cooling down the heat stroke victim

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Oded,

The following is the text from a chapter I wrote for "Advanced Disaster Medical Response: Manual for Providers", edited by Susan Briggs, MD, MPH, FACS, and published in 2003.  I hope this helps.

Ron

Heat Stroke
Heat stroke is a LIFE-THREATENING multisystem disorder reflecting manifested by collapse of the thermoregulatory system, acid-base and electrolyte abnormalities, acute renal and hepatic failure, muscle necrosis, and CNS disturbances. Heat stroke is a medical emergency * mortality can reach 75% if left untreated. Long-term survival is directly related to the rapidity of resuscitative measures.  Cooling should be immediately initiated and continued until the core temperature is below 102°F. The degree of organ damage appears to be related to the magnitude and duration of elevated core temperature. Patients who cool slowly tend to have more serious illness.
Treatment of Heat Stroke 
Initiate ABC’s while cooling efforts are initiated:
§	Move casualty from heat
§	Remove victim’s clothing
§	Initial IV bolus of 1 liter of Ringer’s Lactate or Normal Saline without supplemental potassium
§	Continued IV hydration until normotensive, mental status is normal, and urine output is >30cc/hour
§	Monitor temperature using rectal thermometer if available. Do not attempt to take an oral temperature in a confused or combative person.
§	Immediate seizure control with IV diazepam (5-10mg)
Rapid cooling is mandatory:
§	Ice water immersion or evaporative cooling is most effective.
§	Ice water immersion is most efficient - twice as fast as evaporative spray method, but difficult with obtunded casualty.
§	Cool water is more comfortable.
§	Do NOT use alcohol baths or antipyretics.


>>> "oded private" <tangentcarrot at hotmail.com> 12/23/2006 9:07 AM >>>
Hello list

Another question
I was taought that heat stroke victims should be cooled, in the pre hospital 
and by the nfirst responder, using room temprature water. The logic was that 
cold water or ice will cause vasoconstrtiction, thus limiting radiative and 
eveparotive heat loss by the patient.
However, I keep on finding refrences stating the other way- that cooling 
should be done with cold water and even ice packs.
What do you say?

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