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Wilderness Medicine UpdatesAuthor: Patrick Fink, MD
The podcast for medical providers at the edges, bringing you digestible updates at the growing edge of Wilderness Medicine, Wilderness EMS, Search and Rescue, and more. Language: en-us Genres: Health & Fitness, Medicine Contact email: Get it Feed URL: Get it iTunes ID: Get it |
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Ep. 34 - Icy Hot, a case of Heat Illness with Dr. Gavin Clark and Dr. Nick Daniel
Episode 34
Wednesday, 9 September, 2026
Dr. Patrick Fink interviews Dr. Nick Daniel and Dr. Gavin Clark about an in-hospital case of exertional heat stroke in a mid-20s runner who collapsed just before the finish of an October New England half marathon in 45°F weather. EMS treated presumed SVT with adenosine, but in the ED the patient was hypotensive, profoundly diaphoretic, and altered; an oral temperature was normal while a rectal core temperature was 105.5°F, highlighting that peripheral temps can’t rule out heat stroke. We discuss rapid “cool first” management using ice packs, misting, and fans to reach 102°F within ~30 minutes, compare cooling methods (cold-water immersion, tarp-assisted oscillation, Quantico method, frozen sheets), review labs showing lactate 9 and AKI, explain sepsis-like physiology via gut hypoperfusion, and note possible risk contribution from recent COVID and acute Lyme IgM positivity. Links:Ep. 33 - Heat Illness FundamentalsEp. 27 - Thermoregulation: The Physics and Physiology of Body Temperature RegulationClark G, Kocen S, Daniel N. Icy Hot: A Case of Unexpected Heat Illness. Wilderness Environ Med. 2026 Jun 16:10806032261458332. doi: 10.1177/10806032261458332. Epub ahead of print. PMID: 42300334.Eifling KP, Gaudio FG, Dumke C, et al. Wilderness Medical Society Clinical Practice Guidelines for the Prevention and Treatment of Heat Illness: 2024 Update. Wilderness & Environmental Medicine. 2024;35(1_suppl):112S-127S. doi:10.1177/10806032241227924Chapters:00:00 Show Intro and Guests02:43 Meet the Doctors03:48 Race Day Collapse Setup04:47 Finish Line Differential06:48 EMS Report and History08:55 Core Temp Surprise11:25 Field Temp Takeaways13:38 Rapid Cooling in ED15:36 Cooling Rates and Goals16:28 Immersion and Alternatives18:17 Tarp and Body Bag Hacks19:32 Quantico and Frozen Sheets21:10 Field Cooling Methods21:48 Lab Workup Red Flags23:23 Lactate Nine Explained24:21 Heatstroke Sepsis Pathway26:40 Hidden Factors COVID Ticks29:09 Fever Versus Hyperthermia31:27 Prehospital Takeaways35:00 Race Day Kit Checklist36:35 Cool First Transport Later37:29 Outcome And Wrap Up39:46 Podcast Closing NotesAs always, thanks for listening to Wilderness Medicine Updates, hosted by Patrick Fink MD FAWM. Connect with us by email at wildernessmedicineupdates@gmail.com.You can pay us a compliment and share the show with a new listener on any popular platform here.
