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HEAT INJURIES Types of Heat Injury Heat Cramps Heat Exhaustion Heat Stroke Heat Cramps Painful cramping of the larger muscle groups Due to excessive loss of salt through heavy sweating plus several hours of sustained exertion legs, arms, abdomen acclimatization decreases risk Treatment shaded area massage arms/legs to increase circulation 0.1% salt solution orally (1/2 tsp salt in 1-qt. Water), sports drink, or salted food (MRE) plus fluid Heat Exhaustion Symptoms: Cause: heavy sweating, headache, light-headed, nausea/vomiting, tingling sensations Temperature 99-104 F dehydration plus excessive salt depletion Treatment: shaded environment; loosen clothing If suspect early heat stroke, treat as such oral fluids if can drink cold water, 0.1% salt solution, or 6% carbohydrate beverage 1-2 liters over 2-4 hours EVAC Heat Stroke Symptoms: elevated temperature plus central nervous system disturbance absence of sweating is a late finding Can begin as heat exhaustion and progress End-organ damage: brain damage, kidney failure, liver failure, blood clotting abnormalities related to duration of elevated temperature Treatment of Heat Stroke ABC Lower the body temperature as fast as possible! Unconscious patient may vomit and aspirate IV: no more than 2L unless circulatory collapse All clothes off Cool water with fanning...increase evaporation Ice packs under groin or axilla EVAC...open doors/windows in helicopter/vehicle keep cooling to temp 101-102 F. Ice-water immersion: controversial USASOC and TB MED do not recommend Wilderness Medicine, 3rd ed. supports Risk Factors for Heat Stroke Dehydration Respiratory and GI illnesses most common Alcohol use Laxatives and diuretics Medications Increase heat production and/or decrease heat loss Decrease sweating pseudoephedrine, thyroid hormone, cocaine antihistamines (Benadryl), anti-nausea (meclazine, phenergan) Supplements Ephedrine (MaHuang), caffeine Control Measures Water and sports drinks Salt Acclimatization OTSG Guidance for the Field Use of Sports Drinks Cool water is usually the best rehydration fluid Prolonged training and operational scenarios carbohydrates and electrolytes are also required for optimal physical and mental performance meals and snacks plus water are best When sports drinks are appropriate: duration > 6 hours, hot weather, if snacks/meals not consumed duration > 3 hours, strenuous exercise, if snacks, meals not consumed duration > 6 hours strenuous exercise, if total food intake is significantly limited Sports Drink Recommendations INGREDIENT Sodium Potassium Carbohydrate Amount per 8 ounces (as served) 55-160 mg 20-55 mg 11-19 gm Acclimatization Physiologic adaptation that occurs in response to heat exposure in a natural environment Results: 5 days for most 14 days required for 95% of population to have complete acclimatization. Can deacclimatize as quickly sweat at lower temperature increased volume of sweat decrease in amount to salt secreted in sweat increased heat dissipation = lower core body temperature End result: Decreased risk for heat injury! Fluid Replacement Guidelines for Warm Weather Training (Average Acclimated Soldier Wearing BDU, Hot Weather) Heat Category WBGT Index, °F Easy Work Work /Rest 1 2 (Green) 3 (Yellow 4 (Red) 5 (Black) Moderate Work Work /Rest Hard Work 78-81.9 82-84.9 NL NL Water Intake,Qt/ h ½ ½ NL 50/10 min Water Intake, Qt/h ¾ ¾ Work /Rest 40/20 min 30/30 min Water Intake, Qt/h ¾ 1 85-87.9 NL ¾ 40/20 min ¾ 30/30 min 1 88-89.9 NL ¾ 30/30 min ¾ 20/40 min 1 > 90 50/10 min 1 20/40 min 1 10/50 min 1 The work/rest times and fluid replacement volumes will sustain performance and hydration for at least 4 hours of work in the specified heat category. Individual water needs will vary ± ¼ quart/hour. NL = no limit to work time per hour. Rest means minimal physical activity (sitting or standing) and should be accomplished in shade if possible. Caution: Hourly fluid intake should not exceed 1½ quarts. Daily fluid intake should not exceed 12 quarts. Wearing body armor add 5°F to WBGT Index. Wearing MOPP overgarment add 10°F to WBGT Index. An acclimitized soldier is one who has worked in the given heat conditions for 10-14 days Examples: Easy Work Moderate Work Hard Work • Weapon Maintenance • Walking Loose Sand at 2.5 mph, No Load • Walking Hard Surface at 3.5 mph, • Walking Hard Surface at 2.5 • Walking Hard Surface at 3.5 mph, <40 lb >40 lb Load mph, <30 lb Load Load • Manual of Arms • Calisthenics • Walking Loose Sand at 2.5 mph • Marksmanship Training • Patrolling with Load • Drill and Ceremony • Individual Movement Techniques, i.e. low crawl, high crawl • Defensive Position Construction • Field Assaults Questions?