As we tick through the last days of spring, it’s time to start thinking about the dog days of summer. Although I don’t see a significant number of heat-related emergencies in my office, many patients do end up in emergency departments suffering from heat illness.
These illnesses account tens of thousands of visits each year to doctors’ offices and emergency rooms. Deaths from heat-related illness in America range from 300 to several thousand per year. The number is increasing with our warming climate and increase markedly during heat waves.
Risk factors that make one more prone to heat-related illness include being elderly, very young, or obese. Some prescription or even non-prescription drugs, particularly alcohol, cocaine, antihistamines, beta blockers, diuretics, ADD/ADHD medications, and some psychiatric medications can increase the risk of heat illness. Workers like firefighters, who wear heavy clothing, are at very high risk.
Absorbing too much heat from the environment or producing too much heat internally can lead to heat illness. The two main types of heat illness are heat exhaustion and heat stroke.
Heat exhaustion is caused by excessive loss of body water and salt. Heat exhaustion typically comes on slowly and is characterized by fatigue, weakness, nausea, vomiting, headache, muscle aches, cramping, dizziness, and irritability. These people are usually sweating profusely, are pale with clammy skin, and have a weak, rapid pulse. Low blood volume results in reduced blood flow to the body, commonly known as circulatory shock.
The first thing to do for someone with heat exhaustion is to remove him or her from the hot environment. Standard treatment for shock should then be administered. Elevating the legs above the level of the chest helps get blood to the vital organs and brain. Sports drinks such as Gatorade® or Powerade® are an excellent way to replace water and lost electrolytes.
If a victim shows signs of confusion or lethargy, or is not responding to treatment, rescuers should contact 911 or immediately take the victim to an emergency department. In general, the prognosis for heat exhaustion is very good.
Heat Stroke is a different story. It results when the body’s temperature regulating mechanisms malfunction causing a loss of ability to transfer internal heat to the environment. This can cause dangerously high internal body temperatures, sometimes as high as 105-106 ºF. Heat stroke is a medical emergency and is frequently fatal without immediate treatment.
Symptoms of heat stroke usually come on rapidly and include headache, dizziness, fatigue and weakness. Physical findings can include confusion, hot & dry skin, decreased sweating, rapid pulse, vomiting, loss of consciousness and sometimes seizures.
The initial treatment for someone with heat stroke is to call 911. Remove the person from the hot environment and then place the person in a bathtub or other tub filled with very cold, preferably ice water. Emergency services will usually watch the patient until his or her core temperature has dropped below 102-103 ºF If a tub is not available, place ice packs over the armpits, groin, neck and abdomen to help cool the patient down. Running a fan on the patient and spraying them with tepid water can also be helpful.
As with any medical emergency, the key is prevention. When you’re in the sun or a hot environment for an extended period, be sure to maintain your hydration. Water will do just fine unless you’re involved in intense physical activity for more than an hour. If that’s the case, consider adding in sports drinks. Salt tablets are not recommended.
You should drink roughly 16 ounces of fluid about two hours before outdoor activity if possible. During activity, drink 4 to 8 ounces every 20 minutes. A crude measure of adequate hydration is the color of your urine – clear or pale yellow is what you’re shooting for.
Make sure young children and elderly family or friends stay out of the heat. Also make sure the elderly have a functioning cooling system in their home or apartment and that they have access to fluids.
If you take prescription medication, be sure and read the warnings you receive from the pharmacist or talk to your doctor to determine if it might affect your sensitivity to heat. If you develop any of the symptoms mentioned above, tell someone and get to a cool environment immediately.