The dangers of heat stroke

By Dr. Tom Gross
Marin Independent Journal (California) 
Copyright 2006 Marin Independent Journal, a MediaNews Group publication
All Rights Reserved

During our recent hot spell, the news media reminded us that, in these conditions, we are at risk for heat stroke, and that we should stay hydrated to help prevent heat-related illness. This is the truth; however, it is not the whole truth.

Medical texts describe the classic symptoms of heat exhaustion and heat stroke. Paramedics are taught that patients with heat exhaustion are typically diaphoretic (sweating heavily), but that patients with heat stroke have hot and dry skin. This classic teaching is erroneous, as recent studies have shown that more than 50 percent of heat stroke patients are indeed still very diaphoretic.

The reliable hallmark of heat stroke is altered mental status, presenting as disorientation or confusion. I worked in the medical tent of a triathlon competition, on a hot and humid summer day in Baltimore. (That way I could get the T-shirt without actually having to compete.) We helped many athletes who had fallen out of the race and had been brought to our facility. Most of them were dizzy, nauseated, profoundly diaphoretic and so weak that they could barely stand. These were suffering from heat exhaustion.

However, occasionally a competitor was brought in who was out of his head. He did not know what city he was in or what day it was. Here he was, in the middle of a race for which he had been training for more than a year, and he had no idea what was going on. He had all of the symptoms of heat exhaustion, but he was also severely disoriented.

This was heat stroke. That is why it is called a "stroke" because it is an injury to the central nervous system. This is an extremely dangerous condition. People suffering disorientation during very hot weather should be taken to an emergency department to be evaluated for heat stroke.

Certainly, dehydration plays a factor in heat-related illnesses. You must stay hydrated so that your body can cool itself. If you become dehydrated on a hot day, you will definitely retain heat and your temperature will rise. However, staying hydrated does not always prevent heat-related illness. You must also get rid of the heat.

If you cannot escape the heat by finding an air-conditioned theater or by going to the beach, you must find a way to stay cool.

The most efficient way for a body to lose heat is by evaporation of water off your skin. Do you remember how a breeze blowing onto a wet finger can tell you which way the wind is blowing? This works because the water on the skin is being evaporated on the side where you feel the breeze.

As a teenager, I worked in Sonoma County as a carpenter's apprentice. I was assigned to work with an "old guy" named Archie. We were up on a roof in 100-degree weather. Every few minutes, Archie would wipe a little water on his forearms. He instructed me to do the same. The evaporation of that water off my forearms felt like a cool breeze.

I also learned to wear a brimmed hat, and to soak it with water. The evaporation of water off of the hat made the top of my head much cooler than it would have been otherwise.

So, please remember that it is very important to drink plenty of fluids on a hot day, but please do not think that this alone will help prevent either heat exhaustion or heat stroke.

Get out of the direct sun, sit in front of a fan and apply water to your exposed skin, especially to the face, scalp, neck and forearms.

We live in a desert climate. Let's start acting like it.

Dr. Tom Gross is the emergency medical services director for the Novato Fire Protection District.

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