Exertional heat stroke — DTM&H MCQ

Correct answer: A — Immediate rapid cooling with supportive ABC management

The correct answer is A, immediate rapid cooling with supportive ABC management. This man has classic heat stroke: core temperature over 40C with hot skin and altered mental status after exertion in extreme ambient heat, a life threatening emergency in which the degree and duration of hyperthermia drive mortality through cerebral oedema, rhabdomyolysis and multi organ failure. UK emergency practice, as taught in RCEM resources, mandates active cooling (tepid water spray with fanning, or immersion) started immediately alongside airway, breathing and circulation support, targeting a core temperature of 38.5C to avoid overshoot hypothermia. This is not hypothalamic fever, so antipyretics are ineffective; any delay for other measures worsens outcome. Why the other options are wrong: A, Oral paracetamol and rest in the sun: paracetamol acts on the hypothalamic set point in fever and has no effect on environmental hyperthermia, and continued sun exposure raises core temperature further, delaying essential cooling. B, Fluid restriction until temperature normalises: heat stroke patients are volume depleted from sweating and need prompt, monitored fluid resuscitation within ABC management, since inadequate circulating volume worsens shock and acute kidney injury. D, High-dose corticosteroids: no evidence supports steroids reducing hyperthermia or improving outcome in heat stroke; they do not address the heat load and can worsen catabolic or infective complications. E, Antibiotics before cooling: there is no indication of sepsis here, and even where infection is suspected, cooling must never be delayed for antimicrobial workup because duration of hyperthermia is the key determinant of mortality. Key point: In heat stroke, immediate active cooling started simultaneously with ABC resuscitation, targeting 38.5C, takes absolute priority over every other intervention because outcome correlates directly with duration of hyperthermia.

Reference: Royal College of Emergency Medicine (RCEMLearning), Heat Stroke and Heat Exhaustion: Management, https://www.rcemlearning.co.uk/modules/heat-stroke-and-heat-exhaustion/lessons/management-15/