Dr. Patrick Fink reviews the spectrum of heat illness using 2024 Wilderness Medical Society guidelines, covering recognition, physiology, field treatment, and key mimics. He distinguishes heat edema, heat cramps (salt-depletion vs exercise-associated), heat syncope and exercise-associated collapse, and defines heat exhaustion by preserved mental status versus heat stroke by altered mental status in a heat context, warning not to wait for a temperature threshold. He explains heat stroke pathophysiology as direct thermal injury plus a sepsis-like inflammatory cascade from gut hypoperfusion and barrier failure, emphasizing “heat × time” and a 30-minute cooling window. Core management is “cool first, transport second,” with cold water immersion as gold standard and improvised “tarp taco” alternatives; stop cooling around 38.3–38.8°C, avoid antipyretics and dantrolene, and use fluids only as support. He highlights exercise-associated hyponatremia as a dangerous mimic requiring hypertonic saline, and discusses disposition, including possible field release after full recovery within two hours for healthy exertional cases.

Links

Episode 27: Thermoregulation: The Physics and Physiology of Body Temperature Regulation

Wilderness Medical Society Clinical Practice Guidelines for the Prevention and Treatment of Heat Illness: 2024 Update

Chapters

00:00 Heatstroke Trail Scenario
01:02 Episode Roadmap
03:34 Thermoregulation Basics
06:43 Mild Heat Illness
11:21 Heat Exhaustion Line
13:32 Heat Stroke Recognition
17:18 Why Heatstroke Kills
22:37 Cool First Transport Second
24:51 Cold Water Immersion
27:31 Improvised Field Cooling
28:28 Myths Meds and Fluids
33:56 Hyponatremia Mimic
36:57 Disposition and Transport
39:38 Gear and Preparation
41:05 Key Takeaways Wrap Up

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