injuries poisoning
Heatstroke
Diagnosis of Heatstroke
Clinical evaluation, including core temperature measurement Laboratory testing for organ dysfunction Diagnosis is usually clear from a history of exertion and environmental heat. Heatstroke is differentiated from heat exhaustion by presence of the following: CNS dysfunction Temperature>40° C When the diagnosis of heatstroke is not obvious, other disorders that can cause CNS dysfunction and hyperthermia should be considered. These disorders include the following: Acute infection (eg, sepsis, malaria, meningitis, toxic shock syndrome) Drugs Neuroleptic Malignant Syndrome None Serotonin Syndrome None Status epilepticus (interictal) Stroke Thyroid storm Laboratory testing includes complete blood count, prothrombin time, partial thromboplastin time, electrolytes, bloodureanitrogen, creatinine, calcium, creatine kinase (CK), and hepatic profile to evaluate organ function. A urethral catheter is placed to obtain urine, which is checked for occult blood by dipstick, and to monitor output. Tests to detect myoglobin are unnecessary. If a urine sample contains no red blood cells but has a positive reaction for blood and if serum CK is elevated, myoglobinuria is likely. A urine drug screen may be helpful. Continual monitoring of core temperature, usually by rectal, esophageal, or bladder probe, is desired. 