Dealing With Hyperthermia

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We often discuss infectious disease, traumatic injuries, and other medical issues that might be associated with times of trouble.  One thing we don’t usually address is what could happen as a result of being a victim of your own environment.  In the aftermath of storms or in areas of civil unrest, you may find yourself without shelter to protect you from the elements.  In the heat of summer, a common condition you’ll encounter might be heat stroke. In winter, hypothermia.

Environmental Causes of Illness and How to Prevent Them

Many environmental causes of illness are preventable with some planning. If you are in a hot environment, don’t schedule major outdoor work sessions in the middle of the day. Provide a canopy or other protection against the sun, and be certain that everyone involved gets plenty of water. Failure to do this could lead to dehydration, sunburns and increased likelihood of work injury.

The ill effects due to overheating are called heat exhaustion if mild to moderate; if severe, these effect are referred to as heat stroke. Heat exhaustion does not result in permanent damage, but heat stroke does; indeed, it can permanently disable or even kill its victim.

Simply having muscle cramps or a fainting spell does not indicate a major heat-related medical event, unless there is a significant rise in the body’s core temperature. As many heat-related symptoms may mimic other conditions, a thermometer of some sort should be a component of your medical supplies.

Symptoms of Heat Exhaustion

Heat exhaustion is characterized by confusion, mood swings, rapid pulse, nausea/vomiting, headache and temperature elevations to as high as 105 degrees Farenheit. Heat stroke, in addition to all the possible signs and symptoms of heat exhaustion, will manifest as loss of consciousness, seizures or bleeding (seen in the urine or vomit).  If not dealt with quickly, shock and organ malfunction may ensue; body core temperature may rise to levels of 110 degrees Farenheit or greater.

The skin is likely to be hot to the touch, but sweating might be absent, as the body is failing to use sweating as a natural temperature regulator. The body makes efforts to cool itself down until it hits a temperature of 106 degrees or so. At that point, thermoregulation breaks down and the temperature can hit the roof.

In some circumstances, the patient’s skin may actually seem cool; it is important to realize that it is the body CORE temperature that is elevated. A person in shock may feel “cold and clammy” to the touch.  You could be misled by this finding, but simply taking a reading with your thermometer will reveal the truth.

Now it’s time for you, survival medic, to take over. The medic should remove the patient immediately from exposure to heat (e.g., the sun). The clothing should be removed and the patient should be drenched with cool water (and ice, if available). Elevate the legs above the level of the heart and head to allow blood flow to the brain. If you have access to a fan and electricity or battery power, allow ventilation to help the process of heat evaporation and, thus, cool the victim.

If you have only a small amount of ice, place packs in the armpits, neck and groin areas. Major blood vessels pass close to the skin in these areas, and you will more efficiently cool the body core. In the wilderness, immersion in a cold stream may be all you have in terms of a cooling strategy. This is a worthwhile option as long as you are closely monitoring your patient.

Oral rehydration is useful, but only if the patient is awake and alert. If your patient has altered mental status, he or she might aspirate the fluid into their airways; this causes damage to the lungs and puts you in worse shape than when you started. You might think that acetaminophen or ibuprofen could help to lower temperatures, but this is actually not the case.  These medications are meant to lower fevers caused by an infection, and they don’t work as well if the fever was not caused by one!

If you can avoid dehydration, you will likely avoid heat exhaustion or heat stroke. Work or exercise in hot weather (especially by someone in poor physical condition) will easily cause a person to lose body water content).  A loss of just 1% of your total water initiates the thirst mechanism. You’ll need a pint of water an hour to stay hydrated.  If thirst is not quenched, as little as 2% water loss begin to affect work efficiency, mood, and other parameters.  At 6%, you’re as delirious and uncoordinated as if you’ve been crawling for miles through Death Valley.

Carefully planning your outdoor work in the summer heat and keeping up with fluids will be a major step in keeping healthy and avoiding heat-related illness.  Monitor the workload (and the workers) and you’ll stay out of trouble.

Dr. Bones

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