Heat and Hydration

Question 1

What are the symptoms of Heat Stroke?

Answer 1

Definition: Severe hyperthermia (>104F), Encephalopathy, and possible anhidrosis (lack of sweating).
Dry hot red skin, labored breathing, dizziness, nausea, vomiting, constricted pupils, low urine output, orthostasis.
Anything short of the temperature or AMS changes is heat exhaustion.

Question 2

What are the main treatment modalities for heat exhaustion or heat stroke?

Answer 2

Maintain ABCs, use active cooling (IV fluids, cold packs, immersion), Passive cooling (remove patient from heat)

Question 3

A patient presents after a recent ruck hike in 90 degree temperatures in a humid environment. He is complaining of severe leg muscle pain and tenderness as well as some nausea. He doesn’t think he drank enough water, and his most recent urine was the color of cocacola. What does he have?

Answer 3

Rhabdomyolysis.
You may see AMS, delirium, anuria (no urine), or fever.
Rhabdo can be caused by poor hydration/over exertion OR electrical injury OR a crush injury for >1 hour.
TREAT with large volume IV Fluids (1.5L/hr).

Question 4

What measures can be taken to prevent heat injuries?

Answer 4

Educate personnel on proper water intake.
Acclimatize personnel
Wear proper clothing
Tailor work schedules to the heat/humidity index.

Question 5

What are the signs of dehydration?

Answer 5

thirst
fatigue
lightheaded/dizziness
dry mouth
rapid heart rate
decreased urination
hypotension

Question 6

A patient completes a marathon in 6 hours and is starting to have a headache, nausea, and some malaise. He comes to the medical tent at MCM and you notice that he is slurring his speech a bit. What should you do for this patient?

Answer 6

This guy likely has hyponatremia. He is a slower runner and likely consumed all water during the race. If he used NSAIDs that would put him at higher risk.
DO NOT GIVE FLUIDS, this will worsen the problems.
Support the patient and transfer.