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HIGH-YIELD FACTS

  • Heat-related illnesses comprise a continuum of conditions ranging from minor entities such as heat cramps to more serious conditions including heat exhaustion and heatstroke.

  • Heat exhaustion is a syndrome of dizziness, postural hypotension, nausea, vomiting, headache, weakness, and occasionally syncope.

  • Heatstroke represents complete thermoregulatory failure and can lead to seizure, coma, or death if not recognized and treated immediately.

  • Rapid cooling along with adequate hydration, either parenterally or intravenously, remains the mainstay of treatment of heatstroke.

  • Cold related illnesses are occurring in increasing numbers due to recreational and athletic activities.

  • Frostbite, the freezing of human tissue, may be reversed by warm water submersion, but this should be done only if there is no risk of re-exposure to cold.

  • Extracorporeal rewarming is the most rapid method of rewarming and is indicated in hypothermic cardiac arrest and in patients who present with completely frozen extremities.

HEAT ILLNESS

Heat-related illnesses are often horrific events with significant morbidity and mortality, with the greatest tragedy being that most are preventable. The spectrum of heat illness ranges from mild, self-limited problems to life-threatening conditions including death. Luckily, the majority of patients who are evaluated in the emergency department for heat illness can be appropriately treated and discharged, with only a small fraction requiring transfer or hospitalization.1 Unfortunately, there are still a significant number of serious illnesses and deaths attributed to heat injury in the United States each year. More than 7800 deaths occurred from extreme heat exposure from 1999 to 2009.2

Heat illness can be divided into two categories: classic and exertional. Classic heat illness typically occurs in the elderly and younger children who lack the capability or capacity to remove themselves from high temperature environments. The commonly used example is the infant accidentally left in the backseat of the car. Even on merely warm days, temperatures can rise very rapidly within an enclosed car. Despite windows being cracked open, inside temperatures can still reach greater than 40 degrees above that of the outside air temperature in a matter of minutes.3 These cases often represent tragic mistakes made by caregivers, resulting in devastating loss. Exertional heat illness, on the other hand, is an increase in body temperature due to vigorous exercise usually under hot, humid conditions. Adolescents account for the largest proportion of exertion-related heat illness.4 Participation in high school and college level athletics, especially those with rigorous training programs such as football, is a leading cause of exertional heat illness.5 Military programs also see heat illness in their young, poorly acclimated cadets during basic training.6 Hot and humid weather conditions, poor physical conditioning, hypovolemic state, multiple workout sessions in a day, and clothing/equipment that hinders evaporative heat loss are all contributing factors.7 These coupled with a sense of teenage invulnerability and pride can lead to serious and potentially fatal heat illness.

PATHOPHYSIOLOGY

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