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Heatwave Management

  

Government advice on management of vulnerable patients in heatwave situations.


For full information on this topic click here

At Risk Groups

  • Older age: especially those over 75 years old, or those living on their own and who are socially isolated, or in a care home
  • Chronic and severe illness: including heart conditions, diabetes, respiratory or renal insufficiency, Parkinson’s disease or severe mental illness. Medications that potentially affect renal function, sweating, thermoregulation or electrolyte balance can make this group more vulnerable to the effects of heat (see Additional notes on page 4)
  • Inability to adapt behaviour to keep cool: having Alzheimer’s, a disability, being bed bound, too much alcohol, babies and the very young
  • Environmental factors and overexposure: living in a top floor flat, being homeless, activities or jobs that are in hot places or outdoors and include high levels of physical exertion

Preventative Interventions

  • Keep curtains on windows exposed to the sun closed while the temperature outside is higher
  • Once the temperature outside has dropped lower than it is inside, open the windows (balanced by any possible security concerns)
  • Water external and internal plants, and spray the ground outside windows with water (avoid creating slip hazards) to help cool the air (however, check local drought water restrictions before using hosepipes)
  • Stay out of the sun, especially between the hours of 11am and 3pm
  • Stay in the shade and to wear hats, sunscreen, thin scarves and light clothing if going outside
  • Reduces levels of physical exertion
  • Take regular cool showers or baths, or at least an overall body wash
  • Wear light, loose cotton clothes to absorb sweat and prevent skin irritation
  • Sprinkle their clothes with water regularly, and splash cool water on face and back of neck. A damp cloth on the back of the neck helps
  • Recommend cold food, particularly salads and fruit with a high water content
  • Drink regularly, preferably water or fruit juice, but avoid alcohol and caffeine (tea, coffee, colas)
  • Monitor daily fluid intake, particularly if they have several carers or are not always able to drink unaided

Medications Likely to Provoke or Increase Severity of Heatstroke

Medications likely to provoke or increase the severity of heatstroke

Those causing dehydration or electrolyte imbalance

Diuretics, especially loop diuretics
Any drug that causes diarrhoea or vomiting (colchicines, antibiotics, codeine)

Those likely to reduce renal function

NSAIDS, sulphonamides, indinavir, cyclosporin

Those with levels affected by dehydration

Lithium, digoxin, antiepileptics, biguanides, statins

Those that interfere with thermoregulation:

by central action

Neuroleptics, serotoninergic agonists

by interfering with sweating

Anticholinergics – atropine, hyoscine – tricyclics

– H1 (first generation) antihistamines – certain antiparkinsonian drugs
– certain antispasmodics
– neuroleptics

– disopyramide
– antimigraine agents

Vasoconstrictors

Those reducing – beta blockers cardiac output – diuretics

by modifying basal metabolic rate

Thyroxine

Drugs that exacerbate the effects of heat

by reducing arterial pressure

All antihypertensives Antianginal drugs

Drugs that alter states of alertness (including those in section 4 (Central Nervous System) of the British National Formulary)- particularly 4.1 (Hypnotics and Anxiolytics) and 4.7 (Analgesics).

 

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