Heat Exhaustion
Heat Exhaustion
27 Ways to Stave Off Trouble
Each summer, with everything from garden hoes to golf clubs in hand, the same people who are cautious enough to carry umbrellas when rain is predicted push themselves beyond safe limits in the sun.
The not uncommon result: heat exhaustion, a condition in which excessive loss of body fluid results in a rise in body temperature.
It's important to understand that no one is immune to heat exhaustion, not even the most finely conditioned athlete, says Richard Keller, M.D., an emergency room physician at St. Therese Hospital in Waukegan, Illinois. That's because the hotter we get, the more we perspire, and if we sweat too much, we start to run low on water.
Heat exhaustion is caused by water depletion (dehydration), or in rare cases—rare because of Americans' typically high-salt diets—by salt depletion. (We lose salt along with our sweat.)
Thirst is likely to be the first symptom, followed by loss of appetite, headache, pallor, dizziness, and a general flulike feeling that may include nausea and even vomiting. In more extreme cases, the heart may race and concentration may become more difficult.
Hopefully, you won't find yourself in that situation. Here's how to avoid it, and if necessary, how to cope with it.
Get out of the sun. This is as critical as it is obvious, especially for the person already suffering heat exhaustion. Otherwise body temperature could continue to rise, even if the person is resting and drinking water, Dr. Keller says. He adds that returning to the sun for very long, even if many hours later, could cause a relapse in some cases.
Drink water. It's still the best beverage to turn to for hydration, says Dr. Keller. It should be taken a little at a time—not gulped down. The doctor adds, "Ideally, you would have loaded up on water ahead of time—before going out into the sun."
Eat more fruit and vegetables. "They have a fairly high water content and good salt balance," Dr. Keller says.
Drink diluted electrolyte drinks. Gatorade is the best-known example and is widely used by professional sports teams. Football teams, for instance, often have twice daily practices in July and August, and players who sweat heavily can lose a lot of potassium and sodium, says Bob Reese, head trainer for the New York Jets and president of the Professional Football Athletic Trainers Society. "We have Gatorade and water available on the field at all times," he says.
Avoid salt tablets. Once routinely handed out to athletes and anyone else who wanted them, these pills now are considered bad medicine by most doctors. "They do the opposite of what they're supposed to do," says Larry Kenney, Ph.D., an assistant professor of applied physiology in the Laboratory for Human Performance Research at Pennsylvania State University. "The increased salt in the stomach keeps fluids there longer, which leaves less fluid available for necessary sweat production."
Avoid alcohol. Booze fast forwards dehydration, says Danny Wheat, an assistant trainer for the Texas Rangers baseball club. The team often plays in 100-degree-plus conditions in Arlington, Texas. "We stress to players that the night before a day game, they should limit their alcohol consumption," he says.
MEDICAL ALERT
First Aid for Heatstroke Heatstroke kills. A large number of well-documented cases proved fatal, says Larry Kenney, Ph.D. Of course, no one goes directly from feeling fine to the brink of death—no matter how hot it is. Rather, heatstroke turns lethal when signs of heat exhaustion, and later, heatstroke itself, are ignored or recognized too late, says Richard Keller, M.D. "And it's sometimes difficult to distinguish between heat exhaustion and heatstroke," he says. For this reason, a person who does not respond to self-help measures for heat exhaustion within 30 minutes should be taken to the doctor. "If you have heat exhaustion, the worst you'll get is confused. If you have trouble walking, or become unconscious, then you're getting into heatstroke." Heatstroke is a major malfunction of the body's thermoregulatory system—internal temperature is allowed to rise dangerously high. Symptoms can be similar to those of heat exhaustion—dizziness and nausea, for example. In addition, the person may become very disoriented and even agitated. And when the body quits regulating temperature, the heatstroke victim typically ceases sweating. But not always. "Young people [30 and younger] can sweat the whole way through," Dr. Keller says, "provided they're in pretty good shape." Fainting may or may not signal heatstroke. "If they revive quickly—say in 2 to 5 minutes—that's more likely heat exhaustion," says Dr. Keller, adding that seizure and coma are additional possibilities with heatstroke. It's important to get the person to a doctor as soon as possible for emergency care and observation, says Dr. Kenney, noting that complications such as shock and kidney shutdown could develop. And unless heatstroke strikes in a hospital parking lot, you'll need to administer some fast first aid. So here are recommendations on how to treat heatstroke until you can get to a doctor. Cool with water. "Splash the person with water instead of immersing them in cool water, if possible," Dr. Keller says. "The water will evaporate on the skin more quickly and have a cooling effect." Take advantage of technology. If possible, move the person into an air-conditioned setting. Force fluids. Water is best, provided the person is conscious, Dr. Keller says. Apply cool towels. Again, this is a better choice than immersing the person in ice cold water. Take charge. Some of those afflicted let pride get in the way of treatment. Roofing, for example, can be intensely hot work. "The hot tar is 325°F when you're putting it down," says roofing safety director David Tanner. Add the sun's heat and the humidity and, "We've had people wait too long, become delirious, and just start running across the roof and almost fall off." Know who is at increased risk and exercise caution. Infants are more vulnerable, according to Dr. Kenney, because their sweat glands are not fully developed. "Older people, in general, don't hydrate as well," adds Dr. Keller. "And certain medications, such as those for high blood pressure, can interfere with hydration." |
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Avoid caffeine. Like alcohol, it speeds dehydration and "can make you sweat more than normal," says Dr. Keller.
Don't smoke. Smoking can constrict blood vessels, Dr. Keller says, and impair the smoker's ability to acclimate to heat.
Acclimate slowly. "You can't work and live in air conditioning all the time and then go out and be a weekend warrior," says Dr. Keller. "Starting early in the season, you should get some outdoor time every day and slowly build from there."
Go slower. Whatever you're doing outside, you should do it more slowly than usual when it's extremely hot, Dr. Keller suggests.
Pour a cold one—on yourself. Dousing your head and neck with cold water will help if it's hot and dry, says Dr. Kenney, because the water will evaporate and then cool you off. "In humid conditions," he says, "there's probably no benefit."
Be your own fan. Use a newspaper, a picnic tablecloth—whatever you have—to keep yourself in a cool breeze.
Cheat the sun. You can't beat the sun, so do what you have to do outdoors early and late. "On hot days we start work at daylight," says David Tanner, safety director and project manager for Tip Top Roofers in Atlanta, Georgia. "Then we knock off about 2 or 3 o'clock in the afternoon."
Hit the scales. Heat exhaustion isn't necessarily built in a day. You could be dehydrating gradually over several days. "During training camp we check players' weight every day to make sure the water they sweat off in practice is getting put back," Reese says.
Drink like a baby. Pedialyte and other rehydrant formulas for infants are effective enough that the Texas Rangers give them to their players in extremely hot weather, Wheat says. The primary ingredients are sugar, sodium, and potassium. Drinking 1 quart before a race or tennis match and 1 quart during or after the workout "might not be a bad idea," says Dr. Keller.
Give the weatherman a little credit. Granted, in the winter, predicted 2-inch snowfalls sometimes turn into 10-inch snowfalls. But when it comes to summertime heat and humidity, the forecast is usually accurate. When they say it is going to be hot enough to fry an egg on Main Street, don't make that the day to begin painting your house.
Wear a hat. Preferably one that also shades the neck and is well-ventilated. A wide-brimmed hat with lots of tiny holes, for example, would be a good choice. "The blood vessels in your head and neck are very close to the skin surface, so you tend to gain or lose heat there very quickly," says Dr. Kenney. "And the top of the head is especially sensitive in people who are bald or balding."
Don't bare your chest. "You pick up more radiant heat exposure with your shirt off," says Lanny Nalder, Ph.D., director of the Human Performance Research Center and the Wellness Center at Utah State University.
"Once you start perspiring, a shirt can act like a cooling device when the wind goes through," he adds.
Carry a spare. If your shirt gets wet with perspiration, take it off and wash it as soon as possible. "The dried salt from your sweat impairs the 'breathing' quality of the shirt," Dr. Nalder says. Change it and wash it as soon as possible.
Wear cotton/polyester blends. They breathe better than shirts that are 100 percent cotton or 100 percent tightly woven nylon.
Wear light colors. They reflect the heat, says Dr. Nalder, while dark colors absorb it.
PANEL OF ADVISERS
Richard Keller, M.D., is an emergency room physician at St. Therese Hospital in Waukegan, Illinois.
Larry Kenney, Ph.D., is an assistant professor of applied physiology in the Laboratory for Human Performance Research at Pennsylvania State University in University Park.
Lanny Nalder, Ph.D., is director of the Human Performance Research Center and the Wellness Center at Utah State University in Logan.
Bob Reese is head trainer for the New York Jets and president of the Professional Football Athletic Trainers Society.
David Tanner is safety director and project manager for Tip Top Roofers in Atlanta, Georgia.
Danny Wheat is an assistant trainer for the Texas Rangers baseball club in Arlington, Texas.
