Exertional heat stroke: a rapidly progressive pre-hospital presentation

On a day when outdoor temperatures reached 30 °C, the ambulance service responded to a 19-year-old male who had collapsed in the late afternoon. His first day of employment for a local building company had been spent working outside on the roof of a residential property. He had applied sun cream and hydrated often. His work colleagues were emphatic that he’d been well all day but within 10 minutes he had become disorientated, vomited and collapsed.

An ambulance crew and paramedic single responder arrived 10 minutes after the 999 call was made. The patient was found collapsed on the driveway and a work colleague was holding an electric fan over him. Primary survey revealed a partially occluded airway from neck flexion and vomit, tachypnoea and a weak radial pulse at 170. The patient had no motor response and remained flaccid. Additionally he felt hot.

Initial management involved a head tilt, mechanical suction, oral pharyngeal airway, high concentration oxygen and the removal of the patient’s clothing. He was placed on a stretcher and removed to the air-conditioned ambulance. An IV was placed and monitoring attached. Further observations were noted: SP02 90 %, blood pressure BP 96/79, narrow complex tachycardia (Lead II), tympanic temperature above 42.2 °C and BM 9.7 mmols.