Daily Bolus of LR: Heat Emergencies

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June 11, 2011 by dailybolusoflr

Heat Emergencies


Heat Stroke is a life threatening emergency that is characterized by high core body temperatures (often greater than 104F/40C) in which thermoregulatory functions do not function normally. 


·         Heat Stroke is characterized by tissue death and organ system dysfunction

·         Heat stroke is characterized by neurologic dysfunction, ranging from AMS to coma and is clearly distinct from Heat Exhaustion in which mental status is preserved.

·         Heat Exhaustion and Heat Stroke may have many similar features (for heat stroke this is often the prodromal phase) which include: dizziness, fatigue, orthostatic s/sx, nausea/vomiting, headache

·         Heat Exhaustion is typically associated with temperatures under 104F/40C.

·         The classic teaching is that patients with Heat Exhaustion sweat and those with Heat Stroke do not.  While patients with dry hot skin are more likely to have Head Exhaustion, sweaty skin does not preclude the diagnosis of Heat Stroke.

·         Classic Heat Stroke is seen in heat wave times and is often seen in the elderly patients or in patients on medications such as anticholinergics or neuroleptic medications. 

·         Exertional Heat Stroke is seen in athletes, military recruits or other populations where heavy exertion in hot temperatures or layers of clothing may occur.  This version is associated with renal failure, rhabdomyolysis.

·         For all heat related emergencies: removal from the environment is key

·         For Heat Exhaustion, rehydration is he next most beneficial

·         For Heat Stroke, rapid cooling is essential. The two most common methods are:

o   Evaporative cooling with cool mist and fans

o   Immersion cooling with an ice water bath






Linda Regan, MD FACEP

Program Director, Emergency Medicine Residency

Johns Hopkins Medical Institutions


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