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Editor's Notes

1. Heat exhaustion: Common symptoms of heat exhaustion include headache, weakness, dizziness, goose flesh, nausea, vomiting, diarrhea, irritability, and loss of coordination. The skin may appear pale or ashen, with associated tachycardia or hypotension. Normal mentation is maintained. Patients with heat exhaustion should remove excess clothing and be moved to a shaded, cool environment. They should be placed in a supine position, preferably with their legs elevated. Oral fluids are preferred over intravenous fluids for rehydration in those who are conscious, able to swallow, and not losing fluids secondary to vomiting or diarrhea. 9 Vital signs should be monitored, with transport to an emergency facility if symptoms do not improve after 20 to 30 minutes.3,6,9 Heat cramps: Heat cramps, or exercise-associated muscle cramps, can occur in any setting, but are more common when exercising in hot and humid environments. Dehydration, depletion of electrolytes, and sodium losses from sweat all accelerate in this type of environment, especially in those who sweat profusely.18 Treatment includes rest, prolonged stretching of affected muscle groups, and oral sodium ingestion. Intravenous normal saline may be used for more rapid relief, especially for severe, diffuse cramping or when oral repletion is not possible
2. Thermoregulation by the body during times of heat stress is coordinated by central nervous system centers in the hypothalamus of the brain and the spinal cord; as well as peripheral centers in the skin and other organs Conduction: degree of conduction dependent upon temperature gradient, conductive properties of the object touching the body, and what percentage of surface area is in contact Evaporation: dependent upon sweat production (or ability to produce sweat) and vapor pressure gradient---as humidity increases, evaporation becomes progressively less effective at cooling the body Radiation: think about reflective properties of light colored clothing or upholstry vs. heat absorbing properties with darker clothing/upholstry Convection: convective heat exchange increases with increasing air speed and larger temperature gradient between air and skin
3. Bouchama A, Knochel JP. Heat stroke. N Engl J Med. 2002;346(25): 1978-1988.
4. Children are particularly prone to heat-related illness because of their greater surface area to body mass ratio compared with adults. This permits more heattransfer from the environment to the body. They also have a diminished ability to dissipate heat because of slower sweat rates, a higher temperature threshold for the initiation of sweating, and production of a more diluted sweat. Furthermore, they are slower to acclimatize to the heat and have less of a thirst response. REF: Bytomski JR, Squire DL. Heat illness in children. Curr Sports Med Rep. 2003;2(6):320-324.
5. TX data: 60% forgotten (28% of those were supposed to go to daycare that morning; in past 5 years, 63% forgotten/37% supposed to go to daycare); 12% intentional; remainder gained access; 1 case unknown
6. -from the graph we see that, even on a 78 degree day (ie, not that hot outside), the temperature inside a vehicle within 30 minutes of shutting off the ignition can reach 110 degrees, more than hot enough to kill a small child.
7. -prefrontal cortex: thinks and analyzes -hippocampus: makes and holds onto immediate memories -basal ganglia: nearly identical to the brains of lizards¡ªinattentive, nonanalytical; controls voluntary but barely conscious actions; controls familiar/routine motor skills----kind of takes over as an auxiliary ¡°autopilot¡± ***ie, when our prefrontal cortex and hippocampus are busily planning our day ahead on the way to work, the ignorant but efficient basal ganglia is driving the car---this explains why sometimes you drive from point a to point b without any memory of the route you took, the turns you made, or even the landmarks/ scenery you saw**** **either sudden or chronic stress can weaken the body¡¯s more advanced components/ higher functioning centers, making them more susceptible to being overrun/ ¡°bullied¡± by the more primitive ¡°lizard brain¡± center
8. "The quality of prior parental care seems to be irrelevant,¡° David Diamond, Ph.D., usf