Heat stroke — DTM&H MCQ

Correct answer: D — Immediate active cooling

A) Immediate active cooling is correct because this patient has heat stroke, defined by a core temperature above 40C with altered mental status (confusion) and hot, often dry skin, which is a medical emergency requiring immediate reduction in core temperature to prevent multi-organ failure and death. The priority in heat stroke is rapid physical cooling (cold water immersion, ice packs to neck, axillae and groin, evaporative cooling with fans and tepid water) started at the point of care, not after transfer or investigation. Delay increases the duration of cellular hyperthermia, driving rhabdomyolysis, coagulopathy, acute kidney injury and cerebral oedema, so cooling must begin within minutes of recognition, alongside airway protection and supportive care. Why the other options are wrong: B. Antipyretic monotherapy: Paracetamol and other antipyretics act on the hypothalamic set point in fever mediated by pyrogens; heat stroke is a failure of thermoregulation with a normal or absent pyrogenic drive, so antipyretics are ineffective and can add hepatic or renal stress in a patient already at risk of organ injury. C. Delayed cooling until blood tests: Waiting for laboratory results before cooling allows ongoing thermal cell injury; management is clinical and time critical, cooling must start immediately on diagnosis, with investigations run in parallel, not before treatment. A. Oral fluids after observation: A confused patient cannot safely swallow or protect their airway, risking aspiration, and oral rehydration does not address the core hyperthermia driving organ damage; this is heat stroke, not simple heat exhaustion where oral fluids might suffice. E. Empirical praziquantel: This treats schistosomiasis and has no role in an acute heat related emergency; there is nothing in the vignette suggesting helminthic disease, and it would not address the immediately life threatening hyperthermia. Key point: Confusion plus core temperature over 40C in a hot environment is heat stroke, and survival depends on cooling within minutes, not on drugs, fluids alone, or awaiting investigations.

Reference: NHS, Heat exhaustion and heatstroke, first aid and when to seek emergency help, nhs.uk/conditions/heat-exhaustion-heatstroke/ (accessed 2024)