Learning To Recognize and Treating Dangerous Heat Disorders

It’s the time of the year when a lot of people have to deal with various heat disorders. Not being able to recognize the signs of heat disorders and provide proper care can lead to disaster. These health issues are somehow still not being given the attention they dissever, and it’s something that people handle without proper care. The old “it will pass” habit is still present when it comes to heat disorders.

On a recent trip to Mexico, I had to assist a tourist who was suffering from heat exhaustion. What astounded me about this disorder was not only didn’t anyone recognize the problem but that no one knew how to assist. With the hot and humid summer months upon us, I hope that this basic presentation will serve as a guide to those of you who could assist someone who is suffering from one of three disorders brought on by excessive heat.

Clinically, these syndromes can be separated. Yet, for all practical purposes, each disorder overlaps into one or more of the others. Before attempting to outline specific disorders, we need a list of risk factors that generally can pertain to all.

Risk Factors:

Age:

Over 50 (some authorities state over 40):

In general, the longer we survive, the more medicines we have taken to assure continued survival. After all, to make an extra buck or two, big pharma is counting on you to be sick. Also, as we get older, our bodies deteriorate. Medical disorders such as heart disease are more common with advancing age. In addition, the side effects of various medications can slowly amp up on us.

The Very Young:

The sad thing concerning this category is the very young do not have control of their own lives. Many times adults, without thinking, put children into dangerous heat situations. An example of this is locking a child in a closed car on a hot day while an adult shops for a half hour or so. This situation is often repeated by thoughtless pet owners as well.

Environment:

Indoor or outdoor temperatures are greater than 90 degrees F or relative humidity greater than 60 percent present great risks.

Sports:

Strenuous exercise on hot and humid days is dangerous to someone who is out of shape. A competitive drive in the wrong person at the wrong time could be fatal.

Employment:

A workplace that is poorly ventilated and has high temperatures is dangerous for one’s health.

Medication:

Certain drugs can make us more vulnerable to high temperatures.

Examples are:

DIURETICS:

These drugs increase the rate of urine flow by promoting a net loss of sodium ions and water from the body. Urination obviously causes a loss in fluid or body water. This, along with high environment temperatures (perspiration), can lead to a state of dehydration.

ANTICHOLINERGICS:

Included in this category are many over-the-counter sleeping pills, cold medications as well as atropine, belladonna, scopolamine. etc. In high doses, these medications can induce disorientation, confusion, hallucinations, drowsiness, warm, dry skin, fever, etc. They also decrease the flow of saliva.

ANTIPSYCHOTIC TRANQUILIZERS:

 Large doses of these drugs may lead to somnolence, stupor, and coma. Sodium depletion and polyuria (frequent urination) are adverse reactions that help deplete the body of fluid.

Alcohol:

Alcohol is a sedative-hypnotic. High doses can lead to impaired psychomotor performance and faulty judgment. These can be especially dangerous in an extremely hot or cold environment, we need our wits about us to survive in environmental extremes.

Miscellaneous:

Other contributing factors are:

• Obesity;
• Dressing in warm restrictive clothing on a warm, humid day;
• Restricting the fluids that are necessary to replace electrolytes lost by sweating, etc.;
• Lack of sleep and excessive fatigue;
• Physical or mental illnesses. Various medications used can have side effects that must be monitored;
• Vomiting and diarrhea that accompany many illnesses deplete the body fluids;
• Poor nutrition;
• Those with defective sweating mechanisms due to medical or congenital reasons;

Acclimatization to heat usually results after 8 to 10 days of exposure to high temperatures. But be careful! This helps, but it isn’t an absolute protection from heat disorders, especially if you fall into some of the above categories.

Thermoregulation and Heat Disorders:

Our bodies normally produce heat through the metabolism of the foods we eat. The liver and skeletal muscles are also important factors since they are two organ sources of heat. This heat is used by our body to maintain a more or less constant temperature. Since our parents first took our temperature when we were sick, the number 98.6 degrees or 99 degrees meant something.

The average normal oral body temperature ranges between 96.8 to 99.3 degrees F. or 36 to 37.4 degrees C. If a rectal or vaginal reading is taken, then add 0.5 degrees C. or 1 degree F. to the above ranges. The normal axillary or armpit temperatures is 0.5 degrees C. or I degree F. lower than the oral. Exact? No! This is partly due to a simple factor of time. The time of the day can make a difference in the temperature recorded.

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A person’s temperature is usually lowest in the early morning after a good night’s restful sleep and higher in the late afternoon at the peak of his activity. In medicine, very little is exact, and the temperature is no exception. The proper body temperature is maintained due to the influence of a part of the brain. Thermoreceptors throughout the body send messages to the brain where the hypothalamus or the heat-regulating center of the central nervous system is located.

Depending on the body’s temperature, various body processes are set into motion which activates heat-gaining or heat-losing mechanisms to bring the core body temperature back to normal. All of this depends on the hypothalamus and thermoreceptors being intact.

An example of one of the many mechanisms the body uses to reduce a rising temperature is the process of sweating. The body can withstand high temperatures as long as sweating continues, and the water/sodium lost in the sweat is replaced. In simple terms, this is one example of how the body copes with thermoregulation.

The next section discusses compares and evaluates heat disorders.

Heat Disorders  

Heat cramp:

This anomaly usually follows exercise and is the disorder causing the least problems. It is characterized by painful spasms of the voluntary (skeletal) muscles. The muscles which are usually affected or cramped after physical activity are those of the extremities. Occasionally, abdominal cramps are also experienced.

The body temperature is usually within normal limits. It is also important to realize that direct exposure to the sun is not a prerequisite to being affected. Skiers who overdress against the cold have also been known to experience these cramps.

The symptoms are due to the body’s depletion of salt by profuse sweating. If we work in hot environments or do a lot of exercises that cause us to perspire a lot, we must be careful.

Drinking plenty of fluids and taking salt tablets with every two glasses of water will prevent this problem. Moving the patient to a cool, well-ventilated area and giving him salted water constitutes a good basic treatment. By gently massaging the sore muscles, some of the cramping pain can be relieved. Once recovered, the patient must determine the reason for his predicament. A few days of rest are highly recommended.

Heat exhaustion:

This is probably the most common heat disorder and is the body’s reaction to prolonged exposure to high temperatures. It is caused by excessive fluid loss. Its onset is sudden and is due to dehydration (from inadequate water intake), a depletion of sodium (adequate intake of water but insufficient salt), or a combination of both.

Because of the fluid loss, the victim will become weak, fatigued anxious, and will perspire profusely. All of this can lead to circulatory collapse, major seizures, and eventual heat stroke. Those commonly affected work in hot environments, the elderly, or are taking prescribed diuretics.

Treatment consists of moving the patient to a cool and adequately ventilated area. Wet him and/or fan him to remove body heat by convection. Again be careful since you want the victim cooled but not chilled. If possible, give by mouth, cool water with salt. Send for medical help, if possible, since I.V. fluids and monitoring may be needed. Therefore, hospitalization is recommended,

Heat stroke (Sun Stroke):

The key to this life-threatening medical emergency is an absence in most victims of sweating along with hot and dry skin. This is due to a failure of the body’s heat-regulating mechanisms to self-regulate and lower the temperature.

If the victim is conscious, he will tell you that he feels as if he is burning up. Don’t ignore the symptoms and signs and fail to recognize this deadly syndrome. If you do a rectal temperature and Find it over 104 degrees F. then immediately proceed to lower it. Remember, the victim does not have to be out in the sun for this to occur.

The danger with heat stroke is that it can progress rapidly to shock and eventual death from cerebral, cardiovascular, renal, and hepatic destruction. The body tissue damage is caused by the extremely high body temperature. Therefore, the temperature must be lowered to 102 degrees F. as rapidly as possible. Once 102 degrees F. has been reached discontinue the drastic measures but continue to monitor the rectal temperature every 10 minutes for a possible febrile rebound. It is now important that you do not allow the temperature to fall so fast and low that the patient converts from a state of hyperpyrexia to hypothermia, which in itself is a medical emergency.

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This disorder is commonly seen in the elderly with chronic diseases as congestive heart failure, in long-distance runners, and military recruits. Standard first aid treatment is putting the patient in a cool well-ventilated area. Since external means of heat dissipation must be done at once to lower the temperature, remove the clothing. Now, if available, begin a cold water bath, but be careful. You must not put an unconscious person in a body of water that you can’t control him in. DON’T DROWN ANYONE! You can also wet the body and rapidly fan it to cool it down quicker.

Next massage the extremities to promote the circulation of cooled blood to all body parts. When the opportunity arises, call for help since this patient will need to be hospitalized where drugs, oxygen (if cyanosis is present), further cooling and monitoring can be continued if necessary. This is serious, and the mortality or death rate is close to 100 percent in untreated patients. The victim’s survival depends on your ability to aggressively bring about rapid cooling.

Comparing heat disorders

This table will help you understand better what is present during heat disorders

Conclusion on Heat Disorders:

These disorders can be minor or deadly. Much depends on how you handle them, or if pertaining to yourself, how to avoid the pitfalls. Generally speaking, match your clothing selection for outdoor activities or work to the weather. Remain in a cool, shaded environment when it is hottest out and avoid strenuous activities during those periods of heat and high humidity.

If you have any of the risk factors mentioned, be aware of them and take appropriate action. Before doing strenuous activities or going into the wilderness when medical care is not readily available, get a good physical from your doctor and have he or she explain any side effects yet should be aware of from medicines you may be taking. Remember, the best treatment is, if at all possible, prevention. A good first aid course is also highly recommended.

his article has been written by James H. Redford MD for Prepper’s Will.

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