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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.Classification and risk stratification

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

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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.

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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.

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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.

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  • Clothing

  • Hydration

  • Aerobic exercise

  • Avoidance of drugs affecting thermoregulation