From the Guidelines
The immediate management for a patient with nausea and vomiting due to heat stroke should prioritize rapid cooling and supportive care, with a focus on moving the patient to a cool environment, removing excess clothing, and providing cool liquids if the person is able to swallow, as recommended by the 2024 American Heart Association and American Red Cross guidelines for first aid 1.
Key Management Steps
- Move the patient to a cool environment and remove excess clothing to help reduce body temperature.
- Provide cool liquids if the person is able to swallow, as this can help with hydration and temperature regulation.
- Activate emergency services for patients with heatstroke, especially those with altered mental status.
- Consider active cooling measures such as whole-body cool- to cold-water immersion for 15 minutes or until neurological symptoms resolve, or other forms of active cooling like commercial ice packs, cold showers, or evaporative cooling with water misting and fans, as suggested by the guidelines 1.
Additional Considerations
- For severe nausea and vomiting, antiemetics may be considered, but the primary focus should be on cooling and supportive care.
- Monitoring core body temperature and adjusting cooling measures accordingly is crucial, with a target core temperature of 39°C (102.2°F) or below, as mentioned in the guidelines 1.
- It is essential to assess for complications, including electrolyte abnormalities, rhabdomyolysis, and organ dysfunction, and to avoid medications that may impair thermoregulation.
Guiding Principles
- The management of heat stroke should prioritize reducing morbidity, mortality, and improving quality of life, with a focus on rapid cooling and supportive care.
- The guidelines from the 2024 American Heart Association and American Red Cross 1 and the Society of Critical Care Medicine 1 emphasize the importance of timely and effective management of heat stroke to minimize its consequences.
From the Research
Immediate Management for Nausea and Vomiting due to Heat Stroke
The immediate management of a patient with nausea and vomiting due to heat stroke involves addressing both the heat stroke and the symptoms of nausea and vomiting.
- For heat stroke, the basic principle of management is early resuscitation and immediate cooling, which can be achieved through methods such as cold water immersion or convection evaporation, as stated in 2.
- In terms of nausea and vomiting, these symptoms can be managed symptomatically, especially in the absence of alarm symptoms, as noted in 3 and 4.
- The use of antiemetic drugs can be effective in reducing symptoms of acute nausea and vomiting, but the treatment should be used for the shortest time necessary to control symptoms, as mentioned in 3.
- For patients with heat stroke, fluid replacement is crucial, and the choice of fluid can impact outcomes. Lactated Ringer's solution may be preferred over normal saline for resuscitation in heatstroke patients to minimize organ damage, as suggested by 5.
- Overall, the management of heat-related illnesses, including heat stroke, involves rapid initiation of appropriate therapies such as cooling methods and fluid replenishment, with careful monitoring for complications like multiple organ dysfunction, as discussed in 6.