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From Dr. O'Neill: Heat Related Illness

posted Jun 24, 2013, 7:40 PM by Justin Eberly
Our medical director, Dr. Rory O'Neill, recently published an article in the Carlisle Sentinel regarding heat related illnesses and emergencies:  
Summer is upon us in Central Pennsylvania, which means cookouts, sports and, of course, warm weather.

This time of year brings us lots of “fun in the sun,” however, it also can produce a variety of heat-related illnesses. These ailments range in severity from annoying to serious, and knowing the difference can help you and your family this season.

• Miliaria (aka “heat rash,” “prickly heat”) is a very common skin condition that develops in hot, humid weather. It appears as small, itchy, red spots located in areas of high perspiration like armpits, between skin folds, or where clothing rubs up against your skin. In infants and young children, the rash is typically around the neck, shoulders and chest. Miliaria occurs as a result of blocked sweat glands in the skin. The primary treatment is to control sweating by staying cool, wearing light clothing, using cool compresses and frequent showering. More severe forms of heat rash sometimes require topical lotions like Calamine.

• Heat edema is swelling of the arms or legs associated with high temperatures. It typically occurs during a “heat wave” or occasionally if someone accustomed to a cold climate travels to a warm area. Frequently, patients with heat edema seek medical attention because they cannot remove a ring off their finger due to the swelling. The treatment is to cool down, drink cold fluids and elevate the swollen extremity.

• Heat cramps are exactly what they sound like: painful muscle spasms, caused by exercise or working in a hot environment. The thighs, calves and shoulders are the most common muscles affected. Although the exact cause is unknown, heat cramps are thought to be related to electrolyte changes that occur with vigorous activity in warm climates without proper rehydration. The treatment is to cool off and hydrate, typically with oral fluids like water. However, persistent heat cramps or tetany may require IV fluids.

• Heat exhaustion is another condition that develops as a result of your body overheating. Its symptoms may include dizziness, fatigue, nausea, headache, feeling faint, heavy sweating and pale skin. Heat exhaustion typically occurs at core temperatures between 98.6 and 104 degrees Fahrenheit. It is much more common and much less severe than heat stroke. The treatment is to immediately get out of the hot environment and cool down, drink lots of fluid (avoid caffeine and alcohol), remove tight fitting clothes and apply cooling measures like ice packs and fans.

• Heat stroke is the most serious of all the heat-related injuries. Untreated heat exhaustion can progress to heat stroke, which typically occurs at core temperatures greater than 104 degrees Fahrenheit. There are two forms of heat stroke: classic (NEHS) and exertional (EHS). Classic heat stroke usually develops slowly over days, typically in the elderly population and may not always be associated with excessively high core temperatures. On the other hand, exertional heat stroke typically affects athletes or workers in warm environments. It has a rapid progression and is frequently associated with very high temperatures. This is why sports teams playing in a hot climate must be very diligent about fluid replacement during practice and games.

What differentiates heat exhaustion from heat stroke is involvement of the central nervous system. For example, people experiencing heat stroke may have confusion, difficulty walking or even seizures. It can also affect the heart and liver causing cardiac rhythm abnormalities as well as abnormal bleeding. It has been reported that as many as 10 percent of patients die from this disease. Patients experiencing heat stroke need to be transported immediately to the nearest emergency department. The treatment involves aggressive cooling involving IV fluids, fans, ice baths, as well as management of potential complications.

Summer is a wonderful time of year with lots of outdoor activities and events. Armed with some basic information, you can now enjoy the sun knowing what possible heat-related illness may occur.

Dr. Rory O’Neill is a physician at AllBetterCare Urgent Care Center in Silver Spring Township.
From:  Carlisle Sentinel