Beating Heatstroke: Know the Symptoms, Prevention & Treatment

HASTINGS – As Nebraska is experiencing a dangerous heat wave, with head indices reaching 111 degrees F, Nebraska Department of Health and Human Services (DHHS) wants Nebraskans to be mindful of the symptoms of heatstroke, the most serious form of heat injury, and steps to prevent it.

Heatstroke is a condition caused by a person’s body overheating, usually as a result of prolonged exposure to or physical exertion in high temperatures. This may occur in combination with dehydration, which can lead to failure of the body’s temperature control system. Heatstroke can occur if the body temperature rises to 104 F (40 C) or higher. The condition is most common in the summer months.

Risk factors associated with heat-related illness include:

  • Age; infants and children up to age 4, and adults over age 65, are particularly vulnerable because they adjust to heat more slowly than other people.
  • Health conditions; these include heart, lung, or kidney disease, obesity or being underweight, high blood pressure, diabetes, mental illness, sickle cell trait, alcoholism, sunburn, and conditions that cause fever.
  • Medications; these include antihistamines, diet pills, diuretics, sedatives, tranquilizers, stimulants, seizure medications, heart and blood pressure medications, and medications for psychiatric illnesses. Illegal drugs such as cocaine and methamphetamine also are associated with increased risk of heatstroke.

People with diabetes are at an increased risk of emergency room visits, hospitalization, and death from heat-related illness and may be likely to underestimate their risk during heat waves, according to a recent study presented by researchers from the Mayo Clinic in Arizona, the National Ocean and Atmospheric Administration, and the National Weather Service. A doctor or healthcare provider is the best source to determine if a person’s health condition and personal medications will affect the ability to cope with extreme heat and humidity.

If heatstroke (sometimes also referred to as sunstroke) is suspected, 911 should be called immediately and first aid should be given until paramedics arrive. While waiting, start first aid by moving the person into an air-conditioned environment or at least a cool, shady area and remove any unnecessary clothing.  If possible, take the person’s temperature and initiate first aid to cool it to 101 to 102 degrees F. If no thermometers are available, do not hesitate and begin the first aid process.

Cooling strategies that can be tried include:

  • Fan air over the patient while wetting their skinwith water from a sponge or garden hose
  • Applying ice packs to the patient’s armpits, groin, neck, and back. Because these areas are rich with bloodvessels close to the skin, cooling them first may help reduce body temperature faster.
  • Immersing the patient in a shower or tub of cool water
  • If the person is young and healthy and suffered heatstroke while exercising vigorously (known as exertional heatstroke), an ice bath can help cool the body.
  • Do not use ice for older patients, young children, patients with chronic illness, or anyone whose heatstroke occurred without vigorous exercise. Doing so can be dangerous.

Heatstroke can kill or cause damage to the brain and other internal organs. Although heatstroke mainly affects people over age 50, especially those who live in apartments or homes lacking air conditioning or good airflow, it can take a toll on healthy young athletes. Other high-risk groups include people of any age who don’t drink enough water, have chronic diseases, or who drink excessive amounts of alcohol.

Heatstroke is strongly related to the heat index, which is a measurement of how someone feels when the effects of relative humidity and air temperature are combined. A relative humidity of 60% or more hampers sweat evaporation, which hinders the body’s ability to cool itself. The risk of heat-related illness dramatically increases when the heat index climbs to 90 degrees or more. It is important, especially during a heat wave, to pay attention to the reported heat index, and to remember that exposure to direct sunshine can increase the reported heat index by 15 degrees.

Those living in an urban area may be especially prone to develop heatstroke during a prolonged heat wave, particularly if there are stagnant atmospheric conditions and poor air quality. In what is known as the “heat island effect,” asphalt and concrete store heat during the day and only gradually release it at night, resulting in higher nighttime temperatures.

Heatstroke often occurs as a progression from milder heat-related illnesses such as heat cramps, fainting, and heat exhaustion. But it can strike even if there are no previous signs of heat injury. Other common symptoms include nausea, seizures, confusion, disorientation, throbbing headaches, lack of sweating despite the heat, muscle weakness/cramps, rapid heartbeat, and, sometimes, loss of consciousness.

Heatstroke can be prevented with some precautions. When the heat index is high, stay in an air-conditioned environment. If that is not possible, prevent heatstroke by:

  • Wearing lightweight, light-colored, loose-fitting clothing, and a wide-brimmed hat
  • Using sunscreen with sun protection factor (SPF) of 30 or more
  • Drinking extra fluids. To prevent dehydration, it’s generally recommended to drink at least eight glasses of water, fruit juice, or vegetable juice per day. Because heat-related illness also can result from salt depletion, it may be advisable to substitute an electrolyte-rich sports drink for water during periods of extreme heat and humidity.
  • Taking additional precautions when exercising or working outdoors. The general recommendation is to drink 24 ounces of fluid two hours before exercise, and consider adding another 8 ounces of water or sports drink right before exercise. During exercise, drink another 8 ounces of water every 20 minutes, even if not thirsty.
  • Rescheduling or cancelling outdoor activities. Shift time outdoors to the coolest times of the day, either early morning or after sunset.
  • Monitoring the color of your urine; darker urine is a sign of dehydration. Be sure to drink enough fluids to maintain very light-colored urine.
  • Measuring weight before and after physical activity. Monitoring lost water weight can help determine how much fluid to drink.
  • Avoiding fluids containing caffeine or alcohol, as both may cause dehydration and worsen heat-related illness. Do not take salt tablets unless prescribed by a doctor. The easiest and safest way to replace salt and other electrolytes during heat waves is to drink sports beverages or fruit juice.
  • Check with your doctor before increasing liquid intake if you suffer from epilepsy or heart, kidney, or liver disease. If a fluid-restricted diet is followed, or if there is a problem with fluid retention, a doctor or healthcare provider should be consulted.

Try to spend at least two hours each day, preferably during the hottest part of the day, in an air-conditioned environment if living in an apartment or house without fans or air conditioning. At home, draw the curtains, shades, or blinds during the hottest part of the day, and open windows at night on at least two sides of your home to create cross-ventilation.

Seniors who either can’t afford to buy or run the air conditioner in their home, should check with their local Area Agency on Aging (AAA) for assistance. Additionally, Low Income Home Energy Assistance Program (LIHEAP) provides financial assistance for managing costs of heating and cooling your home. For details, visit https://dhhs.ne.gov/Pages/Energy-Assistance.aspx.

After recovering from heatstroke, sensitivity to high temperatures is heightened. Do not return to normal activities until you receive approval from your healthcare provider, and avoid hot weather and heavy exercise.

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