Exertional heat illness in adolescents and adults: Management and prevention
- Francis G O'Connor, MD, MPH, FACSM
Francis G O'Connor, MD, MPH, FACSM
- Section Editor — Sports-Related Injuries; Symptom Assessment and Physical Examination; Medical Issues Related to Sports and Exercise
- Professor of Military and Emergency Medicine
- Uniformed Services University of the Health Sciences
- Douglas J Casa, PhD, ATC, FNAK, FACSM, FNATA
Douglas J Casa, PhD, ATC, FNAK, FACSM, FNATA
- Chief Executive Officer, Korey Stringer Institute
- Professor, Department of Kinesiology
- College of Agriculture, Health and Natural Resources, University of Connecticut
- Section Editors
- Daniel F Danzl, MD
Daniel F Danzl, MD
- Section Editor — Environmental Emergencies
- Professor of Emergency Medicine
- University of Louisville School of Medicine
- Karl B Fields, MD
Karl B Fields, MD
- Editor-in-Chief — Primary Care Sports Medicine (Adolescents and Adults)
- Section Editor — Biomechanics, Rehabilitation, and Recovery; Sports-Related Injuries; Symptom Assessment and Physical Examination
- Professor of Family Medicine and Sports Medicine
- University of North Carolina at Chapel Hill
- Deputy Editor
- Jonathan Grayzel, MD, FAAEM
Jonathan Grayzel, MD, FAAEM
- Senior Deputy Editor — UpToDate
- Deputy Editor — Adult and Pediatric Emergency Medicine
- Deputy Editor — Primary Care Sports Medicine (Adolescents and Adults)
- Assistant Professor of Emergency Medicine
- University of Massachusetts Medical School
Exertional heat illness (EHI) is among the leading causes of death in young athletes each year [1,2]. A report by the United States Centers for Disease Control (CDC) found that EHI occurs both during practice and competition and noted a disturbing trend of increasing incidence ; despite prevention efforts exertional heat stroke in the military continues to climb . Clinicians who care for athletes, both young and old, and for others who exert themselves in the heat (eg, firefighters, soldiers, construction workers) need to be aware of the basic physiologic principles of thermoregulation, the spectrum of heat illness, strategies for prevention and treatment, and current guidelines for determining safe return to play or work.
The management and prevention of exertional heat illness are reviewed here. Thermoregulation and the clinical presentation and diagnosis of exertional heat illness are discussed separately, as are exercise-associated hyponatremia, nonexertional heat stroke, malignant hyperthermia, and heat illness in children. (See "Exertional heat illness in adolescents and adults: Epidemiology, thermoregulation, risk factors, and diagnosis" and "Exercise-associated hyponatremia" and "Severe nonexertional hyperthermia (classic heat stroke) in adults" and "Malignant hyperthermia: Clinical diagnosis and management of acute crisis" and "Neuroleptic malignant syndrome" and "Heat stroke in children" and "Heat illness (other than heat stroke) in children".)
Two critical observations inform the management of exertional heat stroke (EHS) and all types of severe heat illness [5-7]:
●The severity of a heat illness may not be apparent during the initial presentation.
●Morbidity and mortality are directly related to the duration of core temperature elevation.
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- GUIDING PRINCIPLES
- MANAGEMENT OF EXERTIONAL HEAT STROKE
- - Initial assessment
- - Cooling measures
- - Measuring temperature
- Clinical assessment at the hospital
- Laboratory and radiographic assessment
- Supportive therapy
- Pharmacologic therapy
- Disposition and admission criteria
- MANAGEMENT OF OTHER TYPES OF EXERTIONAL HEAT ILLNESS
- "Heat cramps"
- - Treatment
- - Prevention
- Heat syncope and exercise associated collapse
- Heat exhaustion
- Heat injury
- DETERMINING RETURN TO PLAY
- HEAT TOLERANCE TESTING
- PREVENTION OF EXERTIONAL HEAT ILLNESS
- COMMON MISCONCEPTIONS
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS