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May 2015: Thermoregulation

29-year-old male floorhand presents to the sick bay with complaints of nausea, lightheaded/dizziness, abdominal cramping and chills for one day. He has been working on the rig floor for several hours without any breaks and has been moving drill pipe. He first noticed that he became nauseated while carrying the pipe about one hour prior to presentation. He is on day 18/21 of his hitch.

On review of systems he denies any fever, cough, nasal congestion, vomiting, chest pain, shortness of breath, diarrhea or constipation.

  • Past History: Hypothyroidism
  • Past Surgical History: None
  • Current Medications: MVI, levothyroxine 0.075mg/day
  • Allergies: NKDA
  • Immunization Status: Tetanus and influenza are up to date
  • Social History: Denies alcohol and illicit drugs, smokes 1½ a pack a day
  • Family History: Mother with CAD, diabetes, ovarian cancer; father with CAD, stroke, died at age 56


  • Temp 103
  • Pulse 125
  • Respirations 20
  • Blood pressure 106/67
  • Pulse Ox 100% RA

Physical Exam

  • General: Alert and Oriented x 4, no acute distress, seems comfortable lying on stretcher
  • HEENT: ATNC, TMs clear, nose clear, mucus membranes dry, no lesions appreciated
  • Cardio: Tachycardic, regular rhythm and rate, no murmurs appreciated
  • Lung: clear to auscultation bilaterally
  • Abdomen: soft non-tender, non-distended, normal bowel sounds
  • Extremities: no clubbing, cyanosis or edema
  • Skin: Warm and dry

How would you approach this patient?

Diagnosis: Heat Exhaustion


  • Keep patient in cool shaded area
  • Remove clothing and place cool washcloths over body
  • Aggressive oral hydration with water and sports drinks avoid caffeinated drinks
  • Put patient in front of fan if possible


Must avoid progression to heat stroke. The signs of heat stroke include confusion, hallucinations, dizziness, LOC or seizures as well as the symptoms of heat exhaustion. Oral hydration and removal from heat source is the key to prevent progression from heat exhaustion to heat stroke. For patients who are not capable of oral hydration, aggressive IV hydration may be required to prevent organ damage and further progression. In an offshore environment, MEDEVAC must be considered when a patient is progressing to heat stroke in order to seek a higher level of care. Company policies should be examined and set in place to help prevent employees from experiencing heat stroke. Examples of policies would include mandatory frequent breaks with access to fresh water and shade.