Gabe Mirkin, M.D.
Nobody should ever die of heat stroke, a sudden uncontrolled rise in body temperature that causes you to pass out, because your body sends you warning signals as your temperature rises.
In 1965, I almost died from heat stroke in an unimportant local race in Arlington, Virginia. I am still embarassed by the stupidity that I showed when I ignored all the warning signs as my temperature continued to climb. First your muscles are affected, then your circulation and then your brain. As your temperature starts to rise, your muscles feel like a hot poker is pressing against them.
It is normal for intense exercise to make your muscles burn, but hard exercise does not cause painful burning that feels like fire. Furthermore, the burning of hard exercise is relieved by slowing down. The muscle burning of impending heat stroke does not go away when you slow down.
As your temperature rises further, the air that you breathe feels like it's coming from a furnace and no matter how rapidly and deeply you try to breathe, you can't take in enough air. When you exercise intensely, you can become very short of breath, but the air you breathe will not burn your lungs. Burning in your lungs, not relieved by slowing down, signals impending heat stroke.
When you feel that the air is so hot that it burns your lungs, stop exercising. This sign means that your heart cannot pump enough blood from your exercising muscles to your skin so heat is accumulating rapidly and your temperature is rising rapidly. Your temperature is now over 104 and continuing to exercise will raise your body temperature even further and it will start to cook your brain.
Your head will start to hurt, you'll hear a ringing in your ears, you may feel dizzy, you may have difficulty seeing and then you will end up unconscious. Your temperature is now over 106 and your brain is being cooked just like the colorless portion of an egg turns white when it hits the griddle.
Almost all cases of heat stroke occur when you suddenly increase the intensity of your exercise, like the finishing sprint. of a long distance running or cycling race, or an intense run down the field in soccer.
When a person passes out from heatstroke, get medical help immediately. Any delay in cooling can kill him. Carry the victim rapidly into the shade and place him on his back with his head down and feet up so blood can circulate to his brain. Cool him by pouring on him any liquids you can find or spray him with a hose. It doesn't make any difference what you pour on him: milk, Coca Cola, beer, or anything else. Evaporation of any liquid cools. As you cool him, he will then wake up and talk to you and act like nothing has happened. While he's sitting or lying there, his temperature can rise again and he can go into convulsions or pass out again, so he must be watched for at least an hour.
When you hear of a highly conditioned athlete dying of heat stroke, think of cocaine and amphetamines. An article in the Archives of Internal Medicine shows that a single nasal spray of cocaine blocks blood flow to the skin and sweating, to prevent a person from cooling his own body.
During exercise, more than 70 percent of the energy used to drive your muscles is lost as heat, so you heart has to pump extra blood from your hot muscles to your skin where you sweat, sweat evaporates, and cools your skin to dissipate the heat. The harder you exercise, the more heat your muscles produce. Everyone who exercises, particularly in hot weather, has to sweat to keep your body temperature from rising too high. Cocaine and amphetamines can kill exercisers by blocking sweating and blood flow to the skin.