Heat stroke

Overview 
Theory 
Diagnosis 
Management 
Follow up 
Resources 

Please note that formulations/routes and doses may differ between drug names and brands, drug formularies, or locations. Treatment recommendations are specific to patient groups: see disclaimer

ACUTE

heat exhaustion

mild volume depletion

1st line – supportive care and oral rehydration

significant volume depletion or hyponatremia

1st line – supportive care and rehydration with isotonic intravenous fluids

Back

1st line –

supportive care and rehydration with isotonic intravenous fluids

All patients should be assessed using Advanced Trauma Life Support protocols and managed as appropriate.

The patient should be removed from the external heat source.

Evaporative cooling can be encouraged by wetting the skin.

It is essential that, if the patient is hyponatremic, hypotonic fluids are avoided.[19]

All patients showing signs of significant volume depletion (such as severe postural dizziness, postural hypotension or tachycardia) or hyponatremia should be transferred to a medical facility for further assessment and management.[1]

Intravenous infusion of normal saline or Ringer lactate (Hartmann solution) should be given gradually.[18] Infusions may require 1 to 1.5 L/hour. Patients with severe exercise-associated hyponatremia may require boluses of hypertonic 3% saline.[19]

Core temperature and electrolyte balance are monitored.

heat stroke

1st line – urgent assessment and immediate external cooling

Back

1st line –

urgent assessment and immediate external cooling

Initial treatment of heat stroke in adults is aimed at rapidly decreasing core temperature. This may be initiated in the field, for example, by external cooling, before definitive diagnosis is made.

All patients should be assessed using Advanced Trauma Life Support protocols and managed as appropriate. If necessary patients should receive resuscitation using the ABCs of acute care (securing airway, breathing, and circulation).

Following transfer to a medical facility, cooling should be continued. External cooling methods include immersion and evaporative cooling.[1][34]

Immersion cooling in an ice bath, or cooling blankets used in conjunction with ice packs to the axilla, groin, neck, and head, may be the most rapid methods of cooling.[25][36][37] Guidelines on exertional heat stroke recommend immediate cold water immersion (clothing/equipment removal is time consuming and should occur when the patient is in the tub).[25][38]

Patients cooled in an ice bath frequently experience afterdrop (where their core temperature continues to decline even after they are removed from the bath). To prevent iatrogenic hypothermia, patients are typically removed from the ice bath once their core temperature reaches 100°F (37.8°C).[1][34] Practitioners should be aware of falsely elevated rectal temperatures due to the insulating effects of body mass.[42] Bradycardia due to the diving reflex is not uncommon, and immersion can make access to the patient difficult in case of a cardiac arrest.[1]

Evaporative cooling is where the patient's skin is exposed to warm air at 113°F (45°C) passing over the body while a mist of cool water at 59°F (15°C) speeds heat dissipation. Cooling rates with this technique have been measured at 0.5°F/minute (0.31°C/minute).[34]

Evaporative cooling may be preferred for older adult patients, or for those with compromised mental status, owing to the technical difficulties in performing resuscitation in an immersed patient.

Plus – rehydration with isotonic intravenous fluids