Key messages

• Discontinue exposure to heat source.

• Use cooling methods, including shade, evaporative fanning (Mecca Body Cooling Unit, helicopters, open-air ambulance), air conditioning, ice bags, and cold intravenous infusions.

• Monitor clinical features including pulse rate, level of consciousness, and subjective sensation of coolness. If consciousness returns and shivering develops, cooling should probably be discontinued regardless of rectal temperature measurements. Vasoconstriction should be avoided.

• Maintain basic life support of airway, oxygenation, ventilation, intravenous fluids, and transfusion if necessary.

• Monitor fluid balance, electrolytes, hepatic enzymes, urine, blood gases, and lactate frequently, since initially patients may present in shock, repiratory alkalosis, metabolic acidosis, hypo- or hyperkalemia, and hyponatremia. Some degree of acidosis may be beneficial owing to a shift in the oxyhemoglobin curve. Fluid replacement must be assessed on an individual basis.

• Treat multisystem injuries on an individual basis.

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