Optimal Treatment Methods For Exertional Heat Stroke

Exertional heat stroke (EHS) is a serious condition that primarily affects athletes, the military, and individuals undergoing strenuous exertion. It is characterised by a core body temperature above 105°F (40°C) and central nervous system dysfunction, which can lead to delirium, convulsions, and even coma. As it is one of the leading causes of death in athletes, with a mortality rate of up to 80% if left untreated, prompt recognition and immediate treatment are crucial. The optimal treatment for EHS involves rapid cooling, aiming to reduce the core body temperature below 102°F (38.9°C) within 30 minutes to an hour to prevent irreversible damage or death. This can be achieved through methods such as full-body ice-water immersion, evaporative cooling, or internal cooling techniques like gastric, bladder, and rectal cold-water lavage.

The importance of rapid cooling

Exertional heat stroke (EHS) is a life-threatening condition that requires immediate medical attention. It is characterised by a core body temperature of over 40°C and neurological impairment. The faster the body's core temperature can be lowered, the better the chances of recovery and the lower the risk of complications or death.

Reducing Mortality and Morbidity

Rapid cooling is the most critical factor in treating EHS. Reducing the core temperature to below 38.9°C within 60 minutes is associated with improved survival rates. The longer the body's core temperature remains high, the greater the risk of complications such as organ damage or death. Immediate cooling is therefore the priority in treating EHS.

Methods of Rapid Cooling

There are several methods for rapidly reducing body temperature. Ice-water immersion is the most efficient way of reducing body temperature, although it is not always practical. It can reduce core body temperature to less than 39°C in 20-40 minutes. However, it may be extremely uncomfortable for conscious patients, and there is a risk of hypothermia. Evaporative heat loss, although perhaps less effective, is more practical. This involves removing the patient's clothes and intermittently spraying their body with tepid water while using a powerful fan to blow air across their body, allowing the heat to evaporate. Other methods include cold-water immersion (usually for EHS rather than classic heat stroke), misting and fanning, and applying ice packs to the groin or armpits.

When to Stop Cooling

It is important to monitor core body temperature closely during the cooling process and to stop cooling measures once the patient's temperature reaches 38-39°C to avoid overcooling and hypothermia.

The dangers of exertional heat stroke

Exertional heat stroke (EHS) is a serious and potentially fatal condition that occurs when the body's ability to regulate its temperature becomes overwhelmed during physical exertion. It is characterised by a core body temperature of over 40°C and neurological impairment. EHS is a leading cause of death among athletes and has a mortality rate of up to 80% if left untreated. Even with treatment, it is associated with significant short- and long-term health complications.

The dangers of EHS are clear and wide-ranging. Firstly, EHS can lead to multi-organ failure and dysfunction. This includes renal failure, which may be exacerbated by rhabdomyolysis and dehydration, and can result in the need for renal replacement therapy. Hepatic failure, requiring acute liver transplantation, has also been observed. In addition, EHS can cause disseminated intravascular coagulation (DIC), which can lead to a 40% increased risk of all-cause mortality, even years after the heat stroke event.

The neurological complications of EHS are also significant. Neurocognitive dysfunction, including confusion, seizures, and reduced consciousness, are common. In some cases, long-term cognitive abnormalities and reduced heat tolerance can persist for years after the initial heat stroke event.

The cardiovascular system is also at risk during EHS. Patients may experience ECG changes, such as conduction defects, QT and ST changes, and T-wave abnormalities. Cardiac dysfunction is also possible.

Finally, the delay in treatment is a critical factor in the dangers of EHS. The longer the body's core temperature remains elevated, the greater the risk of complications and death. Therefore, rapid cooling and immediate medical treatment are essential to reduce the dangers and improve outcomes for patients with EHS.

The signs and symptoms of heat stroke

Heat stroke is a life-threatening condition in which the body's ability to manage its temperature is overwhelmed by heat. Heat stroke can develop if you're in a very warm space or if you're doing intense physical activity that generates lots of body heat.

• High internal (core) body temperature, typically over 40°C (104°F).
• Behaviour changes such as agitation or aggression.
• Fast heart rate (tachycardia).
• Fast, shallow breathing (tachypnea).
• Low blood pressure (hypotension).
• Nausea and vomiting.
• Skin colour changes, either flushed or paler than usual.
• Skin that is dry (classic heat stroke) or sweaty (exertional heat stroke).

Heat stroke causes physical symptoms as well as changes to your thinking and behaviour. You may feel confused or have trouble thinking clearly. Others may notice that you're not acting like yourself. This is because heat stroke affects your brain function, causing changes in your thinking and behaviour.

If you or someone around you has signs or symptoms of heat stroke, call emergency services immediately.

The treatment of heat stroke

Heat stroke is a life-threatening condition in which the body's ability to manage its temperature is overwhelmed by heat. It is the most severe form of heat-related illness (hyperthermia) and is characterised by a body temperature of over 40°C (104°F). Heat stroke requires immediate medical treatment and can lead to organ damage or death if the body temperature remains high.

Treatment of Heat Stroke

The priority in treating heat stroke is to cool the patient's body down as quickly as possible. Ideally, this should begin within 30 minutes of the onset of symptoms. The aim is to reduce the body temperature to below 38.9°C (102°F) within 60 minutes.

Immediate Actions

• Move the person out of direct sunlight or heat to a cooler area.
• Pour water over their skin and fan them.
• Soak towels in ice-cold water and apply them to the patient's skin, replacing them frequently.
• Apply ice or cold packs to the person's armpits or neck.

Do Not:

• Give the patient fever-reducing medication, as this may worsen complications.
• Give the patient any fluids to drink, as they may accidentally inhale the liquid.

Hospital Treatment

Once the patient's body temperature has been lowered to a safe level, healthcare providers will focus on monitoring for complications and providing further treatment as needed. This may include:

• Intravenous fluids
• Medications to support organ function

Post-Treatment

After treatment for heat stroke, patients should abstain from exercise for at least one week. They should also be monitored for any signs of end-organ damage.

Prevention

Heat stroke can often be prevented by:

• Keeping homes and living spaces cool using fans or air conditioning.
• Developing a plan for hot days, including identifying places to go to cool down, such as community centres or malls.
• Staying hydrated by drinking plenty of water and electrolytes before, during, and after physical activity.
• Avoiding or limiting heat exposure by scheduling workouts during cooler times of the day or opting for indoor workouts in air-conditioned spaces.
• Acclimatising the body to the heat by gradually increasing the intensity and duration of exercise in hot conditions.

The prevention of heat stroke

Heat stroke is a life-threatening condition that requires immediate medical attention. It is caused by the body's inability to regulate its temperature, resulting in a dangerously high core body temperature, typically above 40°C (104°F). The prevention of heat stroke involves a combination of strategies to keep the body cool and avoid overheating. Here are some measures to prevent heat stroke:

• Maintain a Cool Environment: Use fans and air conditioning to keep indoor spaces cool, especially during hot weather. In extremely high temperatures, fans may not be sufficient, so consider other cooling methods.
• Plan for Hot Days: Identify places to go to cool down, such as community centres, shopping malls, or movie theatres, if your home is not adequately cool.
• Stay Hydrated: Drink plenty of water before, during, and after physical activity, especially in hot weather. Consume electrolytes along with water to maintain proper hydration.
• Avoid or Limit Heat Exposure: Schedule workouts during cooler times of the day or opt for indoor workouts in air-conditioned spaces. If you must work or exercise in the heat, take frequent breaks and stay hydrated.
• Acclimatise to the Heat: Gradually increase the duration and intensity of physical activity in hot weather to allow your body to adjust. Start with shorter workouts and gradually increase the length and intensity over time.
• Wear Appropriate Clothing: Choose loose-fitting, absorbent, and light-coloured clothing when exercising or working in hot conditions.
• Modify Activities: Reduce the intensity of activities that last longer than 30 minutes in hot and humid weather. Take frequent breaks and stay hydrated to prevent overheating.
• Be Aware of Risk Factors: Certain individuals are at higher risk for heat stroke, including older adults, children, pregnant women, and people with medical conditions such as cardiovascular disease. Be mindful of these risk factors and take extra precautions to prevent heat stroke.
• Educate Yourself and Others: Learn the signs and symptoms of heat stroke and educate others about its dangers. Knowing the symptoms can help you seek medical attention promptly and potentially save lives.

Frequently asked questions