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First aid for heat exhaustion includes:
- Moving the person to a cool place
- Having the patient take off extra layers of clothes
- Cooling the patient down by fanning them and putting wet towels on their body
- Having them lie down and put their feet up if they are feeling dizzy
- Having them drink water or sports drinks – but only if they are awake, not confused nor vomiting
- Turning the person on their side if they are vomiting
If a person with heat exhaustion gets medical treatment, Emergency Medical Technicians (EMTs) or doctors and/or nurses may also:
- Give them supplemental oxygen
- Give them intravenous fluids and electrolytes if they are too confused to drink and/or are vomiting
Mild disease can be treated with fluids by mouth. In more significant disease spraying with mist and using a fan is useful. For those with severe disease putting them in lukewarm water is recommended if possible with transport to a hospital.
Prevention includes avoiding medications that can increase the risk of heat illness (e.g. antihypertensives, diuretics, and anticholinergics), gradual adjustment to heat, and sufficient fluids and electrolytes.
International Organization for Standardization helps set standards for monitoring environments, analyzing data, and interpreting results.
The diagnosis of heat syncope is done during a physical examination. During the physical exam the practitioner will test the blood pressure of the patient, and the pulse. If the patient is experiencing heat syncope the blood pressure will be low, and the pulse will be elevated. Observation of excess sweating will also be a key sign. Finally, the practitioner will ask questions figuring out the history of the patient's symptoms. If the patient developed symptoms while engaging in physical activity and high temperatures it will then be a true case of heat syncope.
Accurate determination of core temperature often requires a special low temperature thermometer, as most clinical thermometers do not measure accurately below . A low temperature thermometer can be placed in the rectum, esophagus or bladder. Esophageal measurements are the most accurate and are recommended once a person is intubated. Other methods of measurement such as in the mouth, under the arm, or using an infrared ear thermometer are often not accurate.
As a hypothermic person's heart rate may be very slow, prolonged feeling for a pulse could be required before detecting. In 2005, the American Heart Association recommended at least 30–45 seconds to verify the absence of a pulse before initiating CPR. Others recommend a 60-second check.
The classical ECG finding of hypothermia is the Osborn J wave. Also, ventricular fibrillation frequently occurs below and asystole below . The Osborn J may look very similar to those of an acute ST elevation myocardial infarction. Thrombolysis as a reaction to the presence of Osborn J waves is not indicated, as it would only worsen the underlying coagulopathy caused by hypothermia.
The basic treatment for heat syncope is like that for other types of fainting: the patient is positioned in a seating or supine position with legs raised. Water containing salt, or another drink containing electrolytes, is administered slowly, and the patient is moved to a cooler area, such as the shade.
The affected person should rest and recover, because heat syncope can lead to heat stroke or heat exhaustion.
When ambient temperature is excessive, humans and many animals cool themselves below ambient by evaporative cooling of sweat (or other aqueous liquid; saliva in dogs, for example); this helps prevent potentially fatal hyperthermia. The effectiveness of evaporative cooling depends upon humidity. Wet-bulb temperature, which takes humidity into account, or more complex calculated quantities such as wet-bulb globe temperature (WBGT), which also takes solar radiation into account, give useful indications of the degree of heat stress and are used by several agencies as the basis for heat-stress prevention guidelines. (Wet-bulb temperature is essentially the lowest skin temperature attainable by evaporative cooling at a given ambient temperature and humidity.)
A sustained wet-bulb temperature exceeding 35 °C is likely to be fatal even to fit and healthy people unclothed in the shade next to a fan; at this temperature, environmental heat gain instead of loss occurs. , wet-bulb temperatures only very rarely exceeded 30 °C anywhere, although significant global warming may change this.
In cases of heat stress caused by physical exertion, hot environments, or protective equipment, prevention or mitigation by frequent rest breaks, careful hydration, and monitoring body temperature should be attempted. However, in situations demanding one is exposed to a hot environment for a prolonged period or must wear protective equipment, a personal cooling system is required as a matter of health and safety. There is a variety of active or passive personal cooling systems; these can be categorized by their power sources and whether they are person- or vehicle-mounted.
Because of the broad variety of operating conditions, these devices must meet specific requirements concerning their rate and duration of cooling, their power source, and their adherence to health and safety regulations. Among other criteria are the user's need for physical mobility and autonomy. For example, active-liquid systems operate by chilling water and circulating it through a garment; the skin surface area is thereby cooled through conduction. This type of system has proven successful in certain military, law enforcement, and industrial applications. Bomb-disposal technicians wearing special suits to protect against improvised explosive devices (IEDs) use a small, ice-based chiller unit that is strapped to one leg; a liquid-circulating garment, usually a vest, is worn over the torso to maintain a safe core body temperature. By contrast, soldiers traveling in combat vehicles can face microclimate temperatures in excess of 65 °C and require a multiple-user, vehicle-powered cooling system with rapid connection capabilities. Requirements for hazmat teams, the medical community, and workers in heavy industry vary further.
It is usually recommended not to declare a person dead until their body is warmed to a near normal body temperature of greater than , since extreme hypothermia can suppress heart and brain function. Exceptions include if there is an obvious fatal injuries or the chest is frozen so that it cannot be compressed. If a person was buried in an avalanche for more than 35 minutes and is found with a mouth packed full of snow without a pulse, stopping early may also be reasonable. This is also the case if a person's blood potassium is greater than 12 mmol/l.
Those who are stiff with pupils that do not move may survive if treated aggressively. Survival with good function also occasionally occurs even after the need for hours of CPR. Children who have near-drowning accidents in water near can occasionally be revived, even over an hour after losing consciousness. The cold water lowers the metabolism, allowing the brain to withstand a much longer period of hypoxia. While survival is possible, mortality from severe or profound hypothermia remains high despite optimal treatment. Studies estimate mortality at between 38% and 75%.
In those who have hypothermia due to another underlying health problem, when death occurs it is frequently from that underlying health problem.
Hyperthermia is generally diagnosed by the combination of unexpectedly high body temperature and a history that supports hyperthermia instead of a fever. Most commonly this means that the elevated temperature has occurred in a hot, humid environment (heat stroke) or in someone taking a drug for which hyperthermia is a known side effect (drug-induced hyperthermia). The presence of signs and symptoms related to hyperthermia syndromes, such as extrapyramidal symptoms characteristic of neuroleptic malignant syndrome, and the absence of signs and symptoms more commonly related to infection-related fevers, are also considered in making the diagnosis.
If fever-reducing drugs lower the body temperature, even if the temperature does not return entirely to normal, then hyperthermia is excluded.
Employers can establish prevention programs, which focus on having protocols to gradually increases workloads and concede on allowing on more breaks for new hired workers. Employers can control heat stress through engineering controls, work practices, providing training, implementing an acclimatization schedule, providing water and encouraging workers to drink often, and ensuring workers take appropriate rest breaks to cool down.
Heat cramps, a type of heat illness, are muscle spasms that result from loss of large amount of salt and water through exercise. Heat cramps are associated with cramping in the abdomen, arms and calves. This can be caused by inadequate consumption of fluids or electrolytes. Frequently, they don't occur until sometime later, especially at night or when relaxing. Heavy sweating causes heat cramps, especially when the water is replaced without also replacing salt or potassium.
Although heat cramps can be quite painful, they usually don't result in permanent damage, though they can be a symptom of heat stroke or heat exhaustion. Heat cramps can indicate a more severe problem in someone with heart disease or if they last for longer than an hour.
In order to prevent them, one may drink electrolyte solutions such as sports drinks during exercise or strenuous work or eat potassium-rich foods like bananas and apples. When heat cramps occur, the affected person should avoid strenuous work and exercise for several hours to allow for recovery.
Figures from the 1982 Lebanon war showed that with proximal treatment 90% of CSR casualties returned to their unit, usually within 72 hours. With rearward treatment only 40% returned to their unit. It was also found that treatment efficacy went up with the application of a variety of front line treatment principles versus just one treatment. In Korea, similar statistics were seen, with 85% of US battle fatigue casualties returned to duty within three days and 10% returned to limited duties after several weeks. Though these numbers seem to promote the claims that proximal PIE or BICEPS treatment is generally effective at reducing the effects of combat stress reaction, other data suggests that long term PTSD effects may result from the hasty return of affected individuals to combat. Both PIE and BICEPS are meant to return as many soldiers as possible to combat, and may actually have adverse effects on the long term health of service members who are rapidly returned to the front-line after combat stress control treatment. Although the PIE principles were used extensively in the Vietnam War, the post traumatic stress disorder lifetime rate for Vietnam veterans was 30% in a 1989 US study and 21% in a 1996 Australian study. In a study of Israeli Veterans of the 1973 Yom Kippur War, 37% of veterans diagnosed with CSR during combat were later diagnosed with PTSD, compared with 14% of control veterans.
Modern front-line combat stress treatment techniques are designed to mimic the historically used PIE techniques with some modification. BICEPS is the current treatment route employed by the U.S. military and stresses differential treatment by the severity of CSR symptoms present in the service member. BICEPS is employed as a means to treat CSR symptoms and return soldiers quickly to combat.
The following BICEPS program is taken from the USMC combat stress handbook:
Tissue loss and autoamputation are potential consequences of frostbite. Permanent nerve damage including loss of feeling can occur. It can take several weeks to know what parts of the tissue will survive. Time of exposure to cold is more predictive of lasting injury than temperature the individual was exposed to. The classification system of grades, based on the tissue response to initial rewarming and other factors is designed to predict degree of longterm recovery.
Frostbite is diagnosed based on signs and symptoms as described above, and by patient history. Other conditions that can have a similar appearance or occur at the same time include:
- Frostnip is similar to frostbite, but without ice crystal formation in the skin. Whitening of the skin and numbness reverse quickly after rewarming.
- Trench foot is damage to nerves and blood vessels that results exposure to wet, cold (non-freezing) conditions. This is reversible if treated early.
- Pernio or chillbains are inflammation of the skin from exposure to wet, cold (non-freezing) conditions. They can appears as various types of ulcers and blisters.
- Bullous pemphigoid is a condition that causes itchy blisters over the body that can mimic frostbite. It does not require exposure to cold to develop.
- Levamisole toxicity is a vasculitis that can appear similar to frostbite. It is caused by contamination of cocaine by levamisole. Skin lesions can look similar those of frostbite, but do not require cold exposure to occur.
People who have hypothermia often have frostbite as well. Since hypothermia is life-threatening this should be treated first. Technetium-99 or MR scans are not required for diagnosis, but might be useful for prognostic purposes.
Frail elderly people are at significant risk of post-surgical complications and the need for extended care. Frailty more than doubles the risk of morbidity and mortality from surgery and cardiovascular conditions. Assessment of older patients before elective surgeries can accurately predict the patients' recovery trajectories.
The most widely used frailty scale consists of five items:
- unintentional weight loss >4.5 kg in the past year
- <20th population centile for grip strength
- self-reported exhaustion
- low physical activity such that persons would only rarely undertake a short walk
- slowed walking speed, defined as lowest population quartile on 4 minute walking test.
A healthy person scores 0; a very frail person scores 5. Compared to non-frail elderly people, people with intermediate frailty scores (2 or 3) are twice as likely to have post-surgical complications, spend 50% more time in the hospital, and are three times as likely to be discharged to a skilled nursing facility instead of to their own homes. Frail elderly patients (score of 4 or 5) have even worse outcomes, with the risk of being discharged to a nursing home rising to twenty times the rate for non-frail elderly people.
The treatment options for hypohidrosis and anhidrosis is limited. Those with hypohidrosis should avoid drugs that can aggravate the condition (see medication-causes). They should limit activities that raise the core body temperature and if exercises are to be performed, they should be supervised and be performed in a cool, sheltered and well-ventilated environment. In instances where the cause is known, treatment should be directed at the primary pathology. In autoimmune diseases, such as Sjogren syndrome and systemic sclerosis, treatment of the underlying disease using immunosuppressive drugs may lead to improvement in hypohidrosis. In neurological diseases, the primary pathology is often irreversible. In these instances, prevention of further neurological damage, such as good glycaemic control in diabetes, is the cornerstone of management. In acquired generalized anhidrosis, spontaneous remission may be observed in some cases. Numerous cases have been reported to respond effectively to systemic corticosteroids. Although an optimum dose and regime has not been established, pulse methylprednisolone (up to 1000 mg ⁄ day) has been reported to have good effect.
The primary treatment strategy is to eliminate or discontinue the offensive agent. Supportive therapy, such as ice packs, may be provided to get the body temperature within physiologic range. In severe cases, when the fever is high enough (generally at or above ~104° F or 40° C), aggressive cooling such as an ice bath and pharmacologic therapy such as benzodiazepines may be deemed appropriate.
Sweat is readily visualized by a topical indicator such as iodinated starch (Minor test) or sodium alizarin sulphonate, both of which undergo a dramatic colour change when moistened by sweat. A thermoregulatory sweat test can evaluate the body’s response to a thermal stimulus by inducing sweating through a hot box ⁄ room, thermal blanket or exercise. Failure of the topical indicator to undergo a colour change during thermoregulatory sweat testing indicates hypohidrosis, and further tests may be required to localize the lesion.
Magnetic resonance imaging of the brain and ⁄ or spinal cord is the best modality for evaluation when the lesion is suspected to be localized to the central nervous system.
Skin biopsies are useful when anhidrosis occurs as part of a dermatological disorder. Biopsy results may reveal the sweat gland destruction, necrosis or fibrosis, in addition to the findings of the primary dermatological disorder.
Most drowning is preventable. It has been estimated that more than 85% of drownings could have been prevented by supervision, training in water skills, technology, regulation and public education.
Heat urticaria presents within five minutes after the skin has been exposed to heat above 43 degrees Celsius (109.4 degrees Fahrenheit), with the exposed area becoming burned, stinging, and turning red, swollen, and indurated.
Many pools and designated bathing areas either have lifeguards, a pool safety camera system for local or remote monitoring, or computer-aided drowning detection. However, bystanders play an important role in drowning detection and either intervention or the notification of authorities by phone or alarm.
The acronym "RID" was originated by Frank Pia to summarize important reasons why lifeguards may be unaware of a drowning. The term stands for "failure to recognize the struggle, the intrusion of non-lifeguard duties upon lifeguards' primary task-preventive lifeguarding, and the distraction from surveillance duties". In his paper on the RID factors, Pia makes a number of observations on the role, and the required behavior and training of lifeguards, as well as the importance of administrators directing lifeguards to this role and avoiding double tasking them (due to the very brief time of 20 – 60 seconds required for drowning to occur). He ended by summarizing the role of lifeguards as guardians of life, and that they should be directed exclusively to this duty and none other, while on surveillance, due to the high value placed on human life.
The Dancing Plague (or Dance Epidemic) of 1518 was a case of dancing mania that occurred in Strasbourg, Alsace, (then part of the Holy Roman Empire) in July 1518. Around 400 people took to dancing for days without rest and, over the period of about one month, some of those affected collapsed or even died of heart attack, stroke, or exhaustion.