My Top 3 “Oopsie” Chief Complaints
Sunburns
Yes, I have seen people check into the hospital for a sunburn. Unfortunately, while most sunburns never require medical attention, there are some instances in which you absolutely get that burn checked out. How do you decide? The simplest answer is blistering.
If your sunburn is deep enough to cause large blisters you are at higher risk for thermal burn complications. If your skin is this badly burned, your body has a harder time holding onto moisture and you may develop dehydration. Things to look out for include dry mouth, changes in urination, and any dizziness or confusion.
Try to pre-empt this attack by hydrating (with water or sports drinks) as much as possible from the very beginning of sun exposure and continuing for several days after a serious sunburn.
The next biggest risk with blistering sunburns is infection. This risk is higher a few days after the burn, as the blisters start breaking down. The underlying tissue becomes less protected and therefore more susceptible to common germs that are normally kept OUTSIDE the body. It’s also a little bit harder to notice initial signs of infection because your skin is already red and warm to touch from the burn. Pay attention to the puffiness of the skin around the blisters and any drainage from them. If the area becomes swollen, you notice green or yellow fluid coming out, and especially if you develop a fever, you may have a nasty bug making its home in your body.
Poison ivy
Calamine lotion can be purchased at any local drug store or big box store. Do yourself a favor and buy it before you need it. Keep a little stock in your first aid kit, okay? It’s the thick pink stuff that zaps every last bit of moisture from your skin. I have had patients check into the ER at 3am to get calamine lotion. Don’t be that guy.
Does poison ivy exposure ever require medical attention? Absolutely. When burned, the compound that causes the reaction can be retained in the smoke and it can react in your lungs when inhaled. If you have been around any burning and you develop trouble breathing, please seek medical attention right away and be sure to mention if you suspect poison ivy was in your burn pile.
The other risk is infection from skin compromise just like we discussed with sunburns. If you have a rash from poison ivy, absolutely DO NOT SCRATCH. Helpful at home treatments are topical creams such as calamine lotion, hydrocortisone creams, and colloidal oatmeal. One thing to note is that you should avoid topical antihistamines (benadryl cream) as it can actually make the rash worse. These days there is a cortisone cream that contains benadryl, it’s not advisable here. Cool compresses, and cool baths, especially oatmeal baths, are also helpful to fight the itching.
You may hear someone say they were prescribed an oral (pill form) steroid to combat a poison ivy rash. However, research only shows this being helpful if you start them before a rash ever develops, so it’s not a viable option in most instances.
Heat exhaustion / ETOH
What do the summer float trip, baseball games, and family cookouts all have in common? We usually don’t count how many beers we drink throughout the day. And while this is one thing in the bar after dinner, it’s quite another matter when we are out in the sun all day during the extreme heat of summer. I live in a town with NFL, MLB, and MLS teams, and at the height of summer there is never a shortage of patients checking in after they were at the stadium all day. Drinking. In the sun. At 100 degrees. For hours. And they just don’t know why they feel so dizzy, nauseated, and short of breath.
So here's why. Alcohol acts as a diuretic - it makes you pee more - and at the same time reduces the release of an antidiuretic hormone that normally tells the kidneys not to pee so much. The result is a double whammy of your body forgetting to hold onto any water. The reason it’s so much worse in the heat? Your body is also expelling moisture in an attempt to keep your skin cool. Through sweat, you are losing both water and salt, leading to dehydration. And even if you don’t think you are overly sweaty, it is the evaporation of sweat off your skin that cools you off, so a lot of sweat is actually evaporating off your skin before you really notice it.
Ready for the final punch? The symptoms of ETOH related dehydration issues are mostly cognitive - confusion, dizziness, lack of coordination, slurred speech… sound familiar? You may just think you had a few too many when you are actually experiencing dangerous dehydration. But don’t worry, I’m not going to ask you to give up your favorite drink at the 4th of July BBQ.
My advice to stay safe? Alternate your alcoholic beverages with 8oz - 12oz of water. Every time you finish a drink, finish a bottle of water before you reach for the next margarita. Additionally, remember the cooler your core temp, the less the heat will play a role. Be careful to cool off regularly when you are drinking in the heat. And wear sunscreen!