Heat prevention measures (see below “Heat stroke and sunstroke/prevention”).
General Measures
- Immediately make an emergency call! (Call number 112)
- Vital signs – respiration, cardiovascular, neurological findings, glucose levels – obtained? If necessary, initiate immediate measures!
- Measurement of core body temperature (rectal measurement; in heat stroke usually: > 40.5 °C).
- Reduction of body temperature in heat exhaustion or heat stroke: treatment goal is to reduce the core body temperature to values < 40 °C within 30 minutes (“Golden Half Hour”).
- Move affected person to a shady cool place.
- Undress person
- Cool with cold towels / cool packs; if necessary, rub skin with alcohol (faster cooling); if necessary, take a shower.
- Continue regular control of the core body temperature
- Note: antipyretics are obsolete.
- Review of permanent medication due topossible effect on the existing disease (see below “Heat stroke and sunstroke / prevention”).
Sunstroke
- First measure: shady cool environment and cooling of the head; upper body elevation.
Heat syncope
- For heat syncope, i.e., short-lasting unconsciousness Unconsciousness, shock position (patient lies flat on back while his legs are raised or positioned above the level of his head); shaded cool environment; allow to drink. Medication see under drug therapy.
Heat cramps
- Fluid intake (mineral drink or 1,000 ml full electrolyte solution i .v.) and massage the affected muscles.
Heat exhaustion
- Shady cool environment, shock position, hydration (see above).
Heat stroke
- Transport to an appropriate hospital as soon as possible while observing cooling measures.
Exsiccosis (dehydration)
If there is evidence (clinical signs or laboratory values) of exsiccosis or volume deficiency, rehydration (fluid replacement) is indicated. Therapeutic procedures include oral (“by mouth“), enteral (“via the intestine”), or parenteral (“bypassing the intestine”; e.g., via vein) fluid administration. In cases of mild to moderate exsiccosis, geriatric patients can also be given a subcutaneous infusion (abbreviation: s.c.-Inf., hypodermoclysis). In this case, larger quantities of fluid are administered subcutaneously by means of an indwelling cannula. Suitable sites of application are the lateral abdominal wall, the thighs and the subclavian region (collarbone region). This allows 3 l of volume to be administered in 24 hours. No more than a maximum of 1.5 l per application site should be delivered.
Contraindications to subcutaneous infusion
- Water, electrolyte, and metabolic imbalances in heart failure (cardiac insufficiency) or renal failure.
- Severe dehydration (lack of fluids) or shock in the presence of existing marked edema (water retention) or ascites (abdominal dropsy)
- Need for precise control of fluid balance and need for high perfusion volumes (> 3 liters in 24 hours).
- Blood clotting disorders
