Treatment and Prevention of Heat-Related Illness

A 71-year-old man with a history of coronary artery disease, congestive heart failure, and schizoaffective disorder presents to the emergency department with confusion.On the day of presentation, he was seen walking near his apartment complex in a busy urban area and was later found collapsed outside his building.The local heat index (accounting for temperature and relative humidity) is 105°F (40.6°C).On arrival in the emergency department, he is conscious but confused.His heart rate is 130 beats per minute, blood pressure 100/70 mm Hg, respiratory rate 28 breaths per minute, rectal temperature 40.5°C, and oxygen saturation 90% while he is receiving oxygen at a rate of 3 liters per minute through a nasal cannula.He opens his eyes to voice and can state his name.He is able to move his arms and legs and has no focal neurologic deficits.His skin is hot and dry to the touch.His medications include furosemide, risperidone, and carvedilol.The patient lives alone in a top-floor apartment without air conditioning.How should this heat-related illness be treated, and how could it have been prevented?The Clinic a l Problem C limate change is causing a global increase in average temperatures and increasing the frequency, duration, and intensity of extreme heat events, 1 resulting in unprecedented levels of heat exposure.The past 7 years have been the hottest on record, 1 and climate change either caused or dramatically worsened 2 recent extreme heat events in Europe (2022), 3 India (2022), 4 and the Pacific Northwest of the United States (2021). 5In the past 20 years, there has been a 54% increase in heat-related mortality among persons older than 65 years of age, 6 and more than one third of all global warm-season heat-related deaths are attributable to climate change. 7On our current global greenhouse gas emissions trajectory, with warming of 2°C over preindustrial temperatures expected by midcentury, most of the world is expected to encounter frequent extreme heat events in the coming decades 8 ; formerly once-in-10-years heat waves are projected to occur more than 5 times as frequently and once-in-50-years events almost 14 times as frequently. 2 Elevated global temperatures and heat waves are already increasing the global health burden and causing substantial economic loss. 1 Humans thermoregulate through behavioral and autonomic mechanisms (e.g., vasodilation and sweating) to maintain a core internal temperature of approximately 37°C.Metabolic activity generates an internal heat load, and exogenous heat from Fossil-Fuel Pollution and Climate Change