Hyperthermia

I remember as a kid a variety of adults advising me to drink hot beverages to help beat the heat. The mechanism is to stimulate more sweat and evaporative cooling. Might work in dry Albuquerque, but likely less useful these days in Houston. For me, I still say heck no to hot drinks on hot days. And I’ve certainly never handed a hyperthermic patient in an ER a cup of tea. In any case, given the current heat wave in CA, hyperthermia seems about right for an Anxiometer post.

Medically speaking we talk about heat exhaustion and heat stroke. But for readers here, that’s neither here nor there. To be honest I don’t much care about the distinction either. Too hot is the problem… what are the buzzwords… and how best to make folks feel better.

Red Flags:

• Altered mentation
• Not urinating
• Unable to walk
• Seizures
• Hot, but not sweating
• Suspected infection
• Frail, elderly, kids
• Diabetic
• Taking diuretics
• Concurrent vomiting/diarrhea
• Underlying kidney problems, or already on dialysis
• Long distance running, biking, etc.
• Prolonged associated dehydration/malnutrition (lost at sea, etc.)
• Suspected “street” drug OD (meth and other stimulants)
• Prescription drug OD (antihistamines, antipsychotics, antidepressants, anti Parkinsons meds)
• Jimson weed OD (look up the “anticholinergic toxidrome”)

Happy Words

• Normal temp now
• Able to hydrate orally
• Walking, talking, peeing, pooping, breathing properly
• “The IV bag from the medics helped a ton.”
• “I got too hot at practice, but I feel better now.”

The large majority of hyperthermic patients I see are nearly better by the time they get to the ER. Time spent resting in the shade, or getting hydrated in the back of an air conditioned ambulance, generally helps real quick.

For folks who improve more slowly, we’ll check electrolytes, urine studies, and we’ll look for evidence of muscle breakdown and kidney injury. For anyone not thinking straight, we’ll look for other problems, such as overdose or stroke.

To cool people we consider the four main paths for heat transfer, which are radiation, convection, conduction and evaporation. Ice baths utilize conduction. But not particularly practical. So generally we stick with evaporation using sprayed/misted water, and convection using fans. (No rocket science here.)

IV fluids are fairly standard as well, with brisk urination as the target. Patients can get quite dehydrated in the heat, and they’ll sometimes need 3-5 liters of saline to get the kidneys back in the game… sometimes more. We may supplement with potassium too if low. (Why you’ll see bananas at most finish lines.)

If you have time to read this you probably aren’t facing the more serious forms of hyperthermia. But even if you are, your best bet while waiting for an ambulance is to find shade or AC, use a combo of cool sprayed mist, and fanning. Soaking lightweight clothes may be more effective at transferring heat than stripping down as well, depending on the clothing.

Hydrate with more than just water too. 50:50 diluted Gatorade is pretty good, or water plus Saltines and an apple/banana. Some folks over shoot with gallons of water, and their issue may actually be hyponatremia instead, which can be deadly.

Tylenol is the added finesse.

Feel free to call Pre-R for guidance from a distance, or if you think some IV fluids may be in order.

But probably best to beat the heat with a good book in the public library or a visit to the San Luis Obispo Children’s Museum. They’ve both got great AC.:)

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