SNOWMASS, COLO. — The top priority following diagnosis of heat stroke is to start rapid cooling of core body temperature—and American physicians have much to learn from their Saudi Arabian colleagues in this regard, Eric Johnson, M.D., said at the annual meeting of the Wilderness Medical Society.
Saudi physicians are arguably the world's most expert at treating heat stroke. After all, they get the most practice. Every year they manage vast numbers of patients felled by heat stroke on the pilgrimage to Mecca.
The Saudis do so in enormous field tents equipped with huge fans. Heat stroke victims are brought to the tents and suspended on netting stretchers while the fans blow a fine mist of 32° C water on them.
“They do an incredible job cooling these patients,” said Dr. Johnson, an emergency department physician in Boise, Idaho, and president-elect of the society.
In fact, he has been so impressed with the Saudi evaporative cooling technique that he has adopted it in the emergency departments in which he works. Dr. Johnson calls it the Mecca body cooling unit. It consists of a stretcher made of netting, a big fan, and a mister spraying body-temperature water. Alternatively, a naked patient can be sponged with lukewarm water while being fanned with room air.
The ice-bath immersion method provides faster cooling than Saudi-style evaporative cooling, but Dr. Johnson and his colleagues find it unmanageable in elderly heat stroke patients.
“From our point of view the immersion method is really difficult. It's fine in a young healthy person, but if you get a combative elderly person with heat stroke and you try to put them in the tank with all the leads and monitors and intravenous lines you need, good luck. We don't use that in our system,” he said.
Another cooling method is peritoneal lavage using lavage fluid at 6° C. This also achieves rapid cooling, but it is technically difficult in the elderly, who comprise the great majority of heat stroke victims.
“Most of these folks are going to be in critical condition and have disseminated intravascular coagulation, so peritoneal lavage becomes a real nightmare. We can control them fairly nicely by the mist method if their heat stroke is recognized early enough. The literature supports that,” Dr. Johnson said.
He routinely gives diazepam to prevent shivering while cooling. Alternatively, low-dose meperidine (Demerol) can be used. “Don't let these patients shiver. They'll generate a tremendous amount of heat. They'll beat you at your own game.”