Treating Heat Stroke

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Environmental Causes of Illness: Heat Stroke

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 and heat stroke if severe.  Heat exhaustion does not result in permanent damage, but heat stroke does; indeed, it can permanently disable 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.

Symptoms of  Heat Stroke and Heat Exhaustion

Heat exhaustion is characterized by confusion, mood wings, 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 with loss of consciousness, seizures, bleeding (seen in the urine or vomit), skin rashes, shock and a rise in temperature as high as 115 degrees!  Organ failure and death may follow.
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.  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, but taking a temperature with a thermometer will reveal the truth. 
Using common sense, it is clear that the patient must be cooled as soon as possible.  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.  When the body can no longer cool itself, it will be up to you 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 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.   Immersion in a cold stream may be all you have in terms of a cooling strategy.  If so, never leave the patient unattended.
Oral rehydration is useful, but only if the patient is awake and alert.  Fanning the patient will help with evaporation, which will dissipate the heat.   Strangely, acetaminophen or ibuprofen are less help to lower temperature than you would think in this circumstance:  they 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 lead to dehydration if the person does not take in at least 1 pint of water per hour.   Planning your summer work day and keeping up with fluids will be a major step in keeping healthy in the heat! 
Joe Alton MD
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