Evidence-Based Heatstroke Management in the Emergency Department

Rublee, Caitlin; Dresser, Caleb; Giudice, Catharina; Lemery, Jay; Sorensen, Cecilia

doi:10.5811/westjem.2020.11.49007

Cited by 41 publications

(65 citation statements)

References 67 publications

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“…A hospital in Ahmedabad, India had more neonatal intensive care unit admissions during a heat wave, prompting movement of the maternal ward to a lower level of the hospital [35] . Others have proposed an evidence-based algorithm to rapidly recognize and treat patients with heatstroke with focus on prehospital provider involvement and maximizing available human and supply chain resources [36] . Such attention at the facility level, and in the setting of unreliable energy infrastructure, may be crucial to protecting patients and staff.…”

Section: Discussionmentioning

confidence: 99%

Climate change and emergency care in Africa: A scoping review

Theron

Bills

Hynes

et al. 2022

African Journal of Emergency Medicine

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Section: Discussionmentioning

confidence: 99%

Climate change and emergency care in Africa: A scoping review

Theron

Bills

Hynes

et al. 2022

African Journal of Emergency Medicine

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“…The final phase of EHS clinical management involves advanced care in an ED and hospital with an inpatient critical care capability. This evidence‐based review is not intended to outline detailed ED, inpatient or intensive clinical care management; there are multiple resources with detailed care protocols where key elements of management are discussed (Epstein & Yanovich, 2019; Liu et al., 2020; Rublee et al., 2021).…”

Section: Advanced Clinical Carementioning

confidence: 99%

“…The management of heatstroke complications such as acute respiratory distress syndrome, acute kidney injury, disseminated intravascular coagulopathy, liver dysfunction, seizures and coma require the same organ support provided for other critically ill patients. Figure 3 is adapted from a recently published evidence‐based approach to EHS advanced clinical management in the ED (Rublee et al., 2021). This algorithm assumes that no pre‐hospital cooling has been completed and may not be fully applicable in other circumstances.…”

Section: Advanced Clinical Carementioning

confidence: 99%

Exertional heat stroke: an evidence based approach to clinical assessment and management

DeGroot¹,

O’Connor

Roberts

2022

Experimental Physiology

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New Findings What is the topic of this review?The treatment of exertional heat stress, from initial field care through the return‐to‐activity decision. What advances does it highlight?Clinical assessment during field care using AVPU and vital signs to gauge recovery, approaches to field cooling and end of active cooling, and shared clinical decision making for return to activity recommendations. Abstract Exertional heat stroke (EHS) is a potentially fatal condition characterized by central nervous system (CNS) dysfunction and body temperature often but not always >40°C that occurs in the context of physical work in warm or hot environments. In this paper, we review the continuum of care, from initial recognition and field care to transport and hospital care, and finally return‐to‐duty considerations. Morbidity and mortality can be greatly reduced if not eliminated with prompt recognition and aggressive cooling. If medical personnel are not present at point of collapse during or immediately following exercise, EHS should be the presumptive diagnosis until a formal diagnosis can be determined by qualified medical staff. EHS is a rare medical situation where initial treatment (cooling) takes precedence over transport to a medical facility, where advanced medical care may be required for severe EHS casualties. Recovery from EHS and return to activity is usually straightforward and unremarkable provided the casualty is rapidly cooled at time of collapse and adequate time is allowed for body healing. However, evidence‐based data to guide return to activity following EHS are limited. Current research suggests that most individuals recover completely within a few weeks though some individuals may suffer prolonged sequalae and additional evaluation may be warranted, including heat tolerance testing (HTT). Several aspects of the care of the EHS casualty are based on best practices derived from personal experience and continued research is necessary to optimize evaluation and management.

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“…The initial treatment for EHS is to rapidly reduce the patient’s core temperature, which is often accomplished via immersion in either cold or ice water [ 46 , 66 , 67 ]. Water temperature recommendations vary but typically range between 2°C and 20°C [ 67 , 68 ].…”

Section: Reviewmentioning

confidence: 99%

Drug-Induced Hyperthermia Review

Horseman¹,

Panahi²,

Udeani³

et al. 2022

Cureus

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Humans maintain core body temperature via a complicated system of physiologic mechanisms that counteract heat/cold fluctuations from metabolism, exertion, and the environment. Overextension of these mechanisms or disruption of body temperature homeostasis leads to bodily dysfunction, culminating in a syndrome analogous to exertional heat stroke (EHS). The inability of this thermoregulatory process to maintain the body temperature is caused by either thermal stress or certain drugs. EHS is a syndrome characterized by hyperthermia and the activation of systemic inflammation. Several drug-induced hyperthermic syndromes may resemble EHS and share common mechanisms. The purpose of this article is to review the current literature and compare exertional heat stroke (EHS) to three of the most widely studied drug-induced hyperthermic syndromes: malignant hyperthermia (MH), neuroleptic malignant syndrome (NMS), and serotonin syndrome (SS). Drugs and drug classes that have been implicated in these conditions include amphetamines, diuretics, cocaine, antipsychotics, metoclopramide, selective serotonin reuptake inhibitors (SSRIs), tricyclic antidepressants (TCAs), and many more. Observations suggest that severe or fulminant cases of drug-induced hyperthermia may evolve into an inflammatory syndrome best described as heat stroke. Their underlying mechanisms, symptoms, and treatment approaches will be reviewed to assist in accurate diagnosis, which will impact the management of potentially life-threatening complications.

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Evidence-Based Heatstroke Management in the Emergency Department

Cited by 41 publications

References 67 publications

Climate change and emergency care in Africa: A scoping review

Climate change and emergency care in Africa: A scoping review

Exertional heat stroke: an evidence based approach to clinical assessment and management

Drug-Induced Hyperthermia Review

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