Browse categories and answer follow-up questions to refine your symptom profile.
Recognition and immediate priorities
Heat stroke stabilization
Core temperature threshold
Core temperature >= 40.0 C with CNS dysfunction
Heat stroke possible with lower temperature after partial cooling
Life threats
Airway compromise
Seizure
Shock
Severe electrolyte derangement
Dysrhythmia
Key immediate actions
Move to cool environment
Remove clothing and PPE
Continuous core temperature monitoring
Immediate active cooling as first priority
Cooling strategy and targets
Rapid cooling goals
Core temperature monitoring
Rectal probe preferred for accuracy
Esophageal probe acceptable if intubated
Bladder probe unreliable during oliguria or irrigation
Cooling target temperature
Stop active cooling at 38.5 C to 39.0 C to avoid overshoot hypothermia
Reassess every 5 minutes during active cooling
Cooling method selection
Exertional heat stroke
Ice water immersion preferred when feasible
Limb and trunk agitation in tub for convective flow
Classic heat stroke
Evaporative cooling with mist plus fan
Ice packs to groin, axillae, neck as adjunct
If immersion not feasible
Cold water dousing plus fan
Cooling blanket as adjunct only
Cold IV fluids as adjunct
Airway, breathing, circulation
Resuscitation bundle
Airway and ventilation
Indications for intubation
Persistent agitation preventing cooling
Inability to protect airway
Refractory seizure
Severe hypoxemia or respiratory failure
Ventilation targets
Normocapnia
Avoid permissive hyperthermia from prolonged apneic periods
Circulation
IV access
Two large bore peripheral IVs
Consider intraosseous if access delayed
Fluid strategy
Isotonic crystalloid bolus for hypotension
Reassessment with lung exam and ultrasound
Avoid fluid overload in renal failure
Vasopressors
If hypotension persists after fluids
Norepinephrine first line for distributive physiology
Monitoring
Continuous ECG
Frequent blood pressure
Pulse oximetry
Capnography if intubated
Foley for urine output if not contraindicated
Escalation and consultation triggers
Early escalation
ICU activation triggers
Persistent altered mental status
Temperature not decreasing with cooling
Hypotension requiring vasopressors
Seizure
Lactate rising or metabolic acidosis
Rhabdomyolysis with rising creatine kinase
Acute kidney injury or oliguria
Coagulopathy or bleeding
Hepatic injury with rising aminotransferases
Consultation triggers
Nephrology for severe rhabdomyolysis or hyperkalemia
Toxicology for unclear hyperthermia differential
Hematology for DIC
Obstetrics for pregnancy
Pediatrics for children
PEARLS
Heat stroke time critical principles
Cooling is the definitive therapy
Outcomes correlate with time above critical temperature
Delays to cooling increase organ failure risk
Skin findings unreliable
Diaphoresis can be present in exertional heat stroke
Hot dry skin does not exclude other hyperthermia causes
SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.