What is the procedure for performing a mental status check in a patient suspected of having heat stroke?

Mental Status Assessment in Heat Stroke Patients

The mental status check in patients suspected of heat stroke should include assessment of orientation, level of consciousness, and neurological function, as altered mental status is a defining characteristic that differentiates heat stroke from less severe heat-related illnesses.

Definition and Importance

Heat stroke is a life-threatening emergency characterized by:

• Core body temperature ≥40°C (104°F)
• Central nervous system dysfunction
• Altered mental status

Mental status assessment is critical because:

• It distinguishes heat stroke from heat exhaustion 1, 2
• Altered mental status is the hallmark clinical sign of heat stroke 1
• Rapid identification leads to faster cooling interventions, which directly impacts survival 1

Systematic Mental Status Assessment Procedure

1. Level of Consciousness Assessment

• Apply the AVPU scale:
  • Alert: Is the patient fully awake and responsive?
  • Verbal: Do they respond only to verbal stimuli?
  • Pain: Do they respond only to painful stimuli?
  • Unresponsive: No response to any stimuli
• Any response other than "Alert" indicates altered mental status requiring immediate intervention 1

2. Orientation Assessment

• Assess orientation to:
  • Person (name, identity)
  • Place (current location)
  • Time (day, date, year)
  • Situation (awareness of current circumstances)
• Disorientation in any domain indicates altered mental status 1

3. Neurological Function Assessment

• Check for:
  • Confusion or delirium
  • Combativeness or agitation
  • Seizures or convulsions
  • Coma
  • Abnormal reflexes
  • Incoordination or ataxia
  • Slurred speech 3

4. Associated Symptoms Documentation

Document presence of other heat stroke indicators:

• Core temperature ≥40°C (104°F)
• Hot, dry skin (classic heat stroke) or sweaty skin (exertional heat stroke)
• Nausea/vomiting
• Dizziness
• Headache
• Tachycardia
• Hypotension 4, 3

Clinical Decision Algorithm

1. If mental status is normal AND core temperature <40°C:

   • Consider heat exhaustion or other conditions
   • Implement cooling measures and monitor

2. If ANY alteration in mental status OR core temperature ≥40°C:

   • Diagnose as heat stroke
   • Activate emergency services immediately 1
   • Begin rapid cooling (cold water immersion preferred) 1, 5
   • Continue cooling until neurological symptoms resolve or temperature reaches 39°C (102.2°F) 1

Special Considerations

• Monitoring During Cooling: Continue mental status assessment during cooling as improvement in mental status is an important indicator of treatment success 5

• Differential Diagnosis: Consider other causes of altered mental status if mental function doesn't improve with cooling:

  • Hypoglycemia
  • Hyponatremia
  • Cerebral malaria
  • Meningitis/encephalitis
  • Drug intoxication
  • Cerebrovascular accident 1

• Recurrent Assessment: Mental status should be reassessed frequently during treatment as deterioration may indicate complications such as cerebral edema or cerebral venous thrombosis 6

Common Pitfalls to Avoid

• Misdiagnosis: Don't confuse heat exhaustion (normal mental status) with heat stroke (altered mental status) 2

• Delayed Treatment: Any altered mental status in a hyperthermic patient should trigger immediate cooling without waiting for laboratory confirmation 1

• Inadequate Assessment: Subtle changes in mental status may be missed if assessment isn't thorough; always perform complete evaluation 1

• Premature Cessation of Cooling: Continue cooling until mental status normalizes or temperature reaches 39°C (102.2°F) 1

• Neglecting Ongoing Monitoring: Mental status can deteriorate even after initial improvement, requiring continued vigilance 3