Heat stroke

Types of Heat-related illnesses

The body tries to cool itself by sweating. Heat-related illnesses can occur if sweating cannot meet the body's cooling demands. 

This is a broad-spectrum heat-related illness:

1. Severe heat-related illness

Heat stroke: Life-threatening condition marked by high core body temperature and CNS dysfunction; requires rapid cooling and medical intervention.

Depending on its cause, heat stroke can be categorized as:

Exertional heat stroke

• Occurs in physically active individuals, often after intense exertion in hot and humid conditions.
• Develops rapidly due to inadequate hydration and rest, commonly affecting athletes, military personnel, and laborers.
  
  

Nonexertional or classic heat stroke 

• Arises from a breakdown in the body's temperature regulation system. 
• Typically seen in the elderly or those with chronic illnesses, triggered by prolonged exposure to hot weather, lack of access to cool environments, and impaired thermoregulatory mechanisms.

2. Moderate heat-related illness

Heat exhaustion: Symptoms include profound fatigue, weakness, nausea, headache, or dizziness due to water or salt depletion from heat exposure; mild elevation (<40°C) in body temperature may occur without altered mental status.

3. Mild heat-related illness

• Heat syncope: Brief loss of consciousness due to vasodilation and blood pooling in limbs as a result of heat exposure.
  
  
• Heat edema: Limb swelling due to peripheral vasodilation and fluid pooling in response to heat.
  
  
• Heat cramps: Painful muscle spasms in abdomen, arms, or legs due to salt loss during sweating in heat.
  
  
• Heat rash: Inflammatory skin disorder from blocked sweat glands, potentially leading to bacterial infection.

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Symptoms Of Heat stroke 

Heat stroke is a condition in which the body's temperature rises to high levels. In extreme heat, your body’s ability to cool itself down can fail, causing your body temperature to increase to a dangerous level. 

The symptoms of heat stroke can differ from person to person but often include:

• Absence of sweating due to the body's inability to release heat and cool down
• Symptoms like confusion, convulsions, dizziness
• Hot, dry skin
• Uncontrollable muscle twitching
• Slurred speech
• Rapid, weak pulse
• Throbbing headache
• Shallow breathing, seizures, unconsciousness
• Body temperature spikes to 102° - 104°F or higher rapidly

Note: If the muscles begin to twitch uncontrollably, keep the person from self-injury. Do not place any objects in the mouth. Also, monitor body temperature and continue cooling efforts until emergency medical treatment is provided to the victim.

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Causes Of Heat stroke

Heat stroke occurs when the body's heat-regulating system is overwhelmed by excessive heat. The skin may be dry if the ability to sweat has been lost. It's a life-threatening emergency and needs immediate medical care.

Heat stroke occurs when the body's ability to regulate temperature fails. 

• As the condition worsens, the body reaches a point where it can no longer keep up with the heat it's gaining. 
• This is because the heart is unable to pump enough blood to meet the body's cooling needs. 
• As a result, the body temperature keeps rising (exceeds 104°F or 40°C), causing damage to cells and triggering an inflammatory response.
• This sets off a dangerous cycle, leading to the failure of multiple organs.

Note: Various risk factors associated with heat stroke are discussed below.

Risk Factors For Heat stroke

Heatstroke can affect anyone, but infants and the elderly face heightened risk due to potential difficulties in regulating body temperature. 

The following conditions can increase the susceptibility to a heat stroke:

1. Hot weather: Exposure to scorching and humid weather conditions.

2. Physical exertion: Engaging in vigorous physical activity, especially in hot weather.

3. Dehydration: Insufficient fluid intake or excessive sweating without replenishing fluids.

4. Age: Infants, young children, and older adults. Children have a higher metabolic rate, and older adults may have underlying health conditions that affect their ability to regulate body temperature effectively.

5. Lack of acclimatization: Individuals not used to hot weather or recently moved to a hotter climate.

6. Lack of cooling mechanisms: The inability to access cooling mechanisms like air conditioning, fans, or cool water, especially during heat waves.

7. Certain occupations and activities: Construction workers, firefighters, and athletes who train intensively involve prolonged exposure to high temperatures and physical exertion.

8. Alcohol abuse: Excessive alcohol consumption can interfere with the body's heat regulation mechanisms and increase the risk of heatstroke.

9. Certain health conditions: Individuals with chronic illnesses such as heart disease, lung disease, obesity, diabetes, certain immune-related conditions or having high fever. 

Also, pregnant women and breastfeeding mothers are more prone to heatstroke.

10. Certain medications: Some medications, such as certain antipsychotics, antihistamines, diuretics, beta-blockers, and stimulants, can interfere with the body's ability of temperature regulation.

11. History of heat-related illnesses (HRI): Previous episodes of heat-related problems indicate higher risk in subsequent exposures.

Diagnosis Of Heat stroke

Diagnosing sunstroke usually involves a combination of the following:

1. Physical examination: A doctor will evaluate the individual's signs and symptoms, paying close attention to their body temperature, skin condition, and overall appearance. 

2. Medical history assessment: The doctor may inquire about the person's recent exposure to hot environments, physical exertion, and any underlying health conditions.

3. Rectal temperature: A rectal temperature is more accurate than a mouth or forehead temperature in identifying your core body temperature.

4. Blood tests: In some cases, blood tests may be conducted to assess the individual's electrolyte levels, kidney function, or liver function tests. These tests can aid in identifying any abnormalities or complications associated with sunstroke. 

5. Urinalysis: A urine test may be done to check the color of the urine because it can turn darker if you have a heat-related condition and to check for kidney function, which can be affected by heat stroke.

6. Imaging studies: In severe cases or when complications are suspected, imaging studies such as a computed tomography (CT) scan, magnetic resonance imaging (MRI), chest X-ray, or electrocardiogram (ECG) may be ordered. These tests can help rule out other potential causes of symptoms and provide additional information about the person's condition.

7. Muscle function tests: These assess potential severe muscle tissue damage. This is more prevalent in exertional heat stroke than classical heat stroke.

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Prevention Of Heat stroke

To prevent heat stroke or sunstroke, you can take the following measures:

1. Stay hydrated 

• Keep yourself well-hydrated by drinking ample water throughout the day, regardless of thirst.
• Consider alternatives such as coconut water, buttermilk, juices, lightly salted water, and broth.
• Avoid excessive alcohol and caffeinated beverages.

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2. Dress appropriately

• Wear loose-fitting, lightweight, light-colored clothing in hot weather to facilitate effective temperature regulation and sweat evaporation.

3. Stay informed

• Watch for weather forecasts and heat advisories in your area. 
• Keep an eye on the heat index, which combines temperature and humidity, to determine the severity of heat-related risk.

4. Stay cool and safe 

• Avoid peak heat hours from 10 a.m. to 4 p.m. and take breaks in cool areas if outdoors.

• Minimize outdoor time on hot, humid days by staying indoors when possible.

5. Stay Sun-Safe

• Seek shade or use an umbrella/canopy when outdoors.
• Wear a tightly woven, wide-brimmed hat and sunglasses with UV protection.
• Apply sunscreen with SPF 30 or higher, broad-spectrum protection, and water resistance.

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6. Cool your body

• Take cool baths regularly to regulate body temperature and prevent overheating.
• Stay in air-conditioned environments when possible, such as shopping malls with cooling facilities.

7. Avoid strenuous activities

• Minimize physical exertion in hot and humid conditions.
• Schedule activities for cooler parts of the day and take regular breaks in shaded or cool areas.

8. Acclimatize gradually

• Increase outdoor time gradually to allow the body to acclimatize to the heat.

9. Be mindful of certain medications

• Check with your doctor about any potential side effects of your medications in hot conditions.

10. Medical considerations

• If your child has a medical condition or takes medication, consult their doctor for personalized advice on preventing heat-related illnesses.

Doctor To Visit

If heat stroke persists for over 30 minutes, it becomes a critical situation demanding immediate medical attention. 

Whenever there is a suspicion of heat stroke or uncertainty about the gravity of the symptoms, it is vital to promptly reach out to a doctor or seek medical help without delay. 

Neglecting medical intervention can result in severe complications and potentially life-threatening circumstances.

The doctors you can visit include:

• General physician
• Internal Medicine specialist
• Pediatrician

A General physician recognizes and treats heat stroke symptoms and provides immediate care and advice on prevention.

Internal medicine specialist manage the systemic effects of heat stroke, coordinate comprehensive care, and address underlying medical conditions. 

A pediatrician plays a crucial role in preventing and managing heat stroke in children by educating parents on proper hydration and sun safety and providing prompt diagnosis and treatment to mitigate the effects of heat-related illnesses.

If you notice any symptoms discussed above, seek medical advice immediately, and consult our trusted team of doctors.
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Treatment Of Heat stroke

First-Aid tips

1. Call for emergency help: call a nearby hospital for immediate medical assistance.

2. Stay with the person: check the person’s airway, breathing, and pulse.

If unconscious- position on their side and commence CPR if required. Seek urgent medical advice if the ambulance is delayed.

Remain with the affected individual until emergency services arrive.

3. Move to a shaded area: Transfer the person to a cool, shaded spot and remove any excess clothing. 

4. Prioritize airway protection, breathing support, and circulation (ABC): Prioritize the protection of the airway, ensuring adequate breathing assistance, and maintaining circulation- a critical sequence known as ABC- essential in managing heat stroke effectively.

5. Cool the person quickly: Swiftly initiate cooling procedures after ensuring basic care (ABCs)-

Utilize various cooling methods:

• Submerge in a cold water or ice bath, if possible.
• Wet the skin and apply cold wet cloths.
• Soak clothing with cool water.
• Enhance air circulation around the person for faster cooling.
• Apply cold wet cloths or ice packs to the head, neck, armpits, and groin.

6. Encourage fluid intake: Offer cool fluids if the person is alert and able to drink. Offer a sports drink, rehydration solution, or cool water to drink. 

Intravenous (IV )fluids will be given to the emergency room upon arrival.

Medications

1. Benzodiazepines: Immediately administered in cases of agitation and shivering to halt excessive heat production. 

2. Anticonvulsants: Benzodiazepines and barbiturates are recommended for convulsions. Barbiturates can be used despite potential sweat production impairment.

3. Refractory convulsions: Patients with convulsions unresponsive to benzodiazepines and barbiturates may require paralysis and mechanical ventilation. Electroencephalographic monitoring and adjustment of anticonvulsant medications are essential in such cases.

Note: Antipyretics (fever-reducing medications) and other nonsteroidal anti-inflammatory drugs are not recommended and may harm the liver.

Complications Of Heat stroke

If not treated timely, heat stroke can give rise to a myriad of complications, each of which poses a severe threat to the individual's life. Its complications include:

1. Low blood sugar level: It is a condition characterized by low blood sugar levels and can occur as heat stroke impairs the body's ability to regulate glucose. This can lead to weakness, confusion, and even loss of consciousness.

2. Rhabdomyolysis: This condition occurs when muscle tissue breaks down rapidly, releasing a large amount of myoglobin (a protein) into the bloodstream. Myoglobin can cause acute kidney injury.

3. Disseminated intravascular coagulation (DIC): Heat stroke may trigger a complex and serious clotting disorder in the body, leading to excessive bleeding and clot formation.

4. Acute respiratory distress syndrome (ARDS): High body temperatures can damage the delicate lung tissues, leading to inflammation and fluid accumulation, making it difficult for the individual to breathe. 

5. Heart damage: Heat stroke can disrupt the heart's electrical activity, leading to abnormal heart rhythms (arrhythmias) or even cardiac arrest in severe cases.

6. Brain damage: Heat stroke can cause swelling and inflammation of the brain, leading to neurological complications, including seizures, confusion, memory problems, and even coma.

7. Kidney failure: Heat stroke can affect the kidneys, leading to acute kidney injury or failure. Dehydration reduces blood flow to the kidneys, and direct damage from heat can all contribute to kidney problems.

8. Multi-organ failure: Prolonged exposure to high temperatures can cause damage to various organs, such as the brain, heart, liver, and kidneys.