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Surviving summer

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Surviving summer

Most of us welcome the warmer weather, but it has its downsides too – from sunburn and dehydration to skin allergies and heat stroke. But pharmacy is perfectly placed to offer advice on coping with potential health hazards this summer

When the temperature soars, it brings health hazards, especially to the young, the elderly, those with chronic health conditions and outdoor workers. But the pharmacy team can play a vital role in helping to detect and manage heat-related health problems such as the ones outlined below…

Sunburn

Sunburn occurs when UV rays damage the outer layers of the skin. Dr Anjali Mahto, a consultant dermatologist and British Skin Foundation spokesperson, suggests that people cover the affected area and stay in the shade until the sunburn is healed. 

“Advise loose cotton clothing that allows skin to breathe,” she says. “Cool compresses to the skin or a cool bath or shower will help. Keep the temperature just below lukewarm. Make sure the shower has a gentle flow of water, but if blisters are starting to develop, a bath is preferable. Afterwards, use unperfumed lotion to soothe the skin. Encourage plenty of water to drink to avoid dehydration.”

Over-the-counter painkillers can be given to relieve pain and inflammation. A weak hydrocortisone cream used for 48 hours may also decrease pain and swelling and aid healing.

Polymorphic light eruption (PLE)

This is an itchy, burning rash triggered by UV light rather than heat. It appears on areas of skin that are exposed to sunlight within hours of exposure and can last for up to two weeks. “The customer should be advised to stay out of the sun and wear sunscreen of at least SPF30. It can be very itchy and topical steroids can help calm the inflammation,” says Dr Mahto.

Bites and stings

These are more common in summer months and are most likely to come from bees, wasps, hornets, midges and mosquitoes. To treat bites and stings: 

  • Wash the affected area with soap and water
  • Use a cold compress to reduce swelling
  • Remove visible stings by gently scraping away with the nails or the blunt edge of a knife
  • Use an antihistamine or hydrocortisone spray or cream
  • Take an oral antihistamine if necessary and appropriate for the age of the customer.

If swelling has got worse or the person is having difficulty breathing, refer to the pharmacist immediately as this could be a medical emergency.

Cuts and grazes

These are common in summer, especially when children are playing outdoors. After thoroughly washing and drying hands, wounds should be cleaned under a running tap to remove any dirt. They can then be patted dry with a clean towel and covered with a sterile dressing.

Sprains and strains

A sprain is an injury to a ligament and a strain happens when a muscle is stretched too far, damaging its fibres. Self care measures, known as PRICE, can be used to treat both sprains and strains:

  • Protect the area from further injury using a support
  • Rest the affected joint or muscle
  • Ice for the first 48-72 hours after the injury. Apply ice wrapped in a damp towel for 15-20 minutes every two to three hours during the day
  • Compress the injured area with a bandage to limit swelling and movement
  • Elevate the area above the level of the heart, if possible.

Painkillers can be given to treat pain and inflammation. Paracetamol is advised for the first 48 hours and ibuprofen after that, if suitable for the customer. An anti-inflammatory gel or cream can be used to treat pain locally.

Food poisoning

This is more common in warm weather because leaving food out of the fridge for too long causes bacteria to multiply, and this happens more quickly the warmer it is.

Signs of food poisoning include nausea, vomiting, diarrhoea, stomach cramps, loss of appetite, fever, aching muscles and chills. Most cases are caused by bacteria, such as salmonella or E.coli, or the norovirus. 

How to treat food poisoning:

  • Advise drinking plenty of water to avoid dehydration
  • Recommend oral rehydration to those vulnerable to dehydration
  • Advise eating only bland foods
  • For severe and/or persistent symptoms, refer to the pharmacist as the person may need to see a GP.

Dehydration

Dehydration is more common in hot weather because we sweat more to keep cool, but we don’t always replace the fluids we lose through sweat quickly enough. Signs that a person is dehydrated include:

  • Feeling thirsty
  • Dark coloured urine
  • Passing urine less often
  • Confusion and/or irritability
  • Dry mouth
  • Dizziness
  • Headache.

In babies, signs also include pale skin, sunken eyes and a sunken fontanelle (soft spot on the top of the head).

When it comes to treating dehydration, adults should take a rehydration solution containing a mix of electrolytes (essential minerals and salts) and glucose. These are available over the counter. If a baby is dehydrated, refer to the pharmacist. It is likely that they will need plenty of liquids – breast or formula milk, or extra water for formula-fed babies or those on solid food. Sips of rehydration solution may also be given for older babies, but check for age restrictions before recommending these. Children should not be given just plain water as this can dilute their already low levels of minerals and salts. Instead, they should be given a rehydration solution or diluted squash or juice. For severe dehydration at any age, refer to the pharmacist as the person will need immediate medical help.

Why is heat dangerous?

To put it simply, excessive exposure to high temperatures can kill. According to the Public Health England (PHE) Heatwave Plan for England, during Northern France’s summer heatwave in 2003, unprecedented high temperatures for a period of three weeks resulted in 15,000 excess deaths. “Excess deaths are not just deaths of those who would have died anyway in the next few weeks or months due to illness or old age. There is strong evidence that these summer deaths are indeed ‘extra’ and the result of heat-related conditions,” the plan says.

When the air temperature is higher than our skin temperature, the only way to stay cool is by sweating. Anything that makes sweating less effective, such as dehydration, certain medications or medical conditions, can cause the body to overheat. Age can also be a factor: young children and older people don’t sweat as effectively as others.

“The main causes of illness and death during a heatwave are exacerbation of respiratory and cardiovascular diseases. Watch out for signs that could be attributed to other causes, such as difficulty sleeping, drowsiness, faintness and changes in behaviour, as well as increased body temperature, difficulty breathing, increased heart rate and worsening health problems, especially of the heart or respiratory system,” says a PHE spokesperson. “As frontline healthcare providers, pharmacists are well placed to raise awareness of the risks of heat-related harm.”

Who is at risk?

Joe Mulligan, first aid expert at the British Red Cross, says: “The young and elderly are most at risk, especially those with health conditions. Young people don’t know how to manage their exposure to heat, while older people don’t perceive the rise in temperature as quickly as young people and are particularly at
risk of dehydration as a result of not increasing their fluid intake.” 

PHE adds that anyone in a high-risk category who is living alone is likely to need at least daily contact, whether by care workers, volunteers or informal carers.

PHE's Heatwave Plan

The death rate starts to rise within one or two days of a heatwave starting, so action needs to be taken fast. The aim of PHE’s Heatwave Plan is to raise awareness of the dangers of excessive heat and to ensure healthcare professionals are prepared to deal with a heatwave. It sets out what should happen before and during periods of severe heat and how organisations and individuals can reduce potential risks.

See the full Heatwave Plan for England for in depth information on hot weather and health protection.

Heat exhaustion

This happens when the body’s core temperature remains between 37 and 40ºC as a result of dehydration. Signs of heat exhaustion include tiredness and weakness, feeling faint and/or dizzy, a drop in blood pressure, headache, muscle cramps, nausea/vomiting, heavy sweating, thirst, fast pulse, dark urine and less frequent urination.

St John Ambulance’s head of clinical services Alan Weir has this advice for treating heat exhaustion:

  • Take the person to a cool place and get them to lie down with their legs raised
  • Give them lots of water. You can also give a sports drink or oral rehydration solution
  • Keep checking their breathing, pulse and level of response
  • Even if they recover quickly, suggest they see a doctor
  • If they seem to be getting worse, place them into the recovery position and call an ambulance
  • While waiting, keep checking the person’s breathing, pulse and level of response
  • Remove clothing to expose skin, cool the skin with a wet sponge or flannel and fan the skin while it’s moist.

Heat stroke

“This can occur if heat exhaustion is not managed properly,” explains Joe. “It results from prolonged exposure, when the body overheats to a critical point as a result of the thermoregulatory centre in the brain not working properly. The person can become unresponsive in minutes.”

Signs of heat stroke include a headache, dizziness and discomfort, restlessness and confusion, hot, flushed and dry skin, fast deterioration in level of response, bounding pulse and a body temperature above 40ºC.

Heat stroke is a medical emergency. “Quickly move the person to a cool place and remove their outer clothing, then call for an ambulance,” advises Alan. “Wrap them in a cold, wet sheet and keep pouring cold water over it until their temperature falls to at least 38ºC. If you can’t find a sheet, fan them or sponge them down with cold water. Once the person’s temperature has gone back to normal, replace the wet sheet with a dry sheet. While waiting for help, keep checking their temperature, breathing, pulse and level of response. If they start to get hot again, repeat the whole process.” 

Medication complications

Taking certain drugs can make a person more susceptible to heat-related illnesses. These include the following:

  • Drugs causing dehydration or electrolyte imbalance (e.g. diuretics)
  • Drugs that reduce renal function (NSAIDs, cyclosporine)
  • Drugs with levels affected by dehydration (e.g. lithium, digoxin, statins, anti-epileptics)
  • Those that interfere with thermoregulation (e.g. anticholinergics including tricyclics, H1 antihistamines,
    anti-migraine drugs, vasoconstrictors, beta blockers)
  • Thyroxine
  • Anti-hypertensives and anti-angina drugs.

How to keep cool

What’s the best way to keep cool during a heatwave?
Alan Weir, head of clinical services at St John’s Ambulance, has this advice:

  • Shut windows and pull curtains when it’s hotter outside than indoors. Open them later when it’s cooler
  • Avoid being outside between 11am and 3pm
  • Have cool baths or showers and splash yourself with cool water
  • Drink cold drinks regularly, but avoid tea, coffee and alcohol
  • Wear loose, cool clothing.

Dehydration is more common in hot weather because we sweat more to keep cool, but we don’t always replace fluids quickly enough

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