Heat Stroke

Heat Stroke Guidelines

Dr. Christopher Tedeschi

We’ve had a few cases of extreme heat illness in the past week, and even though things have cooled down for now, here’s some guidance for caring for patients with heat stroke in the ED:

Remember, heat stroke usually presents with altered mental status, collapse, and hyperthermia. Core temp is usually greater than 40C. Please remember that heat stroke is a true emergency and should be treated urgently. Keep in mind:
1) Continuous core temperature monitoring is standard of care. Temperature-reading foley catheters are available in the CUMC adult ED and Allen ED; rectal temperature probes are available in the CHONY ED. 
2) Patients with heat stroke should be rapidly cooled to a temp of 39-40C before stopping cooling efforts.
3) In our EDs, ice water immersion is preferred cooling method — this means completely undressing the patient and covering / immersing the patient with ice, and wet towels/sheets as available, and maintaining contact with ice cold water until the goal temperature is reached. Access to adequate amounts of ice is a challenge — for now, please recruit staff as needed to collect ice from dispensers in the department, and additionally contact a clinical nurse manager who can help obtain large amounts of ice from the kitchen. We will soon have a large cooler full of ice available in the trauma room during periods of NYC declared heat emergency. Evaporative cooling using spray bottles and fans is effective but not logistically feasible in our EDs.
4) Remember, supplementary cooling methods like cold saline might be helpful but they do not replace ice water immersion. Standard of care for ED treatment of heat stroke DOES NOT INCLUDE using chemical cold packs, ‘ice packs to the groin and axillae,’ bladder irrigation with cold saline, the Artic Sun device, etc. 
5) Heat stroke patients are critically ill and warrant evaluation for ICU admission.