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Cooling for Heat Stroke

Cold water immersion is the gold standard treatment for heat stroke. How much should we worry about inducing hypothermia when we cool heat stroke patients with cold water immersion?

This is a classic example of benefit versus risk. The benefit of rapidly cooling heat stroke is clear: it’s life-saving, while the risk of inducing severe hypothermia is fairly low. To manage this risk, many studies recommend stopping cooling at 100°F (38°C), but they can measure temperature accurately. Guidance for real-world situations when we can’t measure core temperature as accurately is hard to find.

Cool the patient down first, then worry about hypothermia later. There is some science that in 50°F (10°C) water, it takes about 15-20 minutes to lower a core temperature just 4°F. Evaporative cooling (tepid water and fanning) takes at least twice as long.

For heat stroke, immersing someone in cold water is strongly recommended if possible. The idea that this is bad due to causing shivering and vasoconstriction which limits heat loss is not true — the conduction of cold water overwhelms these effects, even if they occur.

If applying cold compresses or snow, apply to the whole body. If you don’t have enough, don’t apply to the traditional neck, armpit, chest and groin; instead, apply to the palms of the hand, soles of the feet and cheeks. This technique has been shown to be more than twice as effective.

Don’t give Tylenol (acetaminophen, paracetamol), Ibuprofen (e.g., Motrin, Advil) or Naproxen (Aleve) as they don’t help with heat stroke. Heat stroke is not a fever (your body heating up to kill a virus or bacteria). Your body is overheated due to external forces (overexertion, the sun, etc.).

These curricula recommendations have been adopted from NOLS Wilderness Medicine and have been edited to conform to the standards
set by Center for Wilderness Safety and the Wilderness Medical Society in accordance with the WMS National Practice Guidelines.

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