A 55-year-old Caucasian male is brought to the emergency department by an ambulance after collapsing at a local golf course on a hot summer day. The man had been golfing with friends for several hours, when he reported feeling dizzy and seemed confused. His temperature is 41.2C (106.2F), blood pressure is 110/68 mm Hg, pulse is 104/min, and respirations are 25/min. The man is now unconscious. His skin is hot, dry, and flushed. Which of the following should be undertaken first in managing this condition?

Question

A 55-year-old Caucasian male is brought to the emergency department by an ambulance after collapsing at a local golf course on a hot summer day.  The man had been golfing with friends for several hours, when he reported feeling dizzy and seemed confused.  His temperature is 41.2C (106.2F), blood pressure is 110/68 mm Hg, pulse is 104/min, and respirations are 25/min.  The man is now unconscious.  His skin is hot, dry, and flushed.  Which of the following should be undertaken first in managing this condition?

Quizplus · Accepted Answer

Explanation: Heat stroke is a life-threatening emergency that occurs when an individual is exposed to the sun for an extended period, but does not sweat enough to lower the body temperature. Infants, the elderly, and people who work outdoors are especially prone to developing heat stroke. The most common symptoms of heat stroke include hyperthermia, tachycardia, loss of consciousness, seizure, fatigue, headache, dizziness, agitation or confusion, and hot dry skin that is flushed but not sweaty. Once the heat stroke is recognized, the patient should be immediately removed from the hot environment, and his airway, breathing, and circulation (ABC's) should be stabilized. The initiation of rapid cooling is crucial, and the naked patient should be sprayed with a tepid water mist or covered with a wet sheet while large fans circulate air to maximize evaporative heat loss. Ideally, the patient's core temperature should be dropped by 0.2C/min. (Choice A)An alcohol sponge bath is contraindicated in heat stroke because a significant proportion of the toxin can be absorbed through the dilated cutaneous vessels. (Choice C)Ice water gastric and rectal lavage may be helpful in speeding the cooling of the patient, but are used solely as adjuncts to evaporative cooling. They should not be the first step taken in managing any heat stroke patient. (Choice D) Antipyretics such as acetaminophen are not indicated because the cause of the increased body temperature is not an increased hypothalamic set point. Hepatic damage can also be worsened by large doses of acetaminophen. (Choice E)Phenylephrine is an alpha-adrenergic agonist indicated in shock and severe hypotension. It is contraindicated in heat stroke because it causes vasoconstriction and slows cooling. Educational Objective: Heat stroke should be treated with augmentation of evaporative cooling, and the naked patient should be sprayed with a tepid water mist or covered with a wet sheet while large fans circulate air to maximize evaporative heat loss. Other cooling methods such as ice packs, ice water lavage, or cold intravenous fluids are helpful adjuncts, but not first-line treatments.

A 55-Year-Old Caucasian Male Is Brought to the Emergency Department by an Ambulance