The best management for heat stroke is ice water enema

I wrote a full article in Chinese about an experience while I was a first year resident at Montefiore Hospital in Bronx , NY .   This is an abstract.

 

There were 5 elderly (in 60's) obese women from a nursing home who went into coma from heat stroke in a hot summer evening in July, 1966. Their air con was not working. Three patients were sent to Montefiore and 2 to Morrisania Municipal Hospital where residents from Montefiore rotated. All 3 in the Montefiore survived and those 2 sent to Morrisania died. The difference apparently was, the junior resident on call (i.e. I), ordered ice water enema immediately on the phone. Those in Morrisania were treated with ice packing of the body surface only. The body surface ice packing will constrict blood vessels in the skin and makes dissipation of body heat slower!  By ice water enema and frequent exchange of the ice water, the body temperature of those elderly women lowered significantly to the safety level within one hour!!

 

The chief of medicine came to the morning meeting the next day and lectured to us the difference in the death rate of those 5 patients. The 50-60 residents listened quietly. He did not mention my name. Everyone knew who was the guy.  

 

This article was published in Jing-fu NTU Alumni Bulletin and Pacific Times (Chinese language Weekly Newspaper) in the US a few months ago, 2009.

 

Nobody wants to talk about feces or handle feces. Perhaps that is why the effectiveness of ice water enema for heat stroke has not been emphasized more frequently. The nurses will have to work for hours in stinking room with feces all over their gowns, gloved hands and even faces and hairs. The credit of saving those 3 patients belonged to the nurses who dutifully carried out the doctor's order.

 

Ice water enema is most crucial in the management of the heat stroke. I hope people will spread the words around to save more lives.