How to Stay Safe During the Dangerous Heat Wave in the Eastern U.S. This Week

What are the signs and symptoms of heat exhaustion?

Dr. Blumenberg: A mild form of heat-related illness is heat exhaustion. A person might have flu-like symptoms, such as fatigue, like their body is telling them to take a break. That can be helpful because it may stop them from being in the heat.

Other signs of heat exhaustion include:

• Heavy sweating
• Pale, and clammy skin
• A fast, weak pulse
• Nausea or vomiting

When does heat stroke occur?

Dr. Blumenberg: In extreme cases, heat exhaustion escalates to heat stroke, the most severe form of heat-related illness. Heat stroke is life-threatening, or it can leave someone with permanent neurological problems. During a heat stroke, the major organ systems start to become non-functional because of the heat.

The signs of heat stroke to look out for are a high body temperature of 103°F or higher, hot, red, dry, or damp skin, and a fast, strong pulse, according to the Centers for Disease Control and Prevention. A person can also experience other symptoms like headaches, dizziness, and nausea. 

A characteristic of heat stroke is when the brain is not working right. A person having heat stroke may become confused, unaware of their environment, and might lose the ability to protect themselves or even tell someone that something is wrong. If it gets extreme, they can lose consciousness, and start having seizures or even fall into a coma.

Progression from heat exhaustion to heat stroke can be quick. Someone can go from feeling relatively OK to being unwell over the course of a few minutes. If heat stroke is untreated and the person’s body temperature isn’t brought down quickly, they can die from that.

Who is at a greater risk of heat-related illness?

Dr. Blumenberg: While it can happen to anyone, older adults, young kids, and people with mental health conditions and chronic diseases are at an increased risk. In smaller kids, who do not have the words yet to communicate, they might get a little irritable, excessively cry, and might not act like their usual self. And of course, if they feel very warm, they should be brought into a cooler environment. If they are lethargic and excessively sleepy, then they should get a medical evaluation right away.

If someone is on prescribed medications, what should they keep in mind? 

Dr. Blumenberg: Our bodies have a lot of systems that keep certain values like temperature, heart rate, blood pressure, and respiratory rate within a narrow safe range. These systems function like a thermostat. For example, if we get too hot, our nervous system signals our sweat glands to kick in and skin-surface blood vessels to dilate and radiate off more heat. If we get too cold, our nervous system can turn on the shivering reflex.

A lot of medications can interfere with these systems. For example, antihistamines (e.g., diphenhydramine) decrease the sweat signal and decongestants (e.g., phenylephrine) can decrease the signal that dilates blood vessels. These drugs usually only do this a little bit, but in situations where someone is otherwise close to developing dangerous heat illness, the medications can push them over the edge.

Examples of prescription medications that are associated with excessive body temperature include certain antipsychotics, blood pressure medications, stimulants, and certain antidepressants. Abruptly stopping certain medications can also increase the risk of dangerously elevated body temperature, in some cases.

Dangerous body temperature from prescribed medications is rare but can happen. Talking with your doctor about safety precautions is a great way to stay safe. It is unsafe to make changes to prescribed medicines without consulting your doctor.

What is drug-related heat illness?

Dr. Blumenberg: We see drug-related heat illness more commonly in the emergency rooms. When people are using stimulant drugs, such as methamphetamine or cocaine, that is a big risk factor for developing drug-related heat-related illness. It changes heart rate, blood pressure, and metabolic activity.

What measures should bystanders take if their loved ones are having a heat stroke?

Dr. Blumenberg: The first step is to call 911. If a person is suddenly out of it, is not acting like themselves, if they become confused over a short period of time, that is a medical emergency. The CDC recommends to move the person to a cooler place, help lower the person’s temperature with cool cloths or a cool bath, and not give the person anything to drink. You should never put something in an unconscious person’s mouth because they can choke.

When someone is taken to the emergency room, how are heat-related illnesses treated?

Dr. Blumenberg: The most important treatment for heat stroke is to cool them down quickly. On the hot summer days, a lot of emergency rooms will have a big bucket of ice prepared for this. We might also put ice on their major blood vessels, like under the armpits and groin, and try to cool them down that way as well. We can also give fluids, but usually what works better is to cool the person externally. We give treatment until they are better and either the normal range or at least under 40°C temperature. That seems to be about the temperature where the risk of heat-related illness really takes off.