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Signs Of Heat Stroke & How To Treat Them with Dr. Carl Chudnofsky, Chair, Department of Emergency Medicine, Einstein Healthcare Network

Working up a shvitz has health benefits when done in moderation. But when the thermostat rises to the 90s and stays there for days, a little shvitz can lead to a big problem, says Dr. Carl Chudnofsky, chair of the department of emergency medicine at Einstein Healthcare Network.

“Heat-related illnesses are a spectrum of diseases, beginning with heat cramps and heat exhaustion and rising to heat stroke,” he explains. “It’s very important to recognize the symptoms of the dehydration that causes these problems and take action before heat stroke occurs. One thing all heat related problems have in common is dehydration, so it is very important to stay well hydrated as the temperature rises. If the dehydration goes too far, your judgment is impaired and you may not be able to help yourself.”

Signs of heat stroke include red skin, fatigue and malaise, dizziness, confusion, inability to speak, rapid heart rate and trouble breathing. Children are at risk because they cannot communicate their symptoms and cannot hydrate themselves. Older adults are also at risk because they may have preexisting conditions that create a lower tolerance for heat and because they may be on medications that put them at risk for dehydration.

Don’t underestimate heat-related illnesses, Chudnofsky advises. “Unfortunately, a lot of people brush off the symptoms, and by the time they arrive in our ER, they are in severe trouble. Then, we have to do immediate cooling procedures and sometimes attach them to a respirator to aid in their breathing. In some cases, heat stroke is fatal. Call 911 at the first sign of trouble.”

How exactly does heat affect us? “Bodies require certain amounts of oxygen and of water,” he explains. “When the body is deprived of water, it begins to break down on a cellular level. Organs slowly stop functioning, heart rate rises and breathing becomes difficult.”

The larger the organ or muscle, the more hydration it requires and the faster it can be compromised in severe heat. “Legs are a good example,” Chudnofsky says. “Quadriceps are among the largest muscles in the body. They require a lot of oxygen and hydration. We also use our quadriceps a lot, in general walking and certainly during exercise. In hot weather and without hydration, those quads are one of the first places that we see dehydration problems in the form of heat cramps.”

Why do we sweat? To release moisture onto the skin where it can be evaporated and cool the body. “But in high humidity, there is already so much moisture in the air that sweat does not evaporate, so it doesn’t cool the body,” Chudnofsky explains. “The other problem is if someone sweats without replenishing the fluids coming from within the body. That leads to dehydration.”

Another problem: Thirst is not a good barometer of hydration. There isn’t a your-fluids-will-soon-be-depleted symptom. By the time people feel thirsty, they are already dehydrated. “If you feel thirsty, don’t ignore the feeling because it is your body’s way of sounding an alarm,” Chudnofsky says.

Exercising outdoors in the heat? Wear light-colored loose-fitting clothing and hydrate before, during and after activity, Chudnofsky says. Alcohol doesn’t count; it dehydrates the body and impairs judgment. Some sports drinks have value if they contain electrolytes, but labels should be read carefully. Beware of heat cramps in the legs, back, abdominals or other muscles. At the first sign of heat exhaustion, stop exercising and get into air conditioning. Those at most risk should consider getting rehydration solutions from a pharmacy and keeping them on hand in case of emergency. “When your body tells you it is hot,” Chudnofsky says, listen to it.

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