The initial care of the patient with a heat-related illness should focus on evaluation and support of the ABCs. Dehydration is often associated with heat-related illness and attention should be given to adequate fluid resuscitation. As heat-related illness progresses, attention to complications associated with heat exhaustion and heat stroke need to be addressed, including electrolyte abnormalities, multisystem organ failure, disseminated intravascular coagulation, seizures, and coma.
The key to management is the initiation of rapid cooling, because morbidity and mortality are directly related to the duration and intensity of the hyperthermia.61 A retrospective study concluded that hyperthermic patients with a higher initial temperature, hypotension, or a low GCS score had a higher mortality rate.62 Decreasing the temperature to below 40°C (104°F) is critical and more important than how high the initial temperature was.
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