Risk Factors:
We have the will to outlast everything!
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.
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.
Indoor or outdoor temperatures are greater than 90 degrees F
or relative humidity greater than 60 percent present great risks.
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.
A workplace that is poorly ventilated and has high temperatures
is dangerous for one’s health.
Certain drugs can make us more vulnerable to high temperatures.
Examples are:
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.
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.
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 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.
Other contributing factors are:
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.
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.
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.
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.
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,
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.
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.
This table will help you understand better what is present
during 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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AWESOME information…like you stated in your article, many fail to act on these issues and that leads to more serious issues later. The comparison chart you show is AWESOME!!!!!!!!!!!!!!! more people need to adhere to these guidelines when out and about esp. in the warmer temperature areas like the desert southwest …(my future home!!) As an EMT, we were taught to look for these things in people even when they don’t recognize what going on to themselves. Losing 10% of your body weight due to exertion will get you a trip to the ER…working in a class “A” suit will do that to you big time..I know that one really well!!!!!!!!!!!!! it’s scary when you take the suit off and literally pour water out of it from sweating too much..doesn’t even need to be really hot that day
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