Heat Stroke Management Medical Slides

Present the evidence: cold water immersion (CWI) at 1-2°C achieves cooling rates of 0.15-0.35°C/min — fastest of all methods. Technique: ice water tub covering body to mid-chest, continuous stirring, rectal temperature monitoring (not oral/axillary — inaccurate post-exercise). Target: cool to 38.5-39°C then remove (overshoot cooling continues). Alternative if CWI unavailable: tarp-assisted cooling (patient on tarp, ice water poured over body while agitated), achieves 0.14°C/min. Evaporative cooling (fans + misting) achieves only 0.05°C/min — inferior for heat stroke. Cooled IV fluids: adjunct only, insufficient as primary cooling. Ice packs to groin/axillae/neck: minimally effective alone.

Present the multi-organ involvement: CNS — cerebellum especially vulnerable (ataxia, dysarthria may persist), seizures, cerebral edema, Purkinje cell death. Liver — hepatic injury peaks at 48-72 hours post-event (delayed), ALT/AST may exceed 10,000, fulminant hepatic failure in 5% (consider transplant listing if INR >3 at 48 hours). Kidney — AKI from combination of rhabdomyolysis, direct thermal injury, and hypovolemia (24-30% incidence). DIC — consumptive coagulopathy in severe cases, peak at 24-48 hours. Rhabdomyolysis — CK peaks at 24-96 hours. Key teaching point: laboratory derangements WORSEN for 24-72 hours after cooling — serial monitoring is essential.

Present the structured comparison: Classic — elderly, chronically ill, medications (anticholinergics, diuretics, beta-blockers), develops over days during heat waves, often anhidrotic (dry skin), mortality 40-64% (delayed presentation). Exertional — young healthy athletes/military/laborers, develops over hours during intense exertion, often diaphoretic, mortality 3-5% if rapidly cooled (better baseline health + faster recognition). Shared features: core temp >40°C, CNS dysfunction (confusion, seizures, coma). Key difference in management: exertional heat stroke patients commonly develop severe rhabdomyolysis, DIC, and lactic acidosis requiring aggressive IV hydration and monitoring — more metabolically deranged at presentation despite lower mortality.