Heat Related Illness (>18 years)
Inclusion Criteria
- Clinical concern for heat stroke, heat exhaustion or heat stress
Exclusion Criteria
- None
Signs of heat exhaustion?
lack of rapid improvement or worsening?
Temperature
Signs of heat stroke?
- Protect the airway in an unconscious or obtunded patient
- Place 2 large bore peripheral IV lines
- Cardiac, BP, oximetry and continuous temperature (preferably rectal or foley) monitoring
- Initial cooling:
- Ice bags to axilla and groin
- Constant lukewarm misting
- Fans
- Conductive cooling blanket if available
- Hydration
- Normal Saline 1 L bolusus to maintain MAP > 80
- CVP monitoring for elderly or CHF patients
- Control shivering with lorazepam or diazepam
NS bolus
Complete Blood Count, Serum
Complete Metabolic Panel, Serum
Lactic Acid, Serum
Partial Thromboplastin Time (PTT), Serum
Prothrombin Time (PT), Serum
Creatine Kinase (CK), Serum
Lorazepam injection
Diazepam injection
- Heat stress is treated with oral rehydration and removal from the hot environment
- Patients should be instructed to take adequate fluid and frequent rest breaks when exposed to hot environments
- Remove patient from hot enviroment
- Oral rehydration preferred
- In severe cases of if not tolerating oral fluids: Normal Saline 1-2 L bolus
- Expect rapid improvement
NS bolus
Creatine Kinase (CK), Serum
Basic Metabolic Panel, Serum
Myoglobin, Urine
- Cold water lavage by nasogastric tube and foley
- Central venous cooling device where avaliable
- ECMO where available
- Dantrolene if there is muscle rigidity or if the patient is on a phenothiazine or tricyclic antidepressant
- Admit to ICU
Dantrolene injection
Place Nasogastric tube
Place Foley Catheter
- Admit to ICU
- Stop cooling
- Monitor electrolytes Q1hr initially for hyperkalemia and free water deficit
Clinical signs and symptoms of heat exhaustion
- A core body temperature < 104F (40C)
- Systemic symptoms
- Profuse sweating
- Malaise
- Fatigue
- Headache
- Nausea and possible vomiting
- Tachycardia, possible orthostatic hypotension, syncope
- Mental status is intact, although dizziness and emotional lability may occur
Heat exhaustion exists in continuum with heat stroke. Treat aggressively if the diagnosis is in doubt
Clinical signs and symptoms of heat stroke (all three required)
- Exposure to heat stress (generally working or exercising in hot environments OR decompensated individuals exposed to extreme temperatures)
- Central nervous system dysfunction
- CNS infection, sepsis, neuroleptic malignant syndrome or malignant hyperthermia unlikely
- Core body temperature is classically > 40.5C, but may be lower early in the course or if treatment is initiated in the field.