Your family joins your son’s best friend’s family on a camping trip and to do some river rafting. On the day of the river rafting, it is over 100 degrees with a heat index of 112. When your group pulls out of the river for lunch, they do so at a river bar and restaurant popular with rafters. Your child approaches you and states that his friend is really acting strange, not making sense. You go to investigate and find him with his parents. He does not seem to recognize them. He is hot to touch. No cough, no congestion. His face is erythematous.
After taking a brief history from the parents, you find that he has not been sick other than significant allergies starting last week, for which he is taking diphenhydramine. He takes methylphenidate for ADHD and recently started on sertraline.
Which of the following is the next best management step?
Correct!
Wrong!
EXPLANATION
Correct Answer: D. Immediate ice bath on site
The patient has a set-up for hyperthermia with a high ambient temperature and humidity with anticholinergics, stimulants, and SSRI which all can increase susceptibility to hyperthermia. Transport is likely indicated, but not for a septic work-up. Cool fluids and decreased sun exposure would be insufficient for heat stroke, which this patient is showing signs of with his altered mental status. Ice packs to the groin and axilla will likely increase core body temperature due to vasoconstriction in the extremities.