It’s the time of the year again when high temperatures contribute to the causes of our responses. This column is dedicated to getting you ready for some of the bad things that summer has to offer and our opportunities to beat the heat and appropriately treat our patients—and even, potentially, ourselves and our loved ones—who have heat-related illnesses—from mild to severe, from muscle cramps to heat stroke, from signs and symptoms to treatment modalities.
Muscle cramps
Starting off the list of heat-related illnesses is our good ol’ friend, muscle cramps. Muscle cramps often are caused by a lack of necessary electrolytes (potassium and sodium) that assist with muscle contraction. When we are dehydrated and potentially depleted of these nutrients, muscles will spasm painfully—primarily abdominal, back, arm and leg muscles.
Universal treatment for all environmental emergencies is a great first step. An additional treatment would be providing a carbohydrate/electrolyte supplemental beverage, such as Gatorade and Liquid IV. Water also provides relief if a supplemental beverage isn’t available.
Exertional dehydration
Exertional dehydration is best described as losing more fluids during exertional times than are readily available in the body. With this loss of hydration, cooling of the body is impaired, and fatigue sets in.
Drinking a supplemental beverage helps to curb the issue of dehydration. A good rule of thumb for the consumption of fluids to avoid these issues is the 2:1 method. For every two bottles of water that a person consumes, that person should consume an equal amount of carbohydrate/electrolyte beverage.
A question that I pose to people when I teach classes that concern environmental emergencies is, “How much water should an individual drink per day?” A reasonable answer for the query is followed by this informal equation. Divide your weight by two. The resulting number is how many ounces of water that you should drink per day. So, for my weight, it would go as follows: 190 lbs./2 = 95 lbs. So, I should drink approximately 95 oz. of water on a daily basis.
However, let’s say that you are a peson who is much more exertional during the day (read: firefighting). You must drink vastly more than what the 2:1 method dictates.
Heat exhaustion
Heat exhaustion is a condition in which the body is overheated, which damages its capability to regulate temperature and makes it become overwhelmingly taxed. Tachycardia, tachypnea and vasodilation occur in addition to sweating to attempt to cool the body of excess heat.
Removing the patient from the environment is very important. Removal/loosening of clothing and allowing the patient to lie down in a cool area also are appropriate.
What happens when things get a little worse? The big differences that we see when the body goes from heat exhaustion to heat stroke are best characterized as being neurological in nature. Altered mental status, loss of consciousness and seizing are all possible when the patient is, what I like to say, “too hot to trot.” Patients who suffer from heat stroke either can be sweating or not sweating. (Remember, sweating isn’t just reserved for heat exhaustion patients.)
Heat stroke patients must be cooled immediately, whether via icepacks to the armpits, neck and groin or cool IV fluids. Pouring cool water on the patient or submerging that individual in shallow water (without letting the head go under) can assist in cooling the patient as soon as possible. Note: The patient must be supervised.
Without rapid cooling of these patients, permanent damage to vital organs can occur quickly.
Stay aware
Keep an eye on your crews, keep an eye on your neighbors when they are mowing their lawn and pay attention to those who appear to be suffering from a heat-related illness. Being too hot really is a big deal. So, until winter comes, “Drink up, buttercup.”
