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Heat Exhaustion

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Other Names

  • Heat Exhaustion

Background

  • This page refers to heat exhaustion, characterized by trouble continuing exercise, hyperthermia with normal neurological status

History

Epidemiology

  • Most common form of heat related illness (need citation)

Pathophysiology

  • General
    • Characterized by the inability to maintain adequate cardiac output due to strenuous physical exercise and environmental heat stress
    • Most often this manifests as physical collapse during exercise
    • Body temperature is elevated, typically less than exertional heat stroke, but the patient is neurologically intact
    • Can be thought of as a more common, less severe form of Exertional Heat Stroke
  • Clinical criteria
    • Athlete has obvious difficulty continuing with exercise
    • Core body temperature is usually 101 to 104ºF (38.3 to 40.0ºC) at the time of collapse
    • No significant neurological dysfunction (eg, seizure, altered consciousness, persistent delirium)

Associated Conditions

  • Heat Syncope
    • Conditions may be difficult to distinguish clinically

Risk Factors


Differential Diagnosis

Differential Diagnosis Heat Illness


Clinical Features

  • History
    • Patients endorse discomfort, anxiety,
    • Dizziness, lightheadedness, syncope may or may not occur
    • Weakness may be extreme
    • Profuse sweating, pallor, "prickly heat" sensations
    • Headache
    • Abdominal cramps, nausea, vomiting, diarrhea
    • Persistent muscle cramps
    • Dehydration and thirst
  • Physical Exam
    • Tachycardia, hypotension
    • Core temperature: >37°C (98.6°F) but <40°C (104°F)
    • The patient should be neurologically intact
    • Ataxia and coordination problems can be mild and should rapidly improve

Evaluation

  • Clinical diagnosis
    • Based on history, physical exam and presence of hyperthermia

Classification

  • Not applicable

Management

  • General
    • Remove any athlete from play
    • Move them to a shaded, cool or air-conditioned area
    • Place the patient supine with their feet elevated above the level of their head (ie, raise their legs)
    • Remove excess clothing and equipment
    • Cool the patient until their rectal temperature is approximately 101ºF (38.3ºC).
  • Cooling
    • Mode of cooling less important for heat exhaustion compared to heat stroke (goal: comfort rather than life-saving)
    • Any technique may be used (cold water immersion, running cool water over them using a shower or hose, evaporative cooling measures)
    • Time to reach the goal temperature shorter than with heat stroke
  • Hydration
    • Rehydrate the patient with chilled water or a sports drink if they will tolerate orallly
    • Give IV fluid if the athlete is unable to drink
  • Monitor
    • Continuously observe and re-evaluate patient for mental status changes
    • Monitor vitals: heart rate, blood pressure, respiratory rate, rectal temperature
  • Transport to Emergency Department
    • Indicated if patient does not rapidly improve with appropriate treatment
    • Also indicated if patient is altered or has evidence of end neurological dysfunction
  • Transition to Exertional Heat Stroke
    • If core temperature rises above 40ºC or if patient develops altered mentation, the physician should transition to EHS care algorithm

Rehab and Return to Play

Rehabilitation

  • Not applicable

Return to Play/ Work

  • General
    • There are no clear and validated guidelines for return to play
    • Individuals should abstain from exercise for at least 24 hours following the resolution of all symptoms and laboratory abnormalities.

Complications and Prognosis

Prognosis

  • Generally considered a self limited condition

Complications


See Also


References

Created by:
John Kiel on 30 June 2019 22:50:14
Last edited:
20 September 2022 17:29:22
Category: