What It Feels Like to Die from Heat Stroke

luthj

Engineer In Residence
At about 3% body weight loss through sweat your cooling begins to become impaired. At 5% most people start to experience mild symptoms. At 7% you start really feeling ill. At 10% your life is in danger. In hot weather cut those numbers In half, because cooling is the major concern when you stop sweating...
 

Pacific Northwest yetti

Expedition Medic
Great Advice here!

I treat many people who failed to think before they do.

It is possible to over hydrate on water, creating hyponutremia- however usually only seen with ultra marathoners.

if using the sports drinks. at least 50/50 water to sport drink. Although 60/40 is better,

X2 on the soaking the hats, shemaghs, shirts.
 

billiebob

Well-known member
I am firm believer that long sleeves keeps the body cooler by 1) offering sun protection and 2) maintaining a sheen of cooling sweat, that does not dry.
Yes, 100%.

I install wood stove chimneys and I'm often on steep roofs directly under the sun on 30C days. Long sleeve cotton denim shirts and loose fitting jeans are my clothes all year round. There are days metal roofs get so hot you can burn your knees thru jeans.

I'll have 2L of water plus a few bottles of G2 Gatorade with me every day. Gatorade is wonderful as the body dehydrates and loses electrolytes and the dizzy headache threatens to start.
 

jgaz

Adventurer
It is possible to over hydrate on water, creating hyponutremia- however usually only seen with ultra marathoners.

@Pacific Northwest yetti
I have almost no medical skills compared to yourself but in the last four summer seasons at the Grand Canyon I’ve been involved with two confirmed cases of hyponatremia. Both verified with a portable device that takes a blood sample, I don’t remember the name of the device.

The first was almost a disaster. I wasn’t the lead person on that one, I was partnered with a Wilderness EMT. As time went on I was getting really worried. A lot of things conspired that day to create a very bad situation.

The second case resolved itself with time, a lot of time. When the person finally said they had to pee I think I was even more relived then they were. And holy cow, they should have been VERY relieved, if you know what I mean.

Since there are parallels in how the hyponatremia and dehydration symptoms initially present, do you have any professionally advice as to red flags you look for?

I go by water intake, salty foods eaten, urine output, provided they can tell you. My other indicator is nausea. Dry heaves, dehydration. Projectile vomiting, hyponatremia.
 

shade

Well-known member
One of the reasons I like using a hydration device like a CamelBak bladder is for easy, frequent drinks. Just like other things about hiking, I get in a rhythm with the sips, and I've never had a problem. I know it's a little heavier than using other methods, but if I complicated the process, I'm not sure I'd stay up on hydration.
 

luthj

Engineer In Residence
Regular small drinks are the most effective. A big load in the stomach will just sit. For optimal water storage, you want some fruit juice or non sugary light snack mixed in. That keeps the water in your digestive tract, where it's available if you need. Otherwise it may just go straight out as urine.
 

shade

Well-known member
For optimal water storage, you want some fruit juice or non sugary light snack mixed in.
That's part of my trail routine, too. Cargo pockets are for maps, snacks, and a small trash bag.

I prefer straight water while moving (spraying sports drink on your face isn't very refreshing), but I also try to have something Gatorade-like during meal breaks to bump things up.
 

Pacific Northwest yetti

Expedition Medic
Jgaz-

That is a great question!

What happens is we drink so much water the level of sodium in the blood ( and body) Should be at 0.9% gets so diluted our cells actually swell inside our body.

Now other conditions could cause this, so we will focus on the demographic that is exerting lots of energy, in some sort of usually outdoor pursuit and * has been* consuming lots of water.

The indicators you are using are spot on.

What i use most is that they have been drinking lots of water, and are still showing signs of dehydration. Also with not usually having urine output.

The projectile vomiting is literally the stomach trying to push water back up, most likely due to fast, cold, large intake of the water. They need to sip, not freezing cold water. It shocks the system putting it all into " exit" mode

And not feeling better within 30mins of getting some fluids in them.


I have been told, once you get it- you are more likely to have it appear again, ( however i am not sure of that)

@Pacific Northwest yetti
I have almost no medical skills compared to yourself but in the last four summer seasons at the Grand Canyon I’ve been involved with two confirmed cases of hyponatremia. Both verified with a portable device that takes a blood sample, I don’t remember the name of the device.

The first was almost a disaster. I wasn’t the lead person on that one, I was partnered with a Wilderness EMT. As time went on I was getting really worried. A lot of things conspired that day to create a very bad situation.

The second case resolved itself with time, a lot of time. When the person finally said they had to pee I think I was even more relived then they were. And holy cow, they should have been VERY relieved, if you know what I mean.

Since there are parallels in how the hyponatremia and dehydration symptoms initially present, do you have any professionally advice as to red flags you look for?

I go by water intake, salty foods eaten, urine output, provided they can tell you. My other indicator is nausea. Dry heaves, dehydration. Projectile vomiting, hyponatremia.
 

jgaz

Adventurer
@Pacific Northwest yetti.
I knew I had some dehydration/hyponatremia information from our PSAR annual training, I just needed to find and organize the pictures.

I took this picture during a lecture given by Dr. Tom Myers on the subject. My note taking would not be as clear or detailed as this simple picture. Hope this makes a bit of sense. I know it’s kind of a crappy picture, I was sitting in the back, old habits die hard!
F0578F7D-6FD8-4713-9BEF-612AB1502AD7.jpeg
Interesting as I had forgotten that feeling worse lying down is a possible indicator of hyponatremia. Makes sense because the excess fluid can be causing the brain to swell.
 

GB_Willys_2014

Well-known member
@Pacific Northwest yetti.
I knew I had some dehydration/hyponatremia information from our PSAR annual training, I just needed to find and organize the pictures.

I took this picture during a lecture given by Dr. Tom Myers on the subject. My note taking would not be as clear or detailed as this simple picture. Hope this makes a bit of sense. I know it’s kind of a crappy picture, I was sitting in the back, old habits die hard!
View attachment 540870
Interesting as I had forgotten that feeling worse lying down is a possible indicator of hyponatremia. Makes sense because the excess fluid can be causing the brain to swell.
Good stuff this! Thanks for sharing.

Perhaps this question is too technical for an internet forum ... but what is the tipping point where symptoms are no longer reasonably treatable in the field?

Years ago, I was taught (military first aid) that vomiting, or the inability to intake/hold food water was the key indicator for medical intervention. Is this still the threshold? Or, are there even earlier indicators?

Been a long day, probably shouldn't even be posting, so I hope this makes sense ... :)
 

shade

Well-known member
Good stuff this! Thanks for sharing.

Perhaps this question is too technical for an internet forum ... but what is the tipping point where symptoms are no longer reasonably treatable in the field?

Years ago, I was taught (military first aid) that vomiting, or the inability to intake/hold food water was the key indicator for medical intervention. Is this still the threshold?
I'll let the med folk weigh in, but to me, anything past recovering after a period of cooling down ought to seek at least a quick check by an EMT.

A lot of these casualties come down to a question of transport. If you look at the chart @jgaz posted, once vomiting occurs, the casualty is getting pretty iffy on being able to walk to help, especially over difficult terrain. At that point, I'd probably find the coolest nearby spot to lay up, and call SAR to the casualty, if at all possible. Any more effort on their part will just add more stress to an overtaxed body.
 

Pacific Northwest yetti

Expedition Medic
Thats a great question, and can be pretty easily broken down.

You could say, once lacking the equipment or skills to treat- they need to see someone of higher level of care/ not field treatable. That will change w/ each person, maybe they are dehydrated and just need an IV, an EMT basic could not do that, but an advanced, or paramedic could.- for example. Just knowing the limits is good. Your limits, and the limits of others, limits of equipment on hand, transport times, and communication. Availability of an EVAC.


We also have to recognize that there are really three separate conditions being mentioned above. And all are treated differently, and varies based on the severity.



We have Dehydration: Pretty easily treated in the field - water, fluids, IV, etc some sports drink, that diluted. at least 50/50 with water.

We have; Heat stroke, when dehydration is severe enough it causes altered mental status, and an overheating in the body. Multiple problems here; PT needing to be actively cooled down, AC in truck, ice packs to groin, and armpits. As well as treated for the dehydration. remembering ice cold fluid fast will cause them to vomit. ambient temp fluid, sipped slowly.

We have hyponatremia: Honestly, not very field recoverable w/o advanced intervention.


Not feeling better after hydration and 30mins of shady rest, closer to heat stroke, or hyponatremia. Get em out

Not holding fluid/food down' ( unless its due to fast intake ) get em out.

With any of them, or anything for that mater; Altered Mental Status- needs to leave the field to be evaluated and get treatment- ASAP. This is late sign, getting dangerously close to loosing your PT.

JGAZ, thats a good chart! I take almost all my notes that way now.

Not a super clear answer, i know. Its a muddy water kind of thing, with numerable external factors, that subjectivity change things.
 

jgaz

Adventurer
I am in no means a “Med person” but I’ll give you what little insight I have about when to transport.

During a PSAR patrol in the canyon, while below the rim, I contact someone other than dispatch when I have a patient and/or problem I’m involved with. This contact can see the whole picture as it pertains to resources available or busy. They also are a skilled EMT and can help a person in my position with medical advise or questions to ask. I keep them updated on my patient and they decide when to send the cavalry.

That being said, sometimes, depending on my location, rescue may take different forms. If I’m not near a helipad, the chopper is unavailable, etc. this rescue my involve an EMT hiking either up or down to my location.

During one assist I had during a busy period I was on my own. Questions asked of my patient, and consultation over the radio were what led me to my hyponatremia diagnoses. It was determined that the remedy was “wait it out, pee it out”. Rest, nibbles of salty snacks, and several hours were required. All during this process I was in contact with my “lifeline” and it was decided that there were more pressing needs for the resources available. It worked out fine as I was able to escort the patient out.

So, short story long, it’s very hard for a lay person to determine when more help is needed. This is where a PLB with text capabilities can literally be a life saver.
 

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