Medical Minute: Three Tips for Managing Heat Stroke

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July 14, 2014 by dailybolusoflr

By Lisa Cuttle, MD

Briefly:  heat stroke is an elevated temperature, typically over 104F in conjunction with altered mental status
1.Fluid Resuscitation:  Be judicious with your fluid resucitation. Many patients are relatively euvolemic, and are at risk of catecholamine-induced stress cardiomyopathy, so consider use of boluses of 250-500 ccs. If patients are still hypotensive after 1-2 L, start pressors early to avoid inducing pulmonary edema.
2. Pressors: If pressors are needed, AVOID levophed/alpha-adrenergic agonists  as cooling is inhibited by peripheral vasoconstriction. Dobutamine is first line choice, followed by dopamine.
3. Benzos: Don’t forget to treat shivering with benzodiazepines. Seizures are also common, but should be preferentially treated with midazolam as is shorter acting. Seizures should resolve with cooling.
References:

  1. http://www.uptodate.com/contents/severe-nonexertional-hyperthermia-classic-heat-stroke-in-adults?source=machineLearning&search=hyperthermia&selectedTitle=2%7E150&sectionRank=1&anchor=H2140224#H2140572
  2. Chen WT, Lin CH, Hsieh MH, et al. Stress-induced cardiomyopathy caused by heat stroke. Ann Emerg Med 2012; 60:63.
  3. LoVecchio F. LoVecchio F Heat Emergencies. In: Tintinalli JE, Stapczynski J, Ma O, Cline DM, Cydulka RK, Meckler GD, T. Tintinalli J.E., Stapczynski J, Ma O, Cline D.M., Cydulka R.K., Meckler G.D., T eds. Tintinalli’s Emergency Medicine: A Comprehensive Study Guide. New York, NY: McGraw-Hill; 2011. http://accessemergencymedicine.mhmedical.com/content.aspx?bookid=693&Sectionid=45915551. Accessed July 8th, 2014.

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