On a hot summer day, an obese 15-year-old adolescent boy presents to the ED after a week of two-a-day football practices. He has completed 10 practices to date. He presents with headache, muscle aches, nausea, and 2 episodes of vomiting. The patient denies any trauma or injury. His past medical history includes ADHD, and his home medications include methylphenidate. His physical examination is remarkable for a fatigued-appearing obese boy with flushed, sweaty skin. The patient’s vital signs are: heart rate, 120 beats/min; respiratory rate, 24 breaths/min; blood pressure, 128/76 mm Hg; rectal temperature, 39°C (102.2°F); and oxygen saturation, 98% on room air. You begin to wonder how severe his heat-related illness is and whether diagnostic studies need to be ordered. What treatment needs to be initiated immediately, or can treatment wait while you see another patient?
To continue reading, please log in or purchase access.