Heat stroke in adults

Clinical criteria

Heat stroke[1]Lipman GS, Gaudio FG, Eifling KP, et al. Wilderness Medical Society clinical practice guidelines for the prevention and treatment of heat illness: 2019 update. Wilderness Environ Med. 2019 Dec;30(4s):S33-46. https://www.wemjournal.org/article/S1080-6032(18)30199-6/fulltext http://www.ncbi.nlm.nih.gov/pubmed/31221601?tool=bestpractice.com

• Profound central nervous system (CNS) alterations.

  • Patients with heat stroke present with CNS dysfunction, particularly with an altered level of consciousness, which may range from confusion to coma (encephalopathy). Other CNS findings include agitation, lethargy, seizures, ataxia, and irritability.

  • The presence of CNS dysfunction is a key factor in distinguishing heat stroke from heat exhaustion.

• Elevated core temperature >40°C.

  • Note that not all patients with heat stroke have an elevated core temperature on presentation, either because of inaccurate measuring techniques or from effects of prior cooling (e.g., in the community).

Heat exhaustion[1]Lipman GS, Gaudio FG, Eifling KP, et al. Wilderness Medical Society clinical practice guidelines for the prevention and treatment of heat illness: 2019 update. Wilderness Environ Med. 2019 Dec;30(4s):S33-46. https://www.wemjournal.org/article/S1080-6032(18)30199-6/fulltext http://www.ncbi.nlm.nih.gov/pubmed/31221601?tool=bestpractice.com

• Mild CNS symptoms.

  • Intense thirst, weakness, anxiety, dizziness, syncope

  • Intact mental status

  • Symptoms typically resolve within 2 to 3 hours.

• Elevated core temperature 37°C to 40°C.