PedsCrit Exertional Heat Stroke with Tobias Straube
Jan 26, 2026
Tobias Straube, pediatric critical care physician at Duke who researches exertional heat illness. He walks through recognizing exertional vs classic heat stroke. He highlights risk factors, prevention and acclimatization. He describes on-scene rapid cooling, monitoring core temperature, phases of illness, and common organ injuries to watch for.
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Texas Football Heat Memory
- Tobias recalled high-school football practices in extreme Texas heat and a summer t-shirt culture that now feels unsafe.
- He uses that memory to argue current prevention improvements are important.
Rapid Cooling And Early IV Resuscitation
- Cool rapidly with ice water immersion or an 'ice tarp' and remove clothing immediately.
- Establish large-bore IVs and give crystalloids early to restore perfusion and aid cooling.
Cool Fast But Stop Before Hypothermia
- Aim to cool as fast as possible and monitor core temperature (rectal if available).
- Stop active cooling once temperature approaches ~38–39°C to avoid hypothermia.