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Lesson

Heat Stroke vs Heat Exhaustion

12 min Medical Skip to quiz

Objective: Tell heat exhaustion apart from heat stroke. Start cooling on scene. Sweat does not rule out heat stroke. This is a time-critical emergency of the brain and other organs, not a patient who only needs water.

Why this matters

The scene may be football practice, a warehouse, or an apartment with no air conditioning. Do not delay cooling to get a perfect temperature or to start an IV. Heat stroke is a clinical diagnosis. The patient is hot, and the brain is not working normally. Cooling is the treatment. Delay injures the brain and the liver. Sweat does not rule it out.

Verbalize
  • If they are altered and the environment or the skin is hot, treat it as heat stroke until a better story fits.
  • Cool now with what you have. Do not wait for a tub.
  • Sweat can still be present. Do not require dry skin.
  • Still check the sugar. Think about overdose, sepsis, and toxins. Do not skip cooling while you look.

Clinical sequence

  1. If they are altered and hot from the environment or the skin, call it heat stroke and start cooling. Do not wait for a perfect core temperature.
  2. Remove extra clothing. Use ice-water towels, mist, and a fan. If this is exertional heat stroke and a trained team has an ice-water tub, put them in it.
  3. Check the sugar. Protect the airway. Treat seizures per protocol. Do not require dry skin.
  4. Go to an emergency department that can keep cooling. Do not send them back to practice because they woke up.

Exhaustion vs Stroke

  • Heat exhaustion is dizziness, nausea, headache, a fast heart rate, and thirst or low fluid. Thinking is largely intact. Move them to shade, remove extra clothing, and give oral fluid if they can protect the airway. Keep watching. Do not send them back to work while they are still hot.
  • Heat stroke is the same setting plus a brain that is not working: confusion, seizure, coma, or combativeness. Core temperature is often 40 °C or higher when you can measure it. Do not withhold cooling because an ear thermometer reads “only” 39.
  • Exertional heat stroke is the athlete or the laborer. Classic heat stroke is the older adult, the person on an anticholinergic drug, or the apartment with no air conditioning. An anticholinergic drug can block sweating. Both kinds can kill. Classic patients may look dry. Exertional patients often still sweat.

Cooling That Matters

  • Cool now. Do not delay for an IV or a better core temperature. Most 911 heat stroke is classic: an older adult without air conditioning. You rarely have a tub. Remove clothing. Use ice-water towels or sheets. Mist and fan immediately.
  • Ice-water immersion is preferred for exertional heat stroke when a trained team has a tub. That is a stadium or wilderness setup. It is not the default apartment call.
  • Acetaminophen and ibuprofen do not treat heat stroke. Support the airway, check the sugar, and treat seizures. See the seizure lesson. A benzodiazepine for shivering or a seizure follows your protocol. It does not replace cooling.
  • Give IV fluid for shock, or for the risk of rhabdomyolysis, per protocol. Rhabdomyolysis is muscle breakdown. Do not start a vasopressor, a drug that raises blood pressure by squeezing vessels, in an uncooled patient as the first move. Cool while you package. Do not wait for a hospital shower.

Common errors

  • Requiring dry skin before you call it heat stroke.
  • Skipping cooling because the hospital is 8 minutes away.
  • Calling a hot, combative patient psychiatric and not cooling them.

Practice

One-minute check

August. A football player collapses. The GCS is 10, and he is still sweating. Say whether this is heat stroke. Name the first cooling method you actually have on a typical ambulance, and how that differs from a stadium ice tub.

Related: AMS Framework, Seizure, Sepsis.

Sources & Further Study

Named guidelines for further study. They are not clinical orders and do not replace your protocol or medical direction.

Education only. Apply learning within your protocols and medical direction. This is not clinical care guidance.

Check Your Understanding

Questions drawn only from this lesson. After you check, the key is highlighted. Education practice — not a certification exam.

1. Heat stroke in the field is framed as:
2. Preferred cooling for exertional heat stroke when you have the gear:
3. A combative, hot warehouse worker is most dangerously mislabeled as:
4. Heat exhaustion (mentation largely intact) still gets:
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