Essential Advice on Heat Stroke and Summer Safety

Hello, and I am your host, Dr. Valda Crowder, also known as Dr. V, Board Certified Emergency Room Physician that is committed to empowering you with life-saving information. Please make sure to subscribe to this channel, like, comment, and follow me on all social media, including my YouTube at AskDr. V. All right. Today I've got some international listeners in town visiting the U.S., Ali and Sarah. Welcome, welcome, welcome. What a lot of people don't know is my podcast, about a third of my podcast listeners are international. Um, and the podcast is called What the Health Is Happening. The podcast is available on Apple Podcasts, Spotify, Audible, and all uh podcast platforms. Today we're gonna talk about what is going on this summer. This summer is bringing us some heat. And this is probably we're seeing some of the hottest temperatures, and we're going to see some of the hottest temperatures that we are seeing in years. As you watch the news, you will hear some of the weather forecasters talk about a heat dome where a large area of the country is covered by a blanket of heat. You're also going to hear about broken temperature records and heat advisories that are going to cover almost 160 million Americans. So as an ER physician, I've watched heat stroke walk through the doors of the emergency department on days like this. Um and uh it can really turn deadly in a couple of minutes. And today I want to talk about the summer heat, your health, what's happening in your body, who's most at risk, and exactly what do you need to do if you or someone that you love is in trouble. So let's really start with what are heat-related illnesses. So heat-related illnesses happen when the body absorbs and generates more heat than it can release. It exists in a spectrum. It can really start from something very mild, like mild cramps and a rash all over your body, and then it can proceed to heat exhaustion. And at the very most serious end of things is a heat stroke, which is a true medical emergency. Heat is now the deadliest weather-related hazard in the United States. I want to repeat that because a lot of people don't realize how serious this is. Heat is our most deadliest weather-related hazard in the United States. It kills more people than hurricanes and tornadoes combined. In 2024, we lost about 2,400 people in the United States related to heat emergency. So that's why I really wanted to talk about this today because it's something that people don't always think about, but it's very, very important. So heat illnesses come as a spectrum. So at the beginning of the spectrum is a heat rash. Many people have actually experienced that, or they have had children or or young people in their lives that have experienced that. And that's when you know your sweat ducts get clogged, um, and you sort of get this itchy, prickly rash. You most often see it in infants, um, but sometimes we see it also in the skin folds of even adults or young people. Now, when it progresses, you can actually get heat cramps. So heat cramps are when you actually get painful muscle spasms that occur either during exertion or some sort of exercise, or they sometimes occur afterwards. And they're caused by fluid and electrolyte losses. Then we can get heat syncope, and that's where people actually get a brief fainting or dizziness. Um, they're in the heat, they may be standing too long, they may have gone quickly from an air-conditioned area, quickly into very, very hot heat. We also see this at outdoor concerts, uh stadiums, outdoor stadiums, uh, and also theme parks. Uh then you can also get what we call heat exhaustion. So, heat exhaustion, you usually have heavy sweating, you get weak, um, often you get nauseous, you may see some vomiting, and the body is really, really struggling to cool itself. Um, when people experience heat exhaustion, they sometimes also feel like they're going to faint or they may faint. And lastly, is the most serious and most life-threatening emergency, and that is a heat stroke. And a heat stroke occurs when the body's cooling system actually fails to cool itself off completely. Um, in this scenario, what may happen is um there may not be any sweating at all. Um, and so this is really, really a life-threatening emergency, and I'll go into a little bit more about it, but it is really important at this point that 911 is called for either a heat exhaustion or a heat stroke. So, let's talk about what happens when someone has a heat stroke. So, what happens is the body temperature rises, it may rise gradually, but it goes above 103 degrees Fahrenheit. The body's cooling mechanism, which is primarily sweating, um, completely shuts down. So, in a heat stroke, the person will often be very hot and dry. Every minute counts when you are actually looking at a patient with a heat stroke because the goal is to actually stop the organ damage and actually prevent death. Unlike heat exhaustion, heat stroke can cause confusion, slurred speech, loss of consciousness, and again, the person will probably stop sweating altogether. People call it a heat stroke because often sometimes it can look like a stroke. You may see people start mumbling, they may be disoriented, they may even have um different body parts, arms or legs, that they cannot move like they move normally. So it really does mimic a stroke, and you really do need to actually call 911. At this point, patients are no longer able to regulate their temperature, and sweating is uh sweating actually, which really helps the body uh cool down, uh, completely stops. Now, when you talk about heat exhaustion versus heat stroke, um, it is very difficult to sort of tell the difference between them, but the main difference is often a patient with heat exhaustion will still have some sweating and their skin will be sort of cool and clammy. Whereas a heat stroke, patients often have very hot and dry and flushed skin. What is important is whether or not it's a heat stroke or a heat emergency. It is important to call the emergen call 911 and get the patient into the emergency department as quickly as possible. Maybe you're concerned about something that may be upcoming. I'm going to talk a little bit about the situations and scenarios that actually uh occur when this actually happens and what are the types of environments that actually increase the risk of someone having a heat stroke or heat exhaustion. Alright, so your body cools itself primarily through sweating and also dilating the blood vessels near the skin. And that allows for the heat in your body to be released to the surrounding air. In some situations, there is very, very high humidity. In cases where there's high humidity, like what we normally experience in August in Washington, DC, the sweat cannot evaporate efficiently. So this cooling system doesn't work even though you're still sweating. As core temperatures climb in your body, your cardiovascular system, your heart is working harder and harder and harder to pump blood to the skin, and it's actually straining. Eventually, in a heat stroke, the hypothalamus, which is the body's thermostat, loses control entirely. Proteins in the body begin to break down, and you get what we call multiple organ failure. And multiple organ failure is where your kidneys begin to shut down, your liver begins to shut down, eventually your brain begins to set set shut down, which is why people actually get very, very confused. So heat-related deaths have really doubled since 1999, and they will continue to increase due to climate change and global warming. In 2023, there were 120,000 emergency department visits for heat-related illnesses, and uh 92% of them occurred between the months of May and September. So, who's at risk for this? So basically, everyone is at risk for this. You will find that we will we do find that the extremes of age, um, the younger and older people, actually have the highest death rates because often they are less able to regulate their uh their temperature. So I tell people all the time, if you look at like a new baby when they're born, they're often swaddled and wrapped real tightly in a blanket. That's because newborns do not have the ability to regulate their temperature of their body like we do as an adult. And the other risk factor are those people who are older. So if you are 65 years or older, you're also at risk, uh more at risk for uh heat exhaustion, heat stroke, and possible death. Arizona and Nevada actually report the highest heat-related deaths per capita in the United States. Um, right now, extreme heat is not classified as a major disaster under the Stafford Act. Sofima does not have the ability to respond in the same way that it does for hurricanes or floods. Another risk factor, which I'll go into a little bit later, is uh medication use. I'll actually, I've got a question from a listener on that, and I'll go over some of the medications and also alcohol and drug use. And I think that's really important because a lot of times, sometimes you're sitting out in the heat, you may be drinking a wine cooler or a beer at a barbecue. That also increases your risk for heat, exhaustion, and heat stroke. All right, to hear more about today's topic and other critical health care issues, listen to my podcast, What the Health is Happening, where you get the inside scoop on everything that matters around your health, from breaking news to life-changing medical updates. What the health is happening is available on all podcast platforms, Apple Podcasts, Audible, any podcast platform, we are there. Download, subscribe, and comment. We're gonna go into news you can use. There is a historic heat dome that has actually been shattering records across the East Coast. We had a dangerous multi-day heat dome that gripped the United States uh around the 4th of July holiday and actually involved more than 160 million people. The Washington, D.C. area hit 102. This heat dome is actually supposed to be coming back. This heat dome broke a record from 1872 as far as digital heat indices, and it spread from Washington, D.C. to Philadelphia to New York City and even to Boston. Forecasters and city officials urge residents to limit their outdoor activity, hydrate frequently, and check on your elderly neighbors and family members. It is really, really important, particularly if you have elderly family members that actually do not have air conditioning. That is very, very important. All right, and that heat dome is expected to actually come back. We are really just at the beginning of our summer, and we've got the rest of July and all of August. Alright, second story for news you can use, and this is really, really important. The United States right now is experiencing an outbreak of cyclospora. This is an intestinal parasite, and it actually is linked to fresh produce, things like cilantro, basil, lettuce, the bag salads, raspberry, snow peas, fresh herbs. We have now had a 843 cases in the United States that actually span 31 to 32 states. It is not spread person to person. It is actually spread when you actually ingest this, and it leads to a very explosive diarrhea. Now, we have not actually gotten to what fresh produce is actually causing this, and because of that, all of these fresh produces are being monitored. And I suspect we haven't gotten to which fresh produce is causing this because, as you all know, the CDC was significantly gutted during Doge. So a lot of the experts that we need to actually monitor this situation and find out why it is occurring and where it is occurring and correct it no longer work for the government. So I this news you can use is really, really important. I want people to really, really be careful. Um, if you're actually buying fresh produce, which you should be buying, just make sure to wash it a couple of extra times. Um, this is a very, very infectious parasite that is causing people a lot of uh gastrointestinal symptoms. I've got a couple of questions here. Joanne said, I've heard that some medications make you more sensitive to heat, heat emergencies, and heat exhaustion. Is that true? So, yes, uh there are certain medications that actually make you more sensitive to the heat. So, as I said before, if you're over 65 and also if you're very young, like a neonate or a baby, you are more sensitive to uh to problems with thermal regulation. When you look at the medications that are actually involved in problems related to thermal medications, they're primarily medications that are associated with heart disease, kidney disease, obesity, and diabetes. So uh I'll give them to you sort of in categories. And this is not an exhaustive list. This is just an example of the type of medications that I'm talking about. So diuretics, uhx, hydrochlorothiazide, buumex, aldactone, blood pressure medications, lacinopril, anallopril, lo sartin, valsartin, deltazam, amylopine. Also any sort of anticholinergic medications. So benadryl, uh scopolamine, which a lot of people use for seasickness, medications that are used for mental illness, Haldol, Adderall, Ritalin, uh, diabetic medications such as Jardians, um, and then again, any alcohol or drugs actually make you more susceptible, actually make you more susceptible to to heat, uh, to heat exhaustion or heat stroke. All right, I got another question here from Paul, and Paul said, uh, Dr. B, uh, can you tell us about uh what sort of circumstances occur when you see patients with heat exhaustion or heat stroke in the emergency department? So, Paul, yeah, I can give you some real uh some some real concrete examples of things that I've seen in the emergency department. Um so as an example, usually when I see heat exhaustion, it is usually related to either people at graduations standing outside at graduations where there may not be a lot of shade. Um, or the other thing where I see people a lot is um at theme parks. Um, particularly if it's older people taking their grandkids to a theme park, um, and maybe they're near 65 or older 65, and maybe they're also on some medication. Um, there's not a lot of shade in a theme park, and they may be doing more walking or exercising than they're used to. The other time that I've seen someone in this was someone who came in with heat stroke, uh, and it was a life-threatening emergency, and it was uh a patient who actually uh fell in a parking lot, and she fell in between two cars, and she was um by herself. She wasn't with anyone. So it took a couple of hours for her to be found on the ground, and by the time she was found, um, then what happened was uh her temperature was like 106, 107. She was, we had to admit her to the ICU. Uh she was near unconsciousness, um, all related to uh a heat stroke. Um I think the important thing is when we see these patients, we do have to make sure that they're not having a real stroke or a real bleed in their head. We we can't always assume that it is um that it's absolutely related to temperature. Obviously, there's a lot of things that make people fall. Um people can fall related to a heart attack, people can fall because they bleed in their head. And so there, but this patient wound up actually, it it did wind up, her entire workup was negative, and it was concluded that it was related to uh heat, uh a heat stroke. Um, and uh she was admitted to the ICU. And we were able to catch her in time due to a bystander um noticing her on the ground and calling 911. And and I think the really important thing about that is you know, if you do see someone who's laid out on the ground, appears to be, you know, unconscious or semi-conscious, the best thing to do is just call 911 and um allow uh allow the professionals uh to really handle it. Uh so thanks for the question. Um that's been kind of my experience in sort of dealing with heat, stroke, and heat exhaustion, but we are absolutely seeing more of it. Um all right, I got a question from a mother who says, My kids play outside all summer. How do I know when it's actually too hot? So this is very, this is this is very interesting. So at most temperatures, um, it is okay to play outside. It's just the issue is the hotter it gets, the more you want to limit that amount of time. I actually tell people that the best thing to do and the best thing to follow is the heat index. So the heat index actually takes into account not only the temperature, but also the humidity. And as I said, our primary way of cooling ourselves off is actually by sweating. So in when you have a lot of humidity, sweating doesn't work as well for cooling you off because there's already too much moisture in the air. So when you look at the heat index, which includes uh the temperature and the humidity, that is the best thing to actually follow to determine how how long you want your kids playing outside. The also question is what are they doing outside? So, you know, sometimes, you know, kids are just uh, you know, digging up the yard and and and and doing very mild things. Other times they're doing things that are very exertional related. Every summer around July or August, we have very young football players that die in football practice. So if you have someone who is putting on pads and uh putting on uh, you know, a shirt and a helmet and practicing in July and August for the upcoming uh football season, it is really, really important to understand what is that coach doing to make sure that the kids stay hydrated and to also make sure that they have a break. You want to have a conversation with your child or teenager about the importance of taking a break during football practice because we always have children that die during football practice. So that is very, very uh very, very important. Couple other questions here that we've got. So this is a uh a DC resident named Pauline who said, My power went out during the heat wave uh and I did not have air conditioning. What should I have done? And this, I guess, you know, last right around the 4th of July, we had a big power outage. Um, it it impacted several states. Um and I really wanted to take this question because it also impacted some of the hospitals. I know my hospital actually uh lost electricity. We wound up actually working on a backup generator. The ORs we had to shut down because they got too hot. Uh CT radiology imaging, all those rooms got too hot, and it was a real it was a real problem. So a lot of people who had air conditioning lost air conditioning because their power went out. And so um, this is really important. And I think one of the most important things that our local government can Do is really set up these cooling centers. And I'm not sure if any people have actually gone to them, but they are a very important resource when you have a situation where the power has gone out. When there is a power outage and you may be experiencing a lot of uh heat, the government has the DC government has set up a 211 line and you can dial 211 and you can check on where what are the local government alerts and also where is your nearest cooling center. What is really important is that if you cannot get to a cooling center, there are other things you can do. So let me talk about a couple of them. So one, you can actually take a cold shower. Cold showers actually decrease your temperature. Putting a cold towel around your neck or around your wrist. Also, too, what we do in the emergency department when we deal with patients is we put cold towels like underneath their armpits in their groin area. This is an area that can actually decrease your body's temperature. Fans alone do not help you. You have to have fans and some moisture. So you have to have fans as well as some water on your skin, which is why, again, your body normally actually sweats. But if for some reason uh that is not occurring, you need to call 911. And in the meantime, you can use water from your tap and actually put it around your neck or uh around your wrist or or just or take a cool shower. These are things that really, really make make a difference. All right. So Jasmine asks, what is the single most important thing people can do this summer to stay safe? Um, the single most important thing you can do is hydrate before you feel thirsty. I tell people all the time is that by the time you feel thirsty, you're a little bit behind the eight ball. So what you want to do is you actually want to drink before you feel thirsty. The other thing that's really important is please don't leave children, older adults, or pets in the car. Not even for a minute. You might think that you're gonna go into a grocery store or uh or into a a bit a place of business for a short period of time. I think a lot of people don't realize the car gets quickly very, very fast. If you've ever just turned off your car in the summertime and stayed in it, uh, which I actually did over the 4th of July when I was visiting relatives down in Mississippi, I mean the the car becomes hot in less than a minute, right? So it's really important. I I you know it might take a little bit more effort, but take the older adult and the children uh and the and the pets, take them on out of the car when you actually park. It's also important to check the backseat. I know there's been a lot of really tragic instances that there was somebody in the backseat. And so you want to make sure to actually check the backseat and and just make sure that there is uh nobody back there. I really want to just uh go over a couple of other resources that are really important. If you want to find a cooling center, like I said, you can call or text 211. Um the CDC has extreme heat guidances that are on the actual on their website. Um in addition, OSHA, which actually makes sure that people are safe in their workplaces, have has a whole uh heat safety tool that businesses uh that businesses can use. Um and always take a look at the National Weather Service because you know our our weather folks are going to give us the uh the update. We'll actually hear. They will actually tell you that we're gonna be we're gonna have a heat dome or or something will be happening, and they will actually keep you up to date on what is going on. All right, so to hear more about today's topic and other critical health issues, listen to my podcast, What the Health is Happening, where I give you an inside scoop on all health matters and all breaking news related to health updates. It's available on all platforms. What the health is happening, you can download and subscribe. I want to thank you for joining me today. We're committed to answering your most pressing healthcare questions. You can email me at info at askdrv.us or follow me on YouTube. I will talk with you next week. Thanks for listening to