Disposition

All of the minor heat illnesses except for heat exhaustion can be managed totally in the emergency department, and then patients can be safely discharged to home care and for outpatient follow-up. Patients with heat exhaustion who are at the extremes of age and have substantial volume depletion, comorbid diseases, or heat-induced end-organ damage should be admitted to the hospital.

Heatstroke is a true medical emergency, and all patients with this diagnosis should be admitted. The issue of whether to admit to the floor as opposed to the intensive care unit depends on the level of service that will be required as an inpatient. Patients who are hemodynamically labile, those who need continued cooling, or those who require invasive hemodynamic monitoring should be admitted to the intensive care unit. If the original health care facility is unable to provide the services needed for quality care, then the patient should be referred to a higher-level facility.

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