How to Manage Heat Related Illnesses
Did you know that martial arts movie icon Bruce Lee died of a heat stroke at the age of 32 on July 20, 1973, the hottest day of the month that year in Hong Kong?
Several months before his death, Lee underwent surgery to remove the sweat glands from his armpits, believing that sweaty armpits looked unattractive on screen. This surgery reduced his body's ability to cool itself. On May 10, ten weeks before his death, Lee went into a small dubbing room to re-record dialogue for "Enter the Dragon."
The sound engineers turned off the air conditioner to prevent noise interference with the recording. After about 30 minutes in the stifling room, Lee fainted and began convulsing. He was rushed to the hospital and nearly died from cerebral edema, which the doctors managed to diagnose and treat just in time.
The medical team did not recognize that his collapse was most likely caused by heat stroke, a common cause of death among young athletic men during the summer. In the United States, an average of three high school and college football players die each year from heat stroke. Autopsies of heat stroke victims often reveal cerebral edema.
According to Dr. Lisa Leon, an expert in hyperthermia at the U.S. Army Research Institute of Environmental Medicine, “A person who has suffered one heat stroke is at increased risk for another. Patients experience multi-organ dysfunction during the hours, days, and weeks of recovery, which increases the risk of long-term disability and death.”
Heat Related Illnesses
Heat-related illnesses vary in severity from mild to life-threatening. Additionally, heat exposure worsens many common health conditions such as heart, respiratory, and kidney diseases. As summer is drawing near, we have to be aware of heat related illnesses and its management.
Heat Syncope: This refers to dizziness or fainting due to standing up too quickly in the heat or pooling of blood in the limbs from vasodilation, especially when no other cause is identified. It is more frequent in individuals with heart conditions or those taking diuretics. Treatment: Remove the patient from the heat and treat with rest in a supine position, passive cooling, and rehydration (either oral or intravenous). If recovery is prolonged or if there are concerns about a cardiac cause, especially in patients with cardiac risk factors, further evaluation is necessary.
Heat Edema: This is a mild swelling in dependent areas of the body, typically seen in people who are not yet acclimated to hot environments. Treatment: Remove patient from heat and elevate the legs. Diuretic agents are not indicated.
Heat Cramps: Painful muscle spasms in the abdomen, arms, or legs can occur during or after activity in the heat, often due to excessive salt loss from sweating during physical exertion. Treatment: Remove patient from heat, treat with rest, oral electrolytes, and fluid repletion.
Heat Exhaustion (Prostration) - Profound fatigue, weakness, nausea, headache, or dizziness (or a combination of these symptoms) can result from decreased body water content or blood volume due to water or salt depletion from heat exposure. Mild body temperature elevation (below 40°C) may be present, but there is no altered mental status. Treatment: Remove the patient from the heat and treat with rest in a supine position, evaporative cooling, and rehydration (intravenous or oral). Monitor mental status, and if there is a delayed response to treatment, further evaluation is needed.
Heat Stroke
Heat stroke is the least common but most dangerous heat illness, often fatal without immediate treatment. The most frequent victims are the urban elderly poor. It is identified by a body temperature exceeding 40ºC.
Predisposing Factors: Salt and water depletion, infections, fever post-immunization, lack of acclimatization, obesity, drug use, fatigue, and various medical conditions like cardiovascular disease, diabetes, malnutrition, alcoholism, hyperthyroidism, impaired sweating, and potassium deficiency.
Heat stroke can be categorized into two forms: classic and exertional.
Classic Heat Stroke: Occurs after several days of high temperatures (above 37.0ºC) or lower temperatures with high humidity. Continuous sweating eventually ceases, causing a rapid rise in body temperature. The first symptom may be sudden collapse. In 80% of cases, onset is abrupt with the patient becoming delirious, comatose, or having seizures. In the remaining 20%, symptoms like weakness, dizziness, nausea, fainting, or frontal headache precede collapse. Muscle cramps are rare. Patients typically have hot, dry skin but may continue sweating. Progression to coma is common.
Exertional Heat Stroke: Occurs with activities that increase internal heat production. In the U.S., it commonly affects long-distance runners, football players, and military recruits. Intense physical activity usually precedes heat stroke. Overuse of salt supplements with insufficient water can be fatal. Core temperatures might not exceed 40ºC and still be lethal, while in classic cases, patients have survived with temperatures as high as 43.7ºC. Rapid cooling is crucial to prevent extensive tissue necrosis. Common complications include thrombocytopenia, prolonged PT and PTT, marked DIC, hypotension, shock, acute pulmonary edema, and rhabdomyolysis. Severe hypoglycemia and death often result from acute hyperkalemia or renal failure due to extensive muscle breakdown.
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