Countering heat stroke

12 April 2018 12:00 am - 0     - {{hitsCtrl.values.hits}}

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Despite the recent showers that were observed in several parts of the country, especially in the evening hours, one cannot deny the intolerable heat experienced occasionally, during the other times of the day. Hence, the risk of getting dehydrated is nevertheless high due to the prevailing hot weather during the day.

As such, the need to take necessary measures to avoid suffering a heat stroke is vital under this circumstance. Speaking to , Consultant Physician at the Colombo South Teaching Hospital and the President of the Sri Lanka Geriatric Association Dr. Dilhar Samaraweera shared his insights on how a heat stroke could affect an individual and how to prevent the risk of suffering a heat stroke during hot weather conditions.   

According to the doctor, people have been reported to the hospital after suffering conditions of heat stroke during recent times and especially during this part of the year. Those who have reported to hospitals during recent times as a result of heat stroke are mainly marathon runners (who have collapsed after strenuous activities), elderly patients (who experienced exhaustion due the heat) and people exposed to the sun for prolonged periods, resulting in dehydration. (Those in the latter group include people representing the forces).   

Process of avoiding damage 
Explaining what a heat stoke is, Dr. Samaraweera said that the condition can simply be defined as a situation where the body temperature could rise above 1040F / 400C or higher, which may result in either the loss of consciousness or loss of function. Due to severe dehydration the patient would fail to maintain the normal body temperature since he or she has already sweated and no longer has the ability to sweat further. According to Dr. Samaraweera, when a person perspires, the evaporation of sweat would help bring the body temperature down to the degree at which the normal body temperature is maintained. Moreover, when the environmental temperature increases, the body will try to perspire and reduce the temperature, thereby working towards maintaining the normal body temperature. Otherwise, when the external temperature increases, the body temperature will also increase. Therefore to avoid such damage, the human body has a mechanism of producing lot of sweat and evaporating it to maintain a normal body temperature.   

When inquired about what happens when a person gets dehydrated, he said that in such an instance, the sweating will entirely stop at which point the body temperature will rise rapidly. “The body will try to maintain the temperature by diverting the blood to the skin; a condition known as ‘Cutaneous Vasodilation’, which is the mechanism to reduce the body heat. The blood vessels will dilate in the skin, resulting in sweat and the reduction of body temperature, thereby trying to maintain the normal body temperature. Through this process, the body will try to maintain a constant blood supply to the skin. However, under such circumstances there will be a compromise on the blood supply to the brain. As a result, one may have an alteration in the level of consciousness. Also, one may experience total loss of consciousness and even death. This is what happens during a heat stroke” Dr. Samaraweera explained.  

Vulnerable groups 
There are two ways an individual could develop a heat stroke. The first method is when an individual is exposed to a hot environment. Even if the person is not engaged in exercise, if he or she is exposed to a very hot and humid temperature the chances of developing a heat stroke is high. This particularly affects infants and elderly people above 65 years of age. “They are very likely to develop a heat stroke due to their impaired thermoregulatory mechanism, which is not well developed when an individual is very young. In the case of an elderly person, the thermoregulatory systems does not function well owing to the ageing process.   

The other category vulnerable to developing a heat stroke are people engaged in vigorous physical activities, which may result in increasing their core body temperature. People who prolong standing under the hot sun for long durations such as in the army or sportsman engaged in vigorous activity are vulnerable to get dehydrated. This condition might eventually result in a heat stroke,” he added.   
Additionally, people with heart disease and chronic kidney disease are often under medications to control their health conditions and the chances of them losing much sodium and water are high. When such people are exposed to hot weather they will be prone to lose more salt and water due to the increasing temperature. Such people need to consult their doctors in the event they feel dehydrated in addition to staying away from the heat, the doctor said.   

Red Flag Signs andFirst Aid
Explaining the symptoms related to a heat stroke, he said that a person would notice that he or she is experiencing a low rate of sweating in addition to indicating a very red and bright coloured skin tone. Cramping muscles, weakness in muscles, tiredness, exhaustion and feeling faint are the other symptoms of a heat stroke. “The patient would also experience an increased heart rate with rapid, shallow breathing in addition to feeling light headed. Symptoms of vertigo and headache are also common following which a person will experience alteration of consciousness or total loss of consciousness.

The best example to explain this is the heating of a vehicle. When we drive a vehicle and if there is a radiator leak, the engine will start heating up. When the engine starts heating up, there is an indicator light that lights up in the meter. Once you recognize that there is a warning light, the vehicle should be immediately stopped and allowed to cool down. It is also necessary in some instances to add water to the radiator tank and let the vehicle cool for sometime. If the driver ignores these warnings and continues driving, the engine would heat up and eventually stop functioning” he warned.   

Stating that the example is similar to what happens within the human body in the case of a heat stoke, he added that when warning signs surface, such as when someone feels tired, exhausted or is experiencing a headache or lightheadedness in addition to less sweating and dry skin, it is pivotal that one should immediately stop whatever work he or she was engaged in. The patient should take a rest and seek a place that offers shade. If the person is suffering from heat and exhaustion, it is important that he or she should immediately cool oneself. This cooling can be done using any method such as pouring water on the body. It is better if the person can get totally immersed in water or if possible sponge or cold compress the body using cold water. Also fanning can be used to cool oneself” he added.   

According to the doctor, the evaporation of water would help reduce the body temperature. Therefore, if the clothes the person was wearing is bulky or tight, it is better to either loosen or avoid wearing such clothes and opt for comfort clothing. If the person is able to drink, water should be provided. If available, Oral Rehydration Solution (ORS) would be the best to be administered on the patient since it also contains salt. Explicating that the body loses not only water but also other electrolytes and especially salt/sodium; which is why the patient experiences cramps, weakness of muscles and even confusion, Dr. Samaraweera advised that king coconut would be the ideal if available since it is the closest natural solution to saline.   

Prevention
In order to prevent the risk of heat stroke it is important to ensure that a person consumes plenty of fluids. During situations where an individual experiences much heat and evaporation, it is recommended to consume at least 2.5 to 3 litres of fluid (for an average person) each day. Water, king coconut and fruit juice are recommended in order to stay hydrated.   

“Avoid exposure to the sunlight between 11.00 a.m. and 3.00 p.m. since the heat would be extreme during these hours. Wearing sunscreen and light coloured clothing is recommended when exposed to hot weather. One should note that dark coloured clothing will absorb more heat, which would affect the increasing body heat as well. Wear loose and comfortable clothes instead of opting for bulky and tight clothes when exposed to the heat. Also, those who exercise should avoid engaging in very strenuous activities during times when the temperature is high because it can cause exhaustion. Also, it is encouraged to consume other fluids such as fruit juice in addition to the intake of water when exercising because it helps to keep the body hydrated. People living indoors are encouraged to keep doors and windows open to let the air flow in and facilitate proper ventilation.   

Also, it should be noted that the fan has a negative aspect despite being used to counter the heat because what circulates within the household is often hot air. This will in fact contribute to the increasing level of body temperature resulting in dehydration and exhaustion. Therefore, when the fan is used to counter the heat, it is recommended to keep a bowl of water inside the room since the water would help cool the circulating air. One should also be cautious about the alcohol intake because it is a substance, which causes diuresis; a condition which reduces the water content in the body by the actions of the kidneys. Therefore, alcohol should be avoided at all cost during high temperature because it will dehydrate a person further” he added.   

Moreover, Dr. Samaraweera strongly advised against leaving anyone alone inside a parked vehicle under hot weather conditions. The temperature in a parked vehicle under the hot sun will rise by 200F or more than 6.70C within ten minutes. He said that such a rise in the temperature could result in a heat stroke, in the event someone is inside the parked vehicle, which is left under hot sun or a warm environment. In a final note, Dr. Samaraweera added that if someone suffers a heat stroke or observes any symptoms in a person related to the condition, it is strongly advised to administer first aid and immediately rush the patient to the nearest hospital for further treatment.     

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