How to Handle Heatstroke?

On hot days, if we walk in the sun for a long time, our bodies may experience symptoms such as dizziness and fatigue, which may indicate heatstroke. In the case of heatstroke, it is best to immediately rest in a shady area. If the symptoms are severe, it is necessary to seek medical treatment. When encountering a patient with heatstroke, it is not advisable to immediately send them to a cool, air-conditioned room. Instead, they can be allowed to rest in the shade of a tree. Heatstroke is an acute illness that occurs during hot seasons, high temperatures, and/or high humidity environments, caused by dysfunction of the thermoregulatory center, failure of sweat glands, and excessive loss of water and electrolytes, which primarily manifests as central nervous system and/or cardiovascular dysfunction. Based on clinical manifestations, heatstroke can be classified into prodromal heatstroke, mild heatstroke, and severe heatstroke. Severe heatstroke can be further categorized into heat cramps, heat exhaustion, and heatstroke illness, with heatstroke illness being the most severe type.

(1) Cooling Therapy: Rapid cooling is the primary measure for treatment. This can be achieved through external and internal cooling methods.

1) External Cooling: Quickly remove the patient from the high-temperature and high-humidity environment and transfer them to a ventilated and shady area. Lay the patient flat and remove all clothing. Perform skin and muscle massage to promote heat dissipation. For those without circulatory disorders, apply ice water baths or immerse the body in water at a temperature of 27°C to 30°C for cooling. For those with circulatory disorders, use evaporative cooling methods such as repeatedly wiping the skin with cool water while using a fan or air conditioning to accelerate evaporation.

2) Internal Cooling: If external cooling is ineffective, gastric or rectal lavage with iced saline can be used. Alternatively, sterile saline can be used for peritoneal lavage or hemodialysis. Additionally, autologous blood can be cooled externally and then returned to the body for internal cooling.

3) Pharmacological Cooling: Chlorpromazine can be administered intravenously to patients experiencing chills, while blood pressure should be monitored concurrently.

1) For unconscious patients, maintain a clear respiratory tract, provide oxygen, and perform tracheal intubation if necessary.

2) Actively correct water and electrolyte imbalances to maintain acid-base balance.

3) The speed of fluid replacement should not be too fast to avoid triggering heart failure. In case of heart failure, rapid-acting digitalis preparations should be administered.

4) Use vasopressors to correct shock.

5) Patients suspected of having cerebral edema should be given mannitol for dehydration.