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Melanie Cole (Host): Heat emergencies can be caused by exposure to extreme heat and sun but heat illnesses can be possibly be prevented by learning what to do in hot and humid weather. My guest today is Dr. Janice Forde-Baker. She's the assistant medical director in the emergency department at Lourdes Health System. Welcome to the show, Dr. Forde-Baker. So, let's talk about some of the differences that people realize in these terms that we hear because we hear heat exhaustion and heat stroke. So, explain to us a little bit about some of the heat and illnesses that we might experience.

Dr. Janice Forde-Baker (Guest): Thank you, Melanie, for giving me the opportunity to talk about this. The heat illnesses are a continuum, just like in any disease process and when we look at heat illness, sort of on end of the continuum when it's a very mild disorder, that's when we have minor illnesses such as heat edema or leg swelling that occur when you're out in the heat, or even heat rash, or prickly heat, that's well-known. As we go further in the continuum, you can have much more severe illness from exposure to heat and that's when we get into heat exhaustion and then, the more severe heat illness, heatstroke, that is frequently talked about where you can have a lot of morbidity and even fatalities and death from heat exhaustion.

Melanie: So, let's start with some of the symptoms of just when you start to realize the heat is getting to you. What are some of the symptoms that you would recognize and then, what should you do about those?

Dr. Forde-Baker: Okay, well, initially, our bodies are trained to regulate our heat and we're talking here about external heat measures. This is very different than having a fever from sort of an infection where your body internally increases the heat, but we're talking about ambient weather. Initially, our bodies are very good at adapting to high temperatures because we are able to notice that we're warm; we start sweating which helps for evaporation; and then, we usually--adults at least--can know that we're thirsty. We try to get to drink water or try to get to cooler areas. When things come into trouble are usually at the extremes of ages, when we're talking about older patients who may be on medications that may alter their body's normal response to heat or they just may not be able to physically get out of a hot situation due to decreased mobility. And it may first start off as palpitations. You may feel palpitations, you may feel nauseous, you may feel a headache. Later on, it can become very severe where you become confused and altered and that may not be something that the patient may realize themselves, but people around them may realize. Another form or symptoms we should look carefully to are exertional heat stroke. This happens a lot with children and adolescents, especially during the summer time when we look at the August months when they start back training in the different school activities and you have a high humidity. When you have a humidity index at more than 60-75%, the body is unable to use evaporation as a source to cool down the body. So then, that increases the chance that you’ll develop hyperthermia, or a temperature greater than 104 degrees Fahrenheit and lead to heat stroke. And so, children are at risk as well. So, we have to monitor the temperature that the children are exercising or participating in activities outside, what the heat index and humidity is and paying attention. They may not be sweating profusely but if they start having nausea, if they start complaining of headaches, if they start complaining of heart racing, then we should really take that seriously and make efforts to lower their temperature.

Melanie: What role does hydration play in preventing or hopefully preventing the incidents of heat emergencies?

Dr. Forde-Baker: Oh, it's very, very key. Before we even get to heat stroke, we get to heat exhaustion, and that is due to either water depletion or salt depletion. Staying hydrated and hydrated with water is very, very important. And it's important to do so before you know that you're going to be outside engaging in activities with extra heat that you prepare ahead of time, that you're drinking a lot of water and fluids during your time in the heat, and that you continue to do so afterwards because you're losing a lot of water through evaporation. That is the main way the body can self-regulate and cool itself down and if you don't have that water there to help with that, then it's going to put you at a sore disadvantage in dealing with heat illnesses.

Melanie: So then, when would we really get those red flags and when do we go to a doctor or the emergency room?

Dr. Forde-Baker: So, anytime if you are out and you're consciously aware that you're feeling your heart racing, that you're feeling very dizzy or lightheaded, that's definitely when you should, at first, see if you can get out of that heat environment. Then you can call 9-1-1, you could have a friend do it, and to get to an emergency room. There are cases where you can have seizures, where if you see a child or adult where they are shaking uncontrollably, they lose consciousness, or seem to be passing out, that is definitely a time where you want to get to the emergency department, as well. If you are going to visit someone and you go into their home; they may not have air conditioning--it may be very warm, it may be very humid--and you're talking with them and they seem not to even make sense, they may be off a tad, not a very severe noticeable difference, that's the time to call 9-1-1 because sometimes it can start very slowly. As far as the children, we really want to make sure that they are not engaging in extreme sports and activity for long periods of time outside. So, it's very important that coaches and other people that are out there with them are watching and checking in with them and making sure that they're not sitting out. Why are they sitting out? Are they tired? Or, is it that they're having headaches or feeling nauseous or having palpitations. Those are very important questions and things to always check. And also, another sign is if you see that they are out in the heat and someone is not sweating, they're not getting very sweaty, that's a sign that maybe that they're not able to cool themselves down, and that is an issue also where it can bring markers to your attentions where they're going to need urgent medical care.

Melanie: Is there something we can do in that case? Should we be trying to cool this person down with cool towels or sit them in water? Are there things that we can do?

Dr. Forde-Baker: Oh, yes. I mean, yes. Yes. Because the fatality--and it's interesting in children--is second to crashes or accidents and then cardiac causes of death, heat illness is the third leading cause of death in adolescents. So, it is a very big issue to start thinking about the summer months and training. As soon as you can cool a patient that is experiencing heat exhaustion or heat stroke, that is the best treatment--immersion in ice water, if you have cool towels. If you have just have cool running water, you want to also take off any of the equipment and clothing and such that they may have on. Take that off as much as you can because you really want the cold water to get directly on their skin to aid with the evaporation to bring down their core temperature as quickly as possible. So, if you have ice buckets, you can throw that on them, if you have cold water, a shower--get them in a cold shower. This is something that you can do before paramedics or additional medical supports arrive because the longer that you are in heat stroke, this can affect your body's bodily function and organs from your brain's EMF where you're altered to your kidney function where you can have acute renal deficiencies because of the massive amounts of dehydration. Then, in cases with the young athletes working out in the heat, you can get rhabdomyolysis which is a breakdown of your muscle. That can also potentiate your kidney failure. So, we do want to stop the high heat temperatures as soon as possible as quickly as possible. So, you don't need to wait for medical help to arrive if you have the resources to do that ahead of time.

Melanie: Dr. Forde-Baker, is there something in the case of heat stroke that you want us not to do?

Dr. Forde-Baker: Oh, yes, that's a good question. Sometimes, we're so used to hearing fever or seeing a number that's high and thinking about giving Tylenol or giving Motrin. This is not the same mechanisms as a temperature that your body causes when fighting an infection. In that case, giving antipyretics such as acetaminophen or Tylenol, ibuprofen, or Motrin, Advil could actually potentiate the morbidities associated with heat illness by causing liver failure and potentiating that as well as causing and potentiate renal failure or kidney failure. So, you do not want to give any medication thinking that it's going to help bring down the temperature. The reason with the heat stroke with the temperatures being so elevated is the external heat, so that is the heat that we have to decrease through physical measures and not the internal heat from your body's core temperature. So, we do not want other medications given at all in the case of heat stroke, heat exhaustion or heat illnesses. And also, if you're not sure, even the other aspect of this is that heat stroke is very extreme as I said. We have heat illnesses that can start off as a rash, as edema or cramps. We also get sunburned during this. Our first layer of protection of your body is your skin and you can easily get first-degree sunburns but then second- and third-degree burns out in this heat. So, something you have to remember if you're going to be active and outside, in the sun and in this weather is to make sure that you're using sunblock to protect your skin and realize if you're starting to feel any burns--just a red burn on your skin is a first-degree burn. Once you start to blister, that's already a second-degree burn and that is going to decrease your skin's ability to protect your body and fight infection. So, those are other markers to look for and then seek emergency care for.

Melanie: And, what about hydration and giving water at that point? Is there any point when you say, "You know what? Just don't because they'll vomit or they'll throw it up?”

Dr. Forde-Baker: If anyone is vomiting or they tell you that they're nauseous, at that time, I would not want you to give any water or anything by mouth because if they do vomit and they're in that extreme where they're in heat exhaustion or heat stroke, it's very likely that their mental status may start to deteriorate. They may not understand where they are, they may become very combative and then they may have liquids in their stomach and vomit and not protect their airway. If they are lucid enough to understand, you can get them into a cool area and they can drink fluids, by all means, you can start with that. But, if they're nauseous or vomiting, then you don't want to have to administer fluids internally, but I would still try to get them into an ice bath or into a cold shower, take off the heavy clothing, take off the heavy equipment they may be wearing for sports and still trying to cool the ambient temperature around them first.

Melanie: Just the last few minutes--what great information, you're so well spoken. Please give your best advice as the Assistant Medical Director in Emergency Department at Lourdes Health System for heat emergencies and what you really want us to look out for.

Dr. Forde-Baker: I think everyone is very happy for the summertime. We all are. We want to have fun and engage outside with nature but just realize that we have to be prepared for it. I think that we have to make sure that we have to think about do we have enough water for our trip when we're going outside, whether it's just hiking, whether it's just going to the park. Make sure, also, that you're watching and paying attention to everyone. A lot of times, there's barbeques and get togethers and it's very easy to lose track of younger children, which may be at increased risk, as well as the elderly. If you know that you have family members or friends that are older and they live by themselves, check in on them daily if possible. Their air conditioner may break down and they can be experiencing heat illness, or heat exhaustion, or stroke in their own homes and apartments, so to check on them daily to make sure that they have enough water and supplies. Another careful thing I would want parents to know is to realize that if it already 80 degrees outside, if you leave your child inside of a car with windows up or windows down, the heat increases exponentially and that is not a safe area for a child. You should take them with you at all times and we would not want to have any unfortunate accidents to happen. We really need to pay attention to the heat. It is very necessary for our survival but it can be detrimental to our survival as well, if we are not well-prepared for it. If there's any emergency, any question of anything going wrong, whether someone is not acting right, someone is not breathing right, someone is nauseous, or you're concerned about a rash and such, the emergency department is available 24/7 for all of your concerns and have all the capabilities to take care of your needs.

Melanie: Such great information and so, so important. Thank you so much, doctor, for being with us today. You're listening to Lourdes Health Talk. For more information, you can go to Lourdesnet.org. That's lourdesnet.org. This is Melanie Cole. Thanks so much for listening.