Address ABCs
Rapid cooling (see below) - mainstay of treatment
Reduces morbidity/mortality, should be started in prehospital setting if no other life-threats exist
Remove from environment
IVF (for renal protection and avoiding rhabdomyolysis)
Bolus if hypotensive
Infusion titrated to UOP (goal 2-3ml/kg/hr)
Reduces morbidity/mortality, should be started in prehospital setting if no other life-threats exist
Bolus if hypotensive
Infusion titrated to UOP (goal 2-3ml/kg/hr)
Cooling end point should be ~39°C (102.2°F) - no good data for this goal
No role for: antipyretics or dantrolene
Combination of methods, or adjuncts such as cool IVF may increase efficacy of individual methods
Cool water immersion - treatment of choice
Immersion of body to level of torso or neck in cool or ice-water
Best for exertional<unk>  in young/healthy patients, but benefit shown in elderly patients as well
Diffuse application of ice or cold packs to entire body may provide similar benefit (but less data)
Applying ice packs only to neck, axillae, groin provides only minimal cooling
Benefits: most rapid decrease in temperature, some studies have shown 100% survival (esp when started within 30 minutes of collapse)
Disadvantages: requires special equipment (may not be immediately available), poorly tolerated, unable to provide defibrillation or many other resuscitative measures
Evaporative/Convective Cooling
Spray cool water (15°C / 59°F) on patient while directing fans at patient
Benefits: Easier to apply in ED and while performing other interventions
Disadvantages: Slower cooling (than immersion) with slightly higher morbidity/mortality
Invasive Techniques (limited data )
Bladder Lavage
Gastric Lavage
Thoracic Lavage with chest tubes
Cardiopulmonary bypass/ECMO
Immersion of body to level of torso or neck in cool or ice-water
Best for exertional<unk>  in young/healthy patients, but benefit shown in elderly patients as well
Diffuse application of ice or cold packs to entire body may provide similar benefit (but less data)
Applying ice packs only to neck, axillae, groin provides only minimal cooling
Benefits: most rapid decrease in temperature, some studies have shown 100% survival (esp when started within 30 minutes of collapse)
Disadvantages: requires special equipment (may not be immediately available), poorly tolerated, unable to provide defibrillation or many other resuscitative measures
Applying ice packs only to neck, axillae, groin provides only minimal cooling
Spray cool water (15°C / 59°F) on patient while directing fans at patient
Benefits: Easier to apply in ED and while performing other interventions
Disadvantages: Slower cooling (than immersion) with slightly higher morbidity/mortality
Bladder Lavage
Gastric Lavage
Thoracic Lavage with chest tubes
Cardiopulmonary bypass/ECMO
Heat stroke
Heat cramps
Electrical storm
Heat edema
Spinal shock
Heat exhaustion
Neurogenic shock
Heat tetany