Hello. Iâm looking for help writing a whumpfic centered around heatstroke/exhaustion. Plenty of health websites describe the differences and offer first aid suggestions, but struggling to find how it would be treated at the ER beyond active cooling and fluids. I gather theyâd run lab work to check for things but Iâm not sure what sort of resource to use for this info. Thanks in advance!
Active cooling and fluids help stop the damage from occurring, but you could have them do bloodwork to determine the extent of the damage that has been done and determine what other interventions are necessary to help the patient.
Generally heat exhaustion does not result in an increase of the person's temperature, so it's not going to do any damage. The person might become a little more heat sensitive for a while, but heat exhaustion can generally be treated with fluids and passive cooling (sitting in the shade or going to a place with air conditioning and resting for a while, without having to go to the hospital). Meanwhile, heat stroke is a life-threatening emergency requiring immediate and fairly aggressive cooling.
Humans are much better at making heat than they are getting rid of it. Heat stroke involves environmental or exertional conditions that overwhelm the body's ability to reduce it's own temperature. This results in very high core temperatures very quickly. If it's not treated within a half hour or so, it can result in rhabdomyolysis (the breakdown of muscle tissue), kidney damage, liver damage, and brain damage resulting in ICU stays, long-term disability, or even death. Even short bouts with heat stroke (less than a half hour) can result in long-term heat intolerance.
Initial treatment would involve some IV fluids, the insertion of a foley (urinary) catheter for the monitoring of urine output as well as core temperature, and active cooling. Active cooling involves cooling blankets (basically pads the patient lays on with tubing through which cold water is continuously pumped), ice packs, and damp sheets and fans for evaporative cooling. If the patient is shivering from the sudden onslaught of cold, they may be given muscle-relaxing medications to prevent the body from overcoming the cooling measures. These interventions are designed to reduce the patient's core temperature quickly to about 39*C, which stops the damage done by extremely high temperatures.
The lab work (blood, urine, and sometimes cerebrospinal fluid gathered by lumbar puncture) would focus on checking for damage that has actually been done. It measures the amount of myoglobin in the blood (a protein found after muscle breakdown), waste product buildup that would indicate damage to kidneys, liver enzyme levels that indicate damage to the liver, and changes in electrolyte levels (high or low) that could cause heart arrhythmias (bad heart rhythms) so they could be corrected quickly.
Medications (fluids, mannitol) can be given to prevent the kidneys from clogging with myoglobin from muscle breakdown. Additionally, hypoglycemia is common in heat stroke for some reason and D50 (a strong IV sugar solution) is given to correct this as well as life-threatening potassium abnormalities. Fever-reducing medications have no effect, and may also make liver and kidney damage worse if given.
Assuming no major problems were found, the person would probably stay at the hospital for observation for 48 hours for repeated bloodwork and monitoring (they are looking for seizure activity and heart irregularities/arrythmias related to the electrolyte abnormalities).
Long-term problems (more common if the heat stroke went untreated for a long time) would be dealt with later by an outpatient physician. These include poor heat tolerance, cerebellar movement disorders (balance problems, certain tremors), dementia, personality changes, persistent liver or kidney damage (requiring medications or dialysis), and/or partial paralysis.