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Heat-related illness

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 Wilderness Medical Society (WMS 2019).
1

Guidelines

1.Classification and risk stratification

Risk assessment: use the wet-bulb globe temperature index for the assessment of heat risk.
A
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2.Diagnostic investigations

Temperature measurement
Prefer rectal temperature measurement, when available, as the most accurate measurement of core hyperthermia compared to axillary, oral, or aural thermometry.
B
Do not delay empiric cooling for heat stroke by a measurement value that may be below the diagnostic threshold of 40 °C in hyperthermic patients with an altered sensorium.
D

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  • Screening for comorbidities

  • Cardiac evaluation

3.Medical management

Goals of cooling: cool patients with heat stroke to a target temperature of no less than 39 °C.
B

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  • Rehydration

  • Intravenous cold fluids

  • Antipyretics

  • Dantrolene

4.Nonpharmacologic interventions

Passive cooling: offer passive cooling measures to minimize thermal strain and maximize heat loss.
B

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  • Immersive cooling

  • Evaporative cooling

  • Ice packs

5.Preventative measures

Acclimatization: advise allowing for acclimatization with 1-2 hours/day of heat-exposed exertion for at least 8 days.
B

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  • Clothing

  • Hydration

  • Aerobic exercise

  • Avoidance of drugs affecting thermoregulation