SAQ 438 – Environmental – exertional heat stroke
Model Answer
Environmental – exertional heat stroke.
a. Diagnosis
- Exertional heat stroke.
b. Investigations
| Investigation | Justification |
|---|---|
| Creatine kinase | Assesses rhabdomyolysis. |
| Blood glucose | Identifies hypo- or hyperglycaemia contributing to altered mental state. |
| Coagulation profile/INR | Assesses coagulopathy or DIC and correlates with severity. |
| Blood gas with electrolytes and lactate | Assesses acidosis, potassium, renal/metabolic derangement, and perfusion. |
| FBE, LFTs, U&E, urinalysis, ECG, or CT brain | May identify thrombocytopaenia/leukocytosis, organ dysfunction, myoglobinuria, hyperkalaemia/renal failure, arrhythmia, or an alternative intracranial cause. |
c. Cooling strategies
- Remove clothing and expose the patient.
- Reduce ambient temperature and use fans/cold mist spray.
- Apply ice packs to axillae and groin.
- Give cooled IV fluids.
- Use cold-water immersion if safe with airway and monitoring.
- Consider bladder lavage in severe cases if practical.
d. Other priorities
- Protect the airway with positioning, airway adjuncts, or intubation if needed.
- Correct glucose to normoglycaemia.
- Give aggressive IV crystalloid resuscitation while monitoring for complications.
- Insert IDC and target high urine output, around 2-3 mL/kg/hr.
- Early ICU referral; renal replacement therapy may be required if renal failure or low urine output persists.
- Communicate with next of kin.
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