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Exertional heat stroke — USMLE Step 3 MCQ

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HardEmergency MedicineExertional heat strokeUSMLE Step 3

A 22-year-old college student is brought to the emergency department during summer football practice. He is confused and combative. Temperature is 40.7 C, heart rate is 138/min, blood pressure is 96/58 mm Hg, and skin is hot. Sodium is 149 mEq/L and creatine kinase is 2400 U/L. Which of the following is the most appropriate next step in management?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: A — Begin rapid evaporative and ice-water cooling with supportive care

Exertional heat stroke requires immediate rapid cooling and resuscitation. Antipyretics are ineffective because the mechanism is failed heat dissipation rather than hypothalamic fever.

Reference: Emergency medicine heat illness guidance