Would you recognise this medical emergency?
If last week's soggy 🌧️ interlude has you dreaming longingly of a sunlounger and low 30s temperatures, we don't blame you! But there's always a cautionary note to sound ... so ahead of the full holiday season, we thought we would recap the risks of heat exhaustion and heatstroke. Thank you to Dr Catherine for this week's edition.
What are heat exhaustion and heat stroke?
In simple terms, heat exhaustion is the un-wellness you feel - sweating, nausea, headache, possible confusion or irritability - when you’ve overdone it in the heat. Anything that brings a combination of heat, sweating and a loss of electrolytes (salts in your sweat) can land you in figurative 'hot water'- including actual hot water (hot tub and steam spa fans take note!) It can come on after passive things such as napping too long on a sun lounger, or after vigorous activity such as that overly competitive game of doubles before lunch.
Fortunately, if caught early, heat exhaustion can usually be reversed with basic cooling & hydrating steps: seek out somewhere shady and cool, shed excess clothing, drink water, possibly with a rehydration salt such as dioralyte if available, and cool the skin with damp towels or cold packs. It’s unpleasant at the time, but with the right steps, you should start to feel better within 30 minutes.
Heat stroke is the serious progression of heat exhaustion, to the point where it becomes a medical emergency.
How do we know if it’s heat stroke rather than heat exhaustion?
Patients progress from heat exhaustion to heat stroke when the body’s cooling mechanisms fail triggering a dangerous cascade of medical problems. It can come on quite rapidly, hence the 30 minute rule above, but be aware that it can come on even faster than this during intense activity. It can also come on more slowly - over hours or even days in sustained heat. Here are the red flags to look out for:
❗Temperature of 40 C or more that will not come down, ❗Hot skin but no sweating, ❗Fast heartbeat and rapid breathing, ❗Confusion, irritability, or disorientation, ❗Persistent headache and nausea. ❗ Left untreated, heatstroke can lead to seizures or loss of consciousness.
What should I do if I think someone has heatstroke?
Heatstroke is a medical emergency. Call 999 (or your local emergency number) immediately. While waiting for help, keep up the cooling, maybe using ice packs under the arms and neck, wrapping in cool wet towels or sheets, and using fans if available. If the person becomes unconscious and you know how, place them in the recovery position.
Who’s most at risk of heatstroke?
Anyone can succumb in the right, or rather wrong conditions, but certain groups are more vulnerable, including:
Children under 5 and adults over 75, people who are underweight or overweight; those with chronic health conditions like heart, lung or kidney disease, or diabetes; people taking medications such as diuretics (water tablets), blood pressure medicines, or anticholinergics (used for COPD, bladder issues, gut problems, and Parkinson’s disease)
How is heatstroke treated?
In a hospital- 🏥 where the patient will receive careful monitoring, rehydration (via a drip) and imaging to check for internal damage. Most healthy people recover well. However in severe cases, heatstroke can cause permanent damage to the brain and other vital organs. The risks are highest for those with underlying conditions.
OK, you’ve convinced me. I want to avoid heatstroke. What should I do?
Hydrate, hydrate, hydrate. In the heat or when exercising, drink before you feel thirsty. Steer clear of caffeine and alcohol, which can dehydrate you. As you know, we love chatting about pee in this email and here we go again... it should be light golden - no stewed tea or worse! If things are looking ‘treacley’, proceed directly to the drinking tap and have a long glass.. and another soon after to be sure.
Avoid peak sun hours (11 am to 3 pm) for exercise. Stick to shaded areas and take breaks with a drink.
Wear loose, breathable clothing. Cotton is ideal, and light colours reflect heat better.
Use fans or air conditioning to cool off. Cool showers, compresses, or water sprays can help too. Don’t forget your hat, sunglasses, and sunscreen.
Ease into it. It takes time to adjust to hot climates. Start with short periods in the heat and build up gradually. Keep an eye on older people and young children, who may struggle more.
For a full run down of the first aid kit that our doctors take whenever they go abroad, check out this blog post!