Heat Stroke - Clinician Guidance (VSOS)

Heat stroke needs rapid, decisive action. Active cooling and early airway control when indicated. Don't waste time. Get the temperature down first, then work up complications. Prognosis is generally good when patients are cooled quickly; morbidity rises the longer they remain >41 °C.

Most dogs survive when cooled promptly; deaths are uncommon and typically linked to prolonged exposure (e.g., left in a hot car). Emphasise early recognition and that brachycephalic (eg. Bulldogs, Pugs, Pekingese) have reduced thermoregulatory capacity.

Immediate priorities

• Act early and aggressively: initiate cooling immediately.
• Concurrently place an IV catheter, but do not slow the cooling process.
• Intubate early if needed, especially brachycephalics that can’t self cool easily.

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• Use a sink or shower hose with cold water until the temperature is ~38-38.5 °C, then stop active cooling. 
• Increase air flow over the wet coat, fanning or air conditioning is best.
• Safely wet the mouth and fan the mouth to enhance heat removal.
• Clip long hair or thick matted coats
• Consider rectal lavage with cold water
• Place an IV catheter and start IV fluids concurrently or following, depending on the urgency for IV fluids, eg. is that patient in hypovolemic shock?
• Once cooling is underway/achieved, proceed with diagnostics and further treatments.

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• Intubate early if needed, especially brachycephalics.
• Sequence differs:
  • Brachycephalics: sedate ? intubate ? then cool (airway first).
  • Most other dogs: cool first (often no intubation required).
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• Abnormal mentation, seizure activity
• Haemorrhagic diarrhoea, ileus, gastric haemorrhage.
• Azotemia/AKI
• Blood smear:
  • Nucleated RBCs (can be an early negative prognostic indicator).
  • Thrombocytopenia
  • Haemolysis (schistocytes, echinocytes, spherocytes, stomactocytes)
• Consumptive coagulopathy - Prolonged PT/aPTT, thrombocytopenia, petechiae/ecchymoses.
• Arrythmias
• Acute Lung Injury, pulmonary oedema or haemorrhage.
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• Persistent hyperthermia despite appropriate cooling.
• Delayed recovery, reduced responsiveness
• Need for advanced airway management/ventilation (especially brachys that cannot maintain an airway).
• Early evidence of AKI/MODS or deterioration despite initial therapy.

We’re here when you need us. If your patient requires advanced monitoring, blood gases or ventilation, we can take over.