Thermal Distress and Heat Injury - Heat stroke and Heat Syncope

Heat stroke is difficult to distinguish from heat exhaustion, because sweating may continue. Heat stroke represents thermoregulatory failure, with reduction in skin blood flow in order to maintain the central circulation. Core temperature is more elevated, usually 40 degrees Celcius or higher.

CNS symptoms predominate: unsteady gait, confusion, combative behavior, reduced consciousness, and coma , These s/s represent a medical emergency.

1)Move to a cool, shaded area. Lie down with feet elevated.
2)Loosen or remove clothing.
3)Begin cooling at once, if temperature is elevated. In the field, it may necessary to assume that temperature is elevated, as  taking a rectal temperature may not be feasible. Oral or axillary temperature is quite unreliable. Apply cool water, and fan to increase evaporation. Apply ice packs over major vessels in neck, axillae, groin. Cool to a rectal temperature of 39 degrees Celcius.
4)Re-hydrate, orally if conscious and not nauseated;
5)Evacuate to a medical facility if serious mental or neurologic defects occur. Manage as a medical emergency, with  monitoring of cardiac, neurologic, and renal function, and electrolyte balance.

Heat Syncope is syncope is related to heat exhaustion but can occur even without major sweat loss. It typically occurs after exercise - the person stops moving, blood pools in the lower extremities, and the person faints. It tends to occur in unacclimatized people at the beginning of summer. Heat syncope can occur secondarily to heat exhaustion or can occur independently.
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