Exertional heat stroke
The patient was placed in ice water within a mobile cooling pod (Polar Lifepod) Case Photo #1 for transport. His temperature was reduced from 109.1F to 104.7F by the time he arrived to the ED (timing was unclear). There, he was intubated and cooled with external ice packs and IV fluids, transferred to the ICU, and treated for severe rhabdomyolysis, pneumonia, and delirium. Extubation was on day 6 and hospital discharge on day 15. Outpatient follow up demonstrated continued improvement. Mild obstructive lung disease was newly diagnosed on the most recent PFT. Labs assessing genetic components of heat-borne illnesses were negative.
The patient redshirted his first year, during which he completed 3 heat tolerance tests. His final test at the Korey Stringer Institute included a heat tolerance test, VO2 max test, and a Tier 2 heat exposure trial, which showed excellent heat acclimatization. The Institute report gave him no restrictions for returning to play Division I football. The student-athlete is continuing to play at UVA.
Heat stroke is a life-threatening and time-sensitive medical emergency. Cooling mechanisms in the field tend to vary and largely depend on the availability of submersion resources as well as EMS proximity and time to definitive hospital care. Rapid external and internal cooling is the standard of care, and certain tools, such as mobile cooling pods, make continued external cooling while monitoring vitals and accessing IVs possible during transport. Given the rapid onset of symptoms and severity of illness, means to cool and athlete should be readily available as part of the emergency action plan for each program. Cooled IV fluids should be started immediately in addition to external cooling as adequate cooling within 30 minutes of symptom onset have been shown to have the best outcomes (1).
1. Gauer, R and Meyers, BK. Heat-Related Illnesses. American Family Physician, vol. 99, no. 8, 15 Apr. 2019, pp. 482-489.
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