What is the appropriate treatment for a patient experiencing their first sunstroke with symptoms including headaches, dizziness, and nausea, along with severe burns?

Treatment of First Sunstroke with Severe Burns

This patient requires immediate aggressive cooling, intravenous fluid resuscitation, and urgent referral to a burn center for the severe burns, while managing heat stroke symptoms with supportive care including pain control and monitoring for multi-organ complications. 1, 2

Immediate Heat Stroke Management

Rapid Cooling (Priority #1)

• Begin aggressive cooling immediately as heat stroke is characterized by body temperature >40°C with central nervous system dysfunction, and early cooling is essential to reduce mortality 3, 2
• Cool the patient with clean running water for 5-20 minutes to address both the heat stroke and limit burn tissue damage 1
• Monitor closely for hypothermia, particularly given the extensive burns 1
• Continue cooling measures until core temperature drops below 39°C 2

Fluid Resuscitation

• Administer 20 mL/kg of balanced crystalloid solution (preferably Ringer's Lactate) intravenously within the first hour if burns are severe (>15% TBSA in adults) 4, 5
• Early fluid resuscitation within the first 2 hours reduces morbidity and mortality in burn patients 4
• Establish IV access in unburned areas when possible 5

Pain Management

• Provide titrated intravenous opioids or ketamine for severe burn pain, as burn pain is often intense and difficult to control with over-the-counter medications alone 1
• Acetaminophen or NSAIDs may be used for milder pain but are typically insufficient for severe burns 1, 6

Burn-Specific Management

Wound Care

• After initial cooling, loosely cover burns with clean, non-adherent dressings while arranging immediate transfer 1
• Clean wounds with tap water or isotonic saline if transfer is delayed 1, 5
• Do not apply butter, oil, or other home remedies 1
• Do not break blisters as this increases infection risk 1

Mandatory Specialist Referral

• All severe burns require immediate referral to a burn specialist or burn center as specialist management improves survival and functional outcomes through multidisciplinary care 1, 5
• Direct admission to a burn center (rather than sequential transfers) reduces time to definitive treatment and improves mortality 4, 1
• Use telemedicine consultation if immediate specialist access is unavailable to guide initial management and determine transfer urgency 4, 1

Monitoring for Life-Threatening Complications

Heat Stroke Complications

• Monitor for multi-organ failure including cerebral edema, pulmonary edema, hemorrhagic diathesis, and disseminated intravascular coagulation (DIC), which are common fatal complications 3, 2
• Check laboratory values including LDH, creatine kinase, serum creatinine, AST, and coagulation studies 3
• Watch for signs of central nervous system dysfunction, hypotension, and tachycardia 3, 2

Burn Complications

• Monitor for compartment syndrome including blue, purple, or pale extremities indicating poor perfusion, which requires emergency escharotomy 1, 5
• Watch for signs of infection including increased pain, redness extending beyond burn margins, swelling, or purulent discharge 1
• Do not routinely use systemic antibiotics prophylactically; reserve for clinically evident infections 1, 5

Critical Pitfalls to Avoid

• Do not delay cooling or specialist referral, as heat stroke has high mortality and misdiagnosis leads to inadequate treatment with potential fatal outcomes 3, 2
• Do not underestimate burn severity—undertriage increases morbidity and mortality 4, 1
• Avoid prolonged use of silver sulfadiazine on superficial burns as it may delay healing 1, 5
• Do not perform escharotomy without proper training or specialist consultation, as poorly performed procedures increase complications 4

Medical Certificate Justification

This patient is unable to work due to:

• Acute heat stroke requiring intensive monitoring for multi-organ complications 3, 2
• Severe burns requiring specialist wound care and potential surgical intervention 1, 7
• Significant pain requiring opioid analgesia 1
• Risk of permanent functional disability without appropriate specialist care 1

The combination of heat stroke and severe burns represents a medical emergency with high morbidity and mortality risk that necessitates immediate hospitalization and specialist care 3, 2, 7.