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Heat Awareness: Heat Exhaustion and Heat Stroke

By Jeffrey Sterling, MD September 15, 2019

Introduction

Heat awareness is the topic of this Straight, No Chaser post. With climate change in full effect, “hotter than July” is becoming increasing less likely. What’s more likely is your being at risk for the consequences of heat and sun exposure.

Once the rainy season goes away, you know what will happen next. There’s more heat and all heat. You’d better be ready. The way things work, we just have to deal with it. Unlike when the weather is cold, you can just add layers. When it’s extremely hot, the heat seems unescapable. So we sweat, get fatigued and even cramp up. Surprisingly, there appears not to be much thought given to the notion that heat cramps are an early sign of a life threatening condition. Many of us have had loved ones die from heat related illnesses.

When a loved one dies, families often ask “Is there something I could have done?” Usually I give you information. Today’s Straight, No Chaser gives you information and power to act if needed. There are several varieties of heat-related illness, and you would do well to be aware of them, because you can make a difference if someone’s suffering in the heat.

heat-sickness-signs

Heat Stress

For starters, I really want you to become mindful of Heat Stress, which is the earliest complex of problems arising from excessive heat exposure. Heat stress is that strain and discomfort you get (usually during outdoor exertional activity) that reminds you that you’d be better off inside (assuming it’s cooler inside). You may notice such symptoms as cramping, a prickly-type rash, swelling and a sensation that you want to lose consciousness. If you must remain outdoors due to work, or choose to (playing sports or enjoying the sun), hydration means everything.

(It really is true that in some instances if you’re not actively urinating, you’re not drinking enough fluid. This is the level at which LeBron James was suffering during the NBA finals in 2014. It really does beg the question as to why he was allowed to suffer on the sidelines instead of being taken to the locker room, iced down and given intravenous fluids.)

Heat Exhaustion

Ok, so you’ve ignored both me and your body. You’re still outdoors, not rehydrating enough. Heat exhaustion may occur next. Heat exhaustion is defined by ongoing body salt and fluid losses. Now you’re feeling faint, thirsty, anxious, weak, dizzy, you want to vomit and may have a headache. Internally, your body temperature starts to climb. I see a lot of these patients. Usually it’s because once you get wobbly, your employers or co-workers are getting concerned. This concern is good, because at this point you are actually in danger.

Heat Stroke

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Maybe you didn’t come to see me when you had the chance. You’ve collapsed outdoors, and are found and brought in. This is Heat Stroke. Heat Stroke is defined by changes in your mental status. Also, there are increases in your temperature and disruption of your bodily functions. This can include a loss of ability to sweat and a loss of your kidney and liver’s abilities to detoxify your body the way they normally do.

Exertional vs Classic Heat Stroke

Well, in case you’re feeling good about yourself because you’re too smart to exert yourself outdoors, all I’ve been describing is ‘Exertional’ Heat Stroke. The more deadly form of heat related illness is ‘Classic’ Heat Stroke. This is the type that captures the headlines every year in places like Chicago, New Orleans, Miami and Houston. ‘Classic Heat Stroke’ is seen in those with underlying disease, bad habits or the elderly. I’m talking about the obese, alcoholics, meth and/or cocaine users, folks with thyroid or heart disease or on certain medications like diuretics or beta-blockers. These folks can get the same symptoms simply by not being able to escape the heat. They may actually just be sitting around in a less than optimally air-conditioned home.

Tips to Beat the Heat

So that’s what you’re up against. And yes, many people die from this. By the way, you’re not protected from the heat related illness just because you’re in shape. Let’s end with 2 tips (one for prevention and the other for assessment and treatment) to help you Beat the Heat.

heat_stroke_prevention

1) Take special caution during the following conditions

  1. 95 degrees is high risk, regardless of the humidity
  2. 85 degrees and 60% or above humidity
  3. 75 degrees and 90% or above humidity

heat_maintips

Here, you want to remove yourself from that environment. You need to keep plenty of fluids around. You need to visit an environment where there’s adequate air conditioning. Dress very lightly.

2) If symptoms of heat related illness short of mental status changes occur, think “Check, Call, Care, Cool”

  1. Check – look for those signs and symptoms I mentioned earlier
  2. Call – call 911 immediately. Better to have it and not need it than need it and not have it.
  3. Care – Lie in a cool place, elevate the legs, place cool, wet towels on the body (especially in the armpits and groin), and drink cool fluids. If mental status changes occur, or if the heart or lungs appear to give out, cool by any means necessary while waiting for the ambulance. This could include ice bath, ice packs, fans or cold water, but don’t drown someone trying to put them in a tub of water if you can’t handle them. Don’t forget to remove those layers of clothing.

Please be mindful that it is hotter in July, and unfortunately lives are lost every year to the heat. That said, it doesn’t have to be July for you to get a heat-related illness. If you can’t avoid the exposure, at least have a plan for managing the heat and acting on any mishaps. The life you save may be your own.

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