Summertime Blues: I'm on call tonight, one of the hottest nights (and days) we've had this summer. It was only 91 degrees today, but the radio keeps referring to a heat index of 110 degrees. So far, I've had to calls from patients with heat-related illnesses. One was heat exhaustion, the other was suspicious for heat stroke. (Listen to your mothers, boys. Don't play basketball all day in the hot son with only a lone popsicle as your source of hydration.)

Since one is a minor, first-aid type emergency, and the other a major emergency room worthy emergency, here is the low down on heat exhaustion vs. heat stroke.

Heat exhaustion symptoms:

* Often pale with cool, moist skin
* Sweating profusely
* Feels faint or has collapsed
* May be complaining of headache, weakness, thirst, and nausea
* Core (rectal) temperature elevated—usually more than 100°F—and the pulse rate increased

Heat stroke:

* Unconscious or has a markedly abnormal mental status
* Flushed, hot, and dry skin (although it may be moist initially from previous sweating or from attempts to cool the person with water)
* May experience dizziness, confusion, or delirium
* May have slightly elevated blood pressure at first that falls later
* May be hyperventilating
* Rectal (core) temperature of 105°F or more

Treatment:

....Home care is appropriate for mild forms of heat exhaustion. Heat stroke is a medical emergency, and an ambulance should be called immediately.

* For mild cases of heat exhaustion

o Rest in a cool shaded area.
o Give cool fluids such as sports drinks or Gatorade that will replace the salt that has been lost. Salty snacks are appropriate, as tolerated.
o Loosen or remove clothing.
o Do not use an alcohol rub.
o Do not give any beverages containing alcohol or caffeine.

* Heat stroke (Do not attempt to treat a case of heat stroke at home, but you can help while waiting for medical assistance to arrive.)

o Move the person to a cooler environment, or place him or her in a cool bath of water (as long as he or she is conscious and can be attended continuously).
o Alternatively, moisten the skin with lukewarm water and use a fan to blow cool air across the skin.
o Give cool beverages by mouth if the person will tolerate it.

As always, be careful out there.