UMEM Educational Pearls

Title: Exertional Heat Stroke (EHS)

Category: Orthopedics

Keywords: Heat illness (PubMed Search)

Posted: 8/11/2018 by Brian Corwell, MD
Click here to contact Brian Corwell, MD

Exertional Heat Stroke (EHS)

With football preseason starting across the country, it is important to review this topic

EHS is a medical emergency resulting from progressive failure of normal thermoregulation

EHS has a high mortality

-2^nd most common cause of death in football players

History and Exam

Hyperthermia/Core temperature greater than 40°C (104°F)

Initial profuse sweating with eventual cessation of sweating with hot, dry skin

CNS dysfunction – disorientation, confusion, dizziness, inappropriate behavior, difficulties maintaining balance, seizures, coma

Other: Tachycardia/hyperventilation, fatigue, vomiting, headache

Multi-organ involvement: CNS, cardiac damage, renal failure, hepatic necrosis, muscle (rhabdomyolysis), GI (ischemic colitis), heme (DIC), ARDS

The single most important thing you can do on the field is recognize this entity. Early recognition leads to earlier initiation of treatment which is life saving.

Rapid cooling is key. This is often stated but what this means is whole body immersion in ice water. This should be available and ready for all summer practices.

The temperature needs to be lowered to below 39°C (102°F)

Also consider a cooling blanket, fanning, ice to body

DO NOT put them on ambo without initiating cooling!!!

Sustaining heat injury predisposes to subsequent heat related injury