Sunstroke is a special form of heat stroke caused by exposure to sunlight. The cause of the lesion may be work or a long stay (walking, rest) under the scorching sun. It is accompanied by weakness, lethargy, drowsiness, headache, dizziness, flickering of “flies”, nausea, fluctuations in blood pressure, increased body temperature and cardiac disorders. The diagnosis is made on the basis of anamnesis and clinical symptoms. Conservative treatment – cooling, elimination of dehydration. In severe cases, urgent drug therapy is required.
ICD 10
T67.0 Heatstroke and sunstroke
Meaning
Sunstroke is a pathological condition that occurs under the influence of direct sunlight. As a rule, it develops during outdoor recreation (for example, on the beach), but it can also be observed in the mountains, at a relatively low air temperature, because, unlike heat stroke, it is caused by overheating of only the head, and not the whole body. It can affect people of any age and gender, but it is especially dangerous for children, the elderly and patients with some chronic somatic diseases.
The consequences of sunstroke are circulatory disorders and sweating, as well as a lack of oxygen in the tissues. First of all, the central nervous system suffers, in severe cases, the activity of all organs and systems is seriously disrupted, coma and death are possible. Treatment of sunstroke is carried out by specialists in the field of intensive care, traumatology and orthopedics, cardiology, neurology.
Causes
A sunstroke develops under the influence of the sun, which is at the zenith – at this time, the sun’s rays at the minimum angle act on the maximum possible area. The immediate cause of the occurrence may be work, outdoor recreation, walking or being on the beach in the period from 10-11 to 15-16 hours of the day. The provoking factors include windless stuffy weather, lack of a headdress, overeating, improper drinking regime, drinking alcoholic beverages and taking medications that reduce the body’s ability to thermoregulate (for example, antidepressants). The probability of developing this pathology increases with hypertension, vegetative-vascular dystonia, heart disease and obesity.
Pathogenesis
Direct sunlight heats the head, as a result, hyperthermia develops in all parts of the brain. The membranes of the brain swell, the ventricles overflow with cerebrospinal fluid. Blood pressure is rising. The arteries in the brain expand, small vessel ruptures are possible. The work of the nerve centers responsible for vital functions – vascular, respiratory, etc. – is disrupted. All of the above creates conditions for the occurrence of both immediate and delayed pathological changes.
In severe cases, asphyxia, extensive cerebral hemorrhage, acute cardiovascular insufficiency and cardiac arrest may develop. Among the long-term consequences is a violation of the reflex, sensory and conduction functions of the brain. In the long-term period, headaches, neurological symptoms, difficulties in coordination of movements, visual disturbances and diseases of the cardiovascular system may occur.
Symptoms
The likelihood of developing and severity of symptoms depend on the time spent in sunlight, the intensity of radiation, the general state of health and the age of the victim. There is weakness, lethargy, fatigue, drowsiness, thirst, dry mouth, rapid breathing, dizziness and increasing headache. There are ophthalmological disorders – darkening in the eyes, “flies”, double vision of objects, difficulties in concentrating the gaze. The body temperature rises, hyperemia of the skin of the face is noted. There may be an increase or decrease in blood pressure, with an increase in blood pressure, nausea and vomiting may occur. In the absence of help, the condition of the victim may worsen, cardiac disorders and loss of consciousness are possible.
There are three degrees of sunstroke. With a mild degree, there is general weakness, nausea, headache, dilation of the pupils, increased pulse (tachycardia) and breathing. With an average degree, there is a state of deafness, sharp adynamia, uncertainty of movements, unsteadiness of gait, increased pulse and breathing, severe headaches accompanied by nausea or vomiting. Fainting and nosebleeds are possible. The body temperature rises to 38-40 degrees. Severe sunstroke is characterized by a sudden onset with a change in consciousness from confusion to coma, hallucinations, delirium, clonic and tonic convulsions, involuntary discharge of urine and feces and an increase in body temperature to 41-42 degrees.
Heat stroke in young children has some features due to the imperfection of the body’s thermoregulation system, as well as insufficient protective properties and high sensitivity of the scalp to the effects of heat. Signs of stroke in children appear much faster than in adults. Characteristic sudden lethargy, drowsiness or, conversely, irritability. The child often yawns, perspiration appears on his face. Body temperature rises, nausea and vomiting occur. In severe cases, loss of consciousness, respiratory arrest and cardiac disorders are possible.
Diagnostics
The diagnosis is established during the consultation of a traumatologist, therapist, neurologist or other specialist, taking into account the patient’s complaints, anamnestic data (being under the sun at the zenith) and the results of an external examination. To assess the severity of the victim, pulse, blood pressure and body temperature are measured.
Treatment
At the first aid stage, the victim is immediately moved to a cool place in the shade and laid down, providing air flow to the body. The head is turned sideways so that when vomiting occurs, a person does not choke on vomit. Cool (not icy) wet compresses are applied to the back of the head, forehead and neck. You can also spray the victim with cool water. Ice and cold water should not be used, since the temperature contrast is an additional stress for the body and can cause reflex vasospasm, which will further aggravate the patient’s condition.
If the patient is conscious, he is given a plentiful salted drink to restore the water-salt balance (you can use mineral water without gas). In case of loss of consciousness, ammonia is used. If the condition does not normalize, urgent specialized help is needed. If a sunstroke has happened to a child, an elderly person or a patient suffering from severe somatic diseases, an ambulance should be called in all cases, even when the condition of the victim is normalized.
Specialized medical care consists in restoring vital functions of the body. If necessary, artificial respiration is performed. To restore the water-salt balance, a solution of sodium chloride is injected intravenously. In case of heart failure and asphyxia, subcutaneous injections of caffeine or nicetamide are carried out. Diuretics and hypotensive agents are used to normalize blood pressure. Severe sunstroke requires hospitalization in a hospital and a full range of resuscitation measures, including intravenous infusions, intubation, pacing, stimulation of diuresis, oxygen therapy, etc.
Prognosis and prevention
The prognosis is usually favorable. The list of preventive measures is determined by the specific situation, state of health and age of a person. Among the general recommendations is mandatory protection of the head from sunlight. It is better to use headscarves, panama hats and hats of reflective shades. It is necessary to wear light-colored clothes made of natural materials. You should not work or rest in direct sunlight from 11 to 16 o’clock in the afternoon.
When hiking or performing professional duties related to staying in the sun, you need to take regular breaks and relax in a shady cool place. It is important to observe the drinking regime and drink at least 100 ml of liquid every hour. Sweet carbonated drinks are not recommended, plain or table mineral water is better. Strong tea, coffee and alcohol are contraindicated. You should not overeat on vacation or before going outside – this creates an additional burden on the body. If possible, take a cool shower during the day, moisten your hands, feet and face with water.
After suffering a sunstroke of any severity, it is recommended to consult a doctor for timely detection of negative consequences and exclusion of latent chronic diseases that could increase the likelihood of developing this pathological condition. For several days, you need to limit physical activity, avoid being in the heat and in the sun, otherwise the risk of developing a second stroke increases. If possible, bed rest should be observed, this will give the body the opportunity to restore the functions of the nervous system, blood biochemical parameters and the level of metabolic processes.