Roy on Rescue

Roy on Rescue

What Does An Actual Drowning Look Like And How Do We Help?

Posted on June 6th, 2013 by Roy Shaw

As in all accidental deaths, the more we know about how to prevent them, the better off we will all be. In this episode, I answer an email that asked if I could combine training with some more realistic visuals about how a person may actually look when they’re drowning vs. the hollywood melodramatic look. The rescue fan was concerned that many people may not even realize that a drowning victim could be very quiet and not really even yell for help.

I hope this training helps us all have a much safer summer of fun!

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Whoa!  I can hardly believe that anyone would dare to question the utter possibility of real people suffering after being affected by an explosion, but they are!  I received a comment from a Rescue Fan and they had seen posts and videos put out by someone who claims that the bombing injuries could actually be “mocked” or “fake”.  Now, regardless of whether they are or are not, I would like to answer this question regarding the claims that minimize this type of event.bloodclotfactor

Regardless, it appears that those who are questioning authenticity of the recent bombings and injuries/amputations related to these bombings are due to pictures that show people right after the bombing with little or no visible blood.

Most professionally trained people understand the properties of blood and how amazing our body is.  We understand that the body was created in such a way that it reacts to emergency situations in ways that help to slow down the process of shock and death in time to get help and try to recover from the injury or illness.  The following is a technical breakdown of how the body reacts to injuries, cuts and amputations and why minimal blood is not a good theory to use when it comes to deciding if a person really suffered an amputation or not.

In short, we must remember that when a vessel is cut and the body sends  the signal that an accident has occurred, the body takes action to lose as little blood as possible and conserve it’s life as efficiently as possible.  The following is a very good breakdown as to how and why it does.  I hope it helps and in the mean time.  Let’s be careful about calling every event a hoax even if it is possible.  Especially when innocent lives are part of the equation.

The 3 main functions of platelets are:
1. The release of chemicals important to the clotting process.
2. The formation of a temporary patch in the walls of damaged blood vessels.
3. Active tissue contraction after clot formation has occurred.
 Hemostasis
(the cessation of bleeding) consists of 3 phases:
1.the vascular phase
2. the platelet phase
3.the coagulation phase
The Vascular Phase
*Cutting the wall of a blood vessel triggers a vascular spasm which contracts the diameter of the blood vessel at the site of the injury for about 30 minutes (the vascular phase).
 During the vascular phase:
1. The endothelial cells contract and expose the underlying basal lamina to the bloodstream.
2. The endothelial cells begin releasing chemical factors (ADP, tissue factor and prostacyclin) and
local hormones (endothelins) that stimulate smooth muscle contraction and cell division.
3. The endothelial cell membranes become “sticky,” sealing off blood flow.
The Platelet Phase:
In the platelet phase (within 15 seconds after injury) platelets attach to sticky endothelial surfaces, basal laminae and exposed collagen fibers (platelet adhesion). Many platelets stick together (platelet aggregation) to form a platelet plug that closes small breaks.
Platelets arriving at an injury site become activated, releasing several compounds including:
-ADP
 which stimulates platelet aggregation
-thromboxane A2 and serotonin which stimulate vascular spasms
-clotting factors
-platelet
-derived growth factor (PDGF) which promotes vessel repair
-calcium ions required for clotting
The size of a platelet plug is limited to the immediate site of the injury by:
1. prostacyclin, which inhibits platelet aggregation
2. inhibitory compounds released by other white blood cells in the area
3.circulating enzymes that break down ADP
4. negative (inhibitory) feedback from high concentrations of serotonin
5. development of a blood clot which isolates the area
The Coagulation Phase
The coagulation phase does not begin until 30 seconds or more after the injury. Blood clotting(coagulation) involves a series of steps leading to the conversion of circulating fibrinogen into the insoluble protein fibrin. The fibrin network covers the platelet plug and traps blood cells, forming a blood clot that seals off the area.
Normal blood clotting depends on the presence of clotting factors(procoagulants) in the plasma. During the coagulation phase, enzymes and proenzymes react in chains or
cascades that form 3 pathways:
1. the extrinsic pathway, which begins in the vessel wall, outside the blood stream
2. the intrinsic pathway, which begins with a circulating proenzyme within the bloodstream
3. the common pathway, where intrinsic and extrinsic pathways converge
The extrinsic pathway begins with the release of Factor III or Tissue Factor(TF) by damaged cells. TF combines with a series of other compounds which activate Factor X, the first
 step in the common pathway. The intrinsic pathway begins with the activation of enzymes exposed to collagen at the injury site. All factors leading to the activation of Factor X are found within the blood.
The common pathway begins with the activation of Factor X, forming the enzyme prothrombinase which converts the protein
prothrombin to the enzyme thrombin. Thrombin converts soluble fibrinogen to insoluble fibrin.
 Thrombin stimulates blood clotting by:
(1)stimulating the formation of tissue factor, and
(2)stimulating
the release of PF.
(3) which forms a positive feedback loop with the intrinsic and extrinsic pathways,
accelerating clotting.

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Are Hot Dogs Dangerous?

Posted on May 30th, 2013 by Roy Shaw

I received an email a couple of weeks ago by a well known television news show.  They asked if I could help them with the topic of choking and specifically on hot dogs.  I liked the idea and though they didn’t need the training I put together, I thought you all might benefit from it.  In producing this training, I found that kids choke 60% of the time on food!  Did you also know that of that 60%, 17% of the time it’s a hot dog?  I thought it would be helpful for you rescue fans so I thought I’d share it with you.  In this episode we discuss why kids choke on hot dogs, how kids choke on hot dogs, how to help prevent kids from choking and what to do if it happens.  Get summer safe by catching up on this latest episode of RoyonRescue right now!

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Why Is Smog So Dangerous In Los Angeles In the Summer?

Posted on May 13th, 2013 by Roy Shaw

A rescue fan wrote in and asked, “Why is smog worse in the summer in Los Angeles?”Smog in Los Angeles

I did a little research and found the following.  I hope it helps.

SMOG, nicknamed in the 19th century for the “smoke” and “Fog” found in London due to coal burning fireplaces and furnaces and low hanging fog can be a real problem with increased pollution.  One of the reasons smog is so dangerous is due to the fact that many times higher than the safe level of pollution particles hangs in the air like a nebulizer mist.  when inhaled, this polution can get into our blood stream and effect our whole body and vital organs.  There has been a lot of concern about this especially in China.  Over 8000 deaths have been attributed to SMOG in China and I’m sure that long term affects are even worse.
In an article by the “The Daily Green”, it stated that, “ozone needs heat and sunlight to form from its precursor chemicals. That’s why you hear warnings about air pollution most often on hot sunny summer days. But be aware: Ozone persists for hours after forming, so unhealthy conditions often last well into the evening, after the sun has gone down. Also be aware that ozone isn’t the only pollutant out there. Another major cause for concern are fine particulates — dust and soot, but also tiny chemical droplets. Particulates can cause air pollution problems year round, especially since furnaces and wood-burning stoves can produce unhealthy levels in the winter.”(http://www.thedailygreen.com/environmental-news/latest/ozone-air-pollution-smog-0706)china smog

China too has hit an all time high in air pollution and a complication with Smog.(http://www.cnbc.com/id/100456949)  It is said that High levels of air pollution in China’s cities leads to 350,000-400,000 premature deaths.(http://news.bbc.co.uk/2/hi/asia-pacific/6265098.stm)

So what can be done if you find yourself “socked in” by a cloud of toxic particulate?  Well, depending on the chemicals in the air, we could walk around with particulate filtering masks designed with the appropriate micron filter.  But this is not sustainable.  It is helpful however, if you find yourself in such a slichenituation.  It would be wise to view it like any hazardous environment and try to escape as soon as possible.  One should be aware that some of these chemicals can enter our bodies via  eyes, nose, mouth, food, water and in some cases the skin or breaks in the skin.  So, the next time you go outside and can take a deep breath of fresh air and view the nice minty green lichen growing on the north side of your trees, be sure to thank God that you don’t have to deal with terrible conditions of these very polluted locations.  Oh, but remember, air moves smogmaskeverywhere and it eventually affects us all.  So, don’t forget to call your government reps and let them know you’re thinking about them and the anti pollution policies their voting on.  Here, and everywhere else too!

Here’s a News Video About The China Smog.

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In this episode, I take a closer look at the reasons that tourniquets were so important during the Boston Marathon bombing aftermath. Injuries were similar to those seen on the battle field and the battle field has trauma that requires immediate hemorrhage treatment and usually includes a long transport time. In the case of the bombing, we saw a very similar landscape. Though we don’t use tourniquets often in peaceful situations, there can and may be times where a tourniquet could mean the difference between life and death. Watch this episode to sharpen your skills on how to apply an effective tourniquet.

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Fellow Workers Credited For Saving Co-Workers Life With CPR

Posted on March 26th, 2013 by Roy Shaw

This video covers a story of how a person’s life is saved because others cared enough to try CPR. Watch this video and be encouraged that you never know when you may need to use CPR skills. If you want to learn CPR today, go to www.profirstaid.com and click on the training tab at the top of the site. Then watch the videos for free, and learn what to do in case of an emergency. It really can make a difference! It did in this person’s life.

Keep On Rescuing,
Roy

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I wanted to share this video with you.  We know sudden cardiac arrest happens almost every 2 minutes to someone in the U.S. but we rarely get a chance to watch a real cardiac arrest occur, see the rescue caught on a security camera and then hear the patient talk about his experience so that everyone can learn from it.  If you or someone you know does not know how to provide CPR, please go to www.profirstaid.com and watch the free CPR training by clicking on the training video tab.  Or simply click here after  you watch the video below.

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Lindsey Vonn Super G Skiing Accident Medical Breakdown

Posted on February 7th, 2013 by Roy Shaw

 

newskicrashthumb

In this episode of RoyOnRescue, I take a look at the details of the recent Lindsey Vonn skiing accident and what mechanism of injury caused the serious knee injury she suffered. Watch actual footage of the accident while I comment on how the crash caused her injuries. Then, discuss what steps you might take to minimize further damage and what you would do as the rescuer on scene prior to air evacuation.

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Question: Why Dont We Check ABC’s Anymore?

Posted on January 14th, 2013 by Roy Shaw

In this blog,

20130114-192805.jpg
I answer a question that came in about why we don’t teach lay rescuers to check for pulses after AED shock. This student thought that we were trying to trick them but in reality, the new standards are what may be tricky. Here’s my answer, I hope it helps.

Hi Shelley,

Thank you for taking the time to comment about the training. I’m writing In regards to your question about AED use and then checking for “signs of life” vs checking for Airway, Breathing and Circulation. Id like to assure you that as wrong as it may seem to do CPR without checking for pulses first, the training you received from ProFirstAid.comis based upon the latest guidelines set forth by the American Heart Association and are correct.

The old standards were to shock with AED Training and then assess for Airway, Breathing and Circulation, if no pulse give CPR. The new standards have eliminated pulse checks for lay rescuers in order to simplify and hopefully reduce pulse check “mistakes”. This is designed to shorten time from arrival of help to first chest compression.

Now, if your feeling a little confused, don’t feel bad… many of us do when there are changes. Be assured that most people who are unconscious, not breathing normally and have received a shock are most probably in cardiac arrest and CPR is called for. Besides, studies show that chest compressions when not needed rarely ever cause severe harm. Better to error on the side if giving CPR.

This however, is the reason for change in training and per the AHA standards it is accurate.

I’d be happy to explain further and in more details if you like.

Best Wishes,

Roy Shaw, paramedic, instructor
ProTrainings.com

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What Is Cerebral Venous Sinus Thrombosis?

Posted on January 12th, 2013 by Roy Shaw

Hello Rescuers!

I received an email from a RoyOnRescue friend who had suffered a head injury while playing a sport.  After being seen by the doctor he was diagnosed with Cerebral Venous Sinus Thrombosis or (CVST).  He had asked me if I would give my explanation of what it is and if it was something he should be worried about.  His doctor had exCSVTplained it but he was still a bit foggy regarding the diagnosis.  Well, after looking into it from the clinical perspective, I realized that it was a pretty big deal and in some cases may be fatal.  I researched multiple sources to gather credible information and when it all came down to brass tacks, I found that the Wikipedia explanation had done a pretty dog-gone good job of summarizing CSVT.  So, with all credit given to them for most of this article and a link back to their website, here it is.

I have personally responded and treated many different types of head injuries as a paramedic but had not researched this problem to this level.  Then, shortly after receiving this question, I read that  Secretary of State, Hillary Clinton was diagnosed and hospitalized with the very same problem secondary to her head injury!  Ironic.   So, I thought to myself, if two people experienced this problem secondary to a common traumatic head injury(concussion), there may be more with the same question.

Here’s my trimmed-down version of what it is, what it’s symptoms are, how to determine if it is truly CSVT and then what a person may want to do if they think they may be suffering from such a complication.  So let’s dig into some of the questions you may have!  P.S.  You’ll notice there are more links then usual in this article.  The topic is so complex and has so many different facets I thought it wise to allow you to do some of your own information mining and hope the links make it easier.

Q:  What is a cerebral venous sinus thrombosis anyway?

A:  A CVST is the presence of thrombosis (a blood clot) in the dural venous sinuses, which drain blood from the brain. 

Q:  What causes a CVST?

A:  There can be many causes of CVST.  Here is a few I included:

Q:  How might I know if I have a CVST?

A: Headache that may worsen over the period of several days, but may also develop suddenly.  Strangely the headache may be the only symptom of cerebral venous sinus thrombosis.  Stroke, 40% of all patients have seizures, Common symptoms in the elderly with this condition are otherwise unexplained changes in mental status and a depressed level of consciousness.  The pressure around the brain may rise, causing papilledema (swelling of the optic disc) which may be experienced as visual problems.  In severely raised intracranial pressure, the level of consciousness is decreased, the blood pressure rises, the heart rate falls.  This is a common symptom found in closed head injuries which makes sense as the mechanism is very similar.

Q:  How will the doctor know if this is what I have?

A:  The most commonly used tests are computed tomography (CT) and magnetic resonance imaging (MRI), both using various types of radiocontrast to perform a venogram and  visualise the veins around the brain

Q:  How is a CVST treated and cured?

A: Treatment is with anticoagulants (medication that suppresses blood clotting), and rarely thrombolysis (enzymatic destruction of the blood clot). Given that there is usually an underlying cause for the disease, tests may be performed to look for these. The disease may be complicated by raised intracranial pressure, which may warrant surgical intervention such as the placement of a shunt.

Q:  Can this be serious?ambulance

A:  Yes.  Like any illness or injury that causes a problem with the circulation of oxygenated blood to our tissues, this type of problem can be very dangerous if left untreated.  It also runs a risk of complication in that it raises the intracranial pressures which can act similar to a closed head injury and this too can cause severe injury or death.  If a person has any of the symptoms listed above, they should be seen as soon as possible to rule out this potentially life threatening disorder.  If a person is reacting with decreased level of consciousness, or any type of life threatening complications, activation of Emergency Medical Services or 911 should be immediate with life saving or time buying intervention given.

 

I hope this helps and keep well!

See Source:

http://en.wikipedia.org/wiki/Cerebral_venous_sinus_thrombosis

http://neurology.jwatch.org/cgi/content/full/2007/515/2

http://www.medscape.com/viewarticle/705510_3

 

 

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