Heat Stroke

Clinical scenario: A 19 year-old female is suffering from heat exhaustion.

Clinical question: What is the most effective and most practical way for cooling the patient?

Summary of key evidence: Cool water immersion baths are the most commonly used modalities for treating heat stroke and heat exhaustion. No fatalities have been recorded while a patient has been treated with a cool water immersion modality (McDermott, et al). In some situations, a cool water immersion modality is impractical due to the location of the patient and other cooling modalities should be applied before the patient should be moved to a certified athletic trainer’s clinic for a cool water immersion whirlpool.

Clinical bottom line: Moving a patient suffering from any

Summary of Search

A Boolean search of “cooling techniques AND heat exhaustion” on the online PubMed database returned 36 research articles. While looking at McDermott, et al’s systematic review of whole-body cooling, another interesting article was suggested in PubMed’s “Related citations in PubMed” list. This second piece of literature is an analysis of cooling techniques by Smith.

Clinical Bottom Line

There is solid evidence that ice water immersions are the most effective for lowering a patient’s rectal temperature efficiently. However, ice water immersions are not immediately available and other cooling methods should be used to lower the patient’s temperature. Randomized control trials cannot be created to test which cooling technique is most effective due to ethical considerations.

Search Strategy

Patient: high school and college aged patients

Intervention: cool/ice water immersion

Comparison: other cooling techniques

Outcome: the efficiency of how fast the patient’s body temperature lowered to a normal

In fact, ice water immersion has been tested to show that it can cool a patient suffering from heat exhaustion by 0.35OC per minute (McDermott, et al). However, some patients are too far away from this form of treatment method or there is no ice water bath available. In these cases it is very important to understand how to treat a patient without an ice water immersion modality. Possibly the best cooling technique for situations without ice water immersions is using wet towels (also referred to as ice towels) to help cool the patient. Wet towels are prepared by putting towels in a cooler of ice water. In a study, runners suffering from heat exhaustion were treated with wet towels and were found to have their bodies cooled at a rate of 0.11OC per minute (McDermott, et al). Clearly there is a dramatic drop off in the cooling rate between the ice water immersion modality compared to the wet towel technique. However, it is important to lower the patient’s body temperature immediately before moving the patient, making wet towels effective because they can be applied immediately (McDermott, et