Some like it hot?

As the mercury breaks thousands of records across the country and hits 100 degrees here in Michigan (99 as I write this), it’s important to be aware of the health risks for you and your family.

The range of dangers runs from mild dehydration to heat exhaustion and heat stroke – a life-threatening illness. As with many serious medical conditions, hyperthermia, the medical name of this group of illnesses, poses the greatest threat to the very young and the very old. But even the very fit can be felled by heat illnesses during strenuous outdoor workouts and athletic competitions. Exertional heat stroke remains the 3rd most common cause of death in U.S.  high school students.

The mainstays of prevention of heat illness are an awareness of who is at highest risk and rapid recognition of the earliest signs and symptoms of trouble. The key to spotting the most serious condition – heat stoke – is the mental status of the victim. Any sign of confusion, lethargy or sluggish thought processes in someone who appears to be having difficulty tolerating the heat should prompt immediate medical attention with rapid cooling until help arrives. They may appear pale with moist clammy skin or they may look red with hot dry skin. This latter group is more likely to be suffering from heat stroke, the most serious form of heat illness.

First aid for heat illness is simple: rapid cooling and rehydration. This can be done in a variety of ways.Whenever the topic of therapy for heat illness arises I’m reminded of one  summer in particular during an emergency medicine residency at Detroit Receiving Hospital. The year was 1988 and it was one of the hottest and most humid on record. From 5-10,000 people died across the U.S. during this historic heat wave. Our patients seemed to pour through the door by ambulance. Most were elderly and many were on anti-psychotic medications — another major risk for heat illness. They were all unconscious and many were close to respiratory or even cardiac arrest. Their core body temperatures were often well over 106 and I recall one with a temp of 108. If sustained for more than a few hours these temperatures are not compatible with life. Our job was to get their temps down and fast!

With the large numbers of critical heat stroke patients we developed a system that was both simple and effective: patients were lined up on carts side by side, stripped naked and then covered with bed sheets. A bottle of cool water was poured over them, dousing their sheets. Large 6-foot tall fans were brought up from Housekeeping and deployed at the end of each line of carts creating a veritable “wind tunnel†effect. This, along with ice packs at the patient’s armpits and groins dropped temperatures from 106 to 101 in as fast as 5 minutes. We never lost a patient to heat stroke that summer.

The most important “take home†messages regarding heat illness are as follows. If you remember these, you and your family can safely enjoy the heat this summer!

• Be aware of risk factors for heat illness such as very young or old age, obesity, recent viral illness or chronic health conditions, certain medications such as anti-psychotics (e.g. Haldol and Zyprexa) and amphetamines or drug use (e.g. cocaine and crystal meth).
• Avoid excessive exertion when the Heat Index is in the danger zone (cancel sports events when it’s over 104) and, in general, avoid heavy outdoor exertion during the peak heat periods of 11am-4pm.
• Drink lots of fluids throughout the day — even if you aren’t thirsty. Remind and encourage your family members to do the same.
• NEVER leave children (or pets) alone in vehicles — even for a short period of time!
• Watch closely for signs of heat illness in those at high risk. Symptoms and signs include abdominal and muscle cramps, nausea, vomiting and diarrhea, headache, dizziness and weakness or fatigue. More serious signs include trouble breathing, fever, fainting, confusion, lethargy, combativeness or unconsciousness. Victims may have cool, clammy, pale skin or flushed, red, dry and hot skin.
• Don’t rely on external temperatures such as those obtained with ear, oral or forehead devices. They can give falsely low readings even in heat stroke. Only a rectal thermometer gives an accurate core temperature.
• Treatment should begin BEFORE transport to a medical facility (for serious cases) and should consist of oral hydration in alert patients, rapid cooling with wet sheets or towels and ice/cool packs to the armpits and groin areas. A fan or air conditioning (if available) is very helpful while awaiting medical treatment. If available, an ice bath is very effective at rapid temperature reduction and can be life-saving.

Stay cool and have a safe summer!