Emergency Treatment For Heat Stroke: Hospital Protocols

Heat stroke is a severe heat-related illness that requires immediate medical attention. It is a leading cause of preventable death in sports and can affect individuals of all ages. The condition occurs when the body's temperature regulation mechanisms fail, leading to a dangerous increase in core body temperature. Treatment for heat stroke in hospitals focuses on rapidly lowering the patient's body temperature, typically through methods such as ice packs, cold water immersion, or ice baths. Additionally, intravenous fluids are administered to address dehydration and electrolyte imbalances. In severe cases, patients may require oxygen and ventilation support due to difficulty breathing. The timely recognition of heat stroke symptoms and prompt medical intervention are crucial to preventing life-threatening complications and potential organ damage.

Rapid cooling

There are several methods to achieve rapid cooling in cases of heat stroke. One effective technique is ice water immersion, which involves placing the patient in a tub or pool half-filled with ice water. This method has been shown to be the most effective and rapid way to cool the body. Additionally, ice sheets can be used by soaking ordinary bed sheets in ice water and covering the patient with them. It is important to refresh the sheets with cold water every one to three minutes as they warm up.

Another method involves using ice packs placed in strategic locations, such as the axillae and groin, to reduce the patient's temperature significantly. Removing restrictive clothing and spraying water on the body can also aid in cooling. For patients who are awake and responsive, supplemental oxygen should be administered. Intravenous lines may also be placed in preparation for fluid resuscitation and the infusion of dextrose and thiamine, if indicated.

While rapid cooling is crucial, it is important to monitor the patient continuously and stop the cooling process if they begin to shiver. Additionally, the management of hyperthermia is ideally done under controlled settings by a collaborative team of healthcare professionals, including nurse practitioners, emergency department physicians, and specialty-trained nursing staff.

Intravenous fluids

The cornerstone of treatment for heat stroke is the rapid reduction of the core body temperature, which must begin immediately and continue during resuscitation. While cooling alone is the primary treatment, intravenous (IV) fluids are often necessary to replenish fluids and electrolytes lost through sweating. This is especially important as dehydration is a dangerous side effect of heat stroke and can occur rapidly in extreme heat, particularly in children and the elderly, who are more susceptible to the condition.

The use of IV fluids in heat stroke treatment is also important in addressing acute kidney injury (AKI), which can be a complication of heat stroke. AKI can be caused by direct thermal injury to the kidneys, myoglobinuria, hypotension, and/or shock. Treatment of AKI involves the administration of large amounts of intravenous fluids, as well as diuretics, to correct associated acid-base and electrolyte abnormalities. In cases of rhabdomyolysis, which can lead to AKI, the infusion of large amounts of intravenous fluids is also necessary, with fluid requirements as high as 10 litres.

The administration of IV fluids in the treatment of heat stroke is not without risks, however. Aggressive fluid resuscitation is generally not recommended as it may lead to pulmonary edema, a common complication of heat stroke. Recommendations on the administration of intravenous fluids differ among patient populations and depend on factors such as hypovolemia, pre-existing medical conditions, and cardiovascular disease. When adequate hemodynamic information is not available from pulse rate, blood pressure, and urine output, more invasive parameters such as central venous pressure and cardiac index measurements may be used to guide fluid administration.

Oxygen and ventilation support

Heat stroke is a life-threatening condition that requires immediate medical attention. It is caused when the body gets overheated and is unable to cool itself down, leading to a range of severe symptoms, including dizziness, nausea, confusion, fainting, blurred vision, slurred speech, agitation, and aggression. The condition can also cause reduced blood flow and damage to vital organs, including the brain, lungs, kidneys, heart, and liver. Therefore, early recognition and treatment are crucial to reducing morbidity and mortality.

Initial Assessment

Upon hospital admission, medical providers will assess the patient's vital signs, including their internal (core) body temperature, heart rate, respiratory rate, and oxygen saturation levels. They will also evaluate the patient's level of consciousness and neurological function, as heat stroke can cause central nervous system dysfunction. This initial assessment helps guide the treatment plan, including decisions regarding oxygen and ventilation support.

Oxygen Therapy

The choice of oxygen therapy depends on the patient's condition and the resources available. Unintubated patients can receive oxygen through a nasal catheter or face mask. If the patient's condition does not improve with mask oxygen therapy, alternative methods such as nasal high-flow humidification oxygen therapy or non-invasive positive pressure ventilation may be considered. These methods provide higher oxygen concentrations and respiratory support without the need for intubation.

Mechanical Ventilation

In more severe cases of heat stroke, where patients experience respiratory failure or a significant decline in oxygen saturation levels, mechanical ventilation may be necessary. This involves the use of invasive techniques such as endotracheal intubation, where a tube is inserted through the mouth and into the trachea to deliver oxygen directly to the lungs. This approach is typically recommended for most HS patients and should be initiated as early as possible to support breathing and improve oxygenation.

Patient Monitoring

Throughout the oxygen and ventilation support process, close monitoring of the patient is essential. This includes regularly assessing vital signs, neurological status, and respiratory function. Monitoring helps ensure the effectiveness of the treatment and allows for prompt adjustments if the patient's condition changes.

Prevention of Complications

While providing oxygen and ventilation support, it is crucial to prevent and manage potential complications. For example, heat stroke patients are at risk of developing respiratory infections or experiencing damage to the lungs due to high temperatures. Additionally, coagulopathy is common in HS patients, so early tracheotomy is usually avoided to prevent uncontrolled local bleeding. The overall goal is to maintain adequate oxygenation and ventilation while mitigating any potential adverse events.

Removal of restrictive clothing

The removal of restrictive clothing is a crucial step in treating heat stroke, a medical emergency that often requires immediate attention. Heat stroke occurs when the body's core temperature rises to dangerous levels, typically due to prolonged exposure to excessive heat or strenuous activity in hot conditions. The primary goal of treatment is to rapidly lower the patient's core body temperature to approximately 39°C to prevent further complications and potential organ failure.

When treating heat stroke, medical professionals often start by removing any restrictive clothing from the patient. Restrictive clothing can trap body heat and hinder the cooling process, making it essential to take it off as soon as possible. This removal allows the body to dissipate heat more effectively and helps initiate the cooling process. It is recommended to wear lightweight, loose-fitting, and breathable clothing to aid in body cooling and prevent heat stroke.

Additionally, spraying water on the body, using ice water-soaked sheets, or applying ice packs to the axillae and groin can significantly enhance the cooling effect. These methods are particularly effective in young, active adults experiencing exertional heat stroke (EHS). However, the optimal treatment method for nonexertional heat stroke (NEHS) is still undetermined.

The removal of restrictive clothing is just one aspect of heat stroke treatment. Other interventions, such as initiating cooling measures at the scene, monitoring core body temperature, and providing supplemental oxygen, are also crucial components of comprehensive care. Patients diagnosed with EHS or NEHS are typically admitted to the hospital for a minimum of 48 hours to monitor for potential complications and ensure complete recovery.

In summary, the removal of restrictive clothing is a vital step in treating heat stroke as it facilitates heat dissipation and promotes the cooling of the patient's body. This, combined with other cooling methods and medical interventions, helps to rapidly lower the core body temperature and improve the patient's prognosis.

Monitoring and addressing complications

The treatment of heat stroke in a hospital setting involves careful monitoring and proactive management of any complications that may arise. Here are some critical aspects of monitoring and addressing complications:

Vital Signs and Organ Function Monitoring

Heat stroke can lead to vital sign instability, so continuous monitoring of vital signs is crucial. This includes regular measurement of body temperature, blood pressure, heart rate, respiratory rate, and oxygen saturation. Close observation of the patient's neurological status is also essential, as heat stroke can cause confusion, seizures, and loss of consciousness.

Preventing and Treating Organ Damage

Rapid and sustained elevation of core body temperature can lead to organ damage, especially in the brain, heart, kidneys, and liver. Treating heat stroke aims to prevent this damage by aggressively lowering body temperature. This may involve methods such as ice packs, cold water immersion, or ice-water-soaked sheets. Continuous monitoring of organ function through laboratory tests and imaging studies may be necessary to detect any signs of organ damage early on.

Fluid and Electrolyte Management

Dehydration is a common complication of heat stroke, so intravenous fluid resuscitation is often required. This helps to replenish fluid losses and maintain adequate hydration status. Additionally, electrolytes such as sodium, potassium, and chloride may be administered to correct any imbalances caused by excessive sweating and heat-induced renal losses.

Respiratory Support

In severe cases of heat stroke, respiratory distress may occur. Oxygen therapy and ventilation support may be necessary to assist with breathing and ensure adequate oxygenation of the body's tissues. Endotracheal intubation may be required for patients who are unable to protect their airway due to altered mental status or seizures.

Neurological Monitoring and Management

The neurological impact of heat stroke can vary from confusion and seizures to more severe complications like intracranial hemorrhage and increased intracranial pressure. Close neurological monitoring is essential to detect and manage these complications. This may include the administration of anticonvulsant medications for seizures and careful management of intracranial pressure to prevent further brain injury.

Management of Underlying Conditions

Heat stroke can be exacerbated by underlying medical conditions such as obesity, heart disease, diabetes, and respiratory issues. Treating heat stroke in the context of these conditions may require specialized interventions. For example, in diabetic patients, close monitoring of blood glucose levels and administration of insulin or glucose as needed is crucial.

The successful treatment of heat stroke relies on prompt recognition, aggressive cooling, and comprehensive management of complications. Hospital staff employ various interventions to support vital functions, prevent organ damage, and address underlying medical conditions that may impact the patient's recovery.

Frequently asked questions