Summer Emergencies – Heat Exhaustion
We have the will to outlast everything!
Summer is a fun time of year. Lots of activities such as
fishing, boating, swimming, hiking, and camping, Lots of stuff to do with your
loved ones. People just seem to be more active with the warmer weather. All of
this activity is fine, but it should be realized that with all of the fun stuff
to do, there are certain summer emergencies that can present themselves.
The main problems related to summer as far as medical
emergencies go are heat exhaustion, heat stroke, sunburn, drowning, poisoning
by plants, and insect bites. Let’s discuss these, item by item.
Heat exhaustion is a common problem. It often occurs when
someone works hard in the heat and does not have an adequate fluid intake. What
basically happens is that when the body’s temperature starts to increase with
exercise, especially in a warm and humid environment, the blood collects, to a
degree, near the skin’s surface in an effort to cool down.
Sweating also occurs. For sweating to be effective in
reducing the body’s temperature, it must be able to evaporate. When there is
clothing and high relative humidity, the sweating process is hampered. Problems
can follow.
The signs of heat exhaustion can include rapid and shallow breathing, a weak pulse, cool and clammy skin, and heavy perspiration. Symptoms include weakness, sometimes total, dizziness, and nausea.
Treating the victim of heat exhaustion is usually simple. If
at all possible, move the victim to a cool place, possibly with air
conditioning or shade. It is important not to cool a victim down too much too
soon. The victim must rest and should lie down. They have, to a degree,
experienced hypovolemic shock, and rest is very important. Often these things
will correct a mild case of heat exhaustion.
Additional treatment might be warranted, especially if the
victim progresses slowly or not at all. You can remove clothing which will help
cool the victim’s temperature down a bit. Fans help remove heat also.
Sometimes, and only when a victim is fully able to swallow on their own, you
can give fluids by mouth. Some medical textbooks suggest a salted water
solution: a teaspoon of salt to a quart of water, limiting its amount as the
victim may vomit or choke if it goes down the wrong pipe. It is appropriate to
notify the local E.M.S. (Emergency Medical Services) systems as the problem
could recur and/or there could be a serious underlying cause.
What causes heat stroke it’s not really known. We do know
that it is directly related to the shutting down of the body’s ability to perspire.
This causes no heat loss by evaporation, therefore raising the body’s
temperature, sometimes to a dangerously high level.
Signs of heat stroke can include: deep breaths initially,
followed by shallow ones, a strong, rapid pulse, followed by a rapid and weak
one. Other signs are dilated (enlarged) pupils of the eyes, loss of
consciousness, and sometimes convulsions. The obvious sign with heat stroke is
hot and dry skin.
This is a true emergency! The victim must be cooled down
NOW. If at all possible, move the victim to a cool place and begin cooling.
Methods can include wrapping the victim in wet towels, then pouring cold water
over them. Ice or cold packs placed in the armpit area, groin, ankles and the
neck will often help as the blood passes close to the skin at these points and
will be cooled down to a degree.
Again, alert the E.MS. system, and if it is delayed,
consider placing the victim in an ice water-filled tub, if you can. Be prepared
to institute life-saving measures such as airway maintenance and C.P.R. (cardiopulmonary
resuscitation).
Sunburn should be handled accordingly by the degree of burn
created. Usually, it is a first-degree burn. The sign of a first-degree burn is
skin that is reddened. Most sunburns are minor in nature but can be very
painful and in some cases, require a doctor’s attention.
Obviously, the best cure is not to get sunburned in the
first place. Prevention includes wearing adequate clothing, a good sunscreen
lotion, and limiting one’s exposure to the rays. The problem is that one is
often sunburned before one realizes it.
If the burn is mild, a topical anesthetic lotion or cream
may be effective. More severe cases should be treated as any other burn. Most
sunburns that require more treatment than creams are those involving second-degree
burns or those that cover a large part of the body. These burns should be
covered with cool water-soaked dressings. You do not want to cool the victim
but stop the burning process.
As a general rule, burns covering more than about 10 percent
of the body get a dry dressing instead of a cool, wet one. I would strongly suggest
seeing a doctor at an office or a local emergency room. It may be embarrassing,
but let me tell you, sunburn can hurt like hell, and I’ve seen lots of sunburn
victims in my ambulance and in a hospital’s emergency rooms. Common sense
should override embarrassment.
Drowning is common, all too common. In the United States, there are about ten deaths per day caused by
drowning. All but 10 percent of these drown within 10 feet of safety.
What makes this sadder yet is that alcohol is involved in a large percent of these
drownings.
What happens when a person drowns? First, there are two
types of drownings. One is the “dry” drowning. This is where the
epiglottis and the larynx spasm down, letting a little water into the lungs.
The victim asphyxiates. The other type of drowning is “wet?’ Eighty
percent of drownings are wet. Initially, the spasm of the larynx occurs, but as
the victim struggles and becomes unconscious, it relaxes, and the victim
aspirates water into the lungs. Often there is no lung movement, and a little
water gets in.
The victim needs to be rescued, and resuscitation measures
started at once. As soon as the victim and rescuer are at the surface, mouth-to-mouth
breathing should be started, if at all possible. On shore or in the boat or at
poolside, if the victim is pulseless, external cardiac compression should be
started. This procedure should be done by trained individuals, and I strongly
endorse C.P.R. training. Do not attempt to get water out of the lungs as very
little, if any, will usually have gotten in. Instead, concentrate on getting
air into the lungs.
Now let’s talk about a couple of drowning complications. One
of these is a possible neck injury. Ninety percent of drownings occur in inland
waters and pools. Any drowning where a fall or dive could have caused a neck
injury should have special considerations. The priority is getting the victim
rescued and providing appropriate resuscitation efforts.
Try to be careful with the victim’s neck and back. Turn the
victim as a unit, avoiding all twisting, bending, and shaking. A backboard or substitute
will be a great value, and it or a substitute is suggested. Alter. native
airway opening mechanics such as the modified jaw lift should be employed.
The other complication with drowning is immersion in cold
water. This is often a good complication, considering. What happens is that
when a mammal is placed in cold water (under 70 degrees F.), the Mammalian Dive
Reflex is put into play. The body’s metabolism shuts down, and blood is kept in
the vital areas of the body, the chest, and head. This is what happens when you
see the news or read the newspaper and items pop up about people being saved
from icy waters.
This Mammalian Dive Reflex has changed most thinking about
drowning. You are not dead until warmed and then dead. Even in summer, water
can be below 70 degrees F below the thermocline. In most cases, you do not know
how long the victims have been under water. Try in all cases to save drowning
victims. There have been cases of up to nearly one hour of immersion who have
survived.
In the United States, the most common poison plants are
poison ivy, poison oak, and poison sumac. They can cause itchy, swollen skin
areas, sometimes with blisters. You should immediately remove the victim from
the immediate area where the plants are and remove the clothing that covers or
is near the affected area. The area should be washed with water, ideally with
soap and water. A dressing should be applied, and a doctor’s care sought out if
any complications occur, or if the condition does not improve.
Most people, when stung by insects, have no more than temporary
discomfort. About five percent of the population is allergic to insect stings,
and the complications can vary from very minor to severe anaphylactic shock.
More often than not, swelling and itching will occur. If
stung, realize that wasps, hornets, and yellow jackets retain their stingers
and can sting again. Honey bees sting only once as they leave their stinger in
their victim. Also left is a venom sac. If stung and the stinger has left a
stinger and venom sac, do not grasp them and squeeze or pull as this will
inject some or all of the remaining poison. Scrape the sac and stinger away
from the wound with a knife blade, scissors, or fingernail. When there is a
severe allergic reaction, a type of shock can develop. This shock is
anaphylactic shock. Be alert for this as it can come on after some period of
time following the sting.
Anaphylactic shock presents itself with skin that itches and
burns, often about the face and mouth. Also, there can be difficulty in
breathing, anxiety, dizziness, headaches, and nausea. Look for blotches about
the skin. The victim might wheeze when attempting to breathe. Other signs of
shock might occur, such as rapid, weak pulse, and a decreased level of
consciousness.
Treat the victim of anaphylactic shock as you would any
other form of shock. Priorities are the ABCs. Assure an open airway, make sure
the victim is breathing, and check to see that a pulse is felt. If possible,
provide oxygen, and transport to a doctor or hospital as soon as possible.
Often, individuals who have a known sensitivity to insect
stings have available a kit containing an antihistamine such as injectable
epinephrine. Have this ready for the victim as they are probably trained to use
it. If you need to assist, read the instructions, and follow them closely. The
victim may improve after the medication is given, but needs to have follow-up
care given by a doctor, so see that transportation is arranged.
Summer is a fun time of year. I hope that I have alerted you to some of its hazards and what to do if they are encountered. It’s better to have a basic knowledge and understanding of the above summer emergencies and be ready to limit their effects until medical aid arrives. Be prepared to enjoy the summer, but also be prepared to face the unknown. Stay safe out there!
This article has been written by James H. Redford MD for Prepper’s Will.
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