Environmental Emergencies: Heat Stroke

Heat Stroke is an acute medical emergency caused by failure of the heat-regulating mechanisms of the body. It usually occurs during extended heat waves, especially when they are accompanied by high humidity. People at risk are those not acclimatized to heat, those who are elderly or very young, those unable to care for themselves, those with chronic and debilitating diseases, and those taking certain medication (eg. Tranquilizers, anticholinergics, diuretics and beta-blocking agents). Excertional heat stroke occurs in healthy individuals during sports or work activities, ex. exercising in strong heat and humidity.  Hyperthermia results because of inadequate heat loss. This type of heat stroke can also cause death.

Most heat related deaths occur in the elderly, because their circulatory systems are unable to compensate for stress imposed by heat. Elderly people have decreased ability to perspire as well as a decreased thirst mechanism to compensate for heat. The risk for heat stroke is greater among the elderly because many elderly people do not drink adequate amounts of fluid, partly because of fear of incontinence. In addition, many elderly people fear being victims of crime, so they tend to keep windows closed, even when the temperature and humidity levels are high.

Heat stroke causes thermal injury at the cellular level, resulting in coagulopathies and widespread damage to the heart, liver and kidneys. Recent patient history reveals exposure elevated ambient temperature or excessive exercise during extreme heat.

Common sign and symptoms of heat stroke are:

·         high body temperature

·         the absence of sweating, with hot red or flushed dry skin

·         hypotension

·         rapid pulse

·         difficulty breathing

·         strange behavior

·         hallucinations

·         confusion

·         agitation

·         disorientation

·         seizure

·         coma

Preventing Heat Stroke

·   Avoid reexposure to high temperature; hypersensitivity to high temperature may remain for a considerable time.

·       Emphasize the importance of maintaining adequate fluid intake, wearing loose clothes and reducing activity in hot weather.

·     Advise athletes to monitor fluid losses and weight loss during workout activities or exercise and to replace fluids.

·         Plan outdoor activities to avoid the hottest part of the day.

·        Take extra precautions with certain medications. Be on the lookout for heat-related problems if you take medications that can affect your body's ability to stay hydrated and dissipate heat.

·         Never leave children or anyone else in a parked car. This is a common cause of heat-related deaths in children. When parked in the sun, the temperature in your car can rise 20 degrees F (more than 6.7 C) in just 10 minutes. It's not safe to leave a person inside a parked car in hot weather for any period of time, even if the windows are cracked or the car is in the shade. When your car is parked, keep it locked to prevent a child from getting inside.

The most important measures to prevent heat strokes are to avoid becoming dehydrated and to avoid vigorous physical activities in hot and humid weather.

The primary goal is to reduce the high temperature as quickly as possible, because mortality is directly related to the duration of hyperthermia.

Methods to Treat Heat Stroke Victim

·         Get the victim to a shady area, remove clothing, apply cool or tepid water to the skin (for example, you can spray the victim with cool water from a garden hose), fan the victim to promote sweating and evaporation, and place ice packs for the armpits and groin.

·         If the person is able to drink water, drink them cool water or cool drinks that do not contain alcohol or caffeine.

·       Monitor body temperature with a thermometer and continue cooling efforts until the body temperature drops to 101-102 F (38.3 to 38.8 C).

·   Always notify emergency services (911) immediately. If their arrival is delayed, they can give you further instructions for treatment of the victim.

ALLERGIES: Here’s The Best Relief

“Live With Your Allergies”

Over the past 20 years there’s a marked increase in allergies, from the most prevalent disorder(allergic rhinitis, or hay fever) to food allergies and allergy-related ailments such as asthma and sinusitis. “Allergies seem to increase with the Western lifestyle.” Among the possible correlates: smaller families, use of antibiotic early in life, diesel-exhaust particles and changes in diet toward more processed foods.

ABCs on Allergies. Basically, an allergy is an overreaction of the immune system. An allergic person’s immune system acts like a garrison of jittery sentries patrolling a volatile border. When an “enemy” is spotted, the body responds with overkill: a huge of army of immunoglobulin E (IgE) antibodies fights it off. They attach to mast cells (plentiful in the respiratory and gastrointestinal tracts) that release inflammatory chemicals, including histamine. These spark a classic allergic reaction: itchy eyes, runny nose, lung constriction, hives or even anaphylaxis, sometimes fatal reaction. Allergies are the disease of a thousand faces. An allergen may set off a sneeze in one person and hives in another. If you’re allergy prone, you probably react to more than one allergen. But allergies come and go; you may grow out of childhood eczema and into hay fever. Stress can also play a role in certain allergic reactions.

Cold or Hay Fever? Not surprisingly, even competent physicians over look allergies and treatment have been haphazard. If your symptoms pose more than mild annoyance, see your doctor. He can diagnose and treat many allergies and if necessary, refer you to an allergist for skin tests. If you’re wondering, “Do I have a cold, or hay fever?” the specialist may also examine a nasal smear for white blood cells called eosinophils, which abound in allergic rhinitis. For those with true food allergies, the scary thing is they can be perilous; food included anaphylaxis can land you in the emergency room. A few foods are responsible for 90 % of reactions. In children, it’s milk eggs, peanuts and tree nuts, soy and wheat, in adult, peanuts and tree nuts, fish and shellfish.

First Line Defenses. For most allergies, the first step is generally the same. If you know you’re severely allergic to a certain food, be vigilant in steering clear of it- asking waiters the ingredients of a dish on the menu, for instance. For babies, if there’s a family history of food allergies, it’s best to breastfeed and without solid foods until age six months. There’s no need to introduce peanuts or fish till age three at a minimum. Older children and adults with allergies should eat a varied diet because eating the same foods frequently can create allergies or sensitivities. Divide your allergic triggers into indoor and outdoor allergens. Indoor allergens- dust mites, animal dander and mold proliferate amid carpeting, drapes, feather pillows and down comforters. Other tips clean the house frequently; wash blankets or quilts every 2 weeks in hot water (130 degrees F) use an air conditioner in summer (change the filter yearly) try putting filters over forced air heating vents. Avoid bringing outdoor allergens indoors. Change your clothes and wash you’re your hair before bed during pollen season. After any insect sting, you feel dizzy, faint or headachy, have trouble breathing or develop hives, see your doctor immediately. It could be an anaphylactic reaction. If you do suffer such reactions, you’ll probably get an Epipen- a spring loaded needle that injects epinephrine to carry all times.

Second Line Defenses.  Although avoiding triggers can eliminate 50 to 70 % of allergic reactions. Allergists are enthusiastic  about prescription only antihistamines such as Claritin and Allegra because they’re effective and no sedating. Those whose symptoms persist even with medication or who are at risk for fetal insect stings can report to immunotherapy. For three to five years you receive injections of allergens, gradually desensitizing your immune system. The process brings relief in about 80% of cases.

Alternative Approaches. When stress is contributing factor in allergic asthma attacks, relaxation techniques may help some patients. It’s crucial to help people look at the psychological issues and to give them tools to handle stress. If you wish to explore unconventional therapies, however, you should first discuss them with your primary care doctor.