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.

  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. Accessed July 8th, 2014.

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