Staying Safe In The Heat

Posted on July 23rd, 2010 by Roy Shaw

QUESTION:

“It’s so hot where we live and it seems that we have elderly people who suffer most when it gets hot and humid.  Is there anything I can do to stay cool myself and maybe even help someone who is having a heat related health problem?”

Signed,

Melting in Florida

Dear Melting,

Benjamin Franklin once said “An ounce of prevention is worth a pound of cure.” This saying applies to many different health care related scenarios, heat related emergencies certainly not the least of them.

When staying safe and healthy in hot and humid weather it is important to understand what types of environments will put one at risk.

To get started, let’s take a look at how a heat index works.

A heat index combines air temperature with relative humidity as a way of determining how hot a person feels.  A person feels hotter in more humid climates because the moisture in the air does not allow one’s perspiration to carry the heat generated by the body away and evaporate as easily.  When the body cannot cool itself by perspiration and evaporation, the body’s temperature rises and one may feel less comfortable or may even lead to more serious heat related problem.

An example of what could take place in certain heat indexes are as follows:

1. 80–90 °F  Caution — fatigue is possible with prolonged exposure and activity. Prolonged activity could result in heat cramps.
2. 90-105 °F  Extreme Caution — heat cramps, and heat exhaustion are possible.  Prolonged exposure and activity could result in heat stroke.
3. 105-130 °F  Danger — heat cramps, and heat exhaustion are likely; heat stroke is probable with continued activity.
4. Over 130 °F Extreme danger — heat stroke is imminent.                                                                                                                                                                                               (Please note that these are shade values.  Exposure to direct full sunshine could increase these heat values by more than 10 degrees.) Closely paraphrased from the public domain article Heat Index on the website of the Pueblo, CO United States National Weather Service.

Most individuals can indeed acclimatize to heat which will help the body tolerate hotter conditions with less stress to the body.  This process for normal healthy individuals usually takes about 5 -7 days.  This should be done gradually and with a person maintaining good hydration.  A person is capable of sweating up to 2-3 gallons of water per day in hot conditions and cannot rely on the thirst drive in order to know when to drink.  During heavy sweating, a person should be drinking approximately 5-7 ounces every 15 minutes 20-30 ounces per hour in order to replenish lost fluids.  Valuable electrolytes such as sodium, calcium and potassium may be lost during heavy perspiration and should be replaced with proper nutrition and diet. http://www.cdc.gov/niosh/hotenvt.html

Those who are most vulnerable to these heat indexes include:

• infants,
• the elderly (often with associated heart diseases, lung diseases, kidney diseases, or who are taking medications that make them vulnerable to heat strokes),
• athletes, and
• outdoor workers physically exerting themselves under the sun.

or

Those who do not have means for escaping the heat.  Some examples of how to escape the heat include:

1. Circulation of air by fan or ventilation,
2. Accessing lakes, ponds or pools
3. Air conditioning or subterranean cooling like a vegetable cellar or cool basement.
4. In certain cases, placing ice bags under arm pits or around the neck or over other arteries like the wrists, ankles, top of head which may help in cooling core body temperatures.
5. Cool or tepid bath water or a cool shower

If an individual does not have means of cooling and succumbs to the heat they may be suffering from heat fatigue, heat exhaustion or heat stroke.  Let’s take a look at each of these and how to treat each problem.

Definition Heat Fatigue: The signs and symptoms of heat fatigue may include heavy sweating, muscle weakness, tiredness, and impaired performance of skilled sensorimotor jobs.

Treatment:  Remove from heat, encourage water intake and good healthy nutrition and allow person to rest.  Allow person to acclimatize longer to increased heat environment.

Definition Heat Exhaustion: The signs and symptoms of heat exhaustion may include all of the above with the addition of heat cramps in legs, abdomen, back, calves and arms, headache, nausea, vomiting, dizziness, confusion and lethargy.

Treatment:  Remove from heat, encourage fluid intake, loosen clothing, poor water over persons body to soak clothing and begin cooling persons body. Monitor person for unresponsiveness, difficulty breathing or cardiac arrest.  If person is not improving with treatment or symptoms worsen, activate EMS or 911.  Heat exhaustion can become heat stroke if body temperature is not reduced.

Definition of Heat Stroke:   All of the above for heat exhaustion but usually progress to the following:

• high body temperature
• the absence of sweating, with hot red or flushed dry skin
• rapid pulse
• difficulty breathing
• strange behavior
• hallucinations
• confusion
• agitation
• disorientation
• seizure
• coma

Treatment: Remove person from source of heat, loosen clothing, begin cooling the person’s body safely as soon as possible in order to lower body temperature.  Nothing should be given by mouth once the person cannot drink safely on their own.  Activate EMS/911 and support with CPR and First Aid for life saving measures. http://www.medicinenet.com/heat_stroke/article.htm

So, next time you’re planning a trip out into hot conditions, take a moment to check the heat index and formulate a plan for protecting, preventing and treating yourself and others who might fall to heat related emergencies.  Oh, and if you know someone who may be vulnerable to hot weather, see if you have an extra fan, or maybe even give them some tips on how to cool down right in their own home.  You could just find that you have some rescue hero in you too.

Tags: cooling down, dehydration, environmental emergencies, fatigue, Heat, Heat Exhaustion, heat fatigue, heat headache, Heat related emergencies, Heat Stroke, hot climates, hot weather, how to get cool, humid weather, lowering temperature, ProCPR, procpr.org, ProFirstAid, ProFirstAid.com, royonrescue, royonrescue.com, staying cool, Staying Safe in the Heat, sweating

Shock and the Capillary Refill Test

Posted on July 9th, 2010 by Roy Shaw

In this RoyOnRescue Video Blog, a student had emailed Roy a question about explaining the Capillary Refill Test and how it may relate to determining if someone is suffering from shock.
Be sure to watch this episode of RoyOnRescue and learn a new trick that could either tell you if someone is going into shock, or that their hands are simply cold.
There are three main reasons why a person may have more than a 2 second capillary refill time:
1. Shock
2. Peripheral Vascular Disease
3. Hypothermia or cold hands
This slow capillary refill time of more than 2 seconds should only be an indication that we should check for other problems. Please don’t assume simply because someone has a slow cap. refill that they are going into shock. It is simply a quick and easy test to help point a first aider in the right direction and to tell us we should check for other issues.

Tags: Capillary Refill, Capillary Refill Time, cold hands, early signs of shock, how to test for shock, hypothermia, procpr.org, ProFirstAid.com, royonrescue, royonrescue.com, shock, signs of shock, treatment for shock

Knitting Needles and Puncture Wounds?

Posted on June 11th, 2010 by Roy Shaw

Knitting Needles can be the source of warm mittens, cozy scarves and comforting winter sweaters.  They can also become sharp pointed weapons or injury causing spikes when fallen upon or when they are thrust into the face, neck, chest or abdomen due to a car accident or accidentally falling onto them.  In this RoyOnRescue episode, we take a look at the hidden danger of sharp pointed objects that usually remain harmless but when not respected and carried safely, they could cause great harm.  Learn about the dangers of pointed objects and how to keep knitting needles a source of pleasure not pain.

Tags: breathing, chest injuries, CPR, CPR on Chest Injuries, impailed object, impaled knitting needle, impaled objects, Knitting Needle injuries, Knitting Needles, open chest wounds, patient assessment, ProCPR, procpr.org, ProFirstAid, ProFirstAid.com, rescue breathing, Roy Shaw, royonrescue, sharp objects, Sucking chest Wounds

Giving CPR to People With Bleeding Chest Injuries

Posted on June 7th, 2010 by Roy Shaw

I received an email that I think we can all benefit from.

It read…

“Since most of the first aid measures for a no pulse, no breathing situation is immediate CPR, is it alright to do CPR if the victim has a wound on the chest that is bleeding profusely? This is not that I have seen this situation, but I like to think that if it happens I would know what to do!”
C. H.

That’s a great question C.   Sometimes it’s easy to get distracted by a serious traumatic injury and forget the basics and what needs to be done first in order to try and save the person’s life.  Or, we can look at a complicating injury such as a chest wound and think,  How am I going to do CPR on this person, there chest has a serious bleeding wound right where I’m going to give my compressions?

In this episode of RoyOnRescue we are going to look a proper treatment plan if we ever came across a person who had a serious chest injury and needed CPR.

Tags: bleeding and CPR, Bleeding Chest, Cardiac Arrest, chest injuries, Chest trauma, CPR, CPR and Traumatic chest injuries, CPR on Bleeding Chest, impailed objects in chest, open chest wounds, personal protective equipment, procpr.org, ProFirstAid.com, protection from blood, rescue breathing, royonrescue, Trauma and CPR, traumatic cardiac arrest

Heat Exhaustion vs. Heat Stroke

Posted on May 14th, 2010 by Roy Shaw

In this RoyOnRescue, I reply to a question a student emailed me about how to recognize heat exhaustion and heat stroke and how to treat both.   If you ever wondered if a person was just “over heated” or if they might be in danger of suffering a life threatening heat stroke, you will want to watch this video blog reply.

In some parts of the country it doesn’t feel very hot but don’t be fooled…Summer is just around the corner.  Be ready and don’t allow you or someone you love to become a victim of Heat Stroke!

Tags: Heat Exhaustion, Heat Stroke, how to treat heat stroke, ProCPR, ProFirstAid, Roy Shaw, royonrescue, Symptoms of heat exhaustion, symptoms of heat stroke

How to Deal With Death When CPR Doesn’t “Work”

Posted on May 12th, 2010 by Roy Shaw

This response was written after receiving an email from a person, who has a cousin that is a trained CPR provider and attempted to save their own father’s life with CPR but their father remained dead despite their efforts.  This person felt badly and didn’t know what to say to their cousin to help them not feel guilty or that their father’s death was in some way the rescuer’s fault.  I responded to them, and afterward, felt that my response may be helpful to others who have suffered or are suffering or asking themselves the question, “Was there more I could have done?”.   I hope that this response will be of help to anyone who may have feelings of failure or guilt as a result of their cpr efforts not ending in the survival of the patient.

Student’s Email Question:

(Paraphrased to protect students identity)

Dear Student,
One of the most important things to remember when providing CPR to anyone let alone a loved one, is that people who need CPR are already in a state of death.    When the person is not breathing and they don’t have a pulse strong enough to detect  with obvious signs of life, they are clinically dead.  From the point of clinical death, they are only a short distance from biological death, which is permanent.

One way of looking at the success of CPR, regardless of the outcome, helps me and I believe helps my students to be much more at peace with themselves.  The fact that your cousin’s Dad did not survive cardiac arrest has very little to do with the CPR given to him.  It’s important to remember that CPR, in and of itself does not save anyone’s life directly.  CPR is designed to “Buy Time”.  CPR only provides about 25% of the oxygen circulation that is required for someone to stay alive biologically.  CPR was never designed to be life support viewed as a way to keep people alive indefinitely, but rather to slow down the process of clinical death to biological death.  This is to provide a chance to intercept the patient with electrical therapy, advanced therapy and medications combined with CPR and time to fix the underlying problem which caused the person to die in the first place.

In my opinion what your cousin did, is give his Dad the best chance of survival possible if he was indeed going to survive.  Let’s look at clinical death as a heavy iron gate that is slowly dropping to the ground, and once closed the person is biologically or permanently dead.  CPR is like arms holding the heavy gate of possible survival open a bit longer.  Again, not stopping the progression of clinical death to biological death, but slowing it down so that if there is a chance of survival, they would have the greatest opportunity of slipping back through the gate available.  Eventually, the gate is going to close even if CPR is perfect.  As I said earlier, CPR in and of  itself is not enough to keep the human body alive.  But if the person is going to survive and the person needs more time, CPR buys the precious time required to make this a reality.

Now, it’s  important to remember a simple but powerful truth.  Everyone dies.  I have had patients that had everything go right in order for them to survive a cardiac arrest and they still remained dead despite our rescue efforts.   That day was their day to die and nothing that the cpr providers, paramedics, nurses or doctors did changed the outcome.  The CPR helped keep them viable long enough for the rescue and medical team to try and fix the underlying problem but the person remained dead.  I had to realize that as a professional rescuer and paramedic, everyone has a day to die.   It’s not my job to save everyone but it is my job to give everyone the best chance of  survival possible.  When I provided care to cardiac arrest patients, I provided care to them as if they were suppose to survive and didn’t give up hope unless they proved to me otherwise by not surviving.  It may be frustrating but we  just cannot know what day is the day a person is going to live or die until the outcome is evident.

I’m quite sure that no matter what I say, your cousin is really missing his Dad.  I don’t think there is any amount of explanation of science, death, dying and CPR that’s going to change that.   One thing I do know about what your cousin did the day he provided CPR for his Dad though, he showed others and his Dad how much he loved him.  How much he really cared.  Your cousin gave his Dad his own strength when his Dad didn’t have any of his own.  In my opionion, that’s one of the most loving and unselfish ways to tell a daddy goodbye.

May God bless your cousin and all hurting friends and family during these difficult times.

Sincerely,

Roy Shaw, ProCPR, LLC
RoyOnRescue.com

Tags: CPR, cpr didn't work, cpr on mom, cpr on parent, dad died, dealing with death, death after CPR, death of loved one, depression, depression after death, failed CPR, failed rescue attempt, father died, mom died, ProCPR, royonrescue, royonrescue.com, survivor's depression, tried cpr

New York Stabbing Victim Ignored Death

Posted on April 26th, 2010 by Roy Shaw

“On the surveillance video, a woman is followed by a man, who then appears to accost her.

Tale-Yax walks toward them. What can’t be seen is him being stabbed several times in the torso while trying to save the woman.

Within seconds, the camera captures the apparent attacker running away. Authorities say the woman fled from her assailant.

Tale-Yax, who was homeless, starts to chase the attacker but then collapses.

A minute later, a potential good Samaritan walks right by. And so does the next person and the one after that. A procession of more than 20 people seem to notice and fail to help.”

ABC Video and News Story of Stabbing Victim Ignored

Source: abcnews online

In this Roy On Rescue Video Blog, Roy W. Shaw, EMT-Paramedic explores a most disturbing news story about a man who comes to the aid of a woman being mugged, gets stabbed himself and then is left on the sidewalk to die.   The most disturbing part of the whole story is that approximately 20 people walked, drove or rode their bicycle by the dieing man without doing anything to help.

Roy get’s a bit serious in this episode but wants to make sure that if there is a reasonable doubt about getting involved to save another’s life and one is being stopped because of a misconceived fear, that fear must be removed before another person needlessly dies.

Don’t let one of these fears stop you from rescuing:

1.  Lawsuit

2.  Catching a Disease

3.  Unsure of What To Do

4.  Might Hurt or Kill The Person by doing something wrong

5.  Dangerous Environment (Legitimate)

Roy dissolves the misconceptions and misunderstandings of these top fears and hopes that if you know someone that may not rescue due to being afraid to try, you will pass this story on to them!

If you’re reading this or watching video right now, you are probably one of the ten percent of the total population that this story doesn’t apply to.  That’s why we know we are probably “preaching to the choir” but Roy is sure that you probably know someone that wouldn’t get involved in a rescue.  Please pass this on to them.

Tags: abc news good samaritan dies, abc news new york stabbing, cpr instructors, fears of rescue, five fears, Good Samaritan Died, good samaritan left for dead on city sidewalk, Good Samaritan left to die, Good Samaritan stabbed, Good Samaritan stabbed and ignored, New York Stabbing, New York Stabbing Victim, ProCPR, ProFirstAid, royonrescue, surveillance video stabbing

What’s A Seizure And How Do I Treat It?

Posted on April 16th, 2010 by Roy Shaw

Seizures can be caused by many different things and though they don’t mean that the person has a serious condition, it is important to know what to do during and after a person has one.  A student wrote in asking if I could give  some additional information about how to handle a person who is having a seizure.   Though it seems complicated when you’re watching a seizure in progress, the treatment plan is quite simple.

1. Protect the person while they are having a seizure.

2. If this is the first time this person has ever had a seizure, call 911 or EMS.

3. Treat the patients needs after they stop having a seizure.

4.  Wait for EMS to arrive and takeover.

For a detailed training on seizure first aid, go to www.profirstaid.com and click on the video review tab at the top of the page.  Then search for the topic of seizures, get your favorite beverage and watch the video training.

Until next time…

Roy

http://www.epilepsyfoundation.org/answerplace/medical/seizures/types/

Tags: epilepsy, how to treat seizures with first aid, ProCPR, procpr.org, ProFirstAid, ProFirstAid.com, royonrescue, royonrescue seizures, seizure, seizure foundation, seizures

Gasping For Life!

Posted on March 26th, 2010 by Roy Shaw

If an unconscious person is gasping but not breathing normally should you call 911 and leave them alone, or should you begin aggressive CPR?  In this Video Blog, Roy Shaw, EMT-P tells a true story about how a child may have died due to not having life saving CPR because she was showing signs of agonal breathing.  This caused the rescuer to stop the life saving CPR and ended tragically.
Watch this Video Blog to learn what agonal breathing is and how to respond to it.

http://www.theheart.org/article/924633.do

Tags: agonal breaths, agonal breaths and cpr, agonal respirations, CPR, drownings, Gasping, Gasping breaths, hands only cpr, ProCPR, ProFirstAid, pulse checks, rescue breathing, royonrescue, UK Child Dies When CPR Stopped, UK Lifeguard CPR

Can a Ball Hitting My Childs Chest Kill Him?

Posted on March 24th, 2010 by Roy Shaw

In some cases it has!  The velocity of an object striking one’s chest can cause a phenomenon that could disrupt the normal beating heart.  If this happens, everyone standing by should hope they can recognize it, and treat it.  Here’s how I got on this subject.

An email came in to our offices asking about more information regarding what happens when a child is struck in the chest or abdomen ,ith a ball, puck, bat or other hard object.

Sports can be fun but not when someone gets seriously hurt or dies.  One type of injury that is a real concern to everyone is cardiac arrest secondary to  chest trauma from a blunt object.  This can happen when a baseball, soccer ball, basketball, hockey puck, bat or person hits another persons chest with a great deal of velocity or force.(http://pediatrics.aappublications.org/cgi/content/full/122/2/437)   In some cases, it is suspected that if a ball or other object hits a person chest over the top of the location of the heart, the strike works somewhat like a technique that was once used to mechanically cardiovert a heart called a precordial thump(http://www.heartrhythmjournal.com/article/S1547-5271%2809%2900687-0/abstract).  This technique used force vs. electricity to create some form of rhythm or Arrhythmia/ Ventricular Fibrillation in order for the heart to be corrected so as to regain a purposeful and organized heart rhythm.  This technique though used rarely today, may be the effect that is causing sudden cardiac arrest in children and adults who are involved in a chest trauma from sports.   If this does happen, the person may collapse immediately and stop breathing with no palpable(you can’t feel it) pulse. If the person is in cardiac arrest or is not showing signs of life,  911/Activation of EMS and CPR should be started immediately and an AED may be very useful if the person is in a shockable condition.  If an AED is not present, CPR will be done continuously without interruption unless the person becomes conscious and begins to move or attempts to speak(signs of life).   Be on guard, bruising, punctured lung or other underlying conditions could cause the person to return to a state of cardiac arrest so frequent reassessments will be required until the person is turned fully over to the care of emergency medical services.   The best cure for this injury is prevention.  Many companies are designing and selling chest guards and protective devices to help prevent this condition from happening.(http://www.allsportsarmour.com/CHEST_ARMOUR_SHIRT_p/asa100%20dual.htm A well trained professional or volunteer coaching team in CPR and First Aid (http://www.profirstaid.com)would be highly suggested and an AED can be purchased for less than a laptop today.(ProFirstAid.com)

In comparison another condition related to a blunt trauma to the abdomen is a condition nick named, “getting the wind knocked out”.  This condition usually occurs when a person receives a blow to the upper center abdomen which is approximately where we provide inward and upward abdominal thrusts for a choking victim.  This area is physiologically perfect for compressing the diaphragm and compressing the lower lobes of the lungs.  This forces residual air out of the lungs and feels scary.  Normally, after a few minutes of one trying to breath deeply, fighting hard for that first real deep breath, the spasm releases in the diaphragm and air is gradually brought back into a normal state.  Complications related to this fairly common condition could include ruptured or torn internal organs.  If a person is hit hard enough, as in situations where a bat or object was used, or the lower half of a steering wheel which is common in unrestrained, non airbag vehicular accidents, the trauma could rupture/tear internal organs and even the descending aorta.  If the Aorta is torn or ruptured, it is well know to be a usually fatal injury as time to surgery is quite a few minutes away and one can loose enough blood internally to die from hypovolemia.  A condition where there is not enough blood to circulate oxygenated blood or maintain an adequate blood pressure  which leads to death if not corrected.  Treatment for this more serious condition is activation of emergency medical services while providing CPR, Shock Therapy(http://www.profirstaid.com) and minimization of movement.  A way to prevent this injury is to avoid the types of conditions that could present it.  Another way is to incorporate an aggressive core strength training program which will build strength in the abdominal muscles so as to help protect against sport related injuries.

It is important to consult with your health care professional or physician before beginning any intense workout program and if you are at all concerned that you or someone you know may have internal injuries, call 911/EMS and seek medical help.

Most of the signs and symptoms related to an internal injury in the chest or abdomen are severe pain that disables a person from performing normal behaviors.  Tender abdomen to touch, distending(bulging) belly, rigid or hard belly) bruising or marks over the abdomen or chest, shortness of breath or difficulty breathing, pale, cool, sweaty, increased anxiety, increased respiratory rate, dizziness, fear of dying and unconsciousness.  If any of these signs or symptoms are present or appear after an injury, activate the Emergency Medical Services immediately and/or seek medical help right away.

I hope this answers the question and I hope the next time you are by someone who is struck in the chest or simply gets the wind knocked out of them, you’ll better know what it is, what to do, and how to help.

Best Wishes,

Roy Shaw, EMT-P, RoyOnRescue

www.royonrescue.com

Tweet:  @royonrescue

P.S.  Here’s a link to  a real life scenario.  It’s worth the read Mom and Dad.
http://www.huffingtonpost.com/2008/05/19/family-of-boy-hit-by-base_n_102439.html

Tags: abdominal injury, abdominal strike, aed, baseball to chest, bat, Blow to Chest, blunt trauma to abdomen, blunt trauma to chest, cardiac arrest after hit in chest by baseball, chest injury, Child Cardiac Arrest, coaches, CPR trained, hit by baseball, hit in chest, hockey puck, hockey puck to the chest, kids and cpr, kids hit in chest, losing my wind, ProCPR, ProFirstAid, ProFirstAid.com, punch in stomach, punch to the gut, Roy Shaw, royonrescue, soccerball, Strike to Chest, Sudden Cardiac Arrest, wind knocked out, wind nocked out, wind nocked out of me, winded, youth sport injuries