MSN, RN
As we approach the dog days of summer — July 3 until August 11 — a refresher on the symptoms of, and differences between, serious heat maladies is warranted.
These can affect everyone, but especially the elderly, young children, pregnant women, and those with weakened immune systems.
There are many forms of heat-related issues such as heat rash, heat cramps, heat stroke, and heat exhaustion, but do you know the differences, the symptoms, and what to do if you’re affected by any of these?
When a patient presents with what appears to be a heat-related ailment, we, as nurses, need to recognize the symptoms and deliver immediate treatment. First, ask the patient where they were when symptoms began, such as in a hot car. Then assess the patient’s skin temperature and color.
Is the patient sweating or exhibiting muscle cramping? Monitor their vital signs, level of consciousness, and mental activity. Do they know where they are or what day it is? Are they able to speak? Do they have a history of heat illnesses? Were they hydrating enough at the time?
After getting a brief history from a family member or the patient, start the cooling down process. Offer ice water and determine if an intravenous of iced fluids is needed. Cold, moist cloths to the head and ice packs to the axilla and groin areas can speed up the cool down process.
Heat stroke is the most serious of the heat-related conditions and occurs when your body can no longer control its own temperature. Your temperature rises rapidly, and the sweating process fails, meaning your body can’t cool itself down. Body temperatures can rise to about 106 degrees or higher within 10 to 15 minutes.
The crucial symptoms to watch for are severe neurological dysfunction, which may include seizures, coma, altered levels of consciousness, severe headaches, and confusion. If there is any delay in the cooling process and these symptoms are present, the outcome could prove fatal.
If you are dealing with a possible heat stroke, immediately bring a doctor into the treatment process. Take the patient’s temperature, and if it’s greater than 104 degrees Fahrenheit, and they have hot, dry skin, confusion, or possible seizure, the patient needs rapid cooling processes to be activated.
Monitor vital signs, airway, mentation, any cardiac instability, and possible signs of rhabdomyolysis, where the muscles break down. This is a life-threatening scenario. Symptoms include severe muscle cramping or stiffness, changes in urine color, and severe dehydration.
Heat exhaustion is the body’s response to a disproportionate loss of water and salt, usually by excessive sweating. Your body overheats and cannot cool itself down. Heat exhaustion mostly affects the elderly, people with high blood pressure, and individuals who constantly work in a sweltering environment. Symptoms may include a weak, rapid pulse, gastrointestinal complaints of nausea or vomiting, diaphoretic pale skin, vertigo, and a feeling of weakness.
The core body temperature is elevated but usually remains below 104 degrees F. Treatment for heat exhaustion requires moving the person to a cool area, and laying them down, with their legs raised slightly. Encourage them to drink chilled sports drinks (or any other non-alcoholic drink without caffeine) to replace the electrolytes.
Recovering from an episode of heat exhaustion usually takes 24 to 48 hours, depending on the individual and the severity of the occurrence. If heat exhaustion is not addressed promptly, it can progress to heat stroke.
Heat cramps are painful muscle spasms in the legs and abdomen that can happen during any activity in extremely hot settings. This can be dangerous for those who sweat profusely in heated situations. Fluid and electrolyte imbalances can occur through the sweating process, contributing to the cramping sensation.
To combat this, drink fluids to keep yourself hydrated. Sports drinks filled with electrolytes can help replenish potassium and sodium, which are lost during the sweating process. Drinking water can quickly help hydrate you, but it dilutes any nutrients in the body that can cause muscles to tighten up and cramp. Take short breaks if working outdoors and curtail outdoor activities for a few hours after cramps subside.
The least troubling malady is heat rash, also known as miliaria or prickly heat. Heat rash presents as raised spots that may have fluid-filled blisters. It occurs when sweat is trapped in the skin and sweat glands become blocked. Heat rash usually goes away by itself but can last for a few weeks. Treatment can include medications to reduce itching and inflammation. A cool bath or shower may also soothe itching short term.
In any heat-related occurrence, the following are important to consider:
As part of the nursing team, we need to be aware of symptoms of severe heat illnesses and be ready to treat them as soon as the patient enters the Emergency Department. With severe heat illnesses such as heat exhaustion and heat stroke, time is of the essence.
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