What is the ED management for heat stroke?

• A. Rapid cooling (ice-water immersion or evaporative cooling) with aggressive IV fluids; monitor electrolytes and treat rhabdomyolysis
• B. Slow cooling and no fluids
• C. Administer diuretics and place in hot room
• D. Surgery

Answer: (B)

Heat stroke is a life-threatening emergency that requires two parallel goals in the ED: rapidly lower the body temperature and restore circulating volume to prevent organ injury. The fastest and most effective cooling methods are ice-water immersion or evaporative cooling (mist with water and fans), with clothing removed and the core temperature driven down quickly toward about 38–39°C. Delaying cooling or relying on slower methods increases the risk of CNS damage and multi-organ failure.

At the same time, start aggressive IV fluid resuscitation with isotonic crystalloids to improve perfusion, support kidney function, and address the risk of rhabdomyolysis. Continuous monitoring of electrolytes and renal function is essential, and treat electrolyte disturbances as they arise; manage rhabdomyolysis with hydration and, if indicated, measures to protect the kidneys.

Avoid diuretics and avoid placing the patient in a hot environment, and surgical interventions are not part of heat-stroke management. If the patient’s mental status or airway is compromised, secure the airway and provide appropriate supportive care. The focus is on rapid cooling and aggressive fluids to minimize complications and improve outcomes.