Heat Stroke Treatment
The primary treatment for heat stroke is immediate cooling using whole-body cold-water immersion (1-26°C) until core temperature reaches below 39°C or neurological symptoms resolve. 1
Immediate Management Algorithm
Recognition and Initial Steps
- Move patient from hot environment
- Remove excess clothing
- Activate emergency services
- Provide cool liquids if conscious and able to swallow 1
Rapid Cooling Methods (in order of preference)
- First choice: Whole-body cold-water immersion (cooling rate ~0.2°C/min)
- Alternatives if immersion not available:
- Commercial ice packs to neck, axillae, groin (cooling rate 0.13-0.18°C/min)
- Cold showers or evaporative cooling (cooling rate ~0.03°C/min) 1
Cooling Duration
- Continue until core temperature <39°C
- Continue until neurological symptoms resolve
- Or at least 15 minutes for initial field treatment 1
Critical Care Considerations
- Airway management: Secure airway if altered consciousness present
- Position: Place patient safely to prevent aspiration
- Monitoring: Continuous vital signs and core temperature monitoring 1
- Avoid:
- Antipyretics (aspirin, acetaminophen) - may worsen coagulopathy and liver injury
- Dantrolene sodium - shown to be ineffective
- Vasoactive drugs within first 24 hours (associated with increased mortality) 1
Advanced Cooling Options
In cases where standard cooling methods fail, endovascular cooling devices can be considered as demonstrated in severe cases. A case report showed successful reduction of core temperature from 41.2°C to 37.55°C in less than 45 minutes using endovascular cooling after external methods were insufficient. 2
Monitoring for Complications
- Rhabdomyolysis
- Acute kidney injury
- Disseminated intravascular coagulation
- Hepatic injury
- Electrolyte abnormalities
- Cardiovascular dysfunction 1, 3
Special Considerations
- Children: Similar cooling approach as adults
- Hemodynamically unstable patients: Evaporative cooling may be better tolerated than immersion
- High-risk populations requiring closer monitoring:
- Elderly
- Obese individuals
- Those with chronic illnesses
- Athletes in hot environments
- Military personnel
- Outdoor workers 1
Common Pitfalls to Avoid
- Delaying cooling - most critical error; cooling should begin immediately
- Discontinuing cooling too early
- Relying on antipyretics
- Delaying cooling for diagnostic procedures
- Failing to monitor for multi-organ dysfunction 1
Remember that the degree and duration of hyperthermia are the major determinants of outcome in heat stroke. Rapid cooling is the most effective intervention to reduce mortality and morbidity. 4