The Evaluation and Management of Heat Injuries in the Emergency Department

Younggren, Bradley N. MD, DMCC
Yao, Christepher MD, MPH
Bowman, Andrew J. RN, BSN, CEN, CTRN, CCRN-CMC, BC, CVN-I, NREMT-P
Slovis, Corey M. M.D., FACEP, FACP

¹Authors
²Major, United States Army Assistant Program Director Madigan-University of Washington Emergency Medicine Residency Program Madigan Army Medical Center Fort Lewis, Washington
³Captain, United States Army Senior Resident Madigan-University of Washington Emergency Medicine Residency Program Madigan Army Medical Center Fort Lewis, Washington
⁴Peer Reviewers
⁵Patient Care Coordinator Education Coordinator Home Hospital Campus Greater Lafayette Health Services, Inc., Lafayette, IN
⁶Professor of Emergency Medicine and Medicine Chairman, Department of Emergency Medicine Vanderbilt University Medical Center Medical Director, Metro Nashville Fire Department

Date of original release: June 30, 2006.

Date of most recent review: June 25, 2006.

See “Physician CME Information” on back page.

Emergency Medicine Practice 8(6):p 1-22, June 2006.

A 14 month old boy is brought into the ED by EMS after being left in a locked car while his babysitter was shopping. His rectal temperature is 105.6°F, his skin is dry, and he is hypotonic and unable to be aroused. The paramedics are already actively cooling the child with ice packs in his groin and axillae. Are there any pharmacologic options for therapy?

A 32 year old Hazardous Materials specialist, recently activated from the military reserves, is at the scene of a possible biologic terrorist attack in full protective clothing when he collapses and begins seizing. The temperature outside is only 50°F, his skin is soaked with sweat, and his skin feels hot to the paramedics. Could he have developed heat stroke during the winter while profusely sweating? Is there anything that could have been done to prevent this?

A 16 year old high school athlete is competing in the county track meet on an unusually hot and humid day. Several of the athletes are experiencing muscular cramping, and the only water available is from the city water fountain. After standing for a long time, one of the parents lost consciousness, but has now recovered. Are there any guidelines to better manage these events?