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ICU TopicsEnvironmental emergencies

ICU · Environmental emergencies

Heat Stroke & Heat Illness

Also known as Heat stroke · Heat exhaustion · Heat illness · Exertional heat stroke · Classic heat stroke · Hyperthermia · Rapid cooling

The heat stroke — the core temperature above 40 degrees C with the CNS dysfunction (the confusion, the seizure, the coma). The two types (the classic — the elderly, the drugs; the exertional — the young, the athletes). The thermoregulatory failure → the multi-organ (the CNS, the cardiac, the liver, the renal, the DIC). The RAPID cooling (the priority — the ice-water immersion the fastest; the evaporative the practical). The NOT the antipyretics (the central set-point normal). The benzodiazepine for the shivering. classic mortality high (the 58 per cent the 28-day in the largest the cohort).

medium17 referencesUpdated 26 July 202629 min readVerification in progress

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The one-line answer

Heat stroke is core temperature above 40 °C with CNS dysfunction — the two findings that separate it from heat exhaustion. Two faces share one endpoint: classic (elderly, polypharmacy, heatwave, dry skin) and exertional (young, fit, sweaty, rhabdomyolysis). The only treatment that moves mortality is rapid physical cooling to under 39 °C — antipyretics and dantrolene do not work, because the hypothalamic set-point is normal, not raised.[1]

Meet the patient

A 22-year-old military recruit collapses 8 km into a timed pack march on a humid day. In the medical tent his rectal temperature is 41.8 °C, he is confused and combative, heart rate 150, and his skin is hot and dripping with sweat.[5]

Two traps are planted in that single sentence, and both are favourite exam fodder: sweating does not exclude heat stroke, and you cool him now, in the tub, before you move him anywhere. Hold those two and the rest of the topic is footnotes.[5]

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References17ShowHide
  1. [1]Barletta JF, Palmieri TL, Toomey SA, et al. Management of Heat-Related Illness and Injury in the ICU: A Concise Definitive Review Crit Care Med, 2024.PMID 38240487
  2. [2]O'Connor FG Heat-Related Illnesses Ann Intern Med, 2025.PMID 40569698
  3. [3]Bouchama A, Knochel JP Heat stroke N Engl J Med, 2002.PMID 12075060
  4. [4]Epstein Y, Yanovich R Heatstroke N Engl J Med, 2019.PMID 31216400
  5. [5]Casa DJ, et al. National Athletic Trainers' Association Position Statement: Exertional Heat Illnesses J Athl Train, 2015.PMID 26381473
  6. [6]Argaud L, et al. Short- and long-term outcomes of heatstroke following the 2003 heat wave in Lyon, France Arch Intern Med, 2007.PMID 17698677
  7. [7]Leon LR, Bouchama A Heat stroke Compr Physiol, 2015.PMID 25880507
  8. [8]Gaudio FG, Grissom CK Cooling Methods in Heat Stroke J Emerg Med, 2016.PMID 26525947
  9. [9]Flouris AD, Friesen BJ, Carlson MJ, et al. Effectiveness of cold water immersion for treating exertional heat stress when immediate response is not possible Scand J Med Sci Sports, 2015.PMID 25943674
  10. [10]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
  11. [11]Bouchama A, Cafege A, Devol EB, et al. Ineffectiveness of dantrolene sodium in the treatment of heatstroke Crit Care Med, 1991.PMID 1989755
  12. [12]Smith JE Cooling methods used in the treatment of exertional heat illness Br J Sports Med, 2005.PMID 16046331
  13. [13]Long B, Koyfman A, Gottlieb M An evidence-based narrative review of the emergency department evaluation and management of rhabdomyolysis Am J Emerg Med, 2019.PMID 30630682
  14. [14]Scharman EJ, Troutman WG Prevention of kidney injury following rhabdomyolysis: a systematic review Ann Pharmacother, 2013.PMID 23324509
  15. [15]Bernard S, Buist M, Monteiro O, et al. Induced hypothermia using large volume, ice-cold intravenous fluid in comatose survivors of out-of-hospital cardiac arrest: a preliminary report Resuscitation, 2003.PMID 12505732
  16. [16]Wasserman DD, Kathard R, Healy M Cooling Techniques for Hyperthermia StatPearls, 2026.PMID 29083764
  17. [17]Brower RG, Matthay MA, Morris A, et al. Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome N Engl J Med, 2000.PMID 10793162

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