Doctors' daylong battle ends in tears

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This is pretty gruesome but the old nurse in me just could not comprehend how a seasoned young athlete could lose his life to heatstroke in spite of intensive therapy. The following account, tearfully submitted, does make some sort of sense......

Doctors' daylong battle ends in tears

Jill Burcum    Star Tribune    Thursday, August 2, 2001     MANKATO, MINN. -- Physicians knew how dire Viking Korey Stringer's condition was even before he arrived at the emergency room at Immanuel St. Joseph's Hospital just before noon on Tuesday.

Paramedics on the ambulance transporting him weren't able to get a blood pressure reading, a key vital sign, according to Dr. David Knowles, a Mankato physician who coordinates Vikings medical care while the team is in Mankato. Nor was Stringer ever conscious on the ride to the hilltop hospital. One hopeful sign: He did have a heart beat.

One look at Stringer as he was wheeled in to the emergency room confirmed the paramedics' grim report, Knowles said. They quickly saw that he was in shock and showing another classic symptom of heat stroke: His skin was extremely warm and dry.

As the medical staff stabilized Stringer with intravenous fluids, they also took his temperature. The reading was a frightening 108.8 Fahrenheit.

Knowles and the other emergency staff knew the hours ahead would be difficult ones. "When the [temperature] is that high, there is an 80 percent mortality rate," Knowles said.

The medical staff moved quickly to get fluids into Stringer's body and bring his body temperature down, Knowles said. Doing so is critical to prevent the cascade of organ failure caused by hyperthermia, the medical term for an extremely high body temperature.

When the body is that hot, liver cells start to die. Muscle tissue is damaged and begins to produce a toxin that damages the kidneys. The brain fills with fluids, creating pressure that interferes with the body's most basic functions and can lead to heart failure.

Stringer was transferred out of the emergency room and to the critical care unit on the hospital's third floor. There, a low-tech measure was used to cool Stringer's body down.

Buckets and tubs were brought in filled with icy water, Knowles said. Towels were dipped in the water and then draped over his body and wadded up and tucked under such places as his armpits.

Critical care team: In the meantime, Knowles was on the phone with Mankato's medical specialists. All the possible and severe complications that heat stroke can bring meant medical expertise of almost every type would be needed.

"I called everybody I could think of," Knowles said.

Cardiologists, a pulmonologist, a critical-care physician, anesthesiologist, an orthopedic physician and kidney specialist Dr. Rolf Storvick, who cut short a vacation, were among those who responded to the call for help. At one point, Knowles said, there were 15 or more medical specialists working on Stringer.

All of their expertise would be required as the day turned into night. Stringer appeared to make progress, but then another medical problem would surface.

During the evening, he developed a heat-stroke related bleeding condition called dissemminated intravascular coagulopathy. Essentially, his blood wouldn't clot, Knowles said, and Stringer began to bleed from his orifices and from the places where the needles for the intravenous lines had been inserted.

He was given medications to help control this, and responded well to treatment, Knowles said. But complications continued.

His kidneys failed, Knowles said, and he was put on dialysis machines twice. Physicians felt they were making progress.

But it was almost as if his other organs had given up the fight, too. Stringer needed help breathing and was put on a respirator. Around 10 p.m. his heart began to fail. One of the cardiologists standing by confirmed this with an echocardiogram, an ultrasound test used to gauge heart function.

"We thought we had turned a corner but then his heart gave out and there was nothing we could do," Knowles said.

Grief sets in Stringer never regained consciousness and was pronounced dead at 1:50 a.m. An exhausted medical team grieved for him.

"There were a lot of tears there last night," Knowles said.

Knowles and other physicians said Stringer's death should serve as a powerful reminder of how deadly heat can be. Stringer was in good health and had no underlying health conditions that could have predisposed him to heat stroke, Knowles said.

In fact, he had undergone a complete physical exam in the Twin Cities several days before, Knowles said.

But his massive muscles and size -- 6-4 and 335 pounds -- worked against him, experts said.

Stringer's body generated tremendous amounts of heat. Robert Serfass, a kinesiologist on the faculty at the University of Minnesota, said that 75 to 80 percent of the energy produced by Stringer's workout would have turned into heat. And it had nowhere to go.

No matter how much Stringer drank -- and it was unlikely he could drink enough to replace the liters of water he lost through sweat -- the extremely high humidity meant that sweat couldn't evaporate and cool him off.

No matter how well his powerful heart pushed blood to his skin to release heat into the air, it was too hot. Stringer was working out in conditions that were essentially equal to body temperature, and he could not dissipate his heat into cooler air.

"Size is a significant risk factor," said Dr. Mark Seaburg, chief of internal medicine at Park Nicollet Clinic in St. Louis Park. "Thinner people can dissipate heat better."

-- Jan Zumbo (dvt99@aol.com), August 02, 2001

Answers

This is a GREAT article as all of them were in the Tribune. Good to know the Docs did all they could he was just too sick.

-- Tom (BMatheus@aol.com), August 02, 2001.

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