Do this immediately for heat-injured ED patients

Consider age and activity

Exertional heat-related injuries are on the rise in EDs, with an estimated 54,000 patients treated over a 10-year period — a 133% increase that was not linked to increased seasonal temperatures, according to a new study (see reference).

"Activity and age may be important factors for ED nurses to consider when evaluating patients for exertional heat-related injuries," says Lara McKenzie, PhD, MA, one of the study's authors and principle investigator at the Center for Injury Research and Policy at Nationwide Children's Hospital in Columbus, OH.

For example, men and boys sustained a greater proportion of exertional heat-related injuries while participating in yard work and home maintenance compared to women and girls, and patients younger than 20 sustained a greater proportion of sports and recreational exertional heat-related injuries.  

Educate your ED patients, particularly older adults, that extreme temperatures are not necessary to sustain a heat-related injury, advises McKenzie, and that normal household maintenance, yard work, and leisure activities can pose a risk.

"Be aware that heat-injury cases can come into the ED at any time, not just on heat-advisory days," McKenzie says. "Pay attention to the patient's history to be able to identify heat injury appropriately." Use these practices to improve care:

Remember that elders are at greater risk for heat injury.

This is because they are more prone to environmental stress due to decreased physiological reserves, increased comorbidities, and more likely use of prescription medications, such as diuretics for hypertension, says Curtis Olson, RN, BSN, BA, EMT-P, CEN, an ED nurse at Saint Elizabeth Regional Medical Center in Lincoln, NE.

Remember that dehydration can lead to electrolyte imbalances.

This can, in turn, lead to cardiac arrhythmias, seizures, and kidney damage, says Olson. "The acute kidney failure is exacerbated by rhabdomyolysis, which is also common in heat injury," says Olson.

Obtain an EKG, labs, and urinalysis, and insert a Foley catheter.

"These are essential rapid interventions, along with respiratory support, intravenous fluids, and rehydration," says Olson (See clinical tip on cooling patients, below.)


  1. Nelson NG, Collins CL, Comstock RD, et al. Exertional heat-related injuries treated in emergency departments in the U.S., 1997-2006. Am J Prev Med. 2011;40(1):54-60.


For more information on caring for ED patients with heat-related injuries, contact:

Lara McKenzie, PhD, MA, Assistant Professor of Pediatrics, Center for Injury Research and Policy, Nationwide Children's Hospital, Columbus, OH. E-mail:

Clinical Tips

Don't cool heat-injured patient too quickly

When caring for a heat-injured patient, "cooling should be done up to, but not to the point of, shivering," says Curtis Olson, RN, BSN, BA, EMT-P, CEN, an ED nurse at Saint Elizabeth Regional Medical Center in Lincoln, NE.

"Shivering is the body's response to being cooled too fast, and will increase the body temperature," he warns.