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Introduction
  • Heat stroke is an excessive elevation of core body temperature above the normal range due to failure of thermoregulation
  • Heat stroke can be induced by:
    • Environmental factors, such as excessive heat absorption, hot and humid climates, excessive physical exertion
    • Intrinsic factors, such as metabolic reactions, drugs, infection
  • Heat stroke should be suspected if symptoms do not dissipate when the affected person lies down and rests
Clinical Presentation
  • Signs of an altered mental state or consciousness, including but not limited to, inability to co-ordinate movement, slurred speech, coma or seizure, in circumstances or settings potentially conducive to hyperthermia.
Exclusion Criteria
Exclusion Criteria
Risk Assessment
  • Consider using any facilities that are on scene (i.e. ice bath if available) to help rapidly cool the patient before transporting to hospital. (Immerse the patient up to their neck in the ice bath for up to 15 minutes).
  • In the initial stages of heat stroke, CNS dysfunction is observed. These are the first signs of thermoregulatory failure.
  • Improvements in the patients conscious state is the most promising sign that active cooling is working but may happen slowly.
  • The very young and very old are more prone to heat induced illness.
  • Tympanic temperature readings may not provide a true representation of a patient’s core body temperature in heat extremes.
  • Assess patients left in cars for heat induced illness.
  • Cardiac dysfunction and tachyarrhythmias generally resolve with cooling.
Management
Primary Care
  • Primary Survey
    • When safe to do so, move the patient into a cool environment or shade.
    • Position patient supine if appropriate
  • Vital Sign Survey
    • Closely monitor patients temperature and BGL 
  • Consider Oxygen if indicated as per CPG
  • Provide water to drink if fully conscious
  • Apply critical treatment points:
    • STRIP clothing off patient.
    • SOAK or spray the patient with tepid water.
    • FAN the patient to promote heat loss.
    • IMMERSE the patient in an ice bath if available. If unavailable, apply ice packs to neck, groin and armpits.
    • COVER the patient with wet cold cloths and continue to fan.
  • Consider delaying transport to ensure the patient is adequately cooled (approximately 15 minutes).
  • Continue cooling the patient during transport to hospital.
Intermediate Care (EMT / Level 2)
  • Apply cardiac monitor if trained and authorised
  • Monitor patient persistently, recording full observations every 10 minutes (or 5 minutes if time critical)
  • Transport Priority 1 if patient time critical, pre-notifying receiving facility
Advanced Care (AP)
  • Apply cardiac monitoring
  • Establish vascular access
  • Consider fluid therapy (administering cool IV fluids if possible)
  • Monitor patient persistently, recording full observations every 10 minutes (or 5 minutes if time critical)
  • Transport Priority 1 if patient time critical, pre-notifying receiving facility
Critical & Extended Care (CCP, PSO)
  • As per Advanced Care (AP) guidelines
Additional Information
  • Seizures are common in patients with heat stroke, manage as per Seizures CPG while active cooling occurs.

References
References
Key Terms & Links
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