What therapeutic modality is most effective in the treatment of heat stroke?

Updated: Nov 06, 2018
  • Author: Robert S Helman, MD; Chief Editor: Joe Alcock, MD, MS  more...
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Answer

Controversy still exists over what therapeutic modality is most effective in the treatment of heat stroke. However, the basic premise of rapidly lowering the core temperature to about 39°C (to avoid overshooting and rebound hyperthermia) remains the primary goal.

According to one study, oral temperature assessments consistently reflected inaccurate core body temperatures, which delayed the diagnosis and ultimate treatment of patients with heat stroke. Rectal temperatures are still the preferred method of accurately obtaining core body temperatures. [11]

Some studies have shown that promptly reducing the exposure time to excessive heat can dramatically improve long-term outcomes and decrease irreversible injury. If treatment is initiated within this so-called golden hour and is aggressive enough to rapidly reduce the core body temperature, complications (including multisystem organ failure) may be averted and the patient may have a much better prognosis. [12]

In a review of 19 clinical trials and observational studies involving 556 patients, the conduction method of cooling was found to be more efficacious in young, active adults with EHS. Unfortunately, this review did not identify a preferred treatment found for NEHS, or a temperature endpoint to prevent overcooling. [13]

Removal of restrictive clothing and spraying water on the body, covering the patient with ice water–soaked sheets, or placing ice packs in the axillae and groin may reduce the patient's temperature significantly. Patients who are unable to protect their airway should be intubated. Patients who are awake and responsive should receive supplemental oxygen.


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