May resume full competition after participating in full training in heat Management for 2-4 wks w/o adverse effects. NEVER clear an athlete to return to play from ABCs – intubation, O2, and fluids as necessary the ED- have them followup with another provider as an outpatient. Monitoring Vitals – frequently, rectal/esophageal probe for temp. Contact: , @embasic Fluid status/renal function – Foley catheter Other – cardiac monitor, continuous pulse oximetry Cooling (stop when Temp. 38-39°C = 100.4-102.2°F) Ice water immersion (exertional, avoid in elderly/classic heat stroke) Place pt. in tub with 2-15°C (35-60°F) cold water Keep water cool during process and frequently stir Evaporative cooling (classic or exertional) Removal all of pt.’s clothes and spray pt. with lukewarm water Position fan towards pt. to blow air over skin and evaporate water Water Ice Therapy (alternative to immersion) Place patient on a porous stretcher and position over tub of ice water Ice water taken from bath and continuously poured on patient ↑ skin vasodilation Ice packs to massage major muscle groups and If no tub available, can place a few sheets under pt., cover pt. completely with ice, then wrap him/her with a sheet Ice packs (if ice water techniques or evaporative cooling not possible) Apply to pt.’s neck, groin, and axillae Cold fluid thoracic and peritoneal lavage (last resort) Invasive, should never be used in pregnant pt or those with prior abdominal surgery Adjunctive cooling measures Cooled O2, cooling blankets, IV fluids cooled to 22°C (71.6°F) Disposition Healthy atheletes – if recover rapidly w/cooling and have no complications – d/c after period of observation Multiorgan dysfunction – admit to ICU All others – admit for observation and monitoring Returning an athlete to play- General Advice Avoid significant physical exertion until complete recovery and all blood tests WNL Gradual reintroduction of physical activity
Management ABCs – intubation, O2, and fluids as necessary Monitoring Vitals – frequently, rectal/esophageal probe for temp. Fluid status/renal function – Foley catheter Other – cardiac monitor, continuous pulse oximetry Cooling (stop when Temp. 38-39°C = 100.4-102.2°F) Ice water immersion (exertional, avoid in elderly/classic heat stroke) Place pt. in tub with 2-15°C (35-60°F) cold water Keep water cool during process and frequently stir Evaporative cooling (classic or exertional) Removal all of pt.’s clothes and spray pt. with lukewarm water Position fan towards pt. to blow air over skin and evaporate water Water Ice Therapy (alternative to immersion) Place patient on a porous stretcher and position over tub of ice water Ice water taken from bath and continuously poured on patient Ice packs to massage major muscle groups and ↑ skin vasodilation If no tub available, can place a few sheets under pt., cover pt. completely with ice, then wrap him/her with a sheet Ice packs (if ice water techniques or evaporative cooling not possible) Apply to pt.’s neck, groin, and axillae Cold fluid thoracic and peritoneal lavage (last resort) Invasive, should never be used in pregnant pt or those with prior abdominal surgery Adjunctive cooling measures Cooled O2, cooling blankets, IV fluids cooled to 22°C (71.6°F) Disposition Healthy atheletes – if recover rapidly w/cooling and have no complications – d/c after period of observation Multiorgan dysfunction – admit to ICU All others – admit for observation and monitoring Returning an athlete to play- General Advice Avoid significant physical exertion until complete recovery and all blood tests WNL Gradual reintroduction of physical activity May resume full competition after participating in full training in heat for 2-4 wks w/o adverse effects. NEVER clear an athlete to return to play from the ED- have them followup with another provider as an outpatient. Contact: , @embasic