Hello True Spirit Community! Today is Wilderness Medicine Wednesday again! My goal is to make these posts relevant for you guys and primarily talk about common things you may run across in your adventures outside. With that in mind today we are going to be talking about heat injuries. It has been an incredibly hot summer in Montana and all around the country which unfortunately brings with it the increased risk of heat injuries. When I say “heat injury” I am primarily talking about dehydration, heat cramps, heat exhaustion, heat stroke, and hyponatremia. Hopefully all of these things sound familiar to you but if not let’s talk about it!
Hopefully we are all familiar with the importance of hydration as Coach Leslie talks about it quite often! From a fitness and health perspective hydration is the key to looking good, feeling good, and staying healthy. When it comes to outdoor adventures hydration is the key to performing well, and more importantly, staying safe. When it comes to hydration remember that the water we drink today is mostly the water that we use tomorrow. That means that if you are planning a big hike it is important to properly hydrate the day before! Drinking water the morning of a strenuous event is not going to do as much for you because your body still needs to absorb it from your stomach. It is equally important, especially when it’s hot, to consume water at a constant rate during exercise. The American Council on Exercise recommends drinking 7-10 oz water per hour during exercise (this goes up with heat). That means on a six hour hike you need about 60oz of water, or about 1.5L. In my opinion the easiest way to do this is carry a Camelbak so it’s easy to ensure you’re carrying and drinking enough water without having to stop all the time. Hydrating during exercise is ensuring that you are replacing the water you are sweating out as your body attempts to cool itself. The symptoms of dehydration are: headache, nausea, dark urine, and thirst. Typically dehydration is the first step along the road to a more serious heat injury. If you, or someone in your group, starts to experience these symptoms stop and drink a lot of water before you progress into more serious issues. Also, make sure you plan ahead. There are some places in the area with little or no access to water like the Bridgers. Look at a map before you hike, if there is no water access make sure you are carrying enough water, it could save your life. If the area you are hiking does have water access make sure you bring water purification tools so that you can safely drink it, no matter what urban myths you have heard DO NOT drink water in the wilderness without some kind of purification.
Moving into heat injuries I am going to cover these in order of severity. It is important to note that these will not always occur in order. It is possible for someone to jump right to heat stroke so don’t think of them as having to come one before the other. First, we have heat cramps. These typically occur with dehydration and electrolyte depletion. Electrolytes are substances that help carry electric currents when dissolved in a solution (like water). Your body uses sodium, potassium, and calcium to carry electric currents sent from your heart and brain throughout your body. When there isn’t enough of these elements in your body (because they’re lost through sweat) your body can’t transmit these currents properly and the first thing that happens is you will cramp because it interferes with your muscle contractions. Because they’re the biggest muscles the first thing to cramp is usually your legs. Heat cramps in their own right are not life threatening but they are a signal that something more serious is occurring. If you see this happening it is important to drink water AND consume electrolytes. This can be done through drinking Gatorade, consuming salt in any form, or eating an orange or banana. Typically these will go away very quickly after consuming an electrolyte.
Next up we have heat exhaustion. This is typically seen in people who are not acclimated to hot environments. Again it is not life threatening but it is the last step before we run into really serious problems. Someone experiencing heat exhaustion will complain of feeling very fatigued (pretty self-evident in the name) and they will also begin to develop pretty significant mood changes and maybe even appear dazed or confused. Their skin will talk on a pale, cool, and clammy appearance and their heart and respiratory rates will be very high. Basically, the body knows that something is going wrong because the normal volume of water has decreased and it has to work harder to move the fluids around. If you recognize these symptoms in a wilderness environment (the skin is the easiest one to see) it is important that you get the person to rest in a shady area, remove excess clothing that may trap heart, and make them drink water and consume electrolytes. Remember, electrolytes are just as important to consume as water. Even the worst cases of heat exhaustion should resolve themselves in 6-8 hours if properly treated and it’s key to stop the progression of injury here before we hit heat stroke.
Heat stroke is up next and it’s a life-threatening emergency. Typically, people will stop exerting themselves before they hit this point. We need to be especially watchful for it in people doing some kind of competition, or if there are less fit people in a group who feel pressured to keep up. This can also be a common secondary effect in an emergency situation when people are working harder evacuation another patient or pushing to get off a trail before it gets dark. Remember, in emergency situations the worst thing we can do is create another patient. The easiest way to recognize the onset of heat stoke is looking at someone’s skin. The skin will go from being pale and clammy to red, hot, and dry. After extreme fluid loss the body will lose its ability to sweat, therefore losing its ability to cool itself. It’s important to know that at this point someone’s organs are basically cooking and will lose function. Since the body can’t naturally cool itself we need to take aggressive action to cool the patient as there is no other way it will happen. When you see someone with these symptoms their life is in danger. As soon as possible, take off any clothes that are trapping heat and cool them as fast as possible. In a wilderness environment this means getting them into a lake or stream, or dumping water and ice (if you have it) on them. If you need to take the second route make sure you don’t use all the groups water (we don’t need more patients) and use it where it counts. Focus your efforts on their stomach, chest, groin, and head where it will do the most good. If the patient loses consciousness this indicates that the brain got so hot that it shut down, this is a true emergency and requires cool as fast as possible. I won’t get into all of the possible outcomes but here’s what’s important: when someone enters heat stroke they can’t cool down on their own, you have to do it for them, if they lose consciousness this can cause death or permanent damage, any heat stroke at all is an emergency that requires evacuation and medical treatment, do not “treat” the patient and continue hiking no matter how good they say they feel.
Last but not least is hyponatremia which is a weird one and a little but counter-intuitive. Hyponatremia happens when the body has too much water and not enough electrolytes. This one is pretty rare but I want to illustrate the importance of a water, electrolyte balance. This is actually a very dangerous condition and can eventually lead to death or coma. The more common symptoms begin with excess urination, nausea, fatigue, and confusion. These are easily reversed by consuming electrolytes. My favorite way to do this in a wilderness setting is by carrying Pedia-Lyte packets. These are extremely light and don’t contain as much sugar as Gatorade. Drinking one of these a day (or more if you’re doing something really crazy) will work wonders in warding off heat injury and hyponatremia.
The good news in all of this is that everything I talked about today is preventable! If you plan to venture out and get some hiking in do some quick math to figure out how much water you will need or find a place on a map where you can fill up. Carry some lightweight products that contain a lot of electrolytes (oranges, Gatorade powder, salt sticks etc.) and bring some extras for other members of your group. One thing I like to do is carry an emergency Nalgene in my pack that no one in my group knows about. This is a good thing to have up your sleeve if someone runs out of water, you need it in an emergency, or if you get stuck outside for longer than you were planning. As I say every week, I truly hope that you guys never run into these situations but I hope this post was useful and informative for you! Have a great Wednesday everyone!
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