Page 122 - PJ MED OPS Handbook 8th Ed

Heat Illness

SPECIAL CONSIDERATIONS:
1. Dehydration often accompanies heat illness.
2. Colloids should be avoided in favor of crystalloids.
3. Heat Stroke is a life-threatening effect of hyperthermia and characterized by altered men-
tal status and elevated core temperature typically >104°F.
4. Patients are at risk for multisystem organ failure, and careful monitoring is essential even
after return to normothermia.

Signs and Symptoms:
1. Generally involve physical collapse or debilitation during or immediately following exertion in
the heat
2. Heat Exhaustion: Temp generally ≤104°F, headache, dizziness, nausea, tachycardia, and normal
mental status
3. Heat Stroke: Temp generally >104°F, above symptoms and altered mental status (delirium, stu-
por, coma)
Management:
1. Early rapid cooling reduces mortality and morbidity, and it should be initiated as soon as pos-
sible. Cooling should be the primary goal before transport.
2. Place in cool area and remove clothing.
a. For Heat Stroke: The best option for rapid cooling is full body ice water immersion (keeping
head elevated out of water). If this is unavailable, a continual dousing of cold water (as would
occur in a cold shower or with ice water-soaked towels) provides the fastest cooling rate. A
less ideal option is to spray the patient with water plus rapid air movement provided by a fan.
Apply these active cooling measures until the core temperature reaches 102°F, then take the
patient out so they don’t overshoot normal temperature and become hypothermic.
3. Place oral glucose gel (Gu) or 1 packet of sugar in buccal mucosal region.
a. Treat per Dehydration Protocol. Heat stroke and heat exhaustion with associated severe mus-
cle pain and/or cola colored urine will typically require 2–3 liters of crystalloid and continued
IV hydration to obtain a urine output of 200mL/hr.
4. If the patient is unconscious after exercising on a hot day, limit fluid resuscitation to a max of 2L
of crystalloids unless hemodynamically unstable and a Foley is in place (and optimally laboratory
support).
5. Treat per Nausea and Vomiting Protocol.
6. For cola colored urine or severe muscle pain, treat per Rhabdomyolysis Protocol.

DISPOSITION:
1. Urgent evacuation for Heat Stroke.
2. Routine evacuation for Heat Exhaustion.

120 n Pararescue Medical Operations Handbook / 8th Edition