What are the management strategies for heat exhaustion?

From the Guidelines

Heat exhaustion management should prioritize immediate cooling and hydration, with the goal of preventing progression to heat stroke, as recommended by the 2024 American Heart Association and American Red Cross guidelines for first aid 1. The management strategies for heat exhaustion include:

• Moving the person to a cool, shaded area and having them lie down with legs elevated
• Removing excess clothing and cooling the body by applying cold, wet towels or ice packs to the neck, armpits, and groin, or by spraying cool water on the skin
• Encouraging the person to drink cool fluids containing electrolytes, such as sports drinks or salted water (1/4 teaspoon salt per quart of water), sipping slowly to prevent nausea
• Using fans to increase air circulation, if available
• Monitoring vital signs, including temperature, heart rate, and blood pressure
• Seeking emergency medical care immediately if symptoms don't improve within 30-60 minutes, vomiting prevents fluid intake, or mental status changes occur According to the 2024 American Heart Association and American Red Cross guidelines for first aid, for people with exertional hyperthermia or heatstroke, first aid providers should move the individual from the hot environment, remove excess clothing, limit exertion, and provide cool liquids if the person is able to swallow 1. Additionally, the Society of Critical Care Medicine guidelines for the treatment of heat stroke emphasize the importance of rapid cooling to restore normal physiologic activity and minimize morbidity and mortality 1. It is essential to note that prevention is equally important, and individuals should stay hydrated, avoid outdoor activities during peak heat, wear lightweight clothing, and acclimatize gradually to hot environments to prevent heat exhaustion and heat stroke.

From the Research

Management Strategies for Heat Exhaustion

• The primary goal of managing heat exhaustion is to reduce heat gain and promote heat loss 2
• This can be achieved by:
  • Discontinuing exercise or physical activity
  • Reducing exposure to radiative heat sources
  • Encouraging the individual to drink cool fluids
  • Removing or loosening clothing to facilitate heat loss
• In more extreme situations, more aggressive cooling strategies may be employed, such as:
  • Cold showers
  • Application of wet towels
• Other management strategies for heat-related illnesses, including heat exhaustion, include:
  • Rest and rehydration 3
  • Administration of intravenous fluids 4
  • Cooling with lukewarm-water spray and cool moving air 4
• It is also important to note that heat exhaustion can be prevented by increasing public awareness of the risks associated with exposure to high temperatures and prolonged exercise 2

Cooling Methods

• Various cooling methods can be used to manage heat exhaustion, including:
  • Ice-water immersion 5
  • Evaporative plus convective cooling 5
  • Application of ice packs or cold compresses 5
• However, the effectiveness of these methods may vary depending on the individual and the severity of the heat exhaustion
• Some studies have suggested that cold intravenous saline may not be an effective method for whole-body cooling in hyperthermic individuals 6