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Heat-related illness

What's new

The Society of Critical Care Medicine (SCCM) has published a new guideline for the management of heat stroke. Active cooling is recommended over passive cooling. Suggested methods for rapid cooling include ice-water immersion (1-5°C) and cold-water immersion (9-12°C), aiming to reach the target temperature within 30 minutes of heat stroke symptom recognition at a rate of ≥0.155°C/min. Dantrolene, acetaminophen, NSAIDs, and salicylates are not recommended for temperature reduction. .

Guidelines

Key sources

The following summarized guidelines for the evaluation and management of heat-related illness are prepared by our editorial team based on guidelines from the Society of Critical Care Medicine (SCCM 2025) and the Wilderness Medical Society (WMS 2024).
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Classification and risk stratification

Risk assessment: as per WMS 2024 guidelines, use the wet-bulb globe temperature if available as the preferred metric for the assessment of environmental heat risk.
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Diagnostic investigations

Temperature measurement: as per WMS 2024 guidelines, use rectal temperature as the preferred measure for core temperature when assessing heat illness.
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  • Screening for comorbidities

Medical management

Setting of care: as per WMS 2024 guidelines, offer supportive care, including rest in a cool area and replenishment of basic fluid and nutritional needs in patients with a first episode of minor heat illness.
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  • Rehydration

  • Intravenous cold fluids

  • Antipyretics

  • Dantrolene

  • Other agents

Nonpharmacologic interventions

Initiation of cooling: as per SCCM 2025 guidelines, initiate active cooling methods over passive cooling in patients with heat stroke.
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  • Cold water immersion

  • Ice packs

  • Evaporative cooling

  • Other methods of cooling

Preventative measures

Acclimatization: as per WMS 2024 guidelines, advise heat-exposed exertion 1-2 hours/day for at least 7 days to achieve full acclimatization to a hot environment.
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  • Aerobic exercise

  • Hydration

  • Selection of clothing

  • Rest

  • Avoidance of drugs