Heat stroke free India
Heat stroke: Learn Avoid cure

\Dr. Hemant & Dr. Archana Joshi

Dr. Joshi’s law of heat stroke:
1st law: In summer, when room temperature exceeds 33 degrees Celsius every fever is heat stroke. Alone or superadded to another illness, unless proved otherwise.
2nd law: In summer, or when room temperature exceeds 33 degree Celsius measure oral & skin temperature of every fever patient.
If oral temperature exceeds skin temperature by one degree, it is some illness like viral fever.
If the gap between 2 temperatures is less than 1 degree it is grade 1 heat stroke.
If both are equal it is grade 2 heat stroke.
If skin temperature exceeds oral temperature it is grade 3 heat stroke.
Treatment: 1.Bathe
2 Over hydrate by i.v. fluids. Had the patient  been taking adequate water orally, heat stroke would not have occurred. Give oral fluids too. Ensure excess urination.
3 Sponging. Try this .Add denatured spirit to sponging water in 1: 1 proportion. The alcohol in spirit evaporates and cools the body faster. Any other alcohol works similarly. Use dilution of your choice
4 Keep in cold .room. Use or desert cooler. 
 
  Index:
Introduction
Why we get heat stroke
Example of earthen water pot & radiator
Dr. Joshi’s grades of heat stroke
Young ones & elderly get heat stroke more.
Sick people get heat stroke more
Avoid thirst, & avoid heatstroke
Medical spirit cools faster:
How to measure core temperature and skin temperature?
When to doubt that you have heat stroke?
Breast feeding mother herself is the best thermometer for the baby
How to avoid heat stroke.
Use these facts& remain comfortable ion summer.
Story of a child and a rat: 
 
 

Introduction: Heat stroke kills many Indians every summer.
 Thousands of them directly & many times more indirectly by increasing intensity of all fevers.
Few years ago news papers reported that 3000 people died in one state of Orissa alone in one summer.
Excess heat makes life difficult, sick, short and miserable. Eliminate thirst. Drink water before you become thirsty. Ensure one passes adequate urine every 3 hours. Especially every sick person. That avoids heat stroke and its sufferings and deaths.
Share these ideas with all to avoid and fight heatstroke. This is best service to the nation.
Some where on earth there is summer every day. Reach this information to all.
Mythology: Our fore fathers bathed 5 times daily. This must be for cooling down and for cleanliness.
On  Holi & Ranga Panchami all put water on each other. This must be to teach that we must put plenty of water on ourselves all the summer and avoid heat stroke.
Lord Krishna played rang with gopies. 
  
Why do we get heat stroke?
As room temperature exceeds 33 degrees Celsius we start getting babies with fever due to heat stroke. We all also suffer. Why so?
25 to 30 degrees Celsius is the comfortable range of room temperature for us. As environmental temperature rises above 30 degrees Celsius, we feel the warmth. This excess warmth makes life difficult, sick, short and miserable.
 In most parts of India for more than 8 months temperature is above 30 degrees Celsius. Hence this information must reach all on a war footing.
Important facts: Our body is always warm. It becomes cold when we die. The core or inside of our body is always warmer than the skin by one degree. This difference is there even when we get fever during any illnesses like cough cold fever, typhoid or malaria. 
2 examples explain heat stroke well.
1. Earthen Water pot.
  2. Car Radiator
1. Earthen Water pot.  : Our body is like earthen water pot. 
  
Take 2 earthen water pots. Fill one with water. Keep second empty.
The water from the water filled pot percolates out. It evaporates. While evaporating, it cools the pot.
The empty pot has no water. It warms up with room warmth. 
Our body is like water filled earthen water pot in summer as skin warms up due to warm weather, it sweats. As sweat evaporates body cools. Now if you do not drink water and body has less water, body stops sweating. Now we become a pot with out water. We warm up with the warm room air. 
2. Car Radiator
  
 
  
Skin works like car radiator. Car engines generate heat. They have to be cooled. Else they fail. Car radiator loses heat and keep engine cool. Car radiator has water. If there is no water, it does not work. The engine heats up and fails. It gets heat stroke. 
In summer as we sweat the body water reduces. We feel thirsty. If we drink water we continue to sweat. If we do not drink water body can not make sweat.
It is like car radiator without water. It heats up. We get fever and heat stroke and can die.
Heat stroke means getting fever due to increased room temperature. 
Dr. Joshi’s Grades of heat stroke: We grade heat stroke as grade 1, 2, & 3
Grade 1 heat stroke: Usually core temperature i.e., oral or rectal temperature is more than skin temperature by 1 degree. As the body heats up with hot environmental temperature this gap becomes less than 1 degree. This is grade one heat stroke.  
Grade 2 heat stroke
When skin and oral temperatures become equal it is grade two heat stroke.
Grade 3 heat stroke
When skin temperature exceeds oral temperature it is grade three heat stroke.  
Young and old get heat stroke more
Young ones and old people who depend on others to get water get heat stroke more. 
Sick people are at more risk to get heat stroke.
Sick people already have fever. They also tend to drink less water. They are more likely to get heat stroke in addition to their own fever. So the get much more fever.
For example a person has cough cold and fever due to flu. He tends to drink less water. He also vomits & loses water. He gets heat stroke.
Now, assess the severity of fever. Normally he would get say 100 or 101 degree fever with cough cold fever.
Any other person would get fever of say 100 with heat stroke. When cough cold & fever, and heat stroke come together the fever may rise to much more than 101.
This is how heat stroke increases the severity of all illnesses. This fever won’t go unless the person gets plenty of water by mouth or as saline through vein. Cooling him additionally by bathing, sponging, using air conditioners or desert coolers will help.
Give 2 marks to heat stroke and 2 marks to fever of cough and cold.
Normally 2 + 2 becomes four. When heat stroke and cough cold come together this 2 + 2 becomes 22.
One can have an illness like malaria and heat stroke together. You have to treat both. Only then the fever will go. Treating one will not do. A Person with heat stroke is dehydrated. His all systems will function sub optimally. Only after he is well hydrated he will recover well. A well hydrated person passes adequate urine and is not thirsty.
Lesson: Eliminate thirst, & eliminate heatstroke 
Medical spirit cools faster:
Doctors apply spirit before giving injection. It dries and that time we get a cool sensation.
Medical spirit is available in medical stores.
We can take one part medical spirit and 2 parts water and wet the skin of a person with heat stroke. He will lose heat faster.
Medical spirit has alcohol. Beer and all liquors are alcohols. They can be similarly useful. 
We must ensure that sick people take plenty of water and liquid foods. We must ensure that they pass adequate amount of urine. They must pass little more urine than normal. This shows that they are getting enough water.
Treatment:
Keeping the patient’s room cold in homes & hospitals by use of desert coolers, air conditioners etc. eliminates the environmental heating and hastens recovery of febrile patients. Give plenty of fluids orally and intravenously. Give water before one becomes thirsty.
Eliminate thirst. That eliminates heat stroke in all.
.
Question: How to measure core temperature and skin temperature?
Core temperature can be measured in mouth or rectum by a thermometer. It can be measured at
Ear drum by infra red thermometer. 
Measure Mouth and Axilla temperature to diagnose Heatstroke.
(One may take rectal temperature in place of oral temperature)
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Table
Dr. Joshi’s grades of Heat stroke:        
     Normal or   in any illness: skin temperature less than oral* temperature by 1 degree        
Grade 1 heat stroke: skin temperature less than oral temperature.
Grade 2 heat stroke: skin temperature equals oral temperature the difference is less than 1 degree.                                                                                                                  
     Grade 3 heat stroke:  skin temperature more than oral temperature
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We all wear invisible coat of water. It keeps skin moist and cool. We have to preserve it. As it thins with warmth we sweat. As we sweat we feel thirsty. We must drink water even before becoming thirsty to ensure liberal water supply to the water coat. When this does not happen the water coat disappears. The skin warms up and we get heat stroke. 
Feel the wet skin of your neck. Then feel the skin of the person having fever. If it is dry he has heat stroke.
When to doubt that you have heat stroke? 
Know that you have heat stroke if you have any of the following.

  Breast feeding mother herself is the best thermometer for the baby.
  Tell this to all mothers. 
  
  Babies are in constant touch with the mother. If baby’s skin dries and warms up mother can know immediately. If baby gets ill and baby’s core temperature rises, baby’s mouth becomes warm. Mother know this while breast feeding. She can also tell if only skin has become warm first g that it is a heat stroke or if mouth became warm first telling that it is an illness like viral fever.
  Teach this to all mothers. Only the learned mind can pick up the problem.
Keeping open, sponging, giving breast milk/ORS/water /fluids is treatment of heat stroke. Medicines are needed for other illnesses. 
Newborns do not sweat. So they become hot soon.
Avoid wrapping them in summer. Keep them open Use minimum loose cotton clothes if at all. “No clothes” is best for all especially neonates & children if temperature is above 30 degrees Celsius.  
As newborns get dehydrated, they look more yellow. Their jaundice increases. This jaundice decreases by exposing babies to light. These lights often create more warmth and add to the problem. Solution: Keep these babies in cool rooms. Give plenty of water orally or as saline through veins. (Photo jaundiced baby video) 
Lessons: 1.As one sweats and body water reduces, one fills thirsty. Drink plenty of water. Best is to drink water before you become thirsty. Avoid thirst. That avoids heat stroke.
Lesson 2: Body makes sweat for evaporation and cooling. If you wipe it away, boy has to make fresh sweat. You lose more water. It is wise to allow the sweat to evaporate and dry and cool the body. Do not wipe sweat. (Photo / sweat wiping)
Lesson 3: We also lose salt in sweat. Add a 2 finger pinch of salt to each 200ml.glass of water. Also add a spoon of sugar. Sugar and salt are needed for entry of water from bowels to inside of body .You can add lemon or any other taste maker if you like.
When water is excess you urinate. Drink plenty of water and ensure that you pass a good amount of urine every 3 hours. This will eliminate heat stroke.
Avoid and avoid “less urine status “& eliminate heat stroke.
4. When room temperature exceeds 30 degrees Celsius take skin and oral temperature in every one having fever to rule out heat stroke.
5. Have a room thermometer. Many watches, computers, computerized machines have them. Use them. Highest temperature is in the afternoon. Write it on a chart. Keep it on the wall. (P V)
6 Learn to
-----take oral (core) and maxillary (skin) temperatures.
-- diagnose and treat heat stroke.
7 Eliminate thirst & eliminate heat stroke.
8Breast feeding mothers themselves are best thermometers.
9 To see if some one is alive or dead touch him. On dying a person becomes cold. 
How to avoid heat stroke.
Use these facts& remain comfortable in summer.
Anything that reduces sweating that makes you more comfortable.
Sweating with exercise is good.
Sweating due to warm summer is bad.
Following 4 factors make you sweat.
1. You get more hot in sunlight. Less so in shade or inside a building.
Lesson: Avoid direct sunlight. Learn from Arabs. Cover yourself with white loose cloths. White clothes reflect away maximum heat. Avoid dark clothes especially black Have mercy on your folks. Ask them not to wear black clothes in sun Loose cloths allow air movement. Hosiery clothes are porous. They allow best air movement and hence are the best.
2.If  air is flowing, if there is a fan, you sweat less. If there is no air movement or no fan, you sweat more.
Lesson: 1 Use fan.
         2. Have well ventilated house office.
         3. Clothes  obstruct airflow. Each layer increases obstruction. Tighter the clothes lesser is airflow
Lesson: Wear minimum clothes.
3. Air temperature: More is the air or room temperature more is the sweating and discomfort.
Use room temperature thermometers. If you have a choice, go to coolest room of the house. For example in morning east facing rooms will be warmer. Go to west facing rooms. In the evening west facing  rooms will be warmer. So go to east facing rooms.
Use desert coolers or air conditioners.
Tie obstructs air flow. Avoid tie. It must not be worn by students round the year in hot India. It reduces comfort and studying capacity of students. It should be avoided by marketing persons who have to roam a lot.
4. Humidity: More the humidity more is sweating and discomfort. Air conditioners reduce it.
Our fore fathers used to bathe 5 times a day. That must be their way of keeping cool in hot India. We salute them. 
Request: Have mercy on all.
Provide potable drinking water free to all.
People work in rice fields in rains. They use innovative umbrellas.
Provide umbrella or a coat to labour who work in hot sun on roads, and in fields. Provide them potable water too. They are the true nation builders.
The young and the old are delicate and fragile. They die. Always keep water handy to them.
Small children can not tell they are thirsty. They suffer most.
Make a baby corner in the house. Keep water and snacks there. With in the reach of children. So that children wan walk/ crawl there and mouth and drink water. And eat food. This will eliminate thirst and hunger in children. This will reduce heat stroke. This will reduce malnutrition. 
Story of a child and a rat: One house  had one child. The child had a friendly rat.
In summer both needed more water. The rat went around, found water, drank it & was happy.
The child was thirsty. But the water was on the table. He could not reach it. He could not take it by his hand. He  could not talk. He could not tell he was thirsty. He cried, cried and got   dehydrated  and  GOT HEAT STROKE.
Lesson: Make one child snack water corner. Keep snacks and water there. With in the reach of the children. So that children can drink water when needed and eat snacks when needed.
Keeping food within reach avoids malnutrition.
Keeping water within reach of children avoids heat stroke. 
While going out in Sun Wear a cap on the head with large rim to give shadow to face and neck. Carry a water bottle. Often drink water before becoming thirsty. 
Request: Please translate this in your language and reach it to all with help of media. Electronic & Print journalists, TV. radio, internet  and newspapers and print me
Please pass on this request to Media: Request to Media:
Once idol of Lord Ganesh drank milk. Thanks to media 6 billion people on the earth knew it by evening.
Half the world suffers with heat any time. Please reach this information to all in all languages. And save lives every moment. 
  
In summer when air becomes hot, it heats the skin. So skin becomes warm. Body makes sweat. Sweat dries and keeps skin and body cool.
To make sweat body needs water. If we do not drink enough water, and if body water reduces, body can not make sweat. So skin warms up. We get fever. This is heat stroke.