Heat-Related Illnesses.

There is a growing incidence of heat-related illnesses due to rising global temperatures. Heat-related illnesses range from mild to severe, with heat stroke being the most critical. The wet bulb global temperature index considers humidity and solar intensity; its use is recommended to estimate heat stress on an individual and mitigate risk. Efficient cooling methods, such as cold water immersion, are essential in severe cases. Prevention is through hydration, appropriate clothing, recognition of high risk medications, and awareness of environmental conditions. Recognizing heat-related illnesses early in the clinical course and implementing rapid cooling strategies reduces morbidity and mortality.

Heat exhaustion and heat stroke among active component members of the U.S. Armed Forces, 2019-2023.

The most serious types of heat illnesses, heat exhaustion and heat stroke, are occupational hazards associated with many of the military's training and operational environments. These illnesses can typically be prevented by appropriate situational awareness, risk management strategies, along with effective countermeasures. In 2023, the crude incidence of heat stroke and heat exhaustion were 31.7 and 172.7 cases per 100,000 person-years, respectively. The rates of incident heat stroke declined during the 2019 to 2023 surveillance period, but rates of incident heat exhaustion increased over the same period. In 2023, higher rates of heat stroke were observed among male service members compared to their female counterparts, and female service members experienced higher rates of heat exhaustion compared to male personnel. Heat illness rates were also higher among those younger than age 20, Marine Corps and Army service members, non-Hispanic Black service members, and recruits. Leaders, training cadres, and supporting medical and safety personnel must inform their subordinate and supported service members of heat illness risks, preventive measures, early signs and symptoms of illness, and appropriate interventions.

Escalating climate-related health risks for Hajj pilgrims to Mecca.

BACKGROUND: Global temperatures are on the rise, leading to more frequent and severe heatwaves with associated health risks. Heat-related illnesses (HRIs) are an increasing threat for travellers to hot climate destinations. This study was designed to elucidate the interplay between increasing ambient temperatures, incidence of HRIs and the effectiveness of mitigation strategies during the annual Hajj mass gathering over a 40-year period. METHODS: An observational study was conducted utilizing historical records spanning four decades of meteorological data, and the rates of heat stroke (HS) and heat exhaustion (HE) during the Hajj pilgrimage in Mecca, Saudi Arabia. With an annual population exceeding 2 million participants from over 180 countries, the study analysed temporal variations in weather conditions over two distinct Hajj hot cycles and correlated it with the occurrence of HS and HE. The effectiveness of deployed mitigation measures in alleviating health vulnerabilities between the two cycles was also assessed. RESULTS: Throughout the study period, average dry and wet bulb temperatures in Mecca escalated by 0.4°C (Mann-Kendall P < 0.0001) and 0.2°C (Mann-Kendall P = 0.25) per decade, respectively. Both temperatures were strongly correlated with the incidence of HS and HE (P < 0.001). Despite the intensifying heat, the mitigation strategies including individual, structural and community measures were associated with a substantial 74.6% reduction in HS cases and a 47.6% decrease in case fatality rate. CONCLUSION: The study underscores the escalating climate-related health risks in Mecca over the study period. The mitigation measures' efficacy in such a globally representative setting emphasizes the findings' generalizability and the importance of refining public health interventions in the face of rising temperatures.

[5 cases of occupational heat illness].

Objective: Through the analysis of five cases of occupational heat illness caused by high temperature, we expounded the pathogenesis and summarized the clinical characteristics of heat cramp and heat exhaustion of the newly revised diagnostic criteria for occupational heat illness (GBZ41-2019), in order to prevent the occurrence of occupational heat illness to put forward controllable countermeasures. Methods: According to the occupational history, clinical diagnosis and treatment and the other relevant data submitted by five patients, the diagnosis process was analyzed and summarized. Results: Five patients developed symptoms from July to August in summer, belonging to high-temperature operation. They improved by timely treatment. The symptoms, signs and laboratory tests of the five patients were different, but they were diagnosed as occupational heat illness. Conclusion: Employers should pay attention to the high temperature protection and cooling work, and strengthen the labor protection. If patients with heat cramp and heat exhaustion were timely treated, they could basically recover. Occupational disease diagnosticians should seriously study the new diagnostic criteria of occupational disease and constantly improve their diagnostic ability.

Diagnosing and managing heat exhaustion: insights from a systematic review of cases in the desert climate of Mecca.

Heat exhaustion (HE) is a common, yet obscure, heat-related illness that affects millions of people yearly and its burden is projected to rise due to climate change. A comprehensive literature synthesis is lacking despite previous studies on various HE aspects. This systematic review aims to fill this gap by identifying and synthesizing available evidence on the risk factors, symptoms, biomarkers, treatment options, and outcomes for HE. The review focused on HE during the Muslim (Hajj) pilgrimage where the condition is endemic. We conducted a structured search of MEDLINE/PubMed, Embase, Web of Science Core Collection, SCOPUS, and CINAHL databases. We summarized the data from eligible studies and synthesized them in narrative form using pooled descriptive statistics. Ten studies were included between 1980 and 2019, reporting over 1,194 HE cases. HE cases presented with elevated core temperature (up to 40°C) and mainly affected older males from the Middle East and North Africa region, with overweight individuals at a higher risk. Clinical symptoms included hyperventilation, fatigue, dizziness, headaches, nausea, and vomiting, but not central nervous system disturbances. HE was associated with cardiac stress, and with water, electrolyte, and acid-base alterations. Cooling and hydration therapy were the primary management strategies, leading to a low mortality rate (pooled case fatality rate=0.11 % [95 % CI: 0.01, 0.3]). Most cases recovered within a few hours without complications. HE is associated with cardiac stress and changes in homeostasis, leading to distinct clinical symptoms. Early diagnosis and treatment of HE are crucial in reducing the risk of complications and mortality. The review provides insights into the pathophysiology and outcomes of HE, adding to the scarce literature on the subject. Prospero registration number: CRD42022325759.

A Case of Legionnaires' Disease Manifesting as Heat Exhaustion.

A 69-year-old male with a history of prior admissions of heat exhaustion presented with non-specific symptoms including fatigue, diarrhea, and dehydration. The workup revealed a positive legionella urine antigen. He was treated with levofloxacin with symptom resolution within 48 hours.

Current status of active cooling, deep body temperature measurement, and face mask wearing in heat stroke and heat exhaustion patients in Japan: a nationwide observational study based on the Heatstroke STUDY 2020 and 2021.

Aim: The study aimed to determine the current status of face mask use, deep body temperature measurement, and active cooling in patients suffering from heat stroke and heat exhaustion in Japan. Methods: This was a prospective, observational, multicenter study using data from the Heatstroke STUDY 2020-2021, a nationwide periodical registry of heat stroke and heat exhaustion patients. Based on the Bouchama heatstroke criteria, we classified the patients into two groups: severe and mild-to-moderate. We compared the outcomes between the two groups and reclassified them into two subgroups according to the severity of the illness, deep body temperature measurements, and face mask use. Cramer's V was used to determine the effect sizes for a comparison between groups. Results: Almost all patients in this study were categorized as having degree III based on the Japanese Association for Acute Medicine heatstroke criteria (JAAM-HS). However, the severe group was significantly worse than the mild-to-moderate group in outcomes like in-hospital death and modified Rankin Scale scores, when discharged. Heat strokes had significantly higher rates of active cooling and lower mortality rates than heat stroke-like illnesses. Patients using face masks often use them during labor, sports, and other exertions, had less severe conditions, and were less likely to be young male individuals. Conclusions: It is suggested that severe cases require a more detailed classification of degree III in the JAAM-HS criteria, and not measuring deep body temperature could have been a factor in the nonperformance of active cooling and worse outcomes.

Risk factors for heat-related illnesses during the Hajj mass gathering: an expert review.

Human exposure to a hot environment may result in various heat-related illnesses (HRIs), which range in severity from mild and moderate forms to life-threatening heatstroke. The Hajj is one of the largest annual mass gatherings globally and has historically been associated with HRIs. Hajj attracts over two million Muslim pilgrims from more than 180 countries to the holy city of Makkah, Kingdom of Saudi Arabia. Several modifiable and non-modifiable factors render Hajj pilgrims at increased risk of developing HRIs during Hajj. These include characteristics of the Hajj, its location, population, and rituals, as well as pilgrims' knowledge of HRIs and their attitude and behavior. Makkah is characterized by a hot desert climate and fluctuating levels of relative humidity. Pilgrims are very diverse ethnically and geographically, with different adaptations to heat. Significant proportions of the Hajj population are elderly, obese, and with low levels of fitness. In addition, many have underlying health conditions and are on multiple medications that can interfere with thermoregulation. Other factors are inherent in the Hajj and its activities, including crowding, physically demanding outdoor rituals, and a high frequency of infection and febrile illness. Pilgrims generally lack awareness of HRIs, and their uptake of preventive measures is variable. In addition, many engage in hazardous behaviors that increase their risk of HRIs. These include performing rituals during the peak sunshine hours with no sun protection and with suboptimal sleep, nutrition, and hydration, while neglecting treatment for their chronic conditions. HRIs preventive plans for Hajj should incorporate measures to address the aforementioned factors to reduce the burden of these illnesses in future Hajj seasons. Lessons from the Hajj can be used to inform policy making and HRIs preventive measures in the general population worldwide.

A Case of Heat Exhaustion Masquerading as ST-Elevation Myocardial Infarction.

Heat-related illnesses (HRIs) are characterized by hyperthermia, neurological dysfunction, and multiorgan damage. Cardiac dysfunction has been reported, but ST-elevation with a rise in cardiac markers suggesting acute coronary syndrome has been infrequently reported. Data from the middle east in particular is lacking. This is a case of a 43-year-old male patient from the United Arab Emirates diagnosed with acute inferior ST-elevation myocardial infarction necessitating cath lab activation revealing normal coronary arteries. Echocardiography did not show evidence of wall motion abnormalities. After reviewing his clinical presentation, he was diagnosed with heat exhaustion complicated by rhabdomyolysis and acute kidney injury. The patient fully recovered with intensive medical care. This case showed that the electrocardiographic changes and elevation of cardiac markers do not reflect true cardiac ischemia but rather a pathophysiological response to HRI. Previously published reports were scarce and showed conflicting results due to the heterogenicity of cases and methods as well as the lack of angiographic documentation of coronary pathology. This case report demonstrates the importance of early recognition and timely management of HRI cases with an unusual presentation that mimics myocardial infarction, especially in countries with high ambient temperatures during the summer seasons.

Ross Syndrome Presenting as Heat Exhaustion: A Report of Two Cases.

Ross syndrome is a rare clinical disorder of sweating associated with tonic pupil and areflexia. There are very few case reports of Ross syndrome in dermatology literature, most presenting with patchy hyperhidrosis. Here, we report two isolated cases who had presented to the emergency department with heat exhaustion. Multidisciplinary evaluations of the first case revealed focal anhidrosis, patchy hyperhidrosis, postural hypotension, absent deep tendon reflex, and tonic pupil while the second case had similar features except for postural hypotension, prompting the diagnosis of Ross syndrome. Presentation of these two patients highlights the importance of a high index of suspicion of dysautonomic disorder, interdisciplinary workup of a case of patchy anhidrosis, or hyperhidrosis, which may get missed in busy outpatient department (OPD) visit.

Heat stress morbidity among US military personnel: Daily exposure and lagged response (1998-2019).

Heat stress illnesses represent a rising public health threat; however, associations between environmental heat and observed adverse health outcomes across populations and geographies remain insufficiently elucidated to evaluate risk and develop prevention strategies. In particular, military-relevant large-scale studies of daily heat stress morbidity responses among physically active, working-age adults to various indices of heat have been limited. We evaluated daily means, maximums, minimums, and early morning measures of temperature, heat index, and wet bulb globe temperature (WBGT) indices, assessing their association with 31,642 case-definition heat stroke and heat exhaustion encounters among active duty servicemembers diagnosed at 24 continental US installations from 1998 to 2019. We utilized anonymized encounter data consisting of hospitalizations, ambulatory (out-patient) visits, and reportable events to define heat stress illness cases and select the 24 installations with the highest case counts. We derived daily indices of heat from hourly-scale gridded climate data and applied a case-crossover study design incorporating distributed-lag, nonlinear models with 5 days of lag to estimate odds ratios at one-degree increments for each index of heat. All indices exhibited nonlinear odds ratios with short-term lag effects throughout observed temperature ranges. Responses were positive, monotonic, and exponential in nature, except for maximum daily WBGT, minimum daily temperature, temperature at 0600 h (local), and WBGT at 0600 h (local), which, while generally increasing, showed decreasing risk for the highest heat category days. The risk for a heat stress illness on a day with a maximum WBGT of 32.2 °C (90.0 °F) was 1.93 (95% CI, 1.82 - 2.05) times greater than on a day with a maximum WBGT of 28.6 °C (83.4 °F). The risk was 2.53 (2.36-2.71) times greater on days with a maximum heat index of 40.6 °C (105 °F) compared to 32.8 °C (91.0 °F). Our findings suggest that prevention efforts may benefit from including prior-day heat levels in risk assessments, from monitoring temperature and heat index in addition to WBGT, and by promoting control measures and awareness across all heat categories.

Influence of the coronavirus disease 2019 (COVID-19) pandemic on the incidence of heat stroke and heat exhaustion in Japan: a nationwide observational study based on the Heatstroke STUDY 2019 (without COVID-19) and 2020 (with COVID-19).

AIM: To assess heat stroke and heat exhaustion occurrence and response during the coronavirus disease 2019 pandemic in Japan. METHODS: This retrospective, multicenter, registry-based study describes and compares the characteristics of patients between the months of July and September in 2019 and 2020. Factors affecting heat stroke and heat exhaustion were statistically analyzed. Cramér's V was calculated to determine the effect size for group comparisons. We also investigated the prevalence of mask wearing and details of different cooling methods. RESULTS: No significant differences were observed between 2019 and 2020. In both years, in-hospital mortality rates just exceeded 8%. Individuals >65 years old comprised 50% of cases and non-exertional onset (office work and everyday life) comprised 60%-70%, respectively. The recommendations from the Working Group on Heat Stroke Medicine given during the coronavirus disease pandemic in 2019 had a significant impact on the choice of cooling methods. The percentage of cases, for which intravascular temperature management was performed and cooling blankets were used increased, whereas the percentage of cases in which evaporative plus convective cooling was performed decreased. A total of 49 cases of heat stroke in mask wearing were reported. CONCLUSION: Epidemiological assessments of heat stroke and heat exhaustion did not reveal significant changes between 2019 and 2020. The findings suggest that awareness campaigns regarding heat stroke prevention among the elderly in daily life should be continued in the coronavirus disease 2019 pandemic. In the future, it is also necessary to validate the recommendations of the Working Group on Heatstroke Medicine.

Perceptual strain in a compensable hot environment: Accuracy and clinical correlates.

Heat strain monitoring indexes are important to prevent exertional heat illness (EHI) and uncover risk factors. Two indexes are the Physiological Strain Index (PSI) and a subjective PSI analogue, the Perceptual Strain Index (PeSI). The PeSI is a feasible alternative to PSI in field conditions, although the validity has been variable in previous research. However, the PeSI has been rarely examined at a low heat strain with compensable heat stress, such as during a heat tolerance test (HTT). This study evaluated the discrepancy between the maximal PeSI and maximal PSI achieved during a HTT and determined their association with EHI risk factors, including history of EHI, percent body fat (%BF), relative VO2max, fatigue and sleep status (n = 121; 47 without prior EHI, 74 with prior EHI). The PSI was calculated using the change in rectal temperature (Tre) and heart rate (HR) and PeSI was calculated based on the formula containing thermal sensation (TS), a Tre analogue, and rate of perceived exertion (RPE), a HR analogue. Significant associations were identified between PSI and PeSI and between PSIHR and PeSIHR in the total sample and between PSI and PeSI in the EHI group. Bland-Altman analyses indicated PeSI underestimated PSI in the total sample, PSIHR was greater than PeSIHR, and that PSIcore and PeSIcore were not significantly different, but values varied widely at different heat strains. This indicates the use of RPE underestimates HR and that the accuracy of TS to predict Tre may be subpar. This study also demonstrated that participants with higher %BF have a decreased perception of heat strain and that post-fatigue, sleep status and a prior EHI may increase the perception of heat strain. Overall, these results suggest that PeSI is a poor surrogate for PSI in a compensable heat stress environment at low heat strain.

Heat-related illnesses in a mass gathering event and the necessity for newer diagnostic criteria: a field study.

Heat-related illnesses (HRIs), mainly heat exhaustion (HE) and heat stroke (HS), are characterized by an elevation of core body temperature. In this study, we aimed to explore the HRIs' types and patient characteristics among a sample taken from various representative in-field points in the Hajj season. A cross-sectional study was conducted in 2018 at 80 data collection points distributed in the field. Data related to demographics, features and risk factors were collected and analyzed from all encountered cases with suspected HRIs. Moreover, we developed a diagnostic tree for HRIs by using the XGBoost model. Out of the 1200 persons encountered during the study period, 231 fulfilled the criteria of HRIs spectrum and were included in this study. Around 6% had HS and 20% had HE. All HS cases (100%) were from outside of Saudi Arabia as compared with 72.5% diagnosed with HE (27.5% were from Saudi Arabia). In addition, 16% were considered as heat-induced muscle spasms, and 7% had limb heat edema. Additionally, most of HRIs cases were reported between 11 am and 1 pm. The HRIs diagnostic tree model gave a diagnostic accuracy of 93.6%. This study highlights the magnitude of HRIs among pilgrims in Hajj and provides a diagnostic tree that can aid in the risk stratification and diagnosis of these patients. We advise the implementation of more educational campaigns to pilgrims regarding preventable measures especially for the vulnerable groups (e.g. from outside Saudi Arabia, those with comorbidities and light-skinned people).

Emergency preparedness for heat illness in China: A cross-sectional observational study.

BACKGROUND: The morbidity and mortality rates from heat illness have increased due to a higher number of heatwaves. Effective urgent care of heat illness is crucial for optimizing patient outcomes. However, few studies have examined the emergency preparedness measures required for treating such patients. METHODS: From December 23, 2019, to January 23, 2020, a content-validated instrument containing the Perceived Emergency Preparedness Scale for heat illness (heatPEPS) was administered to emergency nurses in China through WeChat. Some of these nurses were retested two weeks later. SPSS 26, IRTPRO 4.2, and NVivo 12 Plus were used for data analysis. RESULTS: In total, 46.4% (200/431) of the participants returned valid responses. With dichotomous scoring, a high score for heatPEPS (mean 7.29; SD 1.667) was elicited. The reduced 9-item heatPEPS had a perfect fit with the 2PL model (M2 = 27.24, p > 0.05; RMSEA = 0.01) and acceptable internal (α = 0.68) and test-rest reliability (intraclass correlation = 0.56). Many participants (74%) were dissatisfied with their heat illness-related knowledge and skills, suggesting an area that could be improved for better emergency preparedness. CONCLUSION: Emergency departments appear to be well-prepared; however, this is subject to social desirability bias. The 9-item heatPEPS is a reliable and valid tool to measure emergency preparedness for heat illness.

Heat-Related Illnesses Transported by United States Emergency Medical Services.

Background and objectives: Heat-related illness (HRI) can have significant morbidity and mortality consequences. Research has predominately focused on HRI in the emergency department, yet health care leading up to hospital arrival can impact patient outcomes. Therefore, the purpose of this study was to describe HRI in the prehospital setting. Materials and Methods: A descriptive epidemiological design was utilized using data from the National Emergency Medical Services (EMS) Information System for the 2017-2018 calendar years. Variables of interest in this study were: patient demographics (age, gender, race), US census division, urbanicity, dispatch timestamp, incident disposition, primary provider impression, and regional temperatures. Results: There were 34,814 HRIs reported. The majority of patients were white (n = 10,878, 55.6%), males (n = 21,818, 62.7%), and in the 25 to 64 age group (n = 18,489, 53.1%). Most HRIs occurred in the South Atlantic US census division (n = 11,732, 33.7%), during the summer (n = 23,873, 68.6%), and in urban areas (n = 27,541, 83.5%). The hottest regions were East South Central, West South Central, and South Atlantic, with peak summer temperatures in excess of 30.0 °C. In the spring and summer, most regions had near normal temperatures within 0.5 °C of the long-term mean. EMS dispatch was called for an HRI predominately between the hours of 11:00 a.m.-6:59 p.m. (n = 26,344, 75.7%), with the majority (27,601, 79.3%) of HRIs considered heat exhaustion and requiring the patient to be treated and transported (n = 24,531, 70.5%). Conclusions: All age groups experienced HRI but particularly those 25 to 64 years old. Targeted education to increase public awareness of HRI in this age group may be needed. Region temperature most likely explains why certain divisions of the US have higher HRI frequency. Afternoons in the summer are when EMS agencies should be prepared for HRI activations. EMS units in high HRI frequency US divisions may need to carry additional treatment interventions for all HRI types.

Heat-Related Illness Is Associated with Lack of Air Conditioning and Pre-Existing Health Problems in Detroit, Michigan, USA: A Community-Based Participatory Co-Analysis of Survey Data.

The objective of the study was to investigate, using academic-community epidemiologic co-analysis, the odds of reported heat-related illness for people with (1) central air conditioning (AC) or window unit AC versus no AC, and (2) fair/poor vs. good/excellent reported health. From 2016 to 2017, 101 Detroit residents were surveyed once regarding extreme heat, housing and neighborhood features, and heat-related illness in the prior 5 years. Academic partners selected initial confounders and, after instruction on directed acyclic graphs, community partners proposed alternate directed acyclic graphs with additional confounders. Heat-related illness was regressed on AC type or health and co-selected confounders. The study found that heat-related illness was associated with no-AC (n = 96, odds ratio (OR) = 4.66, 95% confidence interval (CI) = 1.22, 17.72); living ≤5 years in present home (n = 57, OR = 10.39, 95% CI = 1.13, 95.88); and fair/poor vs. good/excellent health (n = 97, OR = 3.15, 95% CI = 1.33, 7.48). Co-analysis suggested multiple built-environment confounders. We conclude that Detroit residents with poorer health and no AC are at greater risk during extreme heat. Academic-community co-analysis using directed acyclic graphs enhances research on community-specific social and health vulnerabilities by identifying key confounders and future research directions for rigorous and impactful research.

Thermal stress inside a disabled submarine.

BACKGROUND: Submarine operations require strict adherence to standard operating and safety procedures and errors in judgement or accidents could lead to catastrophe and impair the submarine's ability to surface. In case of disablement of a submarine (DISSUB), the crew would have to survive inside the submarine for a variable period awaiting rescue. Microclimate and habitability of the submarine would have to be maintained and crew would have to consume emergency rations and water. METHODS: In order to validate these procedures, a simulation was carried out in which 80 crew members were closed up inside a submarine in harbour for 24 h simulating a DISSUB situation without power and ventilation. RESULTS: Average temperature of the submarine compartments rose from 29.33 °C at the beginning of the simulation to 33.5 °C at the end of 24 h. Relative humidity increased from 79% to 87.67%. Crew members consumed an average to 973 kcal worth of rations during the 24 h of the exercise with 500 ml water. CONCLUSION: Submarine crew could survive successfully inside a disabled submarine awaiting rescue if thermal stress could be addressed. In the present simulation, the crew suffered from effects of thermal stress. Thermal stress would not only affect damage control capabilities, but could also lead the crew into earlier escape. Greater research and further studies are required to mitigate thermal stress and its effects in order to prolong survival.

Variations in the TRPV1 gene are associated to exertional heat stroke.

OBJECTIVES: Exertional Heat Stroke (EHS) is one of the top three causes of sudden death in athletes. Extrinsic and intrinsic risk factors have been identified but the genetic causes still remain unclear. Our aim was to identify genes responsible for EHS, which is a necessary step to identify patients at risk and prevent crises. DESIGN: Genetic and functional laboratory studies METHODS: Whole Exome Sequencing (WES) was performed to search for candidate genes in a cohort of 15 soldiers who had a documented EHS episode. In silico and in vitro functional studies were performed to evaluate the effect of mutations identified in the candidate gene TRPV1. RESULTS: WES led to the identification of two missense variations in the TRPV1 gene. These variations were very rare or unreported in control databases and located in critical domains of the protein. In vitro functional studies revealed that both variations induce a strong modification of the channel response to one of its natural agonist, the capsaicin. CONCLUSIONS: We evidenced mutations altering channel properties of the TRPV1 gene and demonstrated that TRPV1, which is involved in thermoregulation and nociception, is a new candidate gene for EHS. Our data provide the bases to explore genetic causes and molecular mechanisms governing the pathophysiology of EHS.

Estresse por calor na Atenção Primária à Saúde: uma revisão clínica / Heat stress in Primary Health Care: A clinical review / Estrés por calor en la Atención Primaria a la Salud: una revisión clínica

Introdução: A exposição nociva ao calor ganha mais relevância com a progressão do aquecimento global antropogênico e a Atenção Primária à Saúde (APS) tem um papel crescente nesse cenário. No Brasil, as ondas de calor entre 2014 e 2015 duraram mais tempo que nos anos prévios, além disso, entre 2000-2015 a associação entre temperatura e hospitalizações variou de acordo com a duração da exposição ao calor. Nesse contexto, o objetivo desta revisão é realizar uma atualização sobre manejo clínico de patologias relacionadas ao calor na APS. Metodologia: Realizou-se a busca na base de dados ACCESSS, que utiliza a pirâmide 5.0 da assistência à saúde baseada em evidências. Foram identificados 103 sumários sintetizados para referência clínica com as palavras "Heat stress", "Heat Stroke", "Heat Wave" e "Heat Exhaustion", mas apenas três entravam no escopo deste estudo. Resultados e Discussão: O estresse pelo calor é uma condição comum, negligenciada e evitável que afeta diversos pacientes, iniciando-se com uma má adaptação ao calor que se não for corrigida pode gerar uma cascata de eventos inflamatórios. O estresse pelo calor é caracterizado por sintomas inespecíficos, como mal-estar, cefaleia e náusea. O tratamento envolve o resfriamento do paciente e monitoramento, garantindo hidratação adequada. A exaustão pelo calor, se não tratada, pode evoluir para insolação, uma doença grave que pode levar ao coma e morte, envolvendo disfunção do sistema nervoso central - necessitando de um tratamento mais agressivo além do resfriamento

Introduction: The nocive exposure to heat gets more attention with anthropogenic global warming, and Primary Health Care (PHC) has a growing role in this scenario. In Brazil heat waves between 2014 and 2015 lasted longer than in previous years. Further, in addition between 2000-2015 the association between temperature and hospitalizations varied according to the duration of heat exposure. Therefore, the aim of this review is to perform an update on clinical management of heat related pathologies in PHC. Methodology: The ACCESSS database was searched using the evidence-based health care pyramid 5.0, where we identified 103 synthesized summaries for clinical reference with words "Heat stress", "Heat Stroke", "Heat Wave" and "Heat Exhaustion", but only three fell within the scope of this study. Results and Discussion: Heat stress is a common, neglected and preventable condition that affects several patients, it starts with a poor adaptation to heat that if it is not adjusted it can generate a cascade of inflammatory events. Heat stress is characterized by nonspecific symptoms such as malaise, headache and nausea. The treatment involves patient monitoring and cooling, ensuring adequate hydration. Heat exhaustion, if untreated, can progress to heatstroke, a serious illness that can lead to coma and death, involving central nervous system dysfunction - requiring more aggressive treatment than cooling.

Introducción: La exposición nociva al calor gana más destaque con la progresión del calentamiento global antropogénico, y la Atención Primaria a la Salud tienen un papiel cresciente en este escenario. En Brasil las olas de calor entre 2014 y 2015 duraron más tiempo que en los años previos, además entre 2000-2015 la asociación entre temperatura y hospitalizaciones ha variado de acuerdo con la duración de la exposición al calor. En este contexto, el objetivo de esta revisión es realizar una actualización sobre manejo clínico de patologías relacionadas al calor en la APS. Metodología: Se realizó la búsqueda en la base de datos ACCESSS, que utiliza la pirámide 5.0 de la asistencia a la salud basada en evidencias. Se han identificado 103 sumarios sintetizados para referencia clínica con las palabras "Heat stress", "Heat Stroke", "Heat Wave" y "Heat Exhaustion", pero sólo tres son considerados en el ámbito de este estudio. Resultados y Discusión: El estrés por el calor es una condición común, descuidada y evitable que afecta a varios pacientes, iniciándose con una mala adaptación al calor que si no se corrige puede generar una cascada de eventos inflamatorios. El estrés por el calor se caracteriza por síntomas inespecíficos, como malestar, cefalea y náuseas. El tratamiento implica el enfriamiento del paciente y el monitoreo, garantizando la hidratación adecuada. El agotamiento por el calor, si no se trata, puede evolucionar hacia la insolación, una enfermedad grave que puede llevar al coma y a la muerte, involucrando disfunción del sistema nervioso central - necesitando un tratamiento más agresivo además del enfriamiento.