This is a really important review. Thanks! While I know that you were specifically addressing environmental and exertional heat stroke I wanted to comment on the recommendation of using meperidine (Demerol) to reduce shivering. Often times in the ED these patients are undifferentiated and there may be other factors contributing to heat stroke such as serotonin syndrome or sympathomimetic toxicity. Meperidine has serotonin effects and causes serotonin syndrome (Libby Zion Case). My concern in giving meperidine to an undifferentiated hyperthermic patient is that you could actually worsen their hyperthermia. I tend to stick with benzos, barbs, intubation, propofol and neuromuscular blockade.
Awesome snack! Learned a pearl from one of our prior chiefs when traditional ice baths are not available. Instead grab a body bag and fill it up with ice. Continue the good work!
Shelly B. - July 16, 2018 1:12 PM
great episode! Thanks
Elizabeth M. - July 16, 2018 4:44 PM
This is a really important review. Thanks!
While I know that you were specifically addressing environmental and exertional heat stroke I wanted to comment on the recommendation of using meperidine (Demerol) to reduce shivering. Often times in the ED these patients are undifferentiated and there may be other factors contributing to heat stroke such as serotonin syndrome or sympathomimetic toxicity. Meperidine has serotonin effects and causes serotonin syndrome (Libby Zion Case). My concern in giving meperidine to an undifferentiated hyperthermic patient is that you could actually worsen their hyperthermia. I tend to stick with benzos, barbs, intubation, propofol and neuromuscular blockade.
Elissa Moore
EM and Med Tox
Thao D. - July 25, 2018 3:35 PM
Awesome snack! Learned a pearl from one of our prior chiefs when traditional ice baths are not available. Instead grab a body bag and fill it up with ice. Continue the good work!
Jordan I. - December 12, 2018 6:38 PM
FYI. I listed to this episode and had a young athlete come in with severe heat stroke 2 days later. This review was excellent.