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Rapid cooling of large areas of the body improves morbidity and mortality.
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Commonly used antipyretics (paracetamol/NSAIDs) are ineffective if the aetiology is related to abnormality of heat management (i.e., heatstroke), opposed to being related to hypothalamic activity.
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In exertional heatstroke, rapid cooling should begin immediately in the pre-hospital setting and may include methods such as immersion in cold water, dousing with water, spraying with water and ice packs.
On the critical care unit options include non-invasive and invasive cooling methods:
Non-invasive – reducing ambient temperature, removing clothing/coverings, fans, cold towels, ice packs, cooling blankets (i.e., CritiCool), body wrap systems (i.e., Arctic Sun) and cold water immersion devices.
Invasive - cold intravenous fluids, bladder irrigation with cold fluids, intravascular cooling catheters (i.e., Thermogard XP), continuous renal replacement therapy, cardiopulmonary bypass.
