Severe nausea and vomiting. Progression to heat stroke or orthostatic hypotension. Follow-up Actions Advise employee to report to the health unit to assess readiness to return to work. Discuss safety procedures for working in abnormally warm temperatures. Educate regarding acclimation to hot environments. Counsel regarding appropriate fluid and electrolyte replacement including drinking water every 15–20 minutes. Caution about use of impermeable protective clothing that can block evaporation. Take precautions while working in hot environments with frequent breaks to cool area. Assess employee status. Prevent onset of shock. Replace fluids and electrolytes and pro- vide symptom relief. Monitor employee vital signs. Assess sweating ability by examining fore- head, skin, and axillae. Move to cool place but protect from chill- ing keep body warm. Position lying down, raise feet from 8 to 12 inches, and loosen clothing. Give plain water with adequate concentra- tion of sodium, if not contraindicated by health history, or Gatorade (8 oz. every 15 minutes for 1 hour) if no signs of nausea or vomiting appear, symptoms have cleared, and pulse normalized. Apply cool, wet cloths and fan the body. If vomiting occurs, do not give any more fluids but arrange for transport to hospital. Start IV solution (normal saline or lactated Ringer’s solution) per standing order if nausea or vomiting result. Avoid aspirin and non-steroidal anti- inflammatory (NSAID) drugs because of possible hyperthermic responses. 217 Heat Disorder: Heat Exhaustion— Salt-Depletion Type 109B Definition Acute reaction to heat exposure of the salt-depletion type characterized by fatigue, weak- ness, collapse, and excessive loss of normal fluids and salt from the body. Also referred to as heat collapse and heat prostration. Characteristics Pale clammy skin, rapid weak pulse, muscle twitching, headache, alteration in mental status, nausea and dizziness, and severe cramps in abdomen and legs may occur. Body tempera- ture is usually normal, but blood pressure might be decreased due to hypovolemic shock (e.g., rapid pulse, hypotension, and restlessness). At-risk populations include older workers, those on diuretics, the physically unconditioned, and those who are dehydrated. Policy Evaluate employee in the occupational health unit. Include preventive education as part of employee health and safety training. Objectives Clinical Assessments and Interventions Referral for Medical Action Guideline continues on next page
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