What is the treatment for heat stroke?

Treatment of Heat Stroke

Immediate cold-water immersion is the preferred treatment for heat stroke, as it achieves the fastest cooling rate and should be prioritized whenever available to rapidly reduce core temperature below 39°C within 30 minutes. 1, 2

Diagnosis and Recognition

• Heat stroke is defined as:
  • Core temperature greater than 40°C
  • Central nervous system dysfunction (altered mental status, seizures, coma)
  • Can be classified as classic (non-exertional) or exertional heat stroke

Treatment Algorithm

Step 1: Rapid Cooling (First Priority)

• First-line cooling method: Cold/ice-water immersion up to the chin 1, 2

  • Provides fastest cooling rate
  • Target temperature reduction to below 39°C within 30 minutes
  • Continue until temperature reaches 38-39°C to avoid overcooling

• Alternative active cooling methods (if immersion not available):

  • Remove all clothing
  • Apply ice packs to neck, axillae, and groin
  • Continuous cool water spray with fanning
  • Cooling blankets
  • Evaporative cooling techniques 1

Step 2: Airway and Hemodynamic Management

• Position patient safely to prevent aspiration
• Secure airway if altered consciousness
• Monitor vital signs continuously
• Address circulatory failure, which is present in 20-65% of patients 1
  • Provide IV fluid resuscitation for hypovolemia
  • Monitor for distributive shock
  • Note: Myocardial failure is rare in heat stroke 1

Step 3: Monitor and Manage Complications

• Watch for and treat:
  • Rhabdomyolysis
  • Acute kidney injury
  • Disseminated intravascular coagulation
  • Hepatic injury
  • Electrolyte abnormalities

Important Considerations

Pharmacological Interventions

• Avoid pharmacological cooling agents as there is no evidence supporting their use in heat stroke 1, 2

Special Populations

• For exertional heat stroke (young people, military personnel, athletes):
  • Cold water immersion has proven particularly effective 1
• For classic heat stroke (elderly, chronically ill):
  • Multiple cooling techniques may be equally effective 1
  • Consider comorbidities and medication use

Monitoring

• Use continuous core temperature monitoring when possible
• Continue monitoring even after cooling as patients may develop delayed complications

Novel Approaches

While traditional cooling methods remain the standard of care, emerging technologies like the CarbonCool® cooling suit have shown promise in prehospital settings for rapid cooling, allowing concurrent resuscitative procedures and continuous application from scene to hospital 3. However, these require further validation before becoming standard practice.

Pitfalls to Avoid

• Delaying cooling while waiting for hospital transport
• Relying on antipyretic medications (ineffective in heat stroke)
• Discontinuing cooling too early
• Failing to monitor for multi-organ dysfunction after initial cooling
• Overlooking the need for volume resuscitation alongside cooling

Heat stroke is a true medical emergency where rapid recognition and immediate cooling are critical for preventing irreversible tissue damage, multi-organ failure, and death.