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Case studies

A 14 year old boy is brought by his family to the emergency department after collapsing on the field during a high school football practice. The region has been under a heatwave alert for the past three days, with daytime temperatures reaching 40°C and night time low temperatures of 32°C. The boy’s coach saw him struggling during running exercises, then collapse, and have seizure like activity. The boy’s mother says he has no underlying medical conditions and was feeling well before the practice. On arrival at hospital, his heart rate is 145 beats/min, blood pressure 100/60 mm Hg, and his rectal temperature is 40°C. He is breathing spontaneously and responding to painful stimuli. Heat stroke is identified immediately. The patient is intubated for airway protection, sedated with benzodiazepines, and rapidly cooled with cold water immersion and chilled IV fluids. His temperature comes down to 37.5°C within 30 minutes. On hospital day 1, he is found to have an acute kidney injury and a mild liver injury, which rapidly improve by day 2. On day 3, he is extubated and has an excellent neurological recovery.

A 55 year old woman who works as a store clerk is brought to hospital because she appears confused. She has schizoaffective disorder which has been well managed on clozapine. There is a heatwave in …