Case 2

A 19-year-old army recruit collapses during an endurance march. He becomes increasingly agitated and is transported by military ambulance to the nearest emergency department. On arrival he is combative.

Initial assessment proves difficult due to poor compliance. He is sweating profusely. Over a period of 10 minutes he becomes more 'settled' then develops a tonic-clonic seizure. He is placed in the left lateral position, oxygen is applied and his seizure is terminated after 5 minutes with intravenous lorazepam 4 mg.

Baseline observations are:

• HR = 130 bpm
• BP = 90/70 mmHg
• RR = 16 min
• SpO₂ = 93% (room air)
• Temperature = 42.2°C (axilla)

Blood result

A diagnosis of exertional heat stroke is made. Active cooling measures are commenced. The patient receives 2 L of IV saline rapidly. Recurrent seizures develop. An RSI is performed and the patient is sedated and paralysed. Continuous temperature monitoring is performed via a rectal thermometer.

Despite these measures core temperature remains at 41.0°C. In order to cool to the target temperature of 38.5°C, cold fluid peritoneal lavage is performed. Initial blood results are as follows:

Which of the following complications of heat stroke are developing in this patient?

Which of the following are included in the differential diagnosis of pyrexia and seizures?

Which of the following could be useful in reducing this patient's core temperature?

A CT head scan is performed.

Which of the following is responsible for the patient's neurological condition?

Click on the CT to enlarge.