Overview of Heat-Related Illnesses | NEJM

Summary

The video discusses the alarming trend of increasing global temperatures, with 2023 marking the warmest year on record. It delves into the clinical aspects of heat-related illnesses, their symptoms, and preventive measures. Highlighting the severity of heat stroke and its management, the video also addresses the sociocultural factors that exacerbate heat exposure risks, particularly for vulnerable populations. It concludes with practical advice for clinicians on how to protect patients during heatwaves and the urgent need for systemic changes to mitigate climate change impacts.

Takeaways

• 🌡️ 2023 was the warmest year on record, with each month from June to December setting a new high-temperature global record.
• 🔥 The last decade has seen the ten warmest years in the past 175 years, indicating a clear trend of increasing global temperatures.
• 🌍 The current trajectory of global greenhouse gas emissions is expected to lead to more frequent extreme heat events worldwide.
• 🏥 Heat-related mortality among individuals over 65 has increased by 85% from the 1990s to the past decade, highlighting the impact of heat on vulnerable populations.
• 🧘 Human body temperature regulation mechanisms like sweating, vasodilation, and behavioral changes are crucial to maintaining a stable internal core temperature.
• ⚠️ Heat exposure is linked to a range of medical problems, including cardiac events, stroke, respiratory issues, and mental health issues.
• 🌡️ Heat-related illnesses can range from mild conditions like heat rash and sunburn to severe conditions like heat exhaustion and heat stroke.
• 💊 Treatment for heat exhaustion involves removing the patient from heat, rest, and rehydration, while heat stroke requires immediate cooling and medical attention.
• 🏢 Socioeconomic and environmental factors, such as urban heat islands and sociocultural influences, can increase the risk of heat exposure.
• 👷‍♂️ Outdoor workers are at high risk of heat-related illnesses due to direct heat exposure and physical exertion, often without control over their working conditions.
• 💼 Individual risk factors for heat-related illnesses include underlying health conditions, age, pregnancy, and certain medications that affect thermoregulation.
• 🏠 Systemic changes, preventive measures, and policy advocacy are needed to mitigate the effects of climate change and protect individuals from heat-related health risks.

Q & A

What was the significance of the year 2023 in terms of global temperature records?

2023 was the warmest year ever recorded, with each month from June to December setting a new high temperature global record for that respective month.

What is the trend observed in the last decade regarding the warmest years on record?

The ten warmest years in the nearly 175 years of recorded history have all occurred during the last decade, indicating a significant warming trend.

How has the increase in extreme heat events affected human health?

The increase in extreme heat events has led to a rise in heat-related mortality, particularly among persons over age 65, which has increased by 85% from the 1990s to the past decade.

What are the primary methods the body uses to regulate its temperature?

The body primarily regulates its temperature through sweating, vasodilation, and behavioral modification to maintain an internal core temperature of around 37°C or 98.6°F.

What are some of the milder acute heat-related conditions that people may be familiar with?

Milder acute heat-related conditions include heat rash, heat cramps, heat edema, heat syncope, sunburns, and burns from contact with hot surfaces.

What is the main difference between heat exhaustion and heat stroke in terms of mental status?

The main difference is that in heat exhaustion, the mental status is normal, while in heat stroke, there are neurologic abnormalities such as confusion, delirium, or obtundation.

What are the initial steps recommended for treating heat exhaustion?

The initial treatment for heat exhaustion involves removing the patient from heat, stopping any activity generating excess metabolic heat, encouraging rest in a supine position, and initiating evaporative cooling with misting or spraying cool water and using fans.

What are the key characteristics of heat stroke that differentiate it from other heat-related illnesses?

Heat stroke is characterized by hyperthermia, neurologic abnormalities, and recent exposure to hot weather or physical exertion. It is a severe condition that can progress to multisystem organ failure and death if not treated promptly.

What is the recommended cooling method for treating heat stroke, and what is the target core body temperature?

The most effective cooling method for heat stroke is cold-water or ice-water immersion. The goal is to rapidly cool the patient to a core temperature of 38 to 39°C (100.4 to 102.2°F), ideally within 30 minutes of presentation.

What are some factors that increase an individual's risk of extreme heat exposure and its associated health effects?

Factors that increase risk include living in urban heat islands, being from a low-income community of color, having underlying medical conditions, being very old, very young, pregnant, having cognitive impairments or disabilities, and taking certain medications that affect thermoregulation.

What advice can clinicians provide to patients to reduce the risk of heat-related illnesses?

Clinicians can advise patients to keep living spaces cool on hot days, check the heat index for daily heat risks, limit outdoor exposure, increase water intake, and monitor for symptoms of heat-related illness. They can also help develop a heat plan for those who cannot afford cooling equipment or energy bills.

What is the role of policy and systemic changes in protecting individuals from the effects of extreme heat?

Policy and systemic changes are needed to mitigate the harms of climate change and create population-level protections from heat. This includes public health measures aimed at reducing risks and rapid action to reduce greenhouse gas emissions to prevent further increases in heat-related morbidity and mortality.