An 82-year-old man is brought in by ambulance during a summer heat wave unresponsive with a rectal temperature of 41°C and dry skin. He lives alone in a trailer without air conditioning. No medications were found by emergency medical services (EMS) on the scene. Which of the following is the most appropriate initial management?
Cooling to body temperature of 37°C by immersion bath
CT scan of brain, serum and urine toxicological screens, and cooling blanket
Evaporative cooling and fluid resuscitation
Rectal acetaminophen, blood cultures, and broad-spectrum antibiotics
Thyroid function tests and administration of dantrolene sodium
The likely diagnosis is heat stroke. CT scan of the brain, toxicological screens, endocrine evaluation, and search for infection may be important in this patient to rule out other causes of hyperthermia. However, the initial goal is rapid cooling and fluid resuscitation with normal saline. The goal temperature should be 39°C to avoid overshoot hypothermia, and is best accomplished by evaporative cooling. Immersion cooling makes patient airway management and cardiac monitoring difficult and is not advised. Cooling blankets work too slowly for a patient with heat stroke. Ice packs to groin, neck, and axilla may be useful adjunctive cooling measures. Acetaminophen and dantrolene have no role in treatment of heat stroke.