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Exertional heat stroke — MRCEM SBA MCQ

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HardToxicology and environmental emergenciesExertional heat strokeMRCEM SBA

A 29-year-old man is brought to the emergency department after collapsing during a race in hot weather. He is confused, with a rectal temperature of 41.1 °C, but is breathing adequately and maintaining his airway. Cold-water immersion is started. Twenty minutes later, his rectal temperature is 39.0 °C and he is fully orientated. Initial creatinine, creatine kinase, liver enzymes and coagulation results are within their reference ranges. What is the most appropriate management plan now?

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

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Correct answer: E — Stop immersion at 39.0 °C, then admit for serial blood tests.

His documented core temperature above 40 °C, confusion and collapse during strenuous exercise establish exertional heat stroke. Recovery of his mental status does not retrospectively make this heat exhaustion. Cold-water immersion has brought his rectal temperature to 39.0 °C; the cited UK NHS guidance advises stopping active cooling at this point to avoid overshoot hypothermia. It also advises monitoring for complications that may emerge after apparent recovery, including rhabdomyolysis, acute kidney injury, coagulopathy and liver injury. Normal first blood results therefore do not justify discharge. ([myconnect.swbh.nhs.uk](https://myconnect.swbh.nhs.uk/wp-content/uploads/2022/07/Heat-Stroke-Guidance.pdf)) A continues immersion beyond the advised endpoint. B gives excessive weight to reassuring early results and misses the need for ongoing monitoring. C treats the remaining hyperthermia as fever: antipyretics do not treat heat stroke. D confuses exertional heat stroke with malignant hyperthermia, for which dantrolene is used; the NHS guidance advises against dantrolene here. E combines the appropriate cooling endpoint with hospital monitoring and repeat investigations. ([myconnect.swbh.nhs.uk](https://myconnect.swbh.nhs.uk/wp-content/uploads/2022/07/Heat-Stroke-Guidance.pdf))

Reference: Heat Stroke Guidance (Undated; URL path dated July 2022) — https://myconnect.swbh.nhs.uk/wp-content/uploads/2022/07/Heat-Stroke-Guidance.pdf