Key Points
- Use the highest‑yield diagnostic test early; do not let testing delay time‑critical therapy.
- Set objective targets (hemodynamic, neurologic, respiratory) and reassess frequently.
- Plan definitive source control or reperfusion when indicated; document follow‑up and patient education.
Algorithm
- Recognize heat stroke: hyperthermia with CNS dysfunction; move to cool environment; strip clothing.
- Start whole‑body ice‑water immersion when exertional HS; otherwise evaporative + ice packs if immersion unavailable.
- Secure airway/breathing/circulation; large‑volume IV fluids as needed.
- Monitor core temp q5 min; stop cooling at ~39°C; prevent overcooling.
- Screen and treat complications (rhabdomyolysis, AKI, DIC, arrhythmias); avoid antipyretics.
- Admit to ICU; counsel on return‑to‑activity and heat‑risk mitigation.
Clinical Synopsis & Reasoning
Hyperthermia with CNS dysfunction requires immediate whole‑body cold‑water immersion (exertional) or aggressive evaporative cooling; target core 39°C. Manage airway, fluids, rhabdomyolysis, DIC, and organ failure; avoid antipyretics.
Treatment Strategy & Disposition
Stabilize ABCs. Initiate guideline‑concordant first‑line therapy with precise dosing and continuous monitoring. Escalate to advanced/procedural interventions based on explicit failure criteria. Define ICU, step‑down, and ward disposition triggers; involve specialty teams early.
Epidemiology / Risk Factors
- Risk varies by comorbidity and precipitants; see citations for condition‑specific data.
Investigations
| Test | Role / Rationale | Typical Findings | Notes |
|---|---|---|---|
| Core temperature (rectal) | Severity | Often >40°C | Serial measurements during cooling |
| CK, CMP, coags | Complications | Rhabdomyolysis, AKI, DIC | Trend q6–8 h initially |
| UA/myoglobin | Rhabdo screen | Positive in many cases | Hydration + alkalinization selectively |
Pharmacology
| Medication/Intervention | Mechanism | Onset | Role in Therapy | Limitations |
|---|---|---|---|---|
| Cold‑water immersion (procedure) | Physical cooling | Immediate | First‑line for exertional heat stroke | Stop at 39°C core temp |
| IV crystalloids | Volume support | Minutes | Treat hypovolemia/rhabdo | Avoid overhydration |
| Benzodiazepines (shivering) | GABAergic | Minutes | Control agitation/shivering | Monitor airway |
Prognosis / Complications
- Outcome depends on timeliness of diagnosis and definitive therapy; monitor for complications.
Patient Education / Counseling
- Provide red‑flag education, adherence guidance, and explicit return precautions; arrange timely specialty follow‑up.
References
- Wilderness Medical Society Clinical Practice Guidelines for Heat Illness (2024 update) — Link
- DoD/CHAMP Clinical Practice Guideline: Heat Illness (June 2024) — Link
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