Health check: Heat stroke

APRIL marks the beginning of summer season and the El Niño phenomenon that’s been going around the country.

El Niño brings hotter temperature and summer comes with longer days and lesser rains; heat-related disease cases are bound to increase.

Heat-related diseases are broad spectrum and can be primary, according to doctor Neal Rana, specialist on Occupational Medicine and Pathology and the chairman of the Office of Documents and Records Control of Northern Mindanao Medical Center (NMMC).

“Meaning it is direct result of heat exposure of secondary when heat exacerbates or cause a disease process from an underlying condition,” Rana said.

“Sometimes, it both occurs at the same with intense and prolonged exposure. Specifically, the more common heat-related illness ranges from the heat syncope (fainting), heat exhaustion to the most severe which is heat stroke,” he added.

Heat stroke is the most severe heat-related illness defined as a body temperature higher than 40 degrees Celsius associated with neurologic dysfunction.

One can tell if they have neurologic dysfunction when it already affects the brain and/or spinal cord.

According to the Centers for Disease Control, there is an international average of 334 yearly deaths attributed to excessive heat exposure/heat stroke. And with global warming, heat wave is unpredictable as it can occur anytime and anywhere. In May last year, 2 people were reported dead in manila attributed to heat stroke.

“Ang body po natin ay merong mechanism to lessen the building of excessive heat. Yung skin natin is the major heat dissipating organ. Pag masyado ng mainit, nag transfer ito ng heat to our surroundings through sweating, evaporation, radiation and convection. All mechanism are directed to produce heat loss,” Rana said.

(Our body has a mechanism to lessen the building of excessive heat. The skin is a major heat dissipating organ. If it’s too hot, the heat is transferred through sweating, evaporation, radiation, and convection...)

Heat stroke develops if there is a failure of this normal heat-loss mechanism, when there is too much heat directly from the environment or heat production during fever or in certain diseases like malignant hypothermia; or at times, especially for those living in subtropical areas, when the body is suddenly exposed to excessive heat without acclimatization.

“If hindi ka sanay magbilad sa araw (if you are not used to longer exposure under the sun), you have bigger chance of developing heat-related illness,” Rana said.

According to Rana, heat stroke can be developed through exposure to the heat of the sun during late morning to mid-day and the length of exposure.

People with hypertension, diabetes, kidney problems, and mental illness are highly susceptible to develop heat stroke.

“Yung mga lolo at lola natin karamihan sa kanila meron ng defect ang coping mechanism nila to heat (our grandmothers and grandfathers mostly have defects in coping mechanisms that make them prone to heat), and they also have reduced cardiovascular reserve making them prone to develop complications like dehydration. Kasama din dito yung mga (this include the children) bata and even our pets. They are not fully acclimatize to excessive heat,” Rana said.

The complications of heat stroke will be multi-organ, Raid said, affecting brain with possible long term movement deficits, 25 to 30 percent of cases will develop acute kidney Injury, or acute Liver failure within 48 hours.

Pre-existing patients with heart failure may experience worsening of illness especially when there is already cardiovascular collapse.

Heat stroke can be prevented through minimize exposure of sun, especially for the young adults, athletes or people who frequently do outdoor activities.

However, it doesn’t mean you should spend the whole summer season lock up in your house or room, instead you can lessen the exposure to heat by using hats, umbrella, heat dissipating jackets, applying sunblocks and rehydration of fluids.

“Dahil summer, uso din yung (because it’s summer, it’s also a trend for) body toning or tanning under the heat of the sun, you have to limit the exposure. If nag gi-gym ka (if you’re going to the gym), dalawa yung (there are two) factors na nagpromote ng (that promote) heat buildup: first yung (is the) heat generated by muscle contraction and second, the gym environment if di kaya ng aircon (if air conditioners could not cope) or if nagsa-sauna kapa, (if you are in a sauna),” Rana said.

“For susceptible individuals, itong mga (these) bedridden patients natin or mga bagong anak (newly labored mothers), they have no control of the environment around them. Wag natin silang pabayan or ilagay saan-saan (let us not neglect) in areas with less air exchange and high heat buildup. Some of them cannot even talk or complain so dapat we (need to) have to initiate in making measures to prevent it,” he added.

Heat stroke can be managed through early identification and management.

“If tingin natin (we see) it really as a heat stroke and we are far from hospital, the America College of Sports Medicine, recommends initiation of cooling prior to transport. You have to lower the body temperature at once preferably around 39 degrees Celsius,” Rana said.

General measures for heat stroke include removal of restrictive clothing and spraying of body with water, covering the patient with sheets soaked with cold water and placing ice packs in the armpit or groin.

Rana also advised not to give rapid or too much cooling as there will be possible overshoot and the patient will suffer rebound hypothermia.

If the patient is responsive, let them drink cold water or fluids. If patient is not breathing and unresponsive, do the usual CPR (cardiopulmonary resuscitation) couple with cooling measures. Above all, bring the patient to the nearest medical facility.

“If you are living susceptible individuals, dapat meron kang (you should have a) list of emergency phone numbers so you will know kung sino ang tatawagan mo (who are you calling). Ironically dito sa Pilipinas (here in the Philippines), saka nalang tayo maghanap ng number if meron ng (we only get the numbers if there is an) emergency. Know your police, red cross, nearest hospital or local emergency response unit always,” Rana reminded.

Apart from heat stroke, sunburn, dehydration and the development of complications of patients with existing cardiovascular problems can likewise be attributed to increase body heat systemically.

“Prevention is better than cure. We must think ahead of time if there is possible increase and prolonged sun exposure and prepare the measures I mentioned earlier to avoid health related illness,” Rana said.

“Equally important, know the emergency numbers of the place you are heading. And remember to check the weather outlooks. Disease prevention is not the only responsibility of us in the health sector, lahat tayo ay involve dito (we are all involved here). We must do our part,” he added.


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