What is the treatment for heat stroke?

Treatment of Heat Stroke

The most important action for treating heat stroke is immediate cooling, preferably by immersing the victim up to the chin in cold water, while simultaneously activating the emergency medical system. 1

Definition and Recognition

Heat stroke is a life-threatening emergency characterized by:

• Core temperature greater than 40°C (104°F)
• Central nervous system dysfunction (confusion, seizures, coma)
• Often accompanied by multi-organ failure if not promptly treated

Heat stroke is classified into two types:

• Classic (non-exertional) - occurs during heat waves, affects elderly, chronically ill, and vulnerable populations
• Exertional - occurs during physical activity, affects athletes, military personnel, and outdoor workers

Immediate Management Algorithm

1. Recognition and Activation of EMS

   • Identify signs of heat stroke: high temperature, altered mental status
   • Immediately activate emergency medical services

2. Rapid Cooling (First Priority)

   • Cold/ice-water immersion is the preferred method with fastest cooling rate 1
   • Immerse victim up to chin in cold water if available
   • If immersion is not possible, use alternative active cooling methods:
     • Remove clothing
     • Apply ice packs to neck, axillae, groin
     • Continuous cool water spray with fanning
     • Cooling blankets

3. Monitor Core Temperature

   • Target: reduce temperature to below 39°C as quickly as possible
   • Goal: achieve target temperature within 30 minutes 1

4. Supportive Care

   • Position patient safely to prevent aspiration
   • Maintain airway if altered consciousness
   • Monitor vital signs continuously

Hospital Management

1. Continue Cooling

   • Continue active cooling until core temperature reaches 38-39°C
   • Avoid overcooling which can lead to hypothermia

2. Cardiovascular Support

   • Monitor for signs of shock
   • Provide IV fluids for volume resuscitation
   • Support blood pressure if needed

3. Monitor and Manage Complications

   • Rhabdomyolysis
   • Acute kidney injury
   • Disseminated intravascular coagulation
   • Hepatic injury
   • Electrolyte abnormalities

Important Considerations

• Speed is critical - Mortality increases with delayed cooling 2
• Avoid pharmacological cooling agents - No evidence supports their use in heat stroke 1
• Continue monitoring - Even after cooling, patients may develop delayed complications
• High-risk populations require special attention:
  • Elderly
  • Obese individuals
  • Those with chronic illnesses
  • Athletes in hot environments
  • Military personnel
  • Outdoor workers

Common Pitfalls to Avoid

• Delayed recognition - Heat stroke is often misdiagnosed initially 3
• Inadequate cooling - Passive cooling alone is insufficient 1
• Focusing on hydration alone - While important, cooling takes priority
• Stopping cooling too early - Continue until target temperature is reached
• Missing complications - Multi-organ failure can develop even after successful cooling

Heat stroke is a true medical emergency with high mortality if not treated promptly. The evidence strongly supports immediate, aggressive cooling as the cornerstone of treatment, with cold-water immersion being the most effective method when available.