Travel Reference
In-Depth Information
Heat stroke (sunstroke) is the most severe form of heat illness. Fatalities are common,
as are permanent residual disabilities. The onset typically is very rapid and is characterized
bychangesinmentalfunction.Confusionandirrationalbehavioraremostfrequent,butin-
coordination, delirium, and unconsciousness often follow. Seizures occur commonly. The
pupils may be dilated and unresponsive to light.
The body temperature during heat stroke is almost always above 104°F (40°C) and may
be above 107°F (42°C), which is the upper limit for most clinical thermometers. A rectal
thermometer reading to 113°F (45°C) is usually needed to measure the temperature of in-
dividuals with heat stroke, but that would not be carried unless severe heat stress had been
anticipated, in which case effective preventive measures should have been instituted. If the
temperature is not measured for some time after the onset of the illness, it may have fallen.
The skin feels hot. It is usually covered with perspiration if the person has been exer-
cising at the time of collapse. Later the skin may dry, particularly if cooling has been in-
stituted. The hot, dry skin long associated with heat stroke is typical of individuals with
the abnormal heat loss typical of nonexertional heat illness, not exertional heat illness.
However, sweating does decrease during exercise and can fall to quite small volumes, par-
ticularly when exercise has been prolonged and the individual has become dehydrated.
Pulse and respiratory rates both are increased. The heart rate may be as high as 130.
Shock is usually present.
If a clinical thermometer to measure temperature is not available but typical signs and
symptoms of heat stroke are present, cooling should be instituted as rapidly as possible.
Heat stroke is one of the few true medical emergencies in which a delay of only a few
minutes may significantly alter the outcome. If the person is unconscious, an open airway
must be maintained. Shock should be treated by elevating the feet and by any other meth-
ods that are feasible.
The individual should be moved to the coolest spot possible and shaded from sunlight.
One way of cooling persons with heat stroke in hospital emergency rooms is to remove
their clothing, cover them with wet sheets, and place large fans blowing directly across
their body from two directions. In the wilderness, similar methods should be devised.
Clothing should be soaked with water. If the clothing is removed—or is scanty—the ex-
tremities and trunk should be covered with wet towels or other absorbent fabric and the
body should be fanned to increase air circulation and evaporation. Immersion in water is
also used in hospital emergency rooms and would be useful in a wilderness situation. Any
reasonable method for cooling the individual should be employed.
In a wilderness environment that produced heat stroke, ice or snow would not be avail-
able.Inanurbanenvironment,theyprobablyshouldnotbeused.Apersonwithheatstroke
should be cooled by evaporation. Alcohol sponging should not be used because isopropyl
alcohol may be absorbed through the skin, particularly by children, and is toxic.
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