ERs Not Overheating, but Physicians Wary of Heat Wave

July 7, 2010— -- As temperatures creep into the triple-digits in northeastern states, emergency departments are anecdotally reporting an uptick in heat-related illness, but nothing serious or catastrophic, physicians say.

Medical centers from Boston to Washington, D.C., report seeing more cases of dizziness, weakness, nausea, and other symptoms of heat exhaustion, as well as worsening of chronic illnesses including asthma and cardio-obstructive pulmonary disorder (COPD) -- but so far no surge in deadlier conditions such as heat stroke.

"We've definitely had an increase in heat-related processes resulting from heat exhaustion," Dr. N. Stuart Harris, an emergency physician at Massachusetts General Hospital in Boston, told MedPage Today. But he noted that exposure has been limited "because people are pretty clever" in terms of their ability to stay cool.

The majority of medical centers said they don't need to step up the amounts of staff during an expected heat wave, as physicians have specific protocols for dealing with patients with suspected heat-related illness.

But the fact that this wave is occurring after the July 4th weekend may add to the burden at some centers.

Dr. A. Jon Smally of Hartford Hospital in Connecticut said the first day after a long weekend is usually extremely busy, and his facility has already seen a large amount of patients for such a day. He added that on Tuesday there was even a physician working in the waiting room to keep up with demand.

Still, Smally said, the cases have been limited to minor episodes of heat-related illness.

"To get heat stroke is pretty rare," he said, especially among healthy adults. The elderly, on the other hand, are much more susceptible to heat waves, as are those on the other end of the age spectrum -- children.

Aside from age, certain medications carry an increased risk of heat exhaustion, physicians say. Drugs that affect the cardiovascular system and the central nervous system are particularly concerning, said Dr. Ron Walls, chair of emergency medicine at Brigham & Women's Hospital in Boston.

Some Patients at Special Risk From the Heat

"The combination of circulatory drugs and vasodilation from the heat can drop blood pressure," Walls told MedPage Today. "And medications with central nervous system activity, particularly the major tranquilizers, can impair patients' brains in their ability to interpret [changes in the environment]."

For patients on psychotropic medications, for instance, the heat could affect them both physically and mentally -- impairing both the body's internal thermostatic mechanism to cool itself down, as well as the patient's ability to protect themselves against the heat, Walls added.

In addition to beta blockers, diuretics, anticholinergics, antipsychotics, and the like, antihistamines can also have altered effects in the heat, according to Dr. Gerald Brody, an attending physician at Montefiore Medical Center in New York City.

Brody said the can stop patients from sweating normally.

Still, he warned that patients should not take it into their own hands to alter their medications because of an impending heat wave.

"It's a pretty complex decision-making process," Brody said. "We don't like asking patients to stop their medications carte blanche without some direction."

Rather, the key to preventing heat-related illness is, predictably enough, to stay cool.

Marti Camacho, a nurse practitioner at the University of Pennsylvania Medical Center in Philadelphia, said many of the cases he's witnessed there have had to do with increased outdoor physical activity. Aside from last week's triathlon activities in the city, which he said brought an influx of patients into the ED, injuries during the current heat wave have occurred among "average recreational athletes ... who are ill-prepared to handle the rigors of a high-heat environment."

Walls said one of the most prevalent issues during times of high heat is sports training, especially among younger athletes.

"There's simply no more reason for sports teams to be out aggressively exercising in this heat than there is for them to be out in a lightning storm," he said.

Basic Safety Steps Can Beat the Heat

Walls added that during a heat wave is an opportune time for physicians to remind patients about the basics of preventing heat exhaustion: stay indoors -- in air conditioning, if possible. If air conditioning in the home isn't an option, head to a mall or other area in the community that has air conditioning.

Researchers also recommend staying properly hydrated and avoiding carbonated and caffeinated beverages, which can add to dehydration. If you are out in the heat, you may need as much as a liter (roughly a quart) of water an hour, or even more depending on your level of activity. Go primarily with water, but if you're very active, an occasional sports drink is a good idea.

According to the National Weather Service, three-digit temperatures are expected again on Wednesday, falling into the 90s by Thursday and Friday but coupled with high humidity. Relief is expected to blow through the region on Saturday, with the arrival of cold front and thunderstorms.