The heat is on: How to keep patients cool and safe 

By Lea Moujaes, MD & Kayla Iuliucci, MD, Johns Hopkins Medicine 

A young city sanitation worker arrives at the ED, sweating and reporting muscle pain. They’re diagnosed with rhabdomyolysis and admitted for several days for rehydration and monitoring of kidney function and electrolytes.  

A middle-aged smoker calls 911 from their porch during a summer heatwave, stating shortness of breath. They’re diagnosed with severe COPD exacerbation and require a two-day hospital stay for breathing treatments, BiPAP, and steroids. 

An 86-year-old with a history of heart failure calls the clinic reporting worsening fatigue and lightheadedness. They’ve been taking their medications as prescribed including diuretics. They report decreased fluid intake despite the increasing heat because of fears of worsening their heart condition. You recommend going to the ED where they’re subsequently admitted for observation and titration of outpatient diuretics. 

The commonality between these cases? Heat-related.  

We’re witnessing alarming changes in our climate, particularly with the rise of extreme heat events. Excessive heat can severely hinder the body’s natural cooling mechanisms, leading to a range of symptoms from fatigue, heavy sweating, muscle cramps, to heart irregularities, loss of consciousness, or even death. Additionally, it’s also important to recognize that heat can lead to worsening of pre-existing conditions such as heart, lung, and kidney disease that puts subsets of patients at higher risk. It’s our responsibility to be aware of and address health exacerbations triggered by environmental challenges.  

Here are a few things to recommend to patients: 

1. Increase fluid intake.

Encourage all patients to drink water more frequently, but especially older adults, who have a diminished thirst response. 

2. Wear lightweight clothing and bathe regularly.

Choose light garments and take frequent baths to maintain a cooler body temperature.

3. Limit physical activity.

4. Monitor medications.

Patients on medications that impair heat loss or cause dehydration should receive clear guidance on how to effectively titrate medications. 

5. Look out for signs and symptoms of heat related illness. 

This includes lightheadedness, muscle cramping, thirst, excessive sweating, nausea and vomiting, confusion, syncope, or seizures. 

Exposure reduction: 

1. Avoid direct sun hours. 

Avoid peak sun and seek shade or incorporate other cooling methods such as fans or water spray bottles during these hours. 

2. Visit cooling centers. 

Share resources with patients for cooling centers or anywhere with AC. These are usually found on your local health department website. 

3. Monitor the heat index. 

Stay informed about the weather and take necessary precautions. 

As we navigate these challenges, it’s vital to prioritize the health and well-being of our communities, ensuring everyone has access to resources and support during these extreme conditions. 

This piece expresses the views solely of the author. It does not necessarily represent the views of any organization, including Johns Hopkins Medicine.