Pearl: Each of these diagnoses can be quickly evaluated with history, exam and simple lab tests if available. If the athlete is unconscious without a pulse, initiate ACLS. If the athlete has a pulse, evaluate for the other possible causes. 

Pearl: Oral, tympanic, temporal and skin measurements have repeatedly been shown to be inaccurate.

Pearl: If unable to check a temperature and there is high suspicion for EHS, then the athlete should be cooled empirically.

Pearl: Central nervous system dysfunction can include collapse, syncope, confusion, aggression, irritability, and/or seizures.

Pearl: Cool to 102ºF or 38.9ºC to avoid overcorrection of the temperature.

Pearl: If cold water immersion is not available, place towels from a bucket of ice water on the patient, covering their whole body. Rotate out for fresh cold towels every few minutes. This should only be used as a bridge to transport the patient for cold water immersion, or until an immersion tub can be set up. 

Pearl: EHS can progress to DIC, SIRS, ARDS, rhabdomyolysis, cerebral edema, and multisystem organ failure.

Pearl: Athletes should not return to activity until at least 7-14 days after they have recovered from the episode and they are able to demonstrate heat tolerance.