Heat Cramps – Generally occurring in athletes or those undergoing physical exertion in a hot environment, heat cramps are muscle spasms that mostly occur in the abdomen or extremities. Treatment for Heat Cramps includes general medical care, removing the person from the hot environment, providing oral fluid replacement, and cooling them gently. Heat Stroke – This is a true medical emergency and aggressive treatment is warranted. Treatment for Heat Stroke includes aggressive cooling with ice packs, evaporative cooling, and IV fluids.
Patient information: See related handout on heatstroke, written by the author of this article. Heat-stroke: its clinical and pathological presentation, with particular attention to the liver. Hypothermia An abnormal body temperature below 95 F, occurring when the amount of heat gained is less than the amount of heat given off.
Hyperthermia Abnormal elevation of body temperature, occurring when the amount of heat gained is greater than the amount of heat given off.
Heat Cramps Painful contractions of the larger muscle groups of the body, usually calves and thighs, during or shortly after strenuous exercise. Make sure that your fellow EMS people are staying cool on incident scenes, especially when they may be wearing turnouts or other protective gear. This can result from extrinsic factors that make heat dissipation less efficient, such as extremes of temperature, physical effort, and environmental conditions.
Heat exhaustion typically is associated with nonspecific signs and symptoms and mild pyrexia (Table 2).4,9,18,19 Patients may experience nausea and malaise, and show signs of circulatory collapse. The diagnosis of heatstroke rests on two critical factors: hyperthermia and central nervous system dysfunction. Unless the factors leading to heat exhaustion are corrected swiftly, affected patients can progress to heatstroke.
Because a heat injury releases an inflammatory cascade that may increase risk on subsequent days, patients should be protected from exposure to heat for 24 to 48 hours following a mild injury.Two indices are available to aid physicians in evaluating heat danger.

Recent research has identified a cascade of inflammatory pathologic events that begins with mild heat exhaustion and, if uninterrupted, can lead eventually to multiorgan failure and death. Classic heatstroke is caused by environmental exposure and results in core hyperthermia above 40°C (104°F).
Evidence of central nervous system dysfunction should trigger a diagnosis of heatstroke rather than heat exhaustion.
Heat-stroke is a medical emergency, and mortality can approach 10 percent.3 It is essential that clinicians recognize the signs of heatstroke and initiate cooling rapidly. In emergency care, heat emergencies are generally classified into three levels in terms of severity.
It is becoming shown that patients that suffer near-fatal cases of heat stroke have a strikingly high 1 year mortality rate. Heat exhaustion is characterized by nonspecific symptoms such as malaise, headache, and nausea. When appropriate treatment is provided without delay, survival can approach 100 percent.22Initial evaluation of a patient with suspected heatstroke should include an assessment of the airway, breathing, and circulation. Gone are the days of frostbite and hypothermia and here are the days of heat stroke and bee stings. Classic heatstroke can develop slowly over several days and can present with minimally elevated core temperatures. Untreated heat exhaustion can progress to heatstroke, a much more serious illness involving central nervous system dysfunction such as delirium and coma. These manifestations are thought to be an encephalopathic response to a systemic inflammatory cascade.4Exertional heatstroke is a condition primarily affecting younger, active persons. Physicians also must monitor electrolyte abnormalities, be alert to signs of renal or hepatic failure, and replace fluids in patients with heatstroke.
Symptoms of heat exhaustion are milder than those of heatstroke, and include dizziness, thirst, weakness, headache, and malaise.
It is essential that physicians recognize the signs of hyponatremic heat exhaustion and avoid administering hypotonic fluids (as regards sweat).

Patients with heat exhaustion lack the profound central nervous system derangement found in those with heatstroke. Programs involving identification of vulnerable individuals, dissemination of information about dangerous heat waves, and use of heat shelters may help prevent heat-related illness.
These preventive measures, when paired with astute recognition of the early signs of heat-related illness, can allow physicians in the ambulatory setting to avert much of the morbidity and mortality associated with heat exhaustion and heatstroke.
Illicit drug use and medical comorbidities place patients at increased risk of heat-related illness. Slower recovery should initiate transfer to a medical facility and a careful search for missed diagnoses.10HEATSTROKEPrompt reversal of hyperthermia is the cornerstone of heatstroke treatment.
Patients who present with suspected heatstroke in a community environment should be stabilized in a cool, shady area and transferred to a care facility as soon as heatstroke becomes primary in the differential diagnosis (Figure 1). Signs of central nervous system dysfunction such as irritability, ataxia, and confusion are essential to the diagnosis of heatstroke.
Immediate initiation of rapid and effective cooling is crucial in a patient with heatstroke.24 If feasible, cooling should be initiated while the patient is awaiting transport. Heat-related illnesses are largely preventable, and physicians can do a great deal to ensure the safety of their patients during the hot summer months. Patients may present to their primary care physician with heat exhaustion, and chronic diseases may contribute to heat-related illness.
Cardiopulmonary bypass also is a rare but effective cooling method.Medications have shown little efficacy in treating heatstroke.

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