which are; cold water immersion (ice
bathing for the victim), evaporation cooling techniques – fanning and mist spraying,
ice packs and cooling blankets wrapping. All of those steps is genuinely for reducing
the victim’s body temperature same goes as the first aid treatment. But, doctors or
the medical tem will include one extra steps that is giving medication to stop the
shivering. If treatments to lower the victim’s body temperature leads to shivering,
they may give the victim a muscle relaxant, such as a benzodiazepine. This steps
important because shivering increases the body temperature, making treatment less
effective (Heatstroke: Diagnosis and Treatment, 2018).

CONCLUSION
In a nutshell, heatstroke is a life-threatening condition marked especially by
cessation of sweating, extremely high body temperature, and collapse that results
from prolonged exposure to high temperature. Occur when the body temperature

exceed 40°, from this study we learnt how extremely dangerous heatstroke is as

there were many previous cases that noted heatstroke as the cause of fatal. Varied
from babies to adult, the fatal cases also happened in many ways such as car
greenhouse effect (mostly babies), excessive training during hot days and even
simple dehidration. For further understanding, the phenomenon of heatstroke is not
exist by its own but actually as an after effect of human ignorant itself that leads to
the gobal warming; drastic increase in enviromental temperature. Aside that, mind
to be shared, that there is solution for every problem, the heatstroke occurence to a
certain people or person could be solve in many ways such as seeking help
immediately during emergency and so on as have been discussed in this study. But
still, prevention is better than cure, so bigger steps should be taken to avoid these
heatstroke problems from happening in the future. The decision is in everyone’s
hand and hopefully one day, people would be much aware of these problems and it
is even better if people could consider this problem as a wake up call for human to
appreciate the earth more.

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