Summer is here and temperatures are rising. With the rise in temperature comes more heat related emergencies. So, let us take the time to do a review.
Heat related illness generally occurs from one of two causes: the temperature regulation centers in the brain fail or the patient is overwhelmed by high temperatures, more likely to be seen with physical activity in high temperatures.
There are three different types of heat related illness you might encounter in the field: heat cramps, heat exhaustion, and heat stroke.
Heat cramps illness is caused by fluid and electrolyte loss. This results in painful involuntary muscle cramps that might come and go. Muscles most likely to be affected are the calves, arms, and back. Treatment in the pre-hospital setting is primarily supportive. Remove the patient from the hot environment. You can consider fluid replacement if allowable in policy.
Heat exhaustion results from dehydration and a loss of sodium. Symptoms may include heavy sweating, dizziness, fever, and fatigue. The patient may also be experiencing classic signs of shock, such as tachycardia and hypotension. Patients generally recover quickly when they are removed from the hot environment and fluids are replenished.
Heat stroke occurs when the body temperature-regulating mechanisms breakdown entirely. As the body overheats, proteins begin to unravel, and metabolic process begin to fail. This causes the cell membranes to rupture, generating a systemic inflammatory response. This results in symptoms such as disorientation, lack of perspiration, rapid shallow breathing, and incredibly high body temperature. In any age group, a heat stroke patient may present as hypotensive with a decreased cardiac output.
Treatment for heat stroke should be immediate and aggressive. Remove the patient from the warm environment. Begin rapid cooling measures, by first removing the patient’s clothing. The patient’s body temperature needs to be lowered without stimulating shivering. Consider placing cold packs to the axilla and groin. The patient will need intravenous fluid resuscitation. Consider normal saline of lactated ringers, if available. Remember to follow your local policy and procedures.
So as the summer continues, and temperatures rise, prepare for the increase in heat related emergencies. Stay hydrated and safe!
