On a late summer afternoon shift, a 16-year-old adolescent boy presents to the ED via EMS after collapsing during football practice. The medics state that he complained of dizziness and staggered to the edge of the field before he fell to the ground. The medics call out vital signs: blood pressure, 102/60 mm Hg; heart rate, 120 beats/min; and respiratory rate, 16 breaths/min. They did not measure a temperature, but state that he feels hot to the touch. The patient is brought to the resuscitation room where you begin your evaluation. The patient is awake, but very lethargic and unresponsive to verbal commands. You notice he is flushed, his skin is hot to the touch, and he is sweating. The rectal temperature is 40.3°C. You begin volume resuscitation with normal saline, remove his athletic equipment and clothing, and order laboratory studies. As the nurse tells you that the patient is no longer responding to verbal or noxious stimuli, you wonder if you should intubate him. You consider the quickest and most effective way to cool the patient with the resources available in your department. As you assess what other treatments the patient may need during his resuscitation, the nurse tells you there is a new patient in the next room.
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