Heat wave emergencies.

Abdus Salam Khan, MD FACP
July, 2019

Global warming causes weather changes and one of the width is the heat waves. The resultant public exposure to this heat wave phenomenon can be very diverse dating. The experience of 2015 in Karachi tells us that we all need to be ready if something of that magnitude happens again. Today we will discuss the medical and other aspects of heat waves and see how we can act to make other patients safe.

Hit with don’t have any strict definition but defined around early 1900s it was considered as “. Of excessive hype temperature lasting at least one day, but conventionally last for many days to several weeks”.
The criteria varies from area to area based upon its usual temperature, so a temperature of 32°F may be excessive for Canada but the usual day in Pakistan. What is the heat index when the hot temperature associated with humidity then the temperatures feels like higher than it’s actually is. This is called heat index. The same temperature with humidity may feel very pleasant but with extreme humidity can be very bothersome. These extreme conditions causes different clinical issues and can be summarized as following.

A) Heat rash
B) Heat edema
C) Heat cramps
D) Heat syncope
E) Heat exhaustion.
F) Heat stroke.

Of all the above the most significant are the heat syncope, heat exhaustion and heatstroke as they can be life-threatening. The mechanism responsible for defects are following.

1. Direct cell damage from the temperature
2. Multi organ failure due to volume depletion and the cell death causing inflammatory response.
3. Volume depletion due to excessive fluid loss.
4. Electrolyte disturbances due to improper replacement of salt.

Patients who are exposed to the heat wave can show signs and symptoms of exposure to excessive and prolonged heat or may also show exacerbation of or complications of their already present medical issues. For an emergency doctor it can be a challenge to separate out heat related issues from other medical illnesses, and also to think about the effects of heat exposure on the illnesses.

Our emergency departments should be in tune with the weather service to have first hand info regarding weather related issues, so the emergency departments should be ready to deal with the patients exposed to weather conditions whether it is extremely cold or is very hot. It is also a dream that our emergency departments need to be integrated with each other in such a way that right information can be disseminated within appropriate time, so our patients can get the maximum benefit and feels safe coming to the emergency department for the treatment.

Pakistan Society of Emergency Medicine is finalizing the recommendations and the guidelines for the emergency physicians of Pakistan to deal with the patients exposed to heat waves. These recommendations are based upon the local experiences and consensus opinions of Pakistani Emergency Physicians and as they are local oriented, these are very relevant. It is also important to point out that these guidelines are based upon local resource information and that all these recommendations can be accomplished in any emergency department of the country.

My hope is that our emergency physicians will consider these guidelines when they deal with patients suspected of having heat related exposure. Guideline based treatments will be safe and also standardized.

I can be reached at askhan65@yahoo.com.

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