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<< The Evaluation and Management of Heat Injuries in the Emergency Department
Case Presentation
A 14 month old boy is brought into the ED by EMS after being left in a locked car while his babysitter was shopping. His rectal temperature is 105.6°F, his skin is dry, and he is hypotonic and unable to be aroused. The paramedics are already actively cooling the child with ice packs in his groin and axillae. Are there any pharmacologic options for therapy?
A 32 year old Hazardous Materials specialist, recently activated from the military reserves, is at the scene of a possible biologic terrorist attack in full protective clothing when he collapses and begins seizing. The temperature outside is only 50°F, his skin is soaked with sweat, and his skin feels hot to the paramedics. Could he have developed heat stroke during the winter while profusely sweating? Is there anything that could have been done to prevent this?
A 16 year old high school athlete is competing in the county track meet on an unusually hot and humid day. Several of the athletes are experiencing muscular cramping, and the only water available is from the city water fountain. After standing for a long time, one of the parents lost consciousness, but has now recovered. Are there any guidelines to better manage these events?
Conclusions
One of the biggest issues when evaluating the literature on cooling methods for heatstroke is the fact that it is difficult to achieve enough power to see a difference between methods because there is a paucity of qualifying patients. As such, it is not surprising that many of the studies are observational case series utilizing one method or another. The best studies also tend to compare two similar techniques, and there is certainly a need for good studies comparing immersion therapy with the best evaporative techniques. The only paper that reviewed the literature regarding human reports and studies concluded that immersion in ice water was the most rapid way to cool patients, but this may be impractical in the clinical setting. In such a case with altered mental status, for example, evaporative cooling may be the preferred method of treatment.68
A 32 year old Hazardous Materials specialist, recently activated from the military reserves, is at the scene of a possible biologic terrorist attack in full protective clothing when he collapses and begins seizing. The temperature outside is only 50°F, his skin is soaked with sweat, and his skin feels hot to the paramedics. Could he have developed heat stroke during the winter while profusely sweating? Is there anything that could have been done to prevent this?
A 16 year old high school athlete is competing in the county track meet on an unusually hot and humid day. Several of the athletes are experiencing muscular cramping, and the only water available is from the city water fountain. After standing for a long time, one of the parents lost consciousness, but has now recovered. Are there any guidelines to better manage these events?
Conclusions
One of the biggest issues when evaluating the literature on cooling methods for heatstroke is the fact that it is difficult to achieve enough power to see a difference between methods because there is a paucity of qualifying patients. As such, it is not surprising that many of the studies are observational case series utilizing one method or another. The best studies also tend to compare two similar techniques, and there is certainly a need for good studies comparing immersion therapy with the best evaporative techniques. The only paper that reviewed the literature regarding human reports and studies concluded that immersion in ice water was the most rapid way to cool patients, but this may be impractical in the clinical setting. In such a case with altered mental status, for example, evaporative cooling may be the preferred method of treatment.68
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