Rectal temperatures for suspected heat stroke

I checked and found that rectal temperatures still are recommended for suspected heat stroke. There is apparently a substantial difference between oral and rectal (or core) temperatures.

It is, of course, "unpopular" with young athletes, to say the least.

Does anyone have information on this?

Rectal temps are what we use in suspected heat stroke. As you said there's often a discrepancy between oral and rectal. Also too heat stroke is often accompanied by a clouded sensorium and coma Oral ones just aren't feasible. I have seen several cases of true heat stroke while working in California's Central Valley. Invariably the scenario was someone who'd shot up heroin and fallen asleep in the sun. They were brought in with temps of greater than 110 degrees Fahrenheit. Ordinarily such cases die. I was able to save them by putting lines into the peritoneal cavity and dumping in liters of fluid. I'd just read about this method in reviewing for my board recertification. They promptly woke up! And survived.

WOW! Good for you!

Thanks! It was pretty unbelievable to me too. The maxim is that they die.

Out of curiosity, from what does one die in a heat stroke? Dehydratation, resulting in heart failure?

Wow good for you thank you for doing that

My understanding is that hyperthermia from a core temp of greater than 107 degrees causes denaturing of protein causing multiple organ failure.

When I was in the Navy, I went to both Tropical and Cold Weather medicine schools. Both said that a rectal temp was essential to get the proper core body temp in "environmental injuries"

Once when on deployment in Okinawa, the battalion colonel decided that standing orders did not apply to him and his Marines, so he took the battalion out on a 25 mile hike with full gear...in July. The Preventive Medicine department had already called the day as "Black Flag," Heat and humidity so high that absolutely NO outdoor activity was to be done unless absolutely necessary.

I was working the Battalion Aid Station as Senior Clinician (The MO was on leave in the Philippines.)when the call came in to expect heat casualties. I cranked every AC unit in the building, had some D5W and D5NS chilled, and plenty of cool oral fluisds handy when they started to arrive.

As per procedure and training, EVERYONE who came in got a rectal temp, whether they were walking or being carried in.

The Marines seemed to understand when I told them what we wwould be doing and why. (They also knoew they had no choice. Medical necessity trumps rank.) Oddly enough, it was the younger "green' corpsmen who had the biggest problem with it.

Yes, we used IVAC's with red probe tips, not glass.

To my knowledge, that i still standard SOP.

1Doc1, that's fucking cretinous. I cannot stand these "macho" types that take others on such kind of action. I bet that the colonel didn't even walk with the troops!

Pecan you've got a wild hair today no doubt! Good for you!

The Korey Stringer Institute at the University of Connecticut recommends taking RTs on athletes showing symptoms of heat stroke:

http://ksi.uconn.edu/emergency-conditions/heat-illnesses/exertional-heat-stroke/heat-stroke-treatment/

In our ER, when heatstroke is suspected, a rectal temperature is preferred even if the patient is conscious. But any protests from the patient has to be acknowleged. In the case of an unconscious patient, their rectal temperature is taken regardless. I've taken rectal temperatures of several heatstroke/ heat stress patients over the years, mostly athletes or people who work outdoors. I can tell you most are too sick, delirious, or scared to worry whether or not they get a temperature probe stuck up their butt. It's really for their own good, because a core body temperature is essential in treating heat related illness early as possible.

So what rectal temperature would be considered concerning?

Greater than 106 degrees. At 108 the denaturing of protein occurs and organ failure follows.

I volunteered a couple of times on the medical staff for a marathon. Our training was to do a rectal temp on anyone with signs of hyperthermia with mental status changes. Each aid station was provided with a thermometer and lube.

Was there any privacy provided patients in the marathon medical tent?

I've also read news articles that suggest to take a rectal temp on people who have suffered from hypothermia, after venturing out in frigid weather. I've taken my own rectal temp after being outdoors for an extended time, and the readings were well below normal. I heard that the military uses the term "silver bullet," to describe rectal temps.

As I've said previously I'm not very interested in temps in the normal range. They make little difference in what I do. Those at extremes matter terribly. I once saw a male patient about forty years old. Apparently he'd gone home drunk and fallen asleep with the window open. Nighttime temperatures were 0 to 10 degrees F. He was found with a core temp of 50 degrees. On arrival be was obviously altered but looking around vaguely. The rule is that you can't pronounce them dead until they're warm and dead. He was in profound bradycardia with a rate of 45. We began warming him. Six hours later his temp was 85 degrees. At that point sadly he had ventricular fibrillation. We continued CPR but despite this when he reached 94 degrees we couldn't fix his rhythm and had to pronounce him. What a terrible long code that was. He showed no signs of life after the first twenty minutes or so.

In a case of heat stroke, I&O would be monitored closely as well as temp and vitals. I'd expect to see the use of a urinary cath with temperature sensor.

Heat stroke victims have such a rapid precipitous course that there isn't time in the ED to place a temperature catheter. It's all done in twenty minutes or so. Either they make it or they crump. Quickly. Plenty of time for such monitoring in the ICU later when the critical time is over. If they make it that far.