Heat Stroke (Severe Heat Illness) — Management Pathway

Step-by-step decision

Choose step by step as prompted; reaching an endpoint gives the management recommendation. You can go back a step or restart anytime.

🎓 Want to practice? Do a case challenge with this pathway → (get a case, choose management step by step, scored).

Full pathway

1. [Decision] Is this heat stroke?
   Does it meet heat stroke? (Heat stroke = core (rectal) temperature >40°C + CNS dysfunction (delirium, seizures, coma, ataxia). Classic (hot environment, elderly/chronically ill) vs exertional (intense exercise, young adults; complicated by rhabdomyolysis, DIC, hepatic/renal injury). Do not exclude on temperature alone — delayed measurement can read low.)
   • Meets heat stroke → Heat stroke → rapid cooling
   • Heat exhaustion / prodrome only → Heat exhaustion / prodrome
2. [End] Heat exhaustion / prodrome
   No CNS dysfunction, core temp usually <40°C: move to a cool place, rest, oral or IV fluids and electrolytes, cooling; monitor and treat as heat stroke the moment CNS dysfunction appears.
3. [End] Heat stroke → rapid cooling
   Rapid cooling is the key determinant of outcome ('cool first, transport later'): cold-water immersion (~10°C water, below the neck, cooling rate up to 0.35°C/min) is preferred, targeting core temp <39°C within 30 min then stop to avoid overshoot; if immersion is not possible use evaporative cooling (spray + fan), ice packs over large vessels (neck/axilla/groin) or cooling blankets. Concurrently ABC, IV fluids, treat complications (rhabdomyolysis → fluids, AKI, DIC, seizures, electrolytes). Monitor rectal temperature. Do not use antipyretics or dantrolene (ineffective).

Source guidelines & references

• Chinese expert consensus on diagnosis and treatment of heat stroke
• UpToDate: management and prevention of exertional heat illness

This pathway is our own synthesis of the decision logic in the guidelines above (not the guideline verbatim); thresholds and workflows change as guidelines update — in practice follow the latest guideline, your institution's protocol and the individual patient.

Other pathways