Heat Related Emergencies: What They Are and How to Treat Them
The temperature is heating up outside, which makes this a great time for us to discuss heat related emergencies. Out on the water we have the sun beating down from above and the sun’s rays reflecting back up at us from the water. The danger is more than sunburn. It’s the overheating of our entire body. Those downwind runs where it feels like the fresh breeze has left us and jackets come off is when the heat is particularly noticeable.
How Your Body Cools Itself
Our bodies have processes in place to keep our internal temperature right around 98.6°F. The way we do this is by sweating, which then evaporates and cools the skin. Or by vasodilation – that’s when the tiny blood vessels close to the skin open up wider, allowing heat to escape to the air. These systems are super effective as long as the body has enough fluid to keep the processes going. We have to be able to get rid of more heat than the body produces or things get dicey. The two main ways to assist the body are to get to a cooler place and to replace the fluid being lost. Sometimes though, we may not be aware of the loss, especially with offshore breezes and the high tech fabrics we wear.
Key Indicators for Heat Related Emergencies
For sailors it’s important that we listen to our thirst and be aware of the color and amount of our urine. Thirst is usually a reliable indicator that we’re losing more than we can afford, however the thirst mechanism isn’t as sharp in kids and adults over 50ish. We should all be putting out plenty of pale yellow urine, the color of a Miller Lite. A decreased amount of urine or urine that is becoming darker in color are signs of dehydration. Urine that is brown or reddish, more like an iced tea or cola, can be an indication of muscle tissue damage sometimes seen with heat stroke. Rhabdomyolosis is the fancy medical term for this. Certain medical conditions; prescription medications and street drugs; alcohol; and age (less than 4 and over 65) can increase the risk of heat related emergencies.
Heat emergencies come in three basic flavors and are somewhat progressive. The most basic is heat cramps, followed by heat exhaustion, then the final and life threatening heat stroke. It’s super important that we know how to recognize these three and intervene immediately and effectively.
Heat Cramps – Your Muscles Need Electrolytes!
Heat cramps are muscle spasms brought on by heavy exertion in hot environments. Fluid and electrolyte loss are thought to be the culprits. Electrolytes – sodium, potassium, calcium and magnesium – are the guys that are involved in the chemical reactions that make muscles work. An imbalance causes all kinds of problems.
These muscle spasms tend to occur in the arms, legs, back and stomach and can be accompanied by sweating and a headache. The spasms have a tendency to be more pronounced than typical night-time leg cramps. To treat heat cramps, rest and cool down if possible. Replace fluids and electrolytes by drinking electrolyte-containing sports drinks such as Gatorade, Powerade, Pedialyte or my favorite Shaklee Hydrate. If you don’t have any available go with clear juices, coconut water, cool water or a home-made rehydration solution (most quick recipes call for mixing a ½ tsp of salt and 2 Tbsp of sugar with a quart of water). Cool water and a bit of ice in a bag held over the cramping area or gentle stretching may provide comfort. Do NOT give salt tablets. They’re upsetting to the stomach and don’t replace the fluids lost. My dad gave me a couple with a Coke to wash them down after my first Mac race. That’s the quickest way to barf that I know of.
It’s time to seek medical care if the cramps don’t improve in an hour or so with cooling, rest and fluid replacement. Heat cramps will usually resolve on their own or they may be the first sign of a more serious heat related emergency.
Heat Exhaustion – Your Body Needs Fluids AND Electrolytes
Next up the tree in seriousness is heat exhaustion – dehydration from sweating. High temperatures, physical exertion and high humidity set the stage. Heat exhaustion can lead to fluid volume shock, which is shock caused by loss of fluids, in this case, due to sweating. There’s a boat load of sweating with heat exhaustion and there can be a headache, nausea, vomiting, weakness, dizziness, a rapid pulse, cramps, or fatigue. Our bodies, at least for awhile, compensate for the fluid loss so our heat exhausted patient may have a normal or near normal body temperature; and be awake and alert. This can change if things worsen and would be a red flag that you need medical help.
We must stop the fluid loss and replace the liquids lost. Move them to a cooler location if possible, at least out of direct sun, and have them lie down and rest. Remove any extra clothing (theirs not yours). You can mist, sprinkle or sponge them with water and fan them to help cool the skin (especially the neck, armpits and groin areas), however it’s most important that we begin the rehydration process with fluids AND electrolytes. Because their fluid loss was from sweating they have lost salt too. If we only replace the fluids and not the salt (electrolytes), they are at risk for a nasty business called hyponatremia – or low blood salt
Remember what I said about salt tablets though! NO! Rehydrate with electrolyte drinks. Salt can be replaced with food as well, as long as they aren’t nauseated or vomiting. If they are sickish or barfing, stick with small frequent sips of electrolyte drinks. It may take half a day or so of oral fluids for a dehydrated patient to return to their happy self. You’ll know you’re winning the battle when they feel and look better; and when there’s plenty of Miller Lite yellow going on.
Watch them closely. We have the potential to win the battle with heat exhaustion on the boat, however if you can’t replace the volume and your patient can no longer compensate for the fluid and electrolyte losses and doesn’t improve or worsens, you will have to seek emergency medical intervention. Get them off the boat and to advanced medical care!
Heat Stroke, Also Called Sunstroke, Requires a Hospital
The most critical heat related injury is heat stroke, sometimes called sunstroke. It is a critical problem requiring immediate, emergency treatment. The problem here is a dangerously high body temperature that can quickly cause permanent damage to the brain, heart, kidneys, and muscles and can also cause death. Heat stroke often starts with heat cramps or exhaustion and progresses, but it can happen directly with no signs of other heat illness first. It results from a combination of prolonged exposure to high temperatures, vigorous exercise and dehydration.
The defining symptom is a temperature over 104°F. The hallmarks are hot, red, dry skin, but not always. If the body temperature rose quickly, before dehydration became an issue, they could still be sweaty. Other things we may see in addition to hot, red, dry skin and the symptoms of heat exhaustion (nausea, vomiting, dizziness, weakness, a rapid pulse and cramps), are a decreased level of alertness – confusion, disorientation, lethargy; a decreased amount of urine or urine that looks brown or red; seizures or unconsciousness; a throbbing headache; or rapid shallow breathing.
The first treatment is immediate, aggressive cooling. Please don’t throw them overboard. Lay them on the deck, out of direct sun and pour buckets of water over them. Fan them if possible. Let evaporation, conduction and radiation do their jobs. Once the body temperature has been addressed and is showing improvement, rehydration can be initiated if they are awake and alert enough to participate in the process. Ideally, evacuate them off the boat to a higher level of medical care as soon as can safely be done. There are multiple complications that can happen from heat stroke, including brain swelling and a breakdown of muscle tissue that can lead to kidney failure. They need a hospital.
What to do to Avoid Heat Related Emergencies
We have some power to prevent heat related emergencies. Drink plenty of extra fluid and include some electrolyte drinks and fruit juices when exerting yourself in high heat and humidity. Make sure you’re drinking enough so that you have lots of Miller Lite yellow pee. Avoid alcohol and caffeine. Wear loose fitting, light colored clothing and a wide brimmed hat. Be extra cautious if you’re in a high risk group due to age, medical condition or medications. Please take care out there!