Heatstroke: Know the Signs

Dr. Rick Place is Medical Director of the Pediatric Emergency Department at Inova Children’s Hospital (at Inova Fairfax Medical Campus in Falls Church, VA). Dr. Place is a board certified physician in both Emergency Medicine and Pediatrics.

Increasing temperatures coinciding with mid-summer activities and late summer athletic training schedules brings with it the risk of heatstroke. We need only look as far as University of Maryland College Park and the tragic death of football player Jordan McNair to be reminded of the potentially deadly consequences of delayed recognition and treatment of heatstroke.

Last September, during a late summer heat wave, eight high school students came in to our ER one Saturday morning for heat related illnesses from cross-country events across Northern Virginia.

What exactly is heatstroke?

Heatstroke is not just feeling really hot in the summer sun. Heatstroke is the combination of extreme body temperature (greater than 105 ºF) and mental status changes such as dizziness, extreme weakness, disorientation and confusion. Once confusion, slurred speech, or agitation is recognized, heatstroke should be considered present until proven otherwise. Heatstroke is a true emergency requiring life-saving treatment.

Classic heatstroke results from the exposure of vulnerable people trapped in excessive heat. Elderly people living in homes without air conditioning or infants left inside automobiles are examples of people unable to escape a potentially deadly environment.  More commonly, however, is exertional heatstroke – when a child or adolescent is producing more heat by exercising than she or he is able to eliminate by sweating.

A common misconception I need to address – you cannot get heatstroke from a fever. Heatstroke only occurs by being trapped or exercising in a very hot environment.With fever, the body wants to be hot. There is no question that high fever makes you feel bad, but with fever, the body will not generate enough heat to cause true heatstroke.

What are the symptoms of heatstroke?

“Heat illness” is a continuum that ranges from uncomfortable heat cramps to life-threatening heatstroke. Heat exhaustion is that stage just prior to heatstroke and is characterized by profuse sweating or losing the ability to sweat, dizziness, nausea, weakness, and sometimes even fainting. While these symptoms are not life-threatening, they should be taken seriously. The affected person should be removed from the activity and cooling efforts begun.

If heat exhaustion is like driving down the road at a dangerous speed, heatstroke is the full-on car crash. Beyond the symptoms just described, heatstroke is now a combination of an extremely high body temperature (over 105º F) and behavioral changes and is immediately life-threatening; delayed recognition may result in permanent brain damage or death.

What should you do if you suspect heat exhaustion or heat stroke?

You don’t need to be sure whether it is life-threatening heat stroke or just heat exhaustion. The treatment is the same – cooling.

• Remove the child or teen from any physical activity.
• Move to as cool of an environment as possible. Air conditioning is preferred but not always immediately available.
• Immersion in cool or cold water is the best treatment but drowning is a concern in large volumes of water (e.g. a pool) in confused patients.
• Removing clothing, spraying with cold water, and fanning to promote evaporation is also quite effective, especially with milder heat exhaustion.
• Ice packs in the armpits and groin are often applied for true heatstroke.
• Call 911 if there are any signs of mental dysfunction such as disorientation or confusion. True heatstroke is as critical and time-dependent as a heart attack and needs to be addressed by medical professionals immediately.
• Do not delay cooling measures until help arrives.

Preventing heatstroke

Classic heatstroke is mostly seen in toddlers and infants who are left in a hot car in the summer heat, even for brief periods of time. Never leave anyone in a hot car.

Exertional heat illness and heat stroke is less predictable. It can occur with intense exercise in relatively mild temperatures if the athlete is at the beginning of the training season. Poor fitness, excessive personal motivation, or intense pressure from coaching staff can push the athlete beyond their capacity to shed the excess internal heat they are generating.

Measures to prevent heatstroke:

• Avoid exercising in extreme outdoor temperatures.
• At the beginning of the season, less intense sessions will allow time for the body to acclimate to the heat.
• Wear light clothing.
• Drink lots of water and sports drinks with electrolytes. (However, it is important to remember that heatstroke is not strictly a condition of dehydration, but rather inability to shed exertional heat.)

Most important is for individuals to be very aware of how they are feeling. Recognizing early symptoms of heat illness (heat exhaustion) allows a parent, coach or peer to have the person removed from the heat and the activity before it progresses further.

Paying attention and recognition are your best tools in preventing a catastrophic event.

Save or print our Heat Illness / Heatstroke Action Guide

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