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Journalism of Courage
No, this is not to scare you. But if you don8217;t want to add to the toll of 250 who have died in a month because of the prolonged heat wave sweeping the country. The figures definitely call for more awareness amongst people about the origin of the affliction and its preventive measures. 8220;Heat stroke, a common cause of death during the summer months, is part of a syndrome which occurs when the body is exposed to high temperatures,8221; explains Dr Randeep Guleria physician and pulmonolist, All India Institute of Medical Sciences. The syndrome manifests itself in four basic kinds of diseases 8211; heat cramps, heat exhaustion, exertional heat injuries, and the severest form, heat stroke, which can prove fatal.
Heat cramps
Heat cramps are the mildest form of the heat syndrome. 8220;It occurs in people who are otherwise healthy, but who are exposed to hot weather over a long period,8221; says Dr R.S.K. Sinha Senior Physician, Safdarjang Hospital. Due to prolonged exposure to the sun, these people lose a lot of salt and electrolytes from the body through sweat. As a result, they develop cramps in the muscles of their limbs. Their muscles become stiff and tender to the touch and they experience pain in their arms and legs.
Heat Exhaustion
Heat exhaustion, on the other hand, occurs when there is a failure of the body8217;s cardio-vascular system to respond to high temperatures, the main cause of which is the excessive loss of fluids from the body. It occurs in people who work in a very hot environment. Patients suffering from heat exhaustion are easily fatigued and experience feelings of giddiness, vertigo, headaches, nausea and vomiting. Their blood pressure usually drops and their skin turns pale. 8220;In extreme cases, the person could collapse and become unconscious,8221; warns Guleria.
For such patients, the first thing to be done is to shift them to a cool and well ventilated environment. The body8217;s fluids must be replaced through an increased fluid and electrolyte intake. Almost two to three litres of fluids containing essential salt or commercial preparations of electrolyte powder are essential in a day. It is best to remove their clothes and either give them a wet sponging or cover them with wet sheets. They should be allowed to dry under a fan. But if a patient becomes unconscious, it is best to consult a doctor.
Exertional heat injuries
Exertional heat injuries are common in people, especially athletes, who exert themselves a lot in a hot and humid climate. 8220;Due to the humidity, the sweat on their bodies does not evaporate easily, and hence the body8217;s temperature does decline naturally,8221; explains Sinha. Such patients suffer headaches, vomiting, giddiness and may become delirious and in extreme cases, may lose consciousness. These patients too must be removed immediately to a cool and well ventilated place and be given increased quantities of fluids and electrolytes. If they lose consciousness, a doctor must be consulted.
Heat stroke
The most serious form of the heat syndrome is heat stroke, which if not treated immediately, could prove fatal. The instances of heat stroke are fewer amongst the healthy and the people most susceptible to it include:n Those in extreme age groups 8211; toddlers or the elderly. In toddlers, the thermostat centre in the brain, which maintains a basal body temperature, is not developed enough, while in the elderly, the intake of certain drugs prevents the sweat glands from functioning properly. As Guleria explains: 8220;Sweating is the body8217;s own mechanism for lowering its temperature in the heat. The evaporation of sweat from the skin prevents the body8217;s temperature from rising beyond the danger mark.8221; So, any dysfunction in the sweat glands could prove problematic.
Drug users, particularly those on psychiatric drugs or barbiturates.Diabetics, particularly if they have an autonomic dysfunction 8211; those with problems in their postural mechanisms or sweat glands.
People with injuries to the heat control centre of the brain 8211; those who have suffered haemorrhages or brain tumours, even if fully cured.
Heat stroke occurs when the body8217;s core temperature 8211; the temperature in the mouth or the rectal temperature 8211; rises to more than 41 degrees Centigrade or 105-106 degrees Fahrenheit. Such patients experience headaches, vertigo, abdominal distress and pain in the stomach. Their skin becomes hot and dry and they do not sweat much.
At such high temperatures, the vital organs of the body are effected. 8220;The most sensitive organ, the brain, is the first to be effected,8221; says Sinha. So the first symptoms would probably be an alteration in behaviour. The patient could become irritable and aggressive and display a marked restlessness.
High body temperature can effect the heart muscles leading to myocardial necrosis which has symptoms similar to a heart attack. The other organs that could be effected are the liver leading to jaundice or the kidneys, leading to renal failure. Another complication caused by the high temperature is Disseminated Intravascular Coagulation, a disease in which the mechanisms which stop bleeding are effected so that bleeding and clotting time are prolonged. 8220;As a result you begin to bleed from various parts of your body, and there could be blood in the urine, stools or vomit,8221; says Sinha.
Though death due to heat stroke is more common in the above mentioned groups, a healthy young adult who exerts himself in high temperatures over a long period, could be susceptible to it. But, as Guleria explains: 8220;If the sweat mechanisms of the body in a healthy adult are working all right, then one could get away with mild symptoms.8221;
8220;Though patients of heat stroke must be treated in a hospital, there should be no delay in beginning damage control measures, which must begin at home,8221; says Sinha. These measures include:All clothing must be removed to allow proper sweating.
The patient must be provided adequate fluids and salts.
The patient should be bathed in cold water and allowed to dry under a fan and this process should continue till the patient reaches a hospital. 8220;The idea is to imitate the natural process of sweating,8221; explains Sinha. The aim of the whole exercise is to bring the body temperature down from 41 degrees Centigrade to 38 degrees Centigrade within an hour. 8220;The longer the body remains at a high temperature, the more the danger to the vital organs,8221; says Guleria.
In heat stroke, drugs like crocin and paracetamol are not really effective, as they act on the temperature regulating part of the brain, which is not functioning properly anyway.
Prevention vs cure
The precautions advised by doctors are common knowledge in a country like India and what is required is a more conscious attitude towards actually taking them.
Take plenty of fluids during the day 8-10 glasses of water at a minimum, particularly before moving out in the heat. It is advisable to carry a bottle of water with you.
Wear light, permeable clothes, preferably cotton, which will allow you to sweat freely. Keep your body covered during the day.
Bathing and washing one8217;s hands and face frequently during the day also helps reduce body temperature.
Avoid exertion in the heat, like exercising. Avoid activities like cycling in the heat. If you have no other means of travel, take a bus instead.
Try to move around in shaded areas rather than in direct sunlight.As Guleria puts it: 8220;If people actually took these precautions, instead of ignoring them until it was too late, they could get away with very mild symptoms.8221;
