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Initiate cold water and cold air cooling before and during hospitalization of patients with heatstroke.  |
- Before arrival at the hospital:
- Remove the individual from the hot environment to a cool one; if outdoors, move the patient to a shaded area
- Initiate primary resuscitation
- Immerse the individual's torso in ice water
- Blow air on the individual using any available means (fan, ventilator, air conditioner)
- Use ice packs and alcohol sponges as supplementary means only in patients with exertional heatstroke
- Obtain intravenous access
- Treat complications of heatstroke and:
- For hypotension, increase fluid perfusion rate and consider vasoconstrictors if the patient is in shock
- For convulsions, give diazepam intravenously
- Evacuate rapidly to a hospital
- Differentiate between exertional and classic heatstroke
- Utilize cold water immersion preferentially in patients with exertional heatstroke
- Once admitted to the hospital:
- Monitor the rectal temperature continuously
- Continue prehospital cooling measures or initiate them if not already started
- Use ice water gastric or peritoneal lavage only in patients with exertional heatstroke if cooling measures are not sufficient to cool the patient <3°C/h
- Consider cardiopulmonary bypass for rapid cooling 3° to 5°C/h
| Background
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| Dani Moran, PhD has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations. James Glazer, MD, editorial consultant, has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations. Liran Mendel, BMedSc has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations. Moshe Rav-Acha, MD has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations. |
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The information included herein should never be used as a substitute
for clinical judgment and does not represent an official position of
ACP. Because all PIER modules are updated regularly, printed web pages
or PDFs may rapidly become obsolete. Therefore, PIER users should
compare the date of the last update on the website with any printout
to ensure that the information being referred to is the most current
available.
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PIER is copyrighted (c) 2008 by the American College of Physicians,
190 N. Independence Mall West, Philadelphia, PA 19106-1572, USA.
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Heatstroke
