Summer Heat---A Real and Potential Danger-An Article

[surgblumm]

Summer Heat---A Potential Deadly Enemy

                   Bob Blumm, MA, PA-C, DFAAPA

Two weeks ago my wife came home to realize that our landscaper was using our bathroom and was physically sick after working outdoors for a few hours in 93 degree heat. She hydrated him, let him use an air conditioned room and drove 45 minutes to bring him home. While in Washington a week ago I saw a runner moving through a mall like he was being chased by a German Shepherd. I envied his stamina until I saw him fall to the ground prostrate from heat exhaustion. A bicyclist is riding uphill on the road that leads through the Blue Ridge Mountains and his focus on the road and the beauty that surrounded him was marred by the view of the dirt road that was catching him as he fell from his bike due to the exhaustion of his body augmented by the heat. Then of course, is the person who has gone past the limit, thought that he was an Army Ranger, and stressed his body to the point of sunstroke and a fatal outcome. We are aware of the power of the sun, of UV radiation, of melanoma but there are also the acute raises in temperature that cause us to become dehydrated, exhausted, have sunstroke, require hospitalization and IV fluids and some that require the services of the undertaker.

As humans we are faced with this trio of possible modalities and the progression from one to another is modulated by things such as our age, medications, weight, prior health history and the fluids that we choose to replenish our bodies, some which can make us  victims of excessive electrolyte imbalance and others that can create hyponatremia. Dr. Oz recently had a show where he specifically told the audience that water in itself is sufficient most of the time to rehydrate whereas there is an occasion for Gatorade and other fluids of that composition.

Dehydration occurs when we stop drinking fluids which are necessary for homeostasis. This occurs more frequently in hot climates and in hot humid weather. This can also be the result of prolonged diarrhea, protracted vomiting or sweating or as a result of surgical procedures which can create hypovolemia such as liposuction. In addition this can be the result of diuretic medications, with elevated fevers when fluids are not being consumed and when IV rehydration is not performed. Some of the symptoms of dehydration include “cotton mouth” as when your oral cavity is so dry that your tongue can stick to your palate. This is automatically a serious consequence of burns which cause third spacing and which require formulas such as the “Brooke Burn Formula.” The best manner of distinguishing what is proper replacement is following the guidelines and subsequently performing Foley catheterization to be aware of urine output and to be guided by that number in rehydration.

Your patient will present with hypotension, sleepiness, weakness, sunken eyes, confusion and dizziness or vertigo. In the field it is wise to rehydrate with water and to teach patients that it is essential to drink prior to exercise. If your patient has chronic diarrhea or vomiting they will need labs and possible admission for IV rehydration. It is wise to abstain from fluids that have a natural diuretic effect such as ETOH, coffee and tea.

Heat Exhaustion

This medical condition is very much like a malfunction of an air conditioning system in that normal cooling cannot take place and thusly heat begins to be stored within the body creating a rise in temperature. Not unlike dehydration, it is set off by the same types of behavior. In this case the danger lies in that like the meltdown of a nuclear generator it can be utterly destructive as it can lead to heat stroke, a medical emergency. The patient will present very much like the patient with dehydration but their skin will be hot and dry or they may have moved forward to shock. The treatment is to remove the patient from the source of heat, rehydrate with fluids and maintain a neurological watch.

Heat Stroke

This modality follows heat exhaustion in that the cooling system is ineffective and follows exposure to heat and sun. as your body stops sweating the temperature can rise to dangerous levels as high as 106 and the patient can have seizures and renal failure and die. This is why geriatric patients are encourages to stay indoors in air conditioning or go to a cooling center such as we have in NYC or to a mall. Geriatric patients are usually on polypharmacy which only adds to their potential for complications.  Children are often victims and parents have been arrested for child abuse or even manslaughter when they are left in a motor vehicle with doors and windows locked. This most often happens when a grandparent takes them for a drive or a mom or Dad is so intent on getting to a location that they have forgotten the child asleep in the car. This also happens to animals such as dogs and the end result is death. You may say; Bob , this could never happen yet I saw parents place a car seat on the roof of as car and drive away on the parkway forgetting the child in the car seat. The child fortunately was not injured, a passerby immediately stopped and the police became involved in a problem where innocent but forgetful parents who loved their baby, just forgot.

When a patient presents with heat stroke they are confused, or unconscious, agitated or disoriented they have all the symptoms of a patient in distress with the addition of tachycardia. These people need immediate emergency care in an ER or Urgent Care Center including fluids, cooling blankets, cool IVs, removal of all clothing and observation for 24 hours or until all their vital signs are stable and all their systems are working again. Summer is a time for fun and family but also a time for the utilization of common sense. This article is purposely fairly simple as it is good take away literature for your office in the summer. Time for a cold glass of lemonade. Prevention is still the best medicine

bob

[ohiovolffemtp]

Patients who abuse meth or other stimulants are also of increased risk.  Definitely worth aggressive IVF to start unless there are contra-indications.  Always check CBC, BMP, and CPK.

 

[surgblumm]

Thanks for the additional input which is so relevant for this day and age.