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heat stroke

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EM@3AM: Hyperthermia

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A 34-year-old male is brought via EMS after collapsing during an outdoor adventure race. EMS reports the patient was conscious but altered, with slurred speech and confusion. Point of care glucose in the field was 102 mg/dL. Vital signs include BP 80/40 mm Hg, HR 154 bpm, T 41C rectal, RR 28 breaths per minute, saturation 94% on room air.  The patient is agitated, not oriented, and becoming combative with ED staff.  A 12-lead EKG shows sinus tachycardia but is otherwise normal.  As you attempt to examine the patient, he has a generalized, tonic-clonic seizure. What is your diagnosis, and what are your next steps in evaluation and management?

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EM@3AM: Heat Stroke

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A 72-year-old female is brought to the ED during a heat wave. Her daughter found her confused in her home. She believes the power has been out for several days. The patient appears lethargic and is intermittently confused. A rectal temperature reads 105.1F. The patient’s skin is warm and dry. She is confused, but the rest of her exam is unremarkable. What is the patient’s diagnosis? What’s the next step in your evaluation and treatment?

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Exercise-Induced Emergencies in the Heat: Rhabdomyolysis & Exertional Heat Stroke

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With the increasing popularity of high-intensity exercise regimens, visits to the Emergency Department among otherwise young and healthy individuals may be more common. The majority of metabolic abnormalities that occur after an extreme exercise event, whether a marathon or a new high-intensity exercise class, may resolve within a few days with rest and hydration. But for some, symptoms can be quite severe.

This article will examine the pathophysiology and management of two prevalent exercise-associated injuries: rhabdomyolysis and exertional heat stroke, which may be encountered in the ED.

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