Review Question - QID 4840

The patient in the vignette has heat stroke; this condition is treated with rapid reduction in core body temperature through the use of ice immersion, cooling blankets, and/or internal cooling for a goal temperature below 39 C.

Heat stroke is a medical emergency with a high mortality rate. The hallmark features include central nervous system dysfunction and anhidrosis. Other symptoms include behavioral changes, such as confusion, disorientation, and staggering. Seizures and unconsciousness can also develop. The first modality of treatment is rapid reduction in temperature, which can be accomplished through ice water immersion, cooling blankets, or evaporative cooling methods including fans and cold water sprays. The goal in temperature reduction is 0.2 C per minute for a target temperature of 39 C.

Casa et al. reviewed current literature regarding the cause and care of exertional heat stroke. They stated that mortality from heat stroke remained significant, with the highest rates from sports existing between 2005 and 2009. They recommended accurate temperature assessment, prompt aggressive treatment using an efficient cooling modality (i.e. cold water or ice water immersion) prior to transport, and medically supervised return to play/duty as essential to preventing mortality.

Illustration A shows some of the visible differences between heat stroke and exhaustion, with the key discriminator being mental status changes present in heat stroke.

Incorrect Answers:
Answer 1: Administration of IV fluids would volume resuscitate the volume depleted patient, but rapid cooling is the most important next step.
Answer 2: Acetaminophen is an antipyretic, which works to reduce fever through blockage of cyclooxygenase. This would not treat the underlying condition of the patient in this vignette.
Answer 3: Lying supine with leg elevation and administration of fluids is the treatment for heat syncope, which is defined as a transient loss of consciousness with peripheral vasodilation, decreased cardiac output, and a normal temperature. Lying supine with leg elevation would help with redistribution of circulating volume centrally, thus increasing cardiac output and causing peripheral vasoconstriction (as a response by baroreceptors).
Answer 5: IV antibiotics could help if the elevated temperature was secondary to a systemic infection causing septic shock, but there is no evidence to suggest that the patient has an infection as the cause of his symptoms.