What is the treatment for heat stroke?

Treatment for Heat Stroke

Rapid cooling and hemodynamic support are the most crucial interventions for heat stroke treatment, with cold-water immersion being the preferred cooling method when available to prevent irreversible organ damage and death. 1

Immediate Cooling Interventions

• Cold or ice-water immersion is the most effective cooling technique, particularly for exertional heat stroke in young people, military personnel, and athletes 1
• When cold-water immersion is not feasible, alternative active cooling methods should be employed:
  • Placement of ice packs or ice slush over major parts of the body 1
  • Use of cooling blankets 1
  • Wetting the body surface while continuously fanning 1
• The goal is to decrease body temperature as quickly as possible to prevent irreversible tissue damage and death 1
• No specific endpoint temperature for safe cessation of cooling has been established, but cooling should be discontinued when core temperature reaches 38°C to avoid hypothermia 2

Hemodynamic Management

• Circulatory failure occurs in 20-65% of heat stroke patients and contributes to tissue injury and cell death 1
• The circulatory alterations in heat stroke are primarily due to distributive shock associated with relative or absolute hypovolemia 1
• Hemodynamic support should focus on:
  • Fluid resuscitation to address hypovolemia 3
  • Electrolyte replacement to correct imbalances 3
  • Monitoring of central venous pressure when available 1
• Myocardial failure is rare in heat stroke patients 1

Monitoring and Additional Management

• Core temperature should be continuously monitored during cooling treatment 2
• Neurologic function should be assessed regularly as neurologic dysfunction is a defining characteristic of heat stroke 1
• Potential complications requiring monitoring and management include:
  • Acute renal failure 3
  • Disseminated intravascular coagulation 3
  • Rhabdomyolysis 3
  • Acute respiratory distress syndrome 3
  • Acid-base disorders 3
  • Electrolyte disturbances 3
  • Sepsis due to shifted flora 4

Pharmacological Considerations

• There is no evidence to support pharmacological interventions that affect temperature control in heat stroke patients 1
• Antipyretic medications should be avoided as they do not address the underlying pathophysiology of heat stroke 1
• Early antibiotic therapy may be considered in intensive care settings to prevent microbial imbalance 4

Prognostic Factors

• Prognosis is optimal when heat stroke is diagnosed early and cooling measures are initiated promptly 3
• Prognosis is poorest when treatment is delayed more than 2 hours 3
• Approximately 20% of patients may experience long-term neurologic sequelae 3

Special Considerations

• For patients with renal complications, hemodialysis should be initiated promptly when indicated 4
• Novel cooling technologies such as cooling suits may facilitate rapid cooling in the prehospital setting 5
• Heat stroke can be classified as classic (non-exertional) or exertional, which may influence the choice of cooling method 6

Common Pitfalls to Avoid

• Delaying cooling intervention while waiting for diagnostic confirmation 3
• Failing to monitor core temperature continuously, which can lead to hypothermia from overcooling 2
• Overlooking potential complications such as coagulation abnormalities, liver damage, and renal failure 4
• Relying on passive cooling methods alone, which are less effective than active cooling techniques 1