Heat stroke - Revision history

Danbot: Strip excess bold

2026-03-22T09:36:17Z

Strip excess bold

Danbot: Major update: cooling rate targets, cold water immersion evidence, no antipyretics/dantrolene/NE, avoid shivering, LFT monitoring timeline, exertional vs classic distinctions, updated references with PMIDs

2026-03-21T19:42:08Z

Major update: cooling rate targets, cold water immersion evidence, no antipyretics/dantrolene/NE, avoid shivering, LFT monitoring timeline, exertional vs classic distinctions, updated references with PMIDs

Show changes

Beren85: /* Background */

2022-05-05T17:01:50Z

Background

← Older revision		Revision as of 17:01, 5 May 2022
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	*Severe end of heat-related illness spectrum characterized by severe hyperthermia and neurologic dysfunction		*Severe end of heat-related illness spectrum characterized by severe hyperthermia and neurologic dysfunction
	*True emergency - universally fatal if left untreated		*True emergency - universally fatal if left untreated
	**Mortality approaches 30% even with treatment<ref name="Gaudio">Gaudio FG, Grissom CK. Cooling Methods in Heat Stroke. J Emerg Med. 2015 Oct 31.</ref>		**Mortality approaches 30% even with treatment<ref name="Gaudio">Gaudio FG, Grissom CK. Cooling Methods in Heat Stroke. J Emerg Med. 2015 Oct 31.</ref>, and is directly associated with the duration of elevated core temperature
	*Hallmark is multisystem organ dysfunction from heat-induced damage resulting in systemic inflammatory response		*Hallmark is multisystem organ dysfunction from heat-induced damage resulting in systemic inflammatory response

Alexgrohmann: /* Techniques */

2020-03-02T03:02:25Z

Techniques

← Older revision		Revision as of 03:02, 2 March 2020
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	**Benefits: Easier to apply in ED and while performing other interventions		**Benefits: Easier to apply in ED and while performing other interventions
	**Disadvantages: Slower cooling (than immersion) with slightly higher morbidity/mortality		**Disadvantages: Slower cooling (than immersion) with slightly higher morbidity/mortality
	*Invasive		*Invasive Techniques (limited data <ref name="Gaudio" />)
	**Techniques ~~such as cardiopulmonary bypass/ECMO or cold water lavage of body cavities has been reported, but inadequate~~ data ~~to recommend~~<ref name="Gaudio" />		**Bladder Lavage
			**Gastric Lavage
			**Thoracic Lavage with chest tubes
			**Cardiopulmonary bypass/ECMO

	==Complications==		==Complications==

Alexgrohmann: /* Background */

2020-03-02T03:00:15Z

Background

← Older revision		Revision as of 03:00, 2 March 2020
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	==Background==		==Background==
	*Severe end of heat-related illness spectrum		*Severe end of heat-related illness spectrum characterized by severe hyperthermia and neurologic dysfunction
	*True emergency - universally fatal if left untreated		*True emergency - universally fatal if left untreated
	**Mortality approaches 30% even with treatment<ref name="Gaudio">Gaudio FG, Grissom CK. Cooling Methods in Heat Stroke. J Emerg Med. 2015 Oct 31.</ref>		**Mortality approaches 30% even with treatment<ref name="Gaudio">Gaudio FG, Grissom CK. Cooling Methods in Heat Stroke. J Emerg Med. 2015 Oct 31.</ref>

ClaireLewis at 19:03, 28 September 2019

2019-09-28T19:03:49Z

← Older revision		Revision as of 19:03, 28 September 2019
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	*Classic (nonexertional) - insidious development over days		*Classic (nonexertional) - insidious development over days
	**Seen in children and elderly		**Seen in children and elderly
	**During the time of [[~~Heat~~ wave]]		**During the time of [[heat wave]]
	*Exertional - rapid onset during exercise or other exertion		*Exertional - rapid onset during exercise or other exertion
	**Seen in otherwise young, healthy individuals		**Seen in otherwise young, healthy individuals
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	*Symptoms<ref name="Becker">Becker JA, Stewart LK. Heat-related illness. Am Fam Physician. 2011 Jun 1;83(11):1325-30.</ref>		*Symptoms<ref name="Becker">Becker JA, Stewart LK. Heat-related illness. Am Fam Physician. 2011 Jun 1;83(11):1325-30.</ref>
	**Elevated temperature >40°C (104°F) '''PLUS'''		**Elevated temperature >40°C (104°F) '''PLUS'''
	**CNS neurologic abnormalities (e.g. inappropriate behavior, [[Confusion]], slurred speech, [[Delirium]], [[Ataxia]], [[Coma]], [[Seizures]])		**CNS neurologic abnormalities (e.g. inappropriate behavior, [[Confusion]], [[dysarthria\|slurred speech]], [[Delirium]], [[Ataxia]], [[Coma]], [[Seizures]])
	*Anhidrosis is frequently present; however, its absence does NOT rule out heat stroke		*Anhidrosis is frequently present; however, its absence does NOT rule out heat stroke
	*May have massive hematochezia secondary to decreased intestinal perfusion and ischemia<ref>Lambert GP. Intestinal barrier dysfunction, endotoxemia, and gastrointestinal symptoms: the 'canary in the coal mine' during exercise-heat stress? Med Sport Sci. 2008;53:61-73.</ref>		*May have massive [[rectal bleeding\|hematochezia]] secondary to decreased intestinal perfusion and ischemia<ref>Lambert GP. Intestinal barrier dysfunction, endotoxemia, and gastrointestinal symptoms: the 'canary in the coal mine' during exercise-heat stress? Med Sport Sci. 2008;53:61-73.</ref>

	==Differential Diagnosis==		==Differential Diagnosis==
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	**[[Diabetic ketoacidosis\|DKA]]		**[[Diabetic ketoacidosis\|DKA]]
	*Neurologic		*Neurologic
	**Hypothalamic bleeding or infarct		**Hypothalamic [[ICH\|bleeding]] or [[stroke\|infarct]]
	**[[Stroke (main)\|CVA]]		**[[Stroke (main)\|CVA]]
	**[[Status epilepticus]]		**[[Status epilepticus]]
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	**[[Malignant hyperthermia]]		**[[Malignant hyperthermia]]
	**[[Neuroleptic malignant syndrome]]		**[[Neuroleptic malignant syndrome]]
	**Withdrawal (e.g. ETOH, ~~Benzodiazepines~~)		**Withdrawal (e.g. [[ETOH withdrawal\|ETOH]], [[benzodiazepine withdrawal\|benzodiazepines]])

	{{AMS and fever DDX}}		{{AMS and fever DDX}}
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	*CBC		*CBC
	*Metabolic panel		*Metabolic panel
	*LFTs		*[[LFTs]]
	*Blood gas		*Blood gas
	*[[Lactate]]		*[[Lactate]]
	*Coagulation studies ([[DIC (Disseminated Intravascular Coagulation)\|DIC]])		*Coagulation studies ([[DIC (Disseminated Intravascular Coagulation)\|DIC]])
	*Creatine phosphokinase and myoglobin ([[~~Rhabdomyolisis~~]])		*Creatine phosphokinase and myoglobin ([[Rhabdomyolysis]])
	*[[Urinalysis]]		*[[Urinalysis]]
	*~~Chest x-ray~~		*[[CXR]]
	*CT brain (± LP), if indicated (Cerebral Edema)		*[[CT brain]] (± [[LP]]), if indicated (Cerebral Edema)

	===Evaluation===		===Evaluation===
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	**Reduces morbidity/mortality, should be started in prehospital setting if no other life-threats exist<ref name="Becker" />		**Reduces morbidity/mortality, should be started in prehospital setting if no other life-threats exist<ref name="Becker" />
	*Remove from environment		*Remove from environment
	*IVF (for renal protection and avoiding rhabdomyolysis)		*[[IVF]] (for renal protection and avoiding rhabdomyolysis)
	**Bolus if hypotensive		**Bolus if hypotensive
	**Infusion titrated to UOP (goal 2-3ml/kg/hr)		**Infusion titrated to UOP (goal 2-3ml/kg/hr)
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	*[[Hypotension]]		*[[Hypotension]]
	**Usually responds to small fluid bolus (500cc) and body cooling		**Usually responds to small fluid bolus (500cc) and body cooling
	**If no response to fluids → consider vasopressors (dopamine or dobutamine)		**If no response to fluids → consider [[vasopressors]] (dopamine or dobutamine)
	***Avoid peripheral vasoconstriction (e.g. norepinephrine), which may redirect blood flow away from skin and diminish cooling		***Avoid peripheral vasoconstriction (e.g. norepinephrine), which may redirect blood flow away from skin and diminish cooling
	*[[Electrolyte abnormalities]]		*[[Electrolyte abnormalities]]
	**Variable: hypokalemia and hyper or hyponatremia may be seen		**Variable: [[hypokalemia]] and [[hypernatremia\|hyper]] or [[hyponatremia]] may be seen
	*Hematologic - [[DIC]] or abnormal bleeding		*Hematologic - [[DIC]] or abnormal bleeding
	*Hepatic injury - almost always reversible		*[[hepatic failure\|Hepatic injury]] - almost always reversible
	*Renal failure		*[[Renal failure]]
	*[[ARDS]]		*[[ARDS]]
	*[[Seizure]] - treat with [[Benzodiazepines]]		*[[Seizure]] - treat with [[Benzodiazepines]]
	*Neurologic deficit		*[[focal neuro deficits\|Neurologic deficit]]
	**Persistent in 20%, associated with high mortality		**Persistent in 20%, associated with high mortality

Teledoc4u: /* Types */

2019-06-30T06:59:55Z

Types

← Older revision		Revision as of 06:59, 30 June 2019
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	*Classic (nonexertional) - insidious development over days		*Classic (nonexertional) - insidious development over days
	**Seen in children and elderly		**Seen in children and elderly
			**During the time of [[Heat wave]]
	*Exertional - rapid onset during exercise or other exertion		*Exertional - rapid onset during exercise or other exertion
	**Seen in otherwise young, healthy individuals		**Seen in otherwise young, healthy individuals

Spenceemmett: /* Clinical Features */

2019-06-11T13:16:35Z

Clinical Features

← Older revision		Revision as of 13:16, 11 June 2019
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	**CNS neurologic abnormalities (e.g. inappropriate behavior, [[Confusion]], slurred speech, [[Delirium]], [[Ataxia]], [[Coma]], [[Seizures]])		**CNS neurologic abnormalities (e.g. inappropriate behavior, [[Confusion]], slurred speech, [[Delirium]], [[Ataxia]], [[Coma]], [[Seizures]])
	*Anhidrosis is frequently present; however, its absence does NOT rule out heat stroke		*Anhidrosis is frequently present; however, its absence does NOT rule out heat stroke
	*May have massive hematochezia secondary to ~~dec~~ perfusion and ~~intestinal~~ ischemia<ref>Lambert GP. Intestinal barrier dysfunction, endotoxemia, and gastrointestinal symptoms: the 'canary in the coal mine' during exercise-heat stress? Med Sport Sci. 2008;53:61-73.</ref>		*May have massive hematochezia secondary to decreased intestinal perfusion and ischemia<ref>Lambert GP. Intestinal barrier dysfunction, endotoxemia, and gastrointestinal symptoms: the 'canary in the coal mine' during exercise-heat stress? Med Sport Sci. 2008;53:61-73.</ref>

	==Differential Diagnosis==		==Differential Diagnosis==

Teledoc4u: /* Evaluation */

2019-04-21T08:18:00Z

Evaluation

← Older revision		Revision as of 08:18, 21 April 2019
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	===Evaluation===		===Evaluation===
	*Clinical diagnosis		*Clinical diagnosis
			*Exposure to hot environment and high index of suspicion.

	==Management==		==Management==

Rossdonaldson1: Text replacement - "Urinalysis" to "Urinalysis"

2018-10-20T23:41:22Z

Text replacement - "*Urinalysis" to "*Urinalysis"

← Older revision		Revision as of 23:41, 20 October 2018
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	*Coagulation studies ([[DIC (Disseminated Intravascular Coagulation)\|DIC]])		*Coagulation studies ([[DIC (Disseminated Intravascular Coagulation)\|DIC]])
	*Creatine phosphokinase and myoglobin ([[Rhabdomyolisis]])		*Creatine phosphokinase and myoglobin ([[Rhabdomyolisis]])
	*Urinalysis		*[[Urinalysis]]
	*Chest x-ray		*Chest x-ray
	*CT brain (± LP), if indicated (Cerebral Edema)		*CT brain (± LP), if indicated (Cerebral Edema)