Can't take the heat? Many people can't, and too often they end up in the hospital.
By Martin Downs
Reviewed By Michael Smith
Hot enough for ya? It's an oven in here. Phew!
No one can resist commenting on the heat when the mercury rises above 100 degrees. It affects us profoundly -- in body and mind. In the worst cases, high heat and humidity can be deadly, too.
During a summer heat wave, emergency rooms fill up with people suffering from heat sickness. Many walk in complaining of cramps and exhaustion, and some are rushed in with heat stroke. "Heat stroke is the one we're most concerned about," says Mathew Walsh, MD, a doctor at Thomason Hospital in El Paso, Texas, and spokesman for the American College of Emergency Physicians.
Heat stroke victims, he says, are often near death. "They're treated the same as heart attacks or strokes or trauma patients."
The cause of heat stroke is simple: being too hot for too long. If sweating isn't enough to cool you down, your body temperature rises rapidly, up to 106 degrees in as little as ten or 15 minutes. That's hot enough to literally cook your brain. You pass out, and if you're not treated immediately, you will suffer brain damage or die.
When heat stroke victims are wheeled into the ER, Walsh says, doctors try to cool them by stripping off all their clothes, blowing air over them with fans (it also helps that ERs are air conditioned), and bathing them with lukewarm water. You would think it would be best to douse them with ice-cold water, but water that's too cold causes shivering, which actually warms the body more.
In the most extreme cases, doctors will put the victim on a respirator and give a drug to paralyze the body so they can bring the temperature down quickly.
Elderly at Risk
The elderly are most vulnerable to heat stroke, for various reasons. Imagine a widow living on her Social Security stipend in a neighborhood that was perfectly nice when she moved there in 1946, but has since become seedy. Her doors and windows are shut and locked for fear of burglars, and she doesn't run her air conditioner in order to keep her electric bills low.
On a hot, humid day, she's already in trouble: These conditions are enough to bring on heat stroke. When the air is humid and stagnant, sweat cools the body less efficiently because it can't evaporate. What's more, older people sweat less than younger people.
But let's say this widow takes blood pressure medication, which blunts her thirst, so she doesn't drink enough water. Then, to make matters worse, she has a beer after her morning coffee and chain-smokes. All these things dehydrate her. So she sweats even less, her body temperature soars, and by the time the Meals-on-Wheels man comes to bring her dinner, she's dead.
Walsh says a healthy young person, treated in time, has about a 90% chance of surviving severe heat stroke. Nevertheless, he says two teenage boys in his area recently died because they had gotten high on jimson weed (a.k.a. "loco weed") on a day when the temperature broke 100. They were just too stoned to realize how hot they were.
For an elderly person or someone whose health is fragile to begin with, the survival rate is less than 50%, he says. "It depends on how sick they are when they get to us."
He says El Paso has fewer cases than other parts of the country because the climate is arid. Down on the bayou, in the Everglades, and even in the Northeast, 100-plus degrees is much worse than it is in the Western desert.
Cramps, Exhaustion, Bad Mood
Heat cramps and heat exhaustion are not as scary. "These don't directly lead to heat stroke," Walsh says, but they are disabling. Both conditions are caused by loss of fluid and electrolytes -- salt, potassium, and magnesium -- through sweating. Heat exhaustion is just what it sounds like. Blood pressure drops and circulation decreases, which causes fatigue, fainting, or collapse. Heat cramps set in after strenuous exercise in hot conditions. They're painful, but not too serious.
Doctors treat heat exhaustion and cramps by replacing lost fluids and electrolytes, sometimes intravenously. The first-aid tent at a summer marathon is a good place to see how they do it. Often dozens of stricken runners will be stretched out on cots, hooked up to IV tubes or chugging Gatorade.
Oppressive heat hurts more than the body. If you have to spend a lot of time in the heat, you're likely to get crabby. "It does affect the emotions," says Arthur Bachrach, a psychologist and spokesman for the American Psychological Association.
Road rage is one example of how heat may affect your psyche -- which is no surprise if you've ever crept along in freeway traffic on a sweltering day. "Road rage is at least in part a function of heat stress," Bachrach says.
Heat also makes you feel apathetic and dulls your concentration, which can hurt your work performance and lead to accidents. The National Occupational Safety and Health Administration (NOSHA) takes heat seriously. Of course, tarring a roof in August is nastier business than it is in April, but many Americans work in hot environments year-round -- in laundries, mines, foundries, and steam tunnels, to name a few.
NOSHA recommends that workers gradually expose themselves to heat, so they can acclimate. They should also have a cool place to rest -- where the temperature is about 76 degrees -- and drink five to seven ounces of water every 15-20 minutes, or two to three gallons a day.
The same precautions against heat sickness apply at home and about town. Drink a lot of water, wear lightweight clothing, and never, ever leave a child locked in a car.
Stay in the shade when you can, and use air conditioning whenever possible. If you don't have air-conditioning in your home or car, go someplace that does before you overheat: Catch a movie, stroll around the mall, or linger a while over the ice-cream selection in a grocery freezer. You don't want to take a trip to the ER just because you thought you could take the heat.
Originally published July 15, 2002.
Medically updated May 19, 2003.
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