Dangers of Prehospital Cooling: A Case Report of Afterdrop in a Patient with Exertional Heat Stroke

Background Exertional heat stroke is a potentially life-threatening disease with varying clinical presentations and severity. Given the severe morbidity that can accompany the disease, the immediate management often begins in the prehospital setting. It is important to have not only a comprehensive understanding of the prehospital cooling methods in addition to hospital management strategies, but an understanding of their potential complications as well. Case Report A 32-year-old male presented to a San Antonio hospital in March 2014 with progressive confusion, nausea, nonbloody emesis, and ataxia. Initial presentation was concerning for exertional heat stroke, as the patient was recorded in the field to have a temperature of 42.1°C (106.2°F). The patient, on arrival to the emergency department, was found to have a core body temperature of 38.1°C (100.6°F). All active cooling measures were terminated and active rewarming was initiated. Despite adequate resuscitation and rapid identification of the patient's overcorrection in core body temperature, the lowest recorded temperature was 36.0°C (96.8°F). Why Should an Emergency Physician Be Aware of This ? This case represents the dangers associated with exertional heat stroke, overcorrection of core body temperature, and the potentially lethal complication of afterdrop. It also represents the need for immediate recognition of the condition and initiation of appropriate medical care. Although this patient's clinical outcome was good, the event could have caused serious morbidity or could have potentially been fatal.