General Approach to All Patients


Basic Life Support

  • Move patient to cooler environment

Heat Cramps

  • Painful spasms of the extremities or abdominal muscles, normal mental status and vital signs
    • Oral fluids as tolerated
    • Sponge with cool water

Heat Exhaustion

  • Dizziness, light-headedness, headache, irritability, normal or slightly decreased LOC, normal or decreased BP, tachycardia, normal or slightly elevated temperature
    • Keep patient supine
    • Supplemental 100% oxygen
    • Remove clothing
    • Sponge with cool water and fan

Heat Stroke

  • Marked alteration in LOC, extremely high temperature (often > 104), may be sweating or have red/hot/dry skin
    • Position semi-reclining with head elevated 15-30°
    • Supplemental 100% oxygen
    • Rapid cooling:
      • Cold packs to axilla, groin and neck
      • Sponge with cool water and fan
      • If significant shivering occurs remove cold packs but continue fanning

Advanced Life Support

  • If symptoms moderate to severe perform Full ALS Assessment and Treatment
  • Hyperthermia may result from cocaine or other sympathomimetic toxicity:
    • If cocaine/sympathomimetic toxicity strongly suspected give Midazolam (Versed) 5 mg IM or intranasal via MAD OR 2.5 mg IV
      • Repeat Midazolam (Versed) 5 mg IM or intranasal via MAD OR 2.5 mg IV if adequate sedation not achieved
  • Expedite transport