Risk factors. Heat-related illness can affect patients of all ages and levels of physical fitness; however, certain factors place patients at increased risk. These include physical deconditioning, dehydration, high levels of exercise intensity, obesity, elevated environmental temperatures, sleep deprivation, certain medications, alcohol and drug abuse, concurrent illness, and wearing excessive clothing or equipment. It is imperative that severe cases of heat illness be identified early and treatment be initiated rapidly, as delays in cooling can significantly increase the fatality rate.5
Management: First suspect the diagnosis
Health care providers must first suspect heat-related illness and then accurately diagnose it. It is important to differentiate heat-related illness from syncope, cardiac abnormalities, gastroenteritis, hypoglycemia, and other entities that require alternate management. For cases of collapse, syncope or near-syncope, or altered mental status during exertion, heat stroke should be the default diagnosis until proven otherwise.
Obtain a core body temperature. While attending to airway, breathing, and circulation, obtain a core body temperature. Rectal (or esophageal) core temperatures provide a reliable reading that can assist in determining the severity of the heat illness. Axillary, tympanic, temporal, oral, and skin temperatures are affected by environmental factors and are not accurate determinants of core body temperature.8
Once heat stroke is diagnosed, the physician must immediately initiate cooling by removing clothing, placing the patient in the shade or an air-conditioned area, and beginning aggressive cooling measures (more on this in a bit). While field management requires an accurate diagnosis of the severity of a patient’s heat-related illness, one should not delay treatment in order to obtain a rectal temperature.
When treating the milder forms of heat illness, administer oral or intravenous (IV) isotonic fluids. For heat cramps, stretching the affected muscle can help. For heat syncope, lying the patient down and elevating the legs restores perfusion. Patients with heat exhaustion will require some cooling measures such as relocation to a shaded area, removal of excess clothing, and the use of cold towels, along with hydration and elevation of the feet.
Continue to: Cooling techniques for heat stroke