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Cooling methods for paediatric heat-induced illnesses
  1. Dried Jamal1,
  2. Ibtihal Abdelgadir1,
  3. Colin V E Powell1,2
  1. 1 Pediatric Emergency, Sidra Medical and Research Center, Doha, Qatar
  2. 2 Division of Population Medicine, Cardiff University School of Medicine, Cardiff, UK
  1. Correspondence to Professor Colin V E Powell, Emergency Medicine, Sidra Medical and Research Center, Doha, Qatar; PowellC7{at}

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Clinical bottom line

  • Initiate rapid cooling techniques (aiming for a rate of 0.2°C/min) within the first hour to minimise complications in exercise-induced heat-related illness (grade A).

  • Ice water and cold water immersion cools twice as fast as passive recovery (grade B); however, ice water immersion in a ventilated monitored patient remains technically challenging to perform.

  • There is insufficient evidence to support the use of one different cooling method over another in the paediatric population (grade D).

Clinical scenario

A 5-year-old male presented to the Paediatric Emergency Department (PED) after being accidentally left in a locked car for 3 hours, where the external temperature was 49 °C. His mother realised that the child was missing; she went to the car where she found him unresponsive. The ambulance services were called. The child was noted to be unresponsive with Glasgow Coma Scale score of 3 with a core rectal temperature of 40.6 °C. The patient’s airway was secured with a Guedel support during the transfer then he was intubated and ventilated in PED. His circulation was managed appropriately with a bolus of 20 mL/kg of normal saline and maintenance fluids initiated. Passive cooling was started during the transfer …

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