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HEAT INJURIES OBJECTIVES Risk Factors Types of Heat Injury *symptoms, cause and treatment Pre-hospital care Management Individual Risk Factors Poor fitness Large body mass Minor illness Drugs (cold/allergy/blood pressure/performance enhancing) Highly motivated 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 plus fluids 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 Unconscious patient may vomit and aspirate Keep patent airway IV: no more than 2L unless circulatory collapse Lower the body temperature as fast as possible! All clothes off Cool water with fanning...increase evaporation Ice packs near groin or in the axilla EVAC...open doors/windows in vehicle keep cooling to temp 101-102 F. 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 (Phenergan) Supplements Ephedrine (MaHuang), caffeine Pre-Hospital Care Cooling is first priority Offer drink Drench with water Fan Massage large muscles Stop all measures if shivering occurs Guidance for Sports Drinks Cool water is usually the best rehydration fluid Prolonged training and participation 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 Fluid Replacement Guidelines Easy Activity Moderate Activity 3 QT water per 4 hours Work:rest 40:20 Hard Activity 1 QT water per 2 hours Work:rest as needed 1 QT per hour Work:rest 30:30 more rest with increased RF Do not consume >12 QT per day. 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 DE acclimatize 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 for Warm Weather Heat Category WBGT Index, °F Easy Work Work /Rest 1 2 (Green) 3 (Yellow 4 (Red) 5 (Black) Moderate Work Work /Rest 78-81.9 82-84.9 NL NL Water Intake,Qt/ h ½ ½ NL 50/10 min Water Intake, Qt/h ¾ ¾ 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 Work /Rest 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. Hard Work The End
