Exertional Heat Stroke
Hyperthermia from intense physical activity
⚠️ COOL FIRST, TRANSPORT SECOND!
Lower temperature to below 40°C within 30 minutes of collapse
Definition
Rectal temp ≥40°C WITH altered level of consciousness
(In absence of alternative explanation like infection/sepsis)
Clinical Presentation
- Altered LOC (confusion, aggression, combativeness, sedation, unconsciousness)
- Altered mobility (staggering, incoordination)
- Profuse sweating (common)
- Hyperventilation, collapse, seizures
Rule Out Other Causes
| Check | To Rule Out |
|---|---|
| Full vitals | Hypotension |
| Oximeter | Hypoxia |
| Glucometer | Hypoglycemia |
| Injury evaluation | Head trauma |
| Serum sodium (if available) | Hyponatremia |
Treatment - ALL PROVIDERS
Lower temperature to <40°C within 30 minutes
Cooling Methods
- Conduction: Ice packs to groin, neck, axillae; cold IV fluids
- Convection: Ice water immersion, fans (only if air cooler than patient)
- Radiation: Remove clothing, don't treat on hot surface
- Evaporation: Misting, remove patient's clothing
Anti-pyretics (Tylenol, etc) have NO role in heat stroke!
Reassessment
- Stay with patient
- Rectal temp every 3-5 minutes minimum
- Temp may rise initially (5-10 min) then reduce
- After 15 min cooling, should drop 3°C
- Patient will develop vasoconstriction & shivering
- Discontinue active cooling at 39°C (prevent hypothermia)
Disposition
- Temp >40°C + other causes ruled out: Activate 911 for transport
- Temp reduced to 39°C + recovering well: Some can be released to family care
- Athlete must urinate before discharge
Watch for Rhabdomyolysis
Signs: Myalgia, muscle swelling/tenderness, low back/abdominal pain
Risk factors: Poor fitness, high temp/humidity, sickle cell trait, viral illness, anticholinergic meds, renal insufficiency
⚠️ Safety: Do not leave patient alone in cryotub
Source: Odyssey Medical Consulting
Version: 2023-06-23