From the Guidelines
The most effective treatment for hyperthermia due to heat stroke is immediate active cooling, which can be achieved through whole-body cool- to cold-water immersion for 15 minutes or until neurological symptoms resolve, as recommended by the 2024 American Heart Association and American Red Cross guidelines for first aid 1.
Key Treatment Steps:
- Move the person to a cool environment and remove excess clothing to help lower their body temperature.
- Provide cool liquids if the person is able to swallow, as stated in the guidelines 1.
- Activate emergency services for individuals with heatstroke, characterized by altered mental status 1.
- Consider using other forms of active cooling, such as commercial ice packs, cold showers, ice sheets and towels, cooling vests and jackets, and evaporative, fanning, or a combination of techniques when water immersion is not available 1.
- The target core temperature to cool until is 39° C (102.2° F), and it may be reasonable for first aid providers to measure core temperature during active cooling for heatstroke 1.
Additional Considerations:
- Intravenous fluids should be administered to address dehydration and electrolyte imbalances.
- Benzodiazepines like diazepam may be needed for shivering or seizures.
- Vital signs should be monitored continuously, with special attention to core temperature, heart rate, blood pressure, and mental status.
- Cooling should be slowed once temperature reaches 102°F to prevent overcooling.
- Heat stroke is a medical emergency with significant morbidity and mortality if untreated, and complications like rhabdomyolysis, acute kidney injury, and liver failure may require additional specific treatments.
From the Research
Treatment for Hyperthermia due to Heat Stroke
The primary treatment for hyperthermia due to heat stroke is rapid cooling to reduce core temperature as quickly as possible 2. This is because the major determinant of outcome in heatstroke is the degree and duration of hyperthermia.
Cooling Methods
Several cooling methods can be used to treat hyperthermia due to heat stroke, including:
- Ice-water immersion, which has been shown to be highly effective in exertional heat stroke, with a zero fatality rate in large case series of younger, fit patients 3
- Evaporative plus convective cooling, which may be augmented by crushed ice or ice packs applied diffusely to the body, and is often used in older patients with nonexertional heat stroke 3
- Water immersion, which can rapidly reduce core body temperature in settings where it is feasible 4
- Chilled intravenous fluids, which may supplement primary cooling 3
Monitoring and Discontinuation of Cooling
It is essential to continuously monitor core temperature during cooling treatment to avoid hypothermia 5. Cooling should be discontinued when the core temperature reaches 38°C, and the patient should be dried and covered to prevent further heat loss 5.