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Medical evaluation and monitoring should be used to identify individuals at increased risk for heat disorders The public should be made aware of the early symptoms and signs of heat disorders It is not recommended to make salt tablets available for use without medical supervision; close monitoring of fluid and electrolyte intake and early intervention are recommended in situations necessitating exertion or activity in hot environments Athletic events should be organized and managed with attention to thermoregulation: the wet bulb globe temperature (WBGT) index should be monitored, fluid consumption should be encouraged, and medical support should be immediately accessible Competition is not recommended when the WBGT exceeds 26 28 C Workers should not begin work in hot temperatures without proper acclimatization and should be encouraged to drink water or balanced electrolyte fluids frequently Guidance regarding heat hazard can be found in the National Weather Service s Heat Index that rates weather conditions based on humidity and temperature measurements (wwwweathergov/om/heat/indexshtml) The US Army provides guidance regarding activity levels according to WBGT levels (wwwusariemarmymil/heatill/appendchtm) Acclimatization is achieved by scheduled regulated exposure to hot environments and by gradually increasing the duration of exposure and the work load until the body adjusts by producing sweat of lower salt content in greater amounts at lower ambient temperatures Acclimatization is accompanied by increased plasma volume, cardiac output, and cardiac stroke volume and a slower heart rate

The patient should be moved to a cool environment and given oral saline solution (4 tsp of salt per gallon of water) to replace both salt and water Because of their slower absorption, salt tablets are not recommended The victim may have to rest for 1 3 days with continued dietary salt supplementation before returning to work or resuming strenuous activity in the heat

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You can then see the offending document, as shown in Figure 10-11 Note in the display the Status column shows the check the document failed and should this field be empty, the document did not fail a credit check, even though it may be in the list of SD documents that are required to be released You can filter on the status, as well as adjust the layout of this report by changing its variant To release the document, select it and then click the icon of the little green flag (top right of screen in Figure 10-11) The offending document entry will be highlighted green Click save and you ll see a message that the document number 4000 has been released Other important functions related to the financial side of credit management are [FD10N] Customer balance display (which shows the customer credit/debit and cumulative balance as seen in Figure 10-12 [FBL5N] Customer line item display This is one of the mainstream financial accounting transactions It is useful to view the customer s open items on a specific date [F-28] Reset customers credit limit This calls program RFDKLI20, and may be used to re-create the customer s FI and SD credit-related data

Heat exhaustion results from prolonged strenuous activity with inadequate water or salt intake in a hot environment and is characterized by dehydration, sodium depletion, or isotonic fluid loss with accompanying cardiovascular changes The diagnosis is based on prolonged symptoms and a rectal temperature over 378 C, increased pulse (> 150% of the patient s normal) and moist skin Symptoms associated with heat syncope and heat cramps may be present Nausea, vomiting, malaise, and myalgia may occur The patient may be quite thirsty and weak, with central nervous system symptoms such as headache, dizziness, fatigue and, in cases due chiefly to water depletion, anxiety, paresthesias, impaired judgment, hysteria, and occasionally psychosis Hyperventilation secondary to heat exhaustion can cause respiratory alkalosis; lactic acidosis may also occur due to poor tissue perfusion Heat exhaustion may progress to heat stroke if sweating ceases Treatment consists of patient location in a shaded, cool environment, providing adequate hydration (1 2 L over 2 4 hours), salt replenishment orally, if possible and active cooling (fans, ice packs, etc) if necessary Physiologic saline or isotonic glucose solution should be administered intravenously when oral administration is not appropriate Intravenous 3% (hypertonic) saline may be necessary if sodium depletion is severe At least 24 hours of rest is recommended

Sudden unconsciousness can result from volume depletion and cutaneous vasodilation with consequent systemic and cerebral hypotension Systolic blood pressure is usually less than 100 mm Hg, and there is typically a history of vigorous physical activity for 2 hours or more just preceding the episode The skin is typically cool and moist, and the pulse is weak Treatment consists of rest and recumbency in a cool place and fluid and electrolyte rehydration by mouth (or intravenously if necessary)

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