b. Treatment. The patient should drink at least one canteen of water. Salt
replacement (as for heat cramps) is also advisable if he has been perspiring heavily and
has had poor salt intake. He should lie down with feet higher than the level of his chest,
preferably in a cool place, until his symptoms have improved. If he cannot take oral
fluids, intravenous fluids such as saline solution are needed and he should be
evacuated to a MTF. If water is not available, salt tablets or salt in other forms should
not be administered alone.
4-13. HEATSTROKE (Sunstroke)
Heatstroke is a medical emergency. It is characterized by extremely high body
temperature, usually with coma. The development of heatstroke represents a
breakdown of the body's heat regulating mechanism and is particularly prone to occur in
individuals who are not acclimatized to heat. Physical exertion, immunizations, and
infections may predispose to the development of heatstroke. After the disturbance of
the heat regulating mechanism occurs, the individual may absorb heat from the ground
or the surrounding air. Of great importance is the absence of sweating. During the
early stages of this condition, after sweating has stopped and the temperature has
risen, the individual may be exhilarated and unaware of the dangerous condition that is
developing. All military personnel should be taught the importance of the recognition of
cessation of sweating and the initiation of corrective measures at the stage when the
condition is reversible. It is important to note that it is possible for a patient with
heatstroke to have some sweating. If he has the other signs, mental changes, and high
body temperature, he should be treated for heatstroke.
a. Clinical Picture. There may be early symptoms of headache, dizziness,
mental confusion, weakness, nausea, urination, and diminished or absent sweating.
Usually, however, the onset of heatstroke occurs with dramatic suddenness, with
collapse and loss of consciousness. Deep coma is usually present and convulsions
may occur. In the early stage, the patient's skin is usually hot, red, and dry; there is
usually an absence of sweating. The pulse is full and rapid, and the blood pressure is
normal or elevated. Respirations are rapid and deep. The body temperature is usually
markedly elevated (100F to 104F). As the patient's condition worsens, cyanosis is
usually noted together with a rapid pulse and lowered blood pressure. The breathing
becomes shallow and irregular. Death may ensue very rapidly, but if the patient
survives until the second day, recovery usually occurs. Rectal temperatures of 102 to
103F may persist for several days, during which time mental disturbances, excitement,
and delirium may continue or recur. Headache may persist for several weeks after the
attack. In the first few days after the temperature has been reduced from a critical level,
severe relapses may occur. The patient should, therefore, be observed carefully during
this period, and rectal temperatures should be recorded frequently. Treatment, as
outlined below, should be started again at the first indication of relapse. It is also
important to emphasize that the heat regulating centers may be extremely unstable for
many weeks after an attack. One attack of heatstroke predisposes to future attacks,
and care should be taken by the individual to avoid a second exposure to the
precipitating condition.
MD0008
4-13