# A marathon runner collapses in 38 C heat with rectal temperature 41.4 C and altered mental status. Which intervention is the priority?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=375128&lang=en  
> language: en  
> subject: NCLEX-RN  
> category: PA

## Question

A marathon runner collapses in 38 C heat with rectal temperature 41.4 C and altered mental status. Which intervention is the priority?

## Option

1. Begin rapid external cooling with cold water immersion until core temperature reaches 39 C **✔ Correct answer**
2. Administer acetaminophen 1000 mg PO
3. Apply tepid sponge baths to gradually lower temperature
4. Initiate dantrolene as the antidote for heat stroke

**Correct answer: 1**

## Explanation

Exertional heat stroke (CORE temperature over 40 C with neurologic dysfunction) is treated with RAPID COOLING — cold-water (or ice-water) immersion is the gold standard for exertional heat stroke (cools at about 0.15-0.30 C per minute). Goal: core temp under 39 C within 30 minutes. Evaporative cooling (water spray + fans) and ice packs to neck/axilla/groin are alternatives if immersion not feasible. Antipyretics (acetaminophen, aspirin) are INEFFECTIVE because the hypothalamic set point is not elevated. Dantrolene treats malignant hyperthermia — NOT heat stroke (though sometimes used in NMS).

## In-depth explanation

Classic vs exertional: classic = elderly, environmental, evaporative cooling preferred (less competing physiology). Exertional = athletes, immersion preferred. Both require speed.

## Clinical scenario

HR 148, BP 92/56, GCS 12. No history of HF or heart disease.

## Key concepts

- **heat stroke** — Core temp over 40 C with CNS dysfunction; thermoregulatory failure.
- **cold water immersion** — Gold-standard cooling for exertional heat stroke.
- **evaporative cooling** — Water spray plus fans; alternative when immersion not feasible.

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