During a hospital rotation with the 18D course, I was working in the ER when a soldier was brought in with a core temperature of 108 degrees. We rushed to get his core temperature under control by dousing his entire body with ice and turning on multiple fans. When his core temperature reached 102, myself and the other students wiped the ice off him to begin the slower rate of cooling. Just then, someone else came in and dumped more ice on him, and despite our protests, we were overruled as to these further cooling attempts. This soldiers’ temp dropped all the way into the mid-90’s before they realized their error and tried to reverse the now hypothermic soldier. 3 weeks later when our rotation ended, this soldier was still in the ICU, and his prognosis was not good. Heat injuries are extremely common, and understanding the difference between the different types of heat injuries and can help us identify them early, and render proper treatment.
There are 3 forms of heat injuries. In progression of least to most serious, we have heat cramps, heat exhaustion and heat stroke. The progression of heat cramps to heat stroke can be rapid if not recognized and proper actions taken. Let’s take a few minutes to understand what each of these 3 forms of heat injuries means.
Heat Cramps are exactly what they sound like. Involuntary muscle contractions, aka cramping. They are most likely caused by an electrolyte imbalance caused by dehydration, heavy sweating, and improper rehydration.
Heat Cramps are often: Intermittent, involuntary, and painful. When recognized early and treated properly, they tend to go away on their own.
1) Rest in cool place. Drink cool water, electrolyte drink, and/or eat food.
2) Do not overexert yourself or try and return to activity too early.
Heat Cramps can be a warning sign of impending Heat Exhaustion.
Heat Exhaustion is the next most serious form of heat injury, and is caused when your body begins overheating. This is most commonly associated with strenuous activity in conjunction with high temperatures and high humidity. Body Temps are often found as high as 103-104 in heat exhaustion, but can be lower and still exhibit some or all of the following symptoms.
- Heavy sweating and rapid pulse
- Low blood pressure when standing
- Cool, clammy skin
In order to get a proper reading on temperature, take a CORE temp. Do not take an under-the-tongue temp, forehead temp, etc. as it may not reflect what is happening internal to the body. A CORE temp must be taken.
1) Stop all activity and rest immediately
2) Move to cool place
3) Drink electrolyte fluid and water
4) Do NOT slam fluids down. Take measured sips over time.
5) Just because you FEEL better, does not mean your body has had proper time to recover. If you exhibit any of the above symptoms, give your body adequate time to recover, and return to activity SLOWLY to gauge your ability to handle the heat AFTER your symptoms have gone away.
-- If you are unable to drink fluids due to vomiting or nausea, you may need higher medical attention for IV rehydration.
-- Do NOT give too much IV fluid, and do not give it too quickly. Your body can not process more than around 1L per hour, so slamming home bag after bag of IV fluid is bad medicine, and can lead to hyponatremia (too much water/fluids) and cause additional severe problems to the body.
If Heat Exhaustion is not treated quickly, it can very quickly lead to Heat Stroke, which is extremely life threatening.
The most severe form of heat injury and EXTREMELY LIFE THREATENING
It generally involves a physical collapse or debilitation during or immediately following exertion in the heat. Can be sudden or gradual. Take a CORE temp to determine true body temperature.
- Body core temperature exceeds 104 degrees (F).
- Altered mental status, to include delirium, stupor, coma
Treatment and Management:
-- If you haven’t called 911 or alerted emergency services-do so!
-- Cooling should be immediate and primary goal!
(Early rapid cooling reduces mortality and morbidity!!!)
-- Best option for rapid cooling is an ice bath with full body immersion (minus the head)
-- If unavailable, a continual dousing of cold water such as one would experience in a cold shower.
-- If the first options aren't feasible, spraying patient with water plus fanning/rapid air movement across the body can also be done.
CONTINUOUSLY APPLY THESE MEASURES UNTIL CORE TEMPERATURE GOES BELOW 102 degrees!!! Then, continue to cool at a much slower rate, so as not to drop the bodies temperature into hypothermia.
Risk factors to consider with heat injuries:
-- The very young and very old (Under 4 and over 65) have a much harder time regulating their body temperature.
-- Drugs (Prescription and illicit) Blood pressure medications, antihistamines, antipsychotic, and more tend to make your more vulnerable to heat.
-- Obesity: Excess weight can cause difficulty for your body in regulating its heat.
-- Sudden changes in temperature. Moving or traveling from a cold climate to a warmer one can cause lags in your body’s ability to acclimate and adjust its temperature.
-- Heat Index: Be wary of the heat index and limit exposure during most intense parts of the day.
REMEMBER—You tend to run a higher risk of being a repeat heat casualty if you have had it happen before. Your body’s ability to regulate heat takes a hit after a serious heat related injury, and it may take months to recover. Additionally, the factors that led your body to become a heat injury in the first place are often still there, so you still maintain a higher risk factor. Recognize the risk factors in yourself and others, and be prepared to jump in when you see someone who needs your help!
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