Exertional Heat Illness occurs when the body’s mechanism for heat transfer are not able to keep up with the environmental conditions.
Heat Exhaustion
Heat exhaustion results in the inability to continue exercise with or without collapse. There is no evidence of organ dysfunction.
Signs and symptoms include:
- VS: high HR, low BP
- Sweaty, pale, ashen appearance
- nausea, vomiting
- Headache, irritability, decreased coordination, weakness, dizziness
- May have muscle cramps
- Temp <104ºF/40ºC
Exertional Heat Stroke
Exertional heat stoke occurs when the patient’s temperature exceeds 104ºF/40ºC and demonstrates CNS symptoms. These CNS symptoms include:
- Dizziness, confusion, disorientation, irritability, irrational and inappropriate comments
- May see N/V/D, hyperventilation, seizure, or coma
- May have lucid interval (minimal symptoms)
- Sweat soaked and pale skin (As opposed to lack of sweating in classic heat stroke)
- Altered level of consciousness
- High HR, low BP
Treatment of Exertional Heat Illness
- Elevate pelvis/legs 12 inches
- Get out of direct sun
- Remove excessive clothing
- Monitor vital signs
- Measure core temperature via rectal thermometer or continuous thermistor
- Begin immediate cooling if temperature > 104ºF/40ºC
- Obtain IV access
- Check I-stat serum sodium
- If abnormal (< 135) see Exercise Associated Hyponatremia page
- If normal ( > 135) give 2 L of 0.9% NS over 30 minutes
Cooling Protocol
The amount of time above critical temp (>104ºF/40ºC) is more damaging to body systems than the absolute highest temperature. Cooling should begin within ten minutes. Primary treatment goal is lowering core temp to <104ºF within 30 minutes. Do not delay cooling to start an IV or to give IV fluids. We utilize cold water immersion as the primary cooling modality. The water in the cooling tub should be stirred to aid in heat transfer. Ideally the patient should have their temperature continuously measured with the rectal thermistor. The patient should be removed from the water after their temperature falls below 102ºF. If the continuous probe is unavailable, the patient should be cooled for 10 – 15 minutes prior to being removed from the water to recheck the rectal temperature. Return to the water if temperature remains above 102ºF. If the cooling tubs are unavailable, ice packs to the neck, axilla, and groin along with ice water soak towels placed on the arms and legs may be utilized. These towels should be exchanged every 6 minutes. Fans should be utilized to cool the patient as well.
These patients will be transferred to the ED for further care and monitoring.
