78 - Environmental Stress

Abstract

In this Environmental Stress chapter, heat illness, accidental hypothermia and local cold injuries including drowning and tsunami and finally altitude illness in the pilgrim population are discussed. Heat illness is a spectrum of disorders that ranges in severity from mild cardiovascular and central nervous system disturbances to severe cell damage in multiple organs. This spectrum includes heat cramps, prickly heat rash, heat syncope, heat exhaustion and heat stroke. Hypothermia, which is defined as a core temperature <35°C, can occur in countries with temperate and tropical climates, where it is often underdiagnosed. Hypothermia can mask signs and symptoms of underlying diseases. Drowning refers to respiratory impairment after submersion in water. Drowning kills about 500 000 people annually and is the most common cause of death caused by tsunamis. Although altitude illness is well described among trekkers, mountaineers and the porters who accompany them, there is a dearth of literature on local pilgrims to high altitude. Unlike most tourists sojourning to high altitude, pilgrims are often elderly people with comorbidities and hence may require more care. The clinical features, preventive measures and management strategies for these conditions are discussed in this chapter.