This case comes from Dr. Jared Baylis and Dr. Kelly Huang
Dr. Baylis is the Simulation Medical Director at University of British Columbia – Southern Medical Program and Interior Health, as well as an editor of EM Sim Cases. Dr. Huang a PGY5 Emergency Medicine resident at University of British Columbia and is currently completing a simulation fellowship and area of concentrated expertise through Interior Health and UBC.
WHY IT MATTERS
Heated related illness is a common ailment during the hot summer months. Especially with climate change, certain areas in North America have been seeing record breaking cases of heat related illness. It is critical to recognize both exertional and classic heatstroke, as they have different presentations and affect different populations. Depending on your institution’s capabilities, different therapies can be offered for heat related illness.
CLINICAL VIGNETTE
58 y/o M presents with hyperthermia and confusion, and was found by bystanders to be acting strange. The patient’s wife was contacted after identifying the patient and stated that he had some alcohol before going out for a run on a hot summer day.
CASE SUMMARY
In this case of exertional heatstroke, the team must identify hyperthermia and actively cool the patient while working the patient up for other causes. Ultimately, the patient will require admission to hospital for ongoing treatment.
ECG
Curtesy of Life in the Fast Lane, ECG Library for sinus tachycardia. Link can be found here.
EM Sim Cases 
Thanks for the case! I was going to adapt it for my hospital’s sim program. I did want to ask about the labs, specifically the normal AST/ALT. The usual teaching about heat stroke is that the liver is very sensitive to thermal damage, and elevations of transaminases into the hundreds or low thousands is almost universal in heat stroke, to the degree that normal transaminases should prompt further searching for other causes of altered LoC.
Was this intentional on your part? Or am I mistaken?
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Hi David,
Thanks for the comment! The reason why the LFTs are normal is because this is exertional heat stroke from exercise, which normally would have less deranged bloodwork and have a lower mortality rate. Not impossible of course. It is also relatively a short time frame since the patient’s temperature has been elevated so the LFTs may not have had time to elevate yet, you’ll note that he has kidney dysfunction and electrolyte imbalances already because those typically happen faster than liver injury. If you do want to make the diagnosis more obvious, you can certainly change the LFTs to be elevated. Hope that helps.
Kelly
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