Heat stroke 

(3C: confusion, coarse tremor, core temperature > 40 C)

Clinical feature:

• Heart: tachycardia, may be heart failure 
• Brain: ischemia, cerebral edema
• Gut: sepsis
• Lungs: tachypnea, ARDS
• Kidneys: AKI
• Liver: Acute liver failure
• Hematological: DIC
• Biochemical: hypokalaemia, hypomagnesaemia, hypoglycemia, metabolic acidosis

Complication:

1. Brain ischemia, cerebral edema
2. Heart failure, ARDS
3. Acute liver injury, Acute renal failure
4. Sepsis, DIC
5. Biochemical: hypokalaemia, hypomagnesaemia, hypoglycemia, metabolic acidosis

D/D of elevated core temperature

1. Heat related illness: heat exhaustion, heat stroke
2. Sepsis including meningitis, Malaria
3. Serotonin syndrome, Malignant hyperpyrexia, Drug overdose
4. Thyroid storm

Investigation:

1. CT scan of brain: cerebral ischemia or edea 
2. CXR: ARDS
3. RFT: ARF
4. CBC with DIC profile

Management:

• Mortality of heat illness is around 30%, so 
• Immediate cooling should begin at the scene, before transfer to hospital. 
• The aim is to reduce core temperature to < 39°C.

• • immediate removal from the heat source and put into shade, removal of clothing 
  • Resting in an air-conditioned room 
  • high-flow oxygen 
  • intravenous access with IF fluid 
  • rectal temperature taken, if possible.

• cooling strategies by any of these technique 

1. Ice/cold packs in the axillae, groin and neck
2. Wet towel
3. Evaporative and convective method:  spraying cool water over the patient →fanning.
4. Ice water immersion → caution: reduced conscious level
5. Air-conditioned room
6. IV cold saline: 4 OC saline

• Invasive cooling methods: 

1. gastric, bladder or peritoneal lavage 

Prevention:

1. Ensuring adequate hydration. 
2. Consider accepted WBGT (Wet Bulb Globe Temperature) cut-offs for activities 
3. Health education regarding risk reduction and cooling strategies