EM · Environmental emergencies
Heat illness and heat stroke
Also known as Heat stroke · Heat exhaustion · Heat hyperthermia · Exertional heat stroke · Classic heat stroke · Non-exertional heat stroke
Heat illness and heatstroke in the emergency department — the spectrum from heat exhaustion to heatstroke, classic and exertional forms, pathophysiology and prognosis, cold-water immersion and the cooling target, drugs to avoid, and return to activity.
Checked against its sources on 23 Oct 2026
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Target exams
ACEMFRCEMABEMFRCPCCCFPEMEBEEM
Red flags
- Heatstroke: core temperature above 40 °C with central nervous system dysfunction — cool immediately
- Do not give antipyretics, dantrolene or NSAIDs for heatstroke
- Classic heatstroke carries a mortality of 63.2 per cent under intensive care
Meet the patient
A 24-year-old runner collapses near the finish of a summer half-marathon. He is confused and combative, and his skin is hot. The medical tent has an ice-water tub ready.
References19ShowHide
- [3]Leon LR, Bouchama A Heat stroke Compr Physiol, 2015.PMID 25880507
- [4]Eifling KP, Gaudio FG, Dumke C, et al. Wilderness Medical Society Clinical Practice Guidelines for the Prevention and Treatment of Heat Illness: 2024 Update Wilderness Environ Med, 2024.PMID 38425235
- [5]Douma MJ, Aves T, Allan KS, et al. First aid cooling techniques for heat stroke and exertional hyperthermia: A systematic review and meta-analysis Resuscitation, 2020.PMID 31981710
- [6]Lipman GS, Gaudio FG, Eifling KP, et al. Wilderness Medical Society Clinical Practice Guidelines for the Prevention and Treatment of Heat Illness: 2019 Update Wilderness Environ Med, 2019.PMID 31221601
- [7]Bouchama A, Cafege A, Devol EB, et al. Ineffectiveness of dantrolene sodium in the treatment of heatstroke Crit Care Med, 1991.PMID 1989755
- [8]Luhring KE, Butts CL, Smith CR, et al. Cooling Effectiveness of a Modified Cold-Water Immersion Method After Exercise-Induced Hyperthermia J Athl Train, 2016.PMID 27874299
- [9]Bouchama A, Dehbi M, Chaves-Carballo E Cooling and hemodynamic management in heatstroke: practical recommendations. Crit Care, 2007.PMID 17498312
- [10]Casa DJ, DeMartini JK, Bergeron MF, et al. National Athletic Trainers' Association Position Statement: Exertional Heat Illnesses. J Athl Train, 2015.PMID 26381473
- [11]McDermott BP, Casa DJ, Ganio MS, et al. Acute whole-body cooling for exercise-induced hyperthermia: a systematic review. J Athl Train, 2009.PMID 19180223
- [12]McDermott BP, Casa DJ, O'Connor FG, et al. Cold-water dousing with ice massage to treat exertional heat stroke: a case series. Aviat Space Environ Med, 2009.PMID 19653575
- [13]DeGroot DW, Ruby B, Koo A, O'Connor FG Far from Home: Heat-Illness Prevention and Treatment in Austere Environments. Wilderness Environ Med, 2025.PMID 40262113
- [14]Casa DJ, McDermott BP, Lee EC, et al. Cold water immersion: the gold standard for exertional heatstroke treatment. Exerc Sport Sci Rev, 2007.PMID 17620933
- [15]Bouchama A, Abuyassin B, Lehe C, et al. Classic and exertional heatstroke. Nature reviews. Disease primers, 2022.PMID 35115565
- [16]O'Connor FG Heat-Related Illnesses. Annals of internal medicine, 2025.PMID 40569698
- [17]Perez RI, Londono MJ, Everitt B, et al. Exertional and classic heat stroke: A narrative review. The American journal of emergency medicine, 2026.PMID 41570493
- [18]Gauer R, Meyers BK Heat-Related Illnesses. American family physician, 2019.PMID 30990296
- [19]Garcia CK, Renteria LI, Leite-Santos G, et al. Exertional heat stroke: pathophysiology and risk factors. BMJ medicine, 2022.PMID 36936589
- [20]Adnan Bukhari H A Systematic Review on Outcomes of Patients with Heatstroke and Heat Exhaustion. Open access emergency medicine : OAEM, 2023.PMID 37771523
- [21]Demartini JK, Casa DJ, Stearns R, et al. Effectiveness of cold water immersion in the treatment of exertional heat stroke at the Falmouth Road Race. Medicine and science in sports and exercise, 2015.PMID 24983342