When heat turns dangerous, ER doctors do ‘whatever it takes’ to treat patients

By Jen Christensen, CNN

(CNN) — As temperatures hit extreme levels across the United States, emergency room doctors have had to get creative to try to save people who are dangerously sick from the heat.

“The last heatstroke patient I had, we sent our security guard across the street to the gas station because we ran out of ice” to help cool the person down, said Dr. Cecilia Sorensen, an emergency room doctor who has been working in an ER in Colorado this summer and who is director of the Global Consortium on Climate and Health Education at Columbia University.

“It’s sort of crazy, but we will do whatever it takes.”

Of all natural disasters, extreme heat is the No. 1 killer, studies show, claiming more lives around the world than hurricanes and tornadoes combined. But since it doesn’t usually come with the dramatic images that a hurricane or tornado provides, experts say, people often underestimate the danger.

Extreme high temperatures can be linked to at least 17 causes of death, most of them related to heart and breathing issues but also including suicide, drowning and homicide.

If that heat makes someone so sick that they have to go to the emergency room, doctors can usually take steps to help.

ER doctors say the most common heat-related illnesses they see are heat exhaustion and heatstroke.

Treating heat exhaustion

Heat exhaustion happens when the body loses too much water or salt through excessive sweating. Under normal conditions, the body can cool itself by pumping blood to the surface of the skin, releasing sweat. But when it’s warm and humid, the air can’t absorb as much sweat, so sweating isn’t as effective at cooling the body.

Someone may also not sweat enough if they’re dehydrated and their body doesn’t have enough water and essential salts called electrolytes.

Heat exhaustion can also happen when the body doesn’t sweat enough and overheats. A person may be at higher risk if they have certain underlying conditions like liver or kidney conditions, heart disease, high blood pressure or overweight. Some medications and a person’s age can also make them more vulnerable.

Heat exhaustion can come with symptoms like nausea, dizziness, irritability, thirst, headache and elevated body temperature. Children ay appear very tired and thirsty, and they usually have cool or clammy skin.

At home, heat exhaustion can often be treated by going into a cool area, loosening clothing, taking a cool shower and drinking a liter per hour of something with electrolytes, like Gatorade. But if that isn’t enough, you may have to seek help from a doctor. The trick is to get to one quickly.

“Heat exhaustion is probably the first stage at which I would expect most people to think ‘Oh, I don’t feel good. Maybe I should get checked out,’ ” said Dr. Courtney Mangus, a clinical assistant professor in the Department of Emergency Medicine’s Division of Pediatric Emergency Medicine at the University of Michigan.

Some with heat exhaustion will be evaluated first in the triage area of the emergency department, she said. That means taking vital signs, checking their temperature, and measuring their heart rate and blood pressure. If a person isn’t too nauseated or vomiting, they will be given fluids to drink, or they may get an IV.

“We try to rehydrate them faster than they could do just by drinking fluids alone,” Mangus said.

Doctors will also do some blood tests to see how the person’s organs and other bodily functions are working.

Left untreated, heat exhaustion can turn into the much more serious condition heatstroke.

Treating heatstroke

Heatstroke is one of the deadliest heat-related illnesses.

Doctors must race against the clock with heatstroke, as with a regular stroke, to get the person’s temperature down.

With heatstroke, the body temperature rises quickly, and its natural cooling mechanism — sweat — fails. A person’s temperature can rise to a dangerous 106 degrees or higher within just 10 or 15 minutes. Heatstroke usually starts with confusion and a temperature above 102 degrees.

Someone with heatstroke may sweat profusely or not at all. They could pass out or have a seizure. If doctors can’t get their body temperature down within 30 minutes, they may have permanent organ damage.

Heatstroke can’t be treated at home. Doctors will often start with a bit of ice, a lot of mist and a fan, says Dr. Robert Shesser, a professor and ​​chair of the Department of Emergency Medicine at the School of Medicine & Health Science at George Washington University.

“The object is to increase the amount of heat that’s dissipated from the body via evaporation,” he said.

His emergency department doesn’t want to shut down the blood supply to the skin via an aggressive ice strategy, he said. But other hospitals plunge people into ice baths, Sorensen said.

Staffers used to use bathtubs full of ice, but a lot of emergency rooms don’t have tubs anymore, so doctors may have to improvise.

During the historic 2021 heat wave in the Pacific Northwest, Sorensen said, ERs were inundated with heatstroke patients, and some doctors without access to bathtubs figured out that the next best thing would be to go down to the morgue and get body bags. Body bags were created to prevent the leaks and spills of bodily fluids, so with a little duct tape, doctors would fill the bags with ice water and put the person inside to cool them down quickly.

If someone is unconscious, it may not be possible to immerse them in cold water, so the staff will strip off their clothes and cover them with ice in the groin, neck and armpit areas and then blow fans on them to help disperse heat. They can also infuse the person with very cold IV fluids.

Dr. Frank LoVecchio, an emergency physical with Valleywise Health Medical Center in Phoenix, says he has seen far too many people with heatstroke who end up with permanent organ damage or who die during the ongoing heat wave in Arizona. In just two recent days, he’s had three people come in with temperatures above 107. He’s not sure how far above, because 107 is where the the monitor stops.

If the brain goes over 105 degrees for more than five minutes, he said, the average person will have some degree of permanent brain damage.

“We’re seeing people coming in with levels that are 107, 108 degrees, so your body really can’t handle that,” LoVecchio said.

Those patients with extremely high temperatures were unconscious. “They are truly fighting for their life,” he said. One person he saw last week is still comatose and could remain in a chronic vegetative state, he said.

“This is all from heat,” LoVecchio said. ”Your body is not made to sustain these temperatures right now we’re seeing record high heat.”

The best treatment: Avoid needing the ER

The best way to stay safe this summer is to avoid exposure to extreme heat as much as you can, especially in very hot places like Arizona.

“You have to think of this as our winter. You have to think of this as, maybe you’re living in a place where you get sub-zero-degree temperature, and you’ve just got to relax, bear down and kind of be in your home,” LoVecchio said.

Exercise indoors and early in the day. Wear loose and light-colored clothing, and watch exertion levels.

Mangus also suggests checking on the elderly and on the very young. Make sure they are getting enough to drink and are staying in a cool place, and never leave someone in a hot car. Mangus said she tells parents to put their phone or even one of their shoes by their child’s car seat as a reminder.

“You’re not going to head into work without a shoe or your phone, and it will help you remember your sleeping infant in your backseat,” she said.

CNN’s Stephanie Elam and Jason Kravarik contributed to this report.

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