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Heat-stroke (sunstroke)
Heat-stroke is a medical emergency that is associated with a potentially high mortality rate. It occurs when the body's main mechanism of heat loss (evaporation of sweat) is blocked. There may be early warning symptoms of headache, malaise, and excessive warmth, or a general picture of heat exhaustion. The onset is usually abrupt with sudden loss of consciousness, convulsions, or delirium. Sweating is absent in the typical case.
On physical examination, the skin is hot, flushed, and dry. In severe cases, tiny rounded haemorrhage spots may appear. Deep body temperature is high, frequently in excess of 41 °C. A rectal temperature above 42 °C is not uncommon, and indicates a poor outlook for the patient. The pulse will be rapid and strong and may go up to a count of 160 or more. Respiration may be rapid and deep, and the blood pressure elevated slightly. The pupils of the eyes will first contract then dilate. Muscular twitching, cramps, convulsions, and projectile vomiting may occur and may be followed by circulatory collapse and deep shock.
Because of the extreme seriousness of heatstroke, all members of the vessel's crew should be taught the importance of recognizing cessation of sweating, so that corrective measures can begin at an early reversible stage.
Treatment
Immediate treatment must be given to reduce the body temperature, or brain damage and death may occur. The patient should be undressed and placed in a tub of cold (around 20 °C) water; or covered with continuous cold packs such as wet blankets; or sponged with cold water until the temperature drops. The temperature should be taken every 10 minutes and not allowed to fall below 38.5 °C. The skin should be massaged during this procedure to prevent constriction of the blood vessels, to stimulate return of the cooled blood to the overheated brain and other areas, and to speed up the heat loss. After the body temperature has dropped, the patient should be placed in bed in a cool room with a fan or air-conditioner blowing towards the bed. If the body temperature starts to rise, it will be necessary to begin the cooling procedure again. Do notgive the patient morphine sulfate, epinephrine, or stimulants. Sedatives (Phenobarbital) are given only if convulsionsoccur, to control them. The patient should be kept in bed for several days and cautioned against later exposure to heat.
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II. Remember how to prevent heat stroke
Hernia (rupture)
The abdominal cavity is a large enclosed space lined by a sheet of tissue. The muscles of the abdominal wall resist the varying changes of pressure within the cavity. Increased pressure may force the protrusion of a portion of the lining tissue through a weak spot in the muscles of the abdominal wall. This forms a pouch and usually, sooner or later, some part of the abdominal contents will be pushed into the pouch. It may appear at the navel or through an operation scar, but the commonest position is in the groin. The weakness may have been present from birth, but it may be brought on by a chronic cough or strain. At first, a rupture is noticed under the skin as a soft rounded swelling, which is often no larger than a walnut, but it may become very much bigger after some months. The swelling tends to disappear when the patient is lying down, but it reappears when he stands up or coughs. Normally there is no severe pain, but usually a sense of discomfort and dragging is present.
When a hernia is suspected, the patient must always be examined while standing. In the groin (inguinal hernia), the swelling of a rupture must not be confused with swollen lymph glands. Usually there are several of these swollen tender glands, and they do not disappear when the patient lies down.
It is sometimes possible to see and to feel an impulse transmitted to the hernia swelling, if the patient is asked to cough forcibly several times.
Treatment
A person who knows he is ruptured has often learned to push the swelling back for himself. He should be removed from heavy work. An operation to cure the weakness is necessary. If the hernia is painful, the patient should be put to bed. Often the swelling can be replaced into the abdomen by gentle pressure when the patient is lying on his back with his knees drawn up. He should be kept in bed until he can be seen by a doctor at the next port.