Medical Minute Recap: Heat Stroke

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September 15, 2015 by dailybolusoflr

By: Dylan Kellogg, MD

Both heat exhaustion and heat stroke involve body’s heat production being greater than its ability to disperse heat. 
But one is readily reversible and easily treated, while the other is a life threat.
Wilderness Medical Society Guidelines for prevention:
  • Screen for significant preexisting medical conditions
  • Minimize use of medications that limit thermoregulatory response
  • Recognize that larger body habitus is associated with greater risk
  • Promote regular aerobic activity before exposure
  • Allow for acclimatization with 1 to 2 hours per day of heat-exposed exertion for at least 8 days
  • Ensure euhydration before activity
  • Ensure ongoing rehydration with appropriate replacement fluids sufficient to prevent > 2% loss of body weight
  • Consider previous history of heat injury as a risk factor for recurrence

Medications and drugs that may contribute to heat-related illness
  • Alcohol
  • Alpha-adrenergics
  • Amphetamines
  • Anticholinergics
  • Antihistamines
  • Antipsychotics
  • Benzodiazepines
  • Beta-blockers
  • Calcium-channel blockers
  • Cocaine
  • Diuretics
  • Laxatives
  • Neuroleptics
  • Phenothiazines
  • Thyroid agonists
  • Tricyclic antidepressants

Courtesy of Dylan Kellogg, MD

  1. Lipman GS, et al. 2013. Wilderness Medical Society Practice guidelines for the prevention and treatment of heat-related illness. Wild Env Med. 24:4;351-361.
  2. Waters TA, Al-Salamah MA. 2011. Heat emergencies. Emergency Medicine 7th ed. Tintinalli JE (ed). 1339-1344.

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