HEAT STROKE

TYPES

Exertional heat stroke (EHS) - young, fit adult exposed to heat during prolonged athletic event

Classical heat stroke (CHS) - elderly and debilitated with several co-morbidities and concurrent polypharmacy unable to adapt to hot environment

Rhabdomyolysis is not uncommon in EHS but CHS has poorer outcome

RESUSCITATION

Airway - intubate if decreased consciousness, beware of suxamethonium with rapid sequence intubation (hyperkalaemia secondary to rhabdomyolysis)

Breathing - ventilate if decreased consciousness, sedate/paralyse, (respiratory alkalosis with hypocalcaemia may cause tetany)

Circulation - if BP < 90/60, give 200-400ml fluid challenge (careful with fluid, patient is rarely fluid depleted, cooling will raise BP; if persistently hypotensive, aim for CVP > 12 and then consider inotropes, IDC

Disability - check BSL, check GCS/pupils (for acute cerebral events)

Exposure - continuous rectal temp probe, rapid cooling

IDC (check for myoglobin)

COOLING MEASURES

Aim for < 39 degrees within 30min (immediate cooling is required to prevent brain damage)

Do not use alcohol baths (cutaneous absorption)

Do not use dantrolene (for malignant hyperpyrexia)

INVESTIGATION

OTHER TREATMENT

Do not use aspirin/panadol

TREAT COMPLICATIONS

Rhabdomyolysis

Hyperkalaemia

Coagulopathy

PROGNOSIS

Worse in the following