The Heat is On

It’s 0900 and it’s already 92 degrees Farenheit with 88% relative humidity and you and your brother are in the back corner of your property decked out in heavy gloves, boots, chainsaw chaps and hardhats with face protectors to get trees cut and prepped for firewood for the upcoming winter.

As you continue to work, you take some water breaks and bathroom breaks and remind your brother to do the same. He’s always been pretty stubborn and doesn’t get to the cooler quite as often as you.
By around 1300, it’s 100 degrees with a heat index of 110. You’re getting ready to grab a sandwich and cool off a bit when you notice your brother’s chainsaw has become silent. You walk around the other side of the truck talking to him about how hot it is today and you notice him walking away from you in an unsteady gait. You call out to him and there’s no response. You run up to him and pull his helmet off and the first thing you notice is how red his face is. You put your hand on his head and notice his skin is hot to the touch and dry.
What do you do?
Heat injuries are just as insidious as cold injuries but they do progress in stages if you know what to look for.

What is it?
In this case, we see what looks like a case of classic heat stroke. There are different types of heat stroke out there. Classic and Exertional. Classic is characterized by the person being overwhelmed by the outside temp and humidity and the body loses it’s ability to cool while exertional is caused by the metabolic processes inside the body doing what they normally do but overheating the body due to dehydration and inability of the core to radiate the heat off of the body and can occur with relatively low temps and humidity.
In either case, heat stroke is a true medical emergency and we need to get the victim cool quick!

How do you recognize it?
Their skin can be hot and dry but depending on the ambient humidity, it may still be moist. The higher the humidity, the less evaporation occurs, the more moisture traps the heat, the less cooling occurs. Thus, it can be said that a higher humidity environment may incur a higher amount of heat casualties.
The heat stroke casualty may have an altered mental status due to the high core temp (greater than 104.5 F) and may exhibit nausea, vomiting and seizures. Big concerns, in addition to cooling the victim, is maintaining a patent airway and preventing any kind of aspiration to occur
Prior to heat stroke, there will be several signs and symptoms that show the victim is heading that way. Heat exhaustion can be a precursor to heat stroke and the heat exhaustion victims may have cool, clammy skin and are still sweating. They may have cramping, diarrhea, nausea and vomiting. They are suffering from a form of hypovolemic shock due to sweating out all of their electrolytes and need electrolyte replacement and cooling before they progress to heat stroke. If they start exhibiting these symptoms, get them somewhere cool, quickly! Get them cool, give them fluids and have them rest.

How do you treat it?
Get them cool quickly! If you have a thermometer, get a core temp reading as a baseline (yes, core means rectal temp) In this case, the brothers have some heavy black trash bags and an cooler full of ice and water. Perfect recipe for cooling down a heat casualty.
Get the casualty into the shade, call 911 and attempt to cool them. Get their clothes off and start packing ice packs onto the groin, the head, the back of the neck, the armpits, behind the knees and the wrists. Basically, you’re trying to cool the areas where a high degree of arterial blood flow occurs in order to get the cooling to the core area. You could use the bags and lay the victim in them and ‘dam up’ the edges and put ice and water in to form an improvised immersion cooling bath. Constantly monitor (every 5 minutes) for significant cooling and once the temp is between 100-102, you can get them out of the bath as we don’t want to induce hypothermia, because the muscles will start shivering and this produces heat, which is counterproductive.
If they are lucid, you may try oral rehydration with small sips of cold fluid. Be very, very cautious and constantly observe for nausea, vomiting and seizures. Protect their airway!
Wait for 911 to get there, let them know what happened and let them get the victim to the ER and into treatment. Chances are, they’ve shocked their liver and kidneys and even if they recover, they will need a few days in the ICU and it may take months for their system functions to normalize.

The best medicine in these scenarios is prevention and common sense.
1) Hydration. Around 1L/hr. Alternate water and electrolyte solutions.
2) Rest periods to cool off. Take 15 minutes out of every hour, at the very least.
3) Urination. If you’re not urinating every 1-2 hrs, you’re not drinking enough fluid (that doesn’t mean beer, soft drinks or coffee). If your urine looks like a yellow highlighter, drink more water and electrolyte solutions. Too much water is bad as it can cause “Water Toxicity” where we lose sodium through urination and there’s a fluid shift causing cerebral edema, seizures and death. Many electrolyte solutions are full of sugar. Sugar pulls water into the gut and this can cause diarrhea, making the electrolyte imbalance even worse. Balance it out and make sure the electrolyte solution doesn’t have a lot of sugar. Trade off electrolytes and water on a 1:1 ratio.
4) Buddy Checks. Take care of each other and ensure each other is getting enough rest and fluid.
5) Know the signs and symptoms of heat exhaustion and head off any injuries before they progress.
6) Know your limitations.

Life is complicated. Taking care of each other is pretty simple.

-Pocket Doc