Heat Induced Nursing

June 1st, 2012


By , BSN, RN

My air conditioner is dead. In some parts of the country on June 1 that might not be an issue, but here in Houston, it is miserable. Woke up warm and its only gotten worse. AC guy is on the way but I need to get this blog done. Alrighty then, it’s time to take a look at some of summer’s best-known diagnoses and what to do about them.

Whether saddled with a dead cooling system, playing summer sports (or just watching them in a stadium) or out at a beach or a picnic the summer sun can cause all kinds of problems. And whether you are an Emergency Room Nurse or a Camp Nurse or any other kind of direct care provider you are likely going to deal with some of theses heat induced medical problems.

First, let’s look at what is hyperthermia? It is an elevated body temperature related to the body’s inability to promote heat loss or reduce heat production. Hyperthermia results from an overload of the body’s thermoregulatory mechanisms. Here are a couple of possible diagnoses:

  • Heatstroke – Too much time in the sun will get you here. High environmental temperatures (like living in Texas without air conditioning) can overwhelm the body’s heat-loss mechanisms and high heat can also depress hypothalamic function (the hypothalamus controls body temperature, thirst, and fatigue among other things). A heatstroke is a dangerous emergency situation with a high mortality rate.

    Signs and symptoms of heatstroke include giddiness, confusion, delirium, excess thirst, nausea, muscle cramps, visual disturbances, and even incontinence. The most import sign of heatstroke is hot, dry skin. Victims of heatstroke don’t sweat because of severe electrolyte loss and hypothalamic malfunction.

    Hydrating and cooling the victim are the most important steps in combatting heatstroke. Get the patient out of the sun, take off as much of their clothing as possible, and apply cool water or cold packs to the person’s body to lower their temperature. If they are conscious, provide small sips of water, maybe a little salt water, or other cool liquids (no alcohol, no caffeine), and if you are someplace where they are available get in an IV and some normal saline.

  • Heat Exhaustion – Heat exhaustion occurs when profuse diaphoresis (sweating) results in excess water and electrolyte loss. Caused by environmental heat exposure (being out in the sun or inside a steel mill) the victim exhibits signs of fluid volume deficit. Relative humidity is an important factor in developing heat exhaustion. If the humidity is too high, sweat on the skin cannot evaporate into the surrounding air and body temperature cooling fails.

    The most common signs of heat exhaustion are confusion, dark-colored urine (a sign of dehydration), dizziness, fainting, fatigue, headache, muscle cramps, nausea, pale skin, profuse sweating, and rapid heartbeat.

    Now, heat exhaustion isn’t as serious as a heat stroke but it shouldn’t be dismissed either. Without proper intervention, heat exhaustion can progress to heat stroke. Heat exhaustion usually can be treated at the scene as long as the affected individual can maintain proper hydration. Water, electrolyte replacement solutions, or sport drinks are appropriate to consume.

    It is important to recognize that if the person stops sweating, becomes confused, or has a seizure, heat stroke, a life-threatening condition, may be developing. Emergency medical services should be activated immediately (call 911 if available) and move the affected individual to a cooler place, remove their clothing, and try to cool the body with cold compresses, ice, and oscillating fans.

  • Heat Cramps – Heat cramps usually affect workers who sweat a lot during strenuous activity. This sweating depletes the body's salt and moisture levels. Low salt levels in muscles can cause painful cramps.

    Symptoms are muscle pain or spasms usually in the abdomen, arms, or legs.

    To combat heat cramps the victim needs to stop all activity and sit down in a cool place. Of course, they need to re-hydrate with water or a sports drink. They should not return to strenuous work for a few hours after the cramps subside because further exertion may lead to heat exhaustion or heat stroke.

  • Heat Rash – Heat rash is a skin irritation caused by excessive sweating during hot, humid weather.

    Symptoms of heat rash include red clusters of pimples or small blisters. It is most likely seen on the neck and upper chest, in the groin, under the breasts, and in elbow creases.

    People experiencing heat rash should, of course, try to work in a cooler, less humid environment; effort to keep the affected area dry and sometimes a little dusting powder or cornstarch may increase comfort levels.

So before any of this happens there are tips you can give your campers or construction workers before they head out into the heat of day. According to the Centers for Disease Control and Prevention (CDC) here are some ways to prevent heat-related illnesses.

  1. Drink, Drink, Drink – Drink more fluids (nonalcoholic), regardless of your activity level. Don’t wait until you’re thirsty to drink. In fact, when you are actively thirsty you are already on your way to dehydration. Water is your best bet. Electrolyte drinks are ok but you want to stay away from anything with too much sugar or any alcohol or caffeine. These drinks can actually make you lose fluids more rapidly.
  2. Dress Appropriately – Wear lightweight, light-colored, loose-fitting clothing.
Wear a hat and sunglasses.
  3. Try To Get In – If at all possible get inside. Even a few hours spent in air conditioning can help your body stay cooler in the heat. If your home has no AC try going to a shopping mall or public library.
  4. Being a Fan Is Not Enough – Electric fans may provide comfort, but when the temperature is in the 90s and above, they will not prevent heat-related illnesses. Taking a cool shower or bath will help you cool off more effectively.
  5. Limit It – If you must be outside try to limit it to mornings and evening when the temperature are at least slightly lower.

When all is said and done, it is very likely at least once this summer you will take care of someone who has had a little too much outdoor work or fun. It is clear, hydration is the key to keeping most of these problems at bay. I for one am just about water logged waiting for the AC repair guy. Guess now I need to watch out for fluid volume overload.

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