Environmental Emergencies: Heat Stroke

Heat Stroke is an acute medical emergency caused by failure of the heat-regulating mechanisms of the body. It usually occurs during extended heat waves, especially when they are accompanied by high humidity. People at risk are those not acclimatized to heat, those who are elderly or very young, those unable to care for themselves, those with chronic and debilitating diseases, and those taking certain medication (eg. Tranquilizers, anticholinergics, diuretics and beta-blocking agents). Excertional heat stroke occurs in healthy individuals during sports or work activities, ex. exercising in strong heat and humidity.  Hyperthermia results because of inadequate heat loss. This type of heat stroke can also cause death.

Most heat related deaths occur in the elderly, because their circulatory systems are unable to compensate for stress imposed by heat. Elderly people have decreased ability to perspire as well as a decreased thirst mechanism to compensate for heat. The risk for heat stroke is greater among the elderly because many elderly people do not drink adequate amounts of fluid, partly because of fear of incontinence. In addition, many elderly people fear being victims of crime, so they tend to keep windows closed, even when the temperature and humidity levels are high.

Heat stroke causes thermal injury at the cellular level, resulting in coagulopathies and widespread damage to the heart, liver and kidneys. Recent patient history reveals exposure elevated ambient temperature or excessive exercise during extreme heat.

Common sign and symptoms of heat stroke are:
·         high body temperature
·         the absence of sweating, with hot red or flushed dry skin
·         hypotension
·         rapid pulse
·         difficulty breathing
·         strange behavior
·         hallucinations
·         confusion
·         agitation
·         disorientation
·         seizure
·         coma

Preventing Heat Stroke
·  Avoid re-exposure to high temperature; hypersensitivity to high temperature may remain for a considerable time.
·  Emphasize the importance of maintaining adequate fluid intake, wearing loose clothes and reducing activity in hot weather.
·   Advise athletes to monitor fluid losses and weight loss during workout activities or exercise and to replace fluids.
·   Plan outdoor activities to avoid the hottest part of the day.
·  Take extra precautions with certain medications. Be on the lookout for heat-related problems if you take medications that can affect your body's ability to stay hydrated and dissipate heat.
·  Never leave children or anyone else in a parked car. This is a common cause of heat-related deaths in children. When parked in the sun, the temperature in your car can rise 20 degrees F (more than 6.7 C) in just 10 minutes. It's not safe to leave a person inside a parked car in hot weather for any period of time, even if the windows are cracked or the car is in the shade. When your car is parked, keep it locked to prevent a child from getting inside.

The most important measures to prevent heat strokes are to avoid becoming dehydrated and to avoid vigorous physical activities in hot and humid weather.

The primary goal is to reduce the high temperature as quickly as possible, because mortality is directly related to the duration of hyperthermia.

Methods to Treat Heat Stroke Victim
· Get the victim to a shady area, remove clothing, apply cool or tepid water to the skin (for example, you can spray the victim with cool water from a garden hose), fan the victim to promote sweating and evaporation, and place ice packs for the armpits and groin.
· If the person is able to drink water, drink them cool water or cool drinks that do not contain alcohol or caffeine.
· Monitor body temperature with a thermometer and continue cooling efforts until the body temperature drops to 101-102 F (38.3 to 38.8 C).
· Always notify emergency services (911) immediately. If their arrival is delayed, they can give you further instructions for treatment of the victim.

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