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by Paul Auerbach
Heatstroke is a life-threatening
emergency. Therapeutic cooling measures need to be undertaken rapidly in order
to prevent the catastrophic organ failure associated with markedly elevated
The general dictum is
to cool the victim to a normal body temperature, but to take care not to go
further into the territory of hypothermia ("overshoot"), which
theoretically might create another set of difficulties. But perhaps there is an
opportunity now for new thinking regarding cooling a heatstroke victim in dire
In an article entitled "Successful Treatment of Severe
Heatstroke With Therapeutic Hypothermia by a Noninvasive External Cooling
System" (Annals of Emergency Medicine 2012;59:491-493), Dr. Jen-Yee Hong
and colleagues report treating a near-fatal case of exertional heatstroke using
induced therapeutic hypothermia (33o C [91.4o F]) by a
noninvasive external cooling system. After treatment, the patient recovered
completely, without any neurological sequelae at one year. Prior to cooling,
the victim had multi-organ dysfunction, including seizures, lung injury, and
coagulopathy (diffuse bleeding).
This is a very important case report, because
external cooling devices are much more commonly found these days in emergency
departments because they are used to cool patients to protect their brains
after they have been resuscitated from cardiac arrest, or in certain other
situations where there has been a dangerous period of lack of oxygen to the
The specific device used for this patient was the Medivance Arctic Sun
System, which is a noninvasive (no direct access to the bloodstream is
obtained) cooling system designed for external temperature management. It
circulates chilled water through pads directly adhered to the patient's skin.
While this is a single case report and it is impossible to know if merely
cooling the patient from a hyperthermic (hot) condition to a normal body
temperature would have been sufficient to achieve the same outcome, it is very
important to note that going beyond a normothermic condition to a hypothermic
(cold) condition did not appear to be harmful and may very well have been
helpful, for theoretical reasons noted by the authors.
Outdoor Ed Note: Thanks Paul for this update. The heat waves happening across the U.S this summer are of particular concern for outdoor programs where physical activity is combined with high heat and humidity. Heat stroke can be an immediately life-threatening illness.
Here are a few other good sources about Exertional Heat Stroke (EHS). One critical observation from a number of these articles is advanced recognition of the problem. The person who is "'falling behind' his friends, or collapsing
during or shortly after an exercise is suspected to
suffer from heat stroke. Staff should be taught to look for
these signs and take immediate vigorous steps.
Exertional Heat Illness and Competition - Position Paper by the American College of Sports Medicine (PDF Version)
"Cooling Techniques for Hyperthermia" at Medscape.
Exertional HeatStroke in Israeli Defence Forces (PDF)
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