Injuries due to Exposure - Dehydration and other concerns

Dehydration means the body's level of water and other fluids has fallen below normal. Humans lose water through sweating, breathing and waste elimination. This loss is markedly increased by medical problems that cause vomiting, diarrhea, edema or bleeding.

Signs and symptoms: (Symptoms of a disease are subjective indications that can be detected by a patient, such as pain or fatigue, while signs are objective indications that can be detected by a doctor, such as temperature or pulse.) Even mild dehydration can result in poor judgment, weakness, headache, and lack of energy; in addition, dehydration can make those affected more susceptible to infections, hyperthermia, or decompression illness (DCI). Marked dehydration can also cause imbalances in electrolytes (salts and other minerals in blood and other body fluids).

Individuals suffering from dehydration may also evidence a loss of elasticity in their skin, excessively dry mucous membranes (in the nose and throat, for example), and urine output that darkens in color and declines in quantity. It is of note that if you have been swimming or diving, your first urine output after immersion may be clear, even though you're dehydrated. This is due to an effect known as immersion diuresis — that is, an increased production of urine during immersion due to vasoconstriction (narrowing of the blood vessels); this results in your urine being more diluted than it would otherwise be.

Dehydration is often suspected when someone feels unwell after having been physically active and sweating profusely in a hot, humid environment. But the condition is much more difficult to detect in cooler environments, where an individual's fluid intake still may not keep up with the loss of body fluids. Dehydration in such conditions can be insidious, in that victims may not be aware of their depleted state until an emergency arises — which can be especially dangerous if they are traveling in a remote area.

Treatment and prevention: Travelers in hot and humid environments may need to increase their fluid intake beyond the recommended 8 cups (almost 2 liters) of water per day. When you're traveling in such climates is also not a good time to begin restricting your salt intake, because the loss of salts during prolonged exposure to heat and humidity may result in a condition called hyponatremia; it is characterized by abnormally low levels of sodium in the blood and can cause lethargy, headaches, seizures — and even death, if the brain swells due to ingestion of water but not enough salts and other electrolytes. However, this does not mean you should drink salt water! Salt water is a concentrated solution that can actually dehydrate a victim further if it is used for hydration. Studies of shipwreck survivors have clearly demonstrated that those who survived were those who refrained from drinking salt water.

Treatment of dehydration involves replacing the lost fluids and electrolytes — orally (by mouth) in cases of mild to moderate dehydration, but intravenously in more severe cases. Administering frequent, small amounts of water is the best approach.
Other exposure concerns


It's not possible to detail all the sources of exposure-related injury in a guide of this length, but a few other serious and/or common problems are listed below.

Lightning: The Earth receives an estimated 100 lightning strikes per second. So it should be no surprise that sometimes lightning strikes humans. In 2014, 26 people died from lightning strikes in the U.S. Worldwide estimates of lightning fatalities range from 6,000 to 24,000 per year. An individual's lifetime odds of being killed by lightning are 1 in about 165,000. The U.S. Centers for Disease Control and Prevention (CDC) recommends the following strategies to avoid being struck by lightning:
* Check the weather forecast before an outdoor excursion.
* If you hear thunder, seek shelter if possible — in an enclosed building or a hard-topped vehicle with the windows rolled up. Do not stay in an open structure or vehicle, such as a porch or golf cart.
* If you can't get to shelter and you're in an open area, crouch down in a ball-like position, with minimal contact with the ground. Do not lie down.
* If possible, avoid ridgelines, mountain summits, and isolated trees or other tall items like power poles. If you are in the woods, stay near shorter trees.
* Stay away from water — swimming pools, ponds, rivers, and even puddles.
* Avoid tall structures.
* Avoid contact with anything metal. (And if you are in a concrete structure, avoid leaning against the walls, as lightning can travel through the metal reinforcement in concrete.)
* Be sure you are not wearing or carrying anything metal.
* If you are in a group, separate from each other.
If you or someone you are with does get struck by lightning, call for emergency medical assistance immediately. Then take these steps:
* Minimize the risk of further strikes, moving the victim to a safer location if necessary.
* Check to see if the victim is breathing and has a heartbeat. If not, start chest compressions immediately. Initiate rescue breathing if anyone in your group has CPR training. Learn more about essential skills and CPR.
* Continue chest compressions (and CPR) until medical personnel arrive.
* Assess the victim for other injuries, such as burns or blunt trauma, and administer first aid as appropriate and possible.
* If there is risk of hypothermia, place an insulating layer between the victim and the ground.
Sunburn: The depletion of the Earth's ozone layer has made sunburn an increasingly common hazard of outdoor activities. The U.S. Skin Cancer Foundation has determined that 42 percent of Americans get at least one sunburn a year. And your risk of melanoma, the most deadly form of skin cancer, doubles after just five or more blistering sunburns. Prevention is much more important than treatment. To avoid getting sunburned, the Skin Cancer Foundation suggests these steps:
* Stay in the shade or indoors, especially between 10:00 a.m. and 4:00 p.m. and especially in tropical and polar latitudes and at high altitudes.
* Use a sunscreen with an SPF factor of at least 15. Apply it liberally to all exposed skin 30 minutes before going outdoors, then reapply it every two hours.
* Use sun-protective clothing, including a broad-brimmed hat and sunglasses that block UV radiation.
* Remember, if you're near water, sand or snow, that the sun reflects off such surfaces, increasing the intensity of the UV rays.
* Remember, too, that you can get a sunburn on a cloudy day; in fact, some cloud formations can magnify the effect of the sun's UV rays.
* Do not use tanning booths.
If you do get too much sun, here's what to do:
* Take a cool shower or bath.
* Apply moisturizing lotion.
* Stay well hydrated.
* If you get a painful burn, a pain reliever such as ibuprofen (Advil) can help.
* If a blistering sunburn covers more than 20 percent of your body, you should seek medical attention.
In addition, it's a good idea to check your skin for unusual moles or other signs of potential skin cancer at least once a month.

Poison ivy, oak and sumac: Poison ivy, oak and sumac are the most common contact-poisonous plants in the United States, but there are others within U.S. borders and many more elsewhere around the world. Learning to recognize the leaves of noxious plants is the best way to avoid the misery of the highly itchy rashes they can cause. Learn more about poisonous plants from the CDC . And before you engage in wilderness activities in other parts of the world, research what plants you should watch for there. Remember, too, that it is possible to be exposed to urushiol, the natural chemical that causes the allergic rash, through direct contact with the plant, through indirect contact with a surface that has touched the plant, or by inhaling particles from burning plants that contain urushiol.

The CDC recommends the following preventive steps if you may come into contact with such plants:
* Cover up — wear long sleeves, long pants, and gloves.
* Consider the use of a barrier lotion containing bentoquatum, for example; however, such lotions must be washed off and reapplied twice a day.
* Clean any gear that may have come in contact with such plants with rubbing alcohol (isopropanol or isopropyl alcohol) or soap and water; urushiol can remain potent on the surface of objects for up to five years.
* Do not ever burn plants that may contain urushiol or similar substances.
But if, despite your best efforts, you do come in contact with poisonous plants, the CDC recommends these steps:
* Immediately wash well with rubbing alcohol, a specialized plant wash, or a degreasing soap (such as dishwashing liquid) and lots of water. Then rinse well.
* Scrub under your nails with a brush.
* If you have a blistering rash, apply wet compresses, calamine lotion or hydrocortisone cream to mitigate the itching. An oatmeal bath or oral antihistamines (such as Benadryl) may also relieve itching.
* In case of a severe allergic reaction or severe itching or blistering, seek medical attention.

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