A young man is brought in by ambulance with severe hyperthermia, tachycardia and tachypnoea. This has a mortality rate of over 95% if not aggressively managed.

Preparations include:Resusc team

Reduce temp generation – stop seizures, paralyse

Cooling plan – ice, water, fans, cooling blankets, consider bladder lavage/ chest drains

Early ICU consult for dialysis (think about central venous access/ vascath insertion)

Prepare for potential arrest/ inotrope requirement from severe myocardial depression

Anticipate multi organ failure, clear CK, watch K etc

His blood tests indicate:

severe mixed respiratory and high anion gap metabolic acidosis (lactate – seizure, hypoperfusion, rhabdomyolysis, renal impairment)

delta ratio of 1.35 – pure HAGMA

Elevated K and CK from rhabdo and renal failure

Treatment:

COOL fast, paralyse and intubate, keep paralysed

Consider early dialysis – central  line, vascath, urine catheter, art line

Inotropic support

monitor urine output

ICU