The heat we’ve been having at or around 100 degrees is uncomfortable, but also dangerous if you’re not careful. In this KERA Health Checkup, a talk about heat-related illnesses with Dr. Ketan Trivedi. He heads the emergency department at Methodist Mansfield Medical Center.
Dr. Trevedi: The heat illness is a continuum. We have the, on one end, very mild illness, you get heat cramps, some people get prickly heat so they get rash on their skin, some people get mild heat exhaustion. Elevated body temperature along with nausea, vomiting, dizziness. Some people actually pass out and that’s call heat syncope so their body temperature goes up at the same time all their blood vessels all dilate because their muscles are working hard, they’re out there running. At the same time their body is trying to get more blood to the body surface to cool them down because they suddenly lose the blood in the body and they pass out.
Baker: At what point does this develop into heat stroke?
Dr. Trevedi: Not only the temperature of the body goes up, but you have altered mental status. So you have things like seizures, coma, delirium, confusion, very critical condition. Patient needs to be cooled down immediately; patient needs to be admitted to the hospital. IV fluids need to be given to the patient. Oftentimes patients have electrolyte imbalances. They have organ dysfunction so kidneys may be shutting down, they may have signs of muscle breakdown. All these things need to be corrected.
Baker: So, without a doubt, it’s potentially fatal.
Dr. Trevedi: It’s oftentimes fatal.
Baker: What kind of time window are we talking about between the point a person might suffer heatstroke and the time he or she needs to get to the hospital?
Dr. Trevedi: If you live in a metroplex like this, it’s pretty easy. You call 911, EMS gets there quickly. Within minutes they’re at the hospital. If you live in more rural areas where EMS may take some time to get there, the best treatment that’s showed to start the treatment for any kind of heat illness really, is called evaporative cooling. Simply get the person out of the elements into a shaded area or even indoors if possible where there’s AC, fan. And you take off as much clothing as you can, leaving the bare essentials on. You take a spray bottle, spray them down with a mist of water and as many fans as you can gather, put them all around the patient and cool them down in that way and that’s shown to be the most effective way to cool a person down pretty quickly.
Baker: Should you give them liquids?
Dr. Trevedi: Water is good, but water with salt is even better. Gatorade or any kind of sports drink, they have a lot of minerals and salts in there. They’re more helpful than just plain water alone.
Baker: Who is more susceptible to heatstroke?
Dr. Trevedi: Infants, young children. Elderly patients who have multiple medical problems, who are on multiple medications.
Baker: I would imagine people engaged in a lot of physical activity, out of doors for long periods of time?
Dr. Trevedi: Sure. Football players are typically thought to be more at risk than other sports, partly because one, they run around quite a bit, and secondly they put on all this heavy gear, helmet, so all that prevents your body from dissipating the heat and traps more heat in so they have a hard time cooling down.
Baker: I would imagine the same could be said for construction workers, people who work on roofs –
Dr. Trevedi: People working on heights are at more risk because the temps above a certain height can be 15, 20 degrees hotter than down below on the surface. And again, same thing, they wear extra clothing and helmet to keep them safe; at the same time it will prevent them from cooling down.
Baker: Is there any such thing as becoming used to the heat?
Dr. Trevedi: Acclimatizations – say you start off playing sports, football, 20 minutes being out there in the heavy gear, you’ll start getting warm and start getting weak and fatigued and you’ll need to rest. As time goes on, you’ll notice that you’re able to tolerate that more and more because your body can get used to having all this gear on and being in the heat. But that’s different for different people; some people take a few days to get used to the temperature and the heat and humidity and some people take a longer time.
Baker: I suppose the concern is maybe that you get used to the heat –
Dr. Trevedi: As warning signs go away, they stay out there longer, they start drinking less and when the heat illness actually sets in, they’re much more ill than they would have been otherwise.
Baker: What can people do to prevent heat-related illnesses?
Dr. Trevedi: Common sense things, really. Stay indoors as much as possible. If you go outdoors, then limit the exposure to the sun. Light clothing, loose clothing. Plenty of beverages. The problem with caffeinated beverages and high sugar beverages is that they’ll also deplete your water. They’re diuretics. They’ll make you urinate. The other problem with caffeinated drinks is they also ramp up your metabolism so that builds up a lot of heat to begin with. So if you’re running around doing sports activities, you drank caffeinated beverages, it’s hot outside. So it’s a perfect storm.
Dr. Ketan Trivedi is Medical Director of the Emergency Department at Methodist Mansfield Medical Center.