From the Guidelines
Heat stroke and heat exhaustion are two distinct conditions that require different approaches to management, with heat stroke being a life-threatening emergency that necessitates immediate cooling and medical attention, as emphasized in the 2024 American Heart Association and American Red Cross guidelines for first aid 1.
Key Differences in Symptoms
The symptoms of heat exhaustion include heavy sweating, cold and clammy skin, weakness, dizziness, headache, nausea, and a rapid but weak pulse, whereas heat stroke is characterized by a high body temperature (above 103°F), hot and dry skin, confusion, slurred speech, seizures, and unconsciousness.
Treatment Approaches
For heat exhaustion, treatment involves moving to a cool place, loosening clothing, sipping cool water, and applying cool compresses, with recovery typically occurring within 30-60 minutes with these measures 1.
Heat Stroke Management
Heat stroke, however, requires immediate emergency medical attention as it's life-threatening, and while waiting for help, one should move the person to a cooler area, remove excess clothing, and cool them with whatever means available, such as cold water, ice packs on neck/armpits/groin, or a cool bath, without giving fluids to an unconscious person 1.
Importance of Rapid Cooling
The speed at which temperature reduction is achieved is crucial for survival in heat stroke, with faster cooling associated with better survival outcomes, highlighting the need for prompt and effective cooling measures 1.
Recommendations
The most recent and highest quality guidelines recommend immediate active cooling for heat stroke using whole-body water immersion if possible, or other active-cooling methods if immersion is not available, with a target core temperature of less than 39°C (102.2°F) 1.
From the Research
Symptoms of Heat Stroke and Heat Exhaustion
- Heat stroke is characterized by a core temperature greater than 40°C (104°F) and central nervous system manifestations, such as delirium, convulsions, or coma 2
- Heat exhaustion, on the other hand, has early warning signs that include flushed face, hyperventilation, headache, dizziness, nausea, tingling arms, piloerection, chilliness, incoordination, and confusion 3
- Heat stroke can be easily mistaken for head injury in contact sports, especially when players are dehydrated, have febrile illness, and play in warm conditions 4
Treatment of Heat Stroke and Heat Exhaustion
- Immediate cooling treatment is crucial for heat stroke, and core temperature should be continuously monitored to avoid hypothermia 5
- Aggressive cooling, management of life-threatening systemic complications, and early recognition are essential to reduce morbidity and mortality in heat stroke cases 2
- For heat exhaustion, early diagnosis is vital, and treatment includes emergency on-site cooling, intravenous fluids, and addressing hypoglycemia, seizures, or severe cramping as needed 3
- Prevention is the best treatment, and tips to avoid heat illness include drinking on schedule, monitoring weight, watching urine, and knowing the early warning signs of heat illness 3
Key Differences
- Heat stroke is a more severe condition with a higher core temperature and central nervous system involvement, whereas heat exhaustion has milder symptoms and is often a precursor to heat stroke
- Treatment approaches differ, with heat stroke requiring more aggressive cooling and management of systemic complications, while heat exhaustion focuses on early recognition, cooling, and hydration 2, 3