Heat Stroke & Hypothermia

1 · First minutes

1. Measure a true core temperature (rectal/esophageal/bladder) — peripheral temps lie.
2. Heat stroke: cool first (ice-water immersion when available), then support ABC and look for rhabdo, DIC, and liver injury.
3. Hypothermia: handle gently, start rewarming and follow the local temperature-specific ALS shock/drug algorithm; discuss ECLS transfer early in arrest or instability.

3 · Immediate workup

• Core temperature; ECG (Osborn J waves, VF risk); glucose; SpO₂
• Strip and cool, or insulate and rewarm, while lines go in

4 · Don’t miss

• Classic or exertional heat stroke
  Altered mentation + high core temperature — cool immediately to ~39°C. Ice-water immersion is first-line for exertional heat stroke (ACSM/NATA). Antipyretics do not work.
• Heat exhaustion vs sepsis vs NMS / serotonin syndrome / sympathomimetic storm
  Not every hot altered patient is environmental — toxidrome, rigidity, meds, and infection still apply. Cooling proceeds while you sort.
• Accidental hypothermia with cardiac arrest
  Prolonged CPR and extracorporeal rewarming when available; use a validated prognostic approach such as HOPE and specialist assessment; no single temperature determines when resuscitation stops. Gentle handling to avoid VF.
• Submersion / drowning
  Hypoxia is the disease. Rescue breaths, intubation as needed, delayed pulmonary edema. C-spine if diving or trauma mechanism.
• Rhabdomyolysis / DIC / acute liver failure after heat stroke
  The cooling is not the end — watch CK, coagulation, glucose, and mental status for 24 h.