Why Do We Cover A Patient In Shock?

Hello Rescue Fans!

In this unedited video, I talk about and explain why we cover a patient who may be showing signs of shock after this question came in by emashockblanketil.  Remember, it’s important to help the patient feel comfortable, cared for, and safe as best as possible.  But physiologically speaking…keeping the patient warm helps prevent hypothermia “which shifts the oxyhemoglobin dissociation curve to the left, impairs oxygen delivery, and exacerbates the shock state.”(http://www.ebmedicine.net/topics.php?paction=showTopicSeg&topic_id=110&seg_id=2113)  And in the end, the fact that the person feels well cared for can help them become less anxious and do better through the traumatic event.  Hope this helps.

I Broke My Wrist As A Kid, And Now It’s Starting To Hurt Again! Why?

I got another email from a Rescue Fan that asked about pain in the wrist that has recently become very bad.  He had injured the scaphoid bone in his wrist as a teenager, got a cast, took it off prematurely and then just recently began to really feel pain, numbness and discomfort in the same area.  I emailed him back and then thought there may be other’s with the same question due to the popularity of this type of injury. Here’s my email back to him.  I hope it helps.

Dear _____

I’m sorry to hear that you’re going through so much discomfort.  I looked up your injury and though nothing has told me anything you didn’t already know about this type of injury I’m including a video that may help refresh your memory.

In regards to the injury causing more problems.  You are always welcome to request a second opinion and may even want to find a good “sports medicine” Ortho Doctor.  It could be a number of things causing the pain but one reason is due to the possibility of developing “traumatic arthritis”, it could be Simple immobilization in a cast will not lead to healing of the bone. This scaphoid bone is particularly prone to this for several reasons: there is the possibility of the fracture being missed at the initial injury leading to a delay in treatment; secondly, the bone has a poor blood supply. The fact that it is inside the joint and is constantly being bathed by synovial fluid also contributes to the development of a nonunion. A nonunion, in other words, is a failure on the part of the patient’s bone to complete the healing process. A “false joint” occurs at the nonunion since the ends of the broken scaphoid are attached to ligaments at each end of the bone, further separating the fracture and preventing healing(http://www.arthroscopy.com/sp04013.htm). This can only be verified via thorough investigation by a qualified physician. In the mean time, rest, ice, elevation when possible and maybe even a splint of some sort can help to immobilize while on the way to the doctor to get to the bottom of the issue.

I hope this helps and I hope you’ll let me know what you find out.

Best Wishes,

Roy

Why Wouldn’t Someone Bleed Much After A Traumatic Amputation?

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.

Are Hot Dogs Dangerous?

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!

And For My Next Heart Attack, I’ll Take An Extra Dose Of Estrogen Please!

SaladAn article found in this news provider wrote that higher levels of the hormone estrogen are associated with an increased risk of sudden cardiac death in men and women, a new study suggests.  Could there be something to this or should we just blow it off as another scare tactic?  Well, when we consider all of the different ways humans get exposed to estrogen in the form of xenoestrogens(pronounced: zeno-estrogen and are a type of xenohormone that imitates estrogen. They can be either synthetic or natural chemical compounds.), it becomes quite clear that we have a problem on our hands and the side effects are coming to roost.

How do we become exposed to these synthetic or foreign hormones?  Well sit back and take a look at this pretty comprehensive list provided by a site dedicated to endocrinology.

* Commercially-raised, non-organic meats such as beef, chicken, and pork
* Commercial dairy products including milk, butter, cheese, and ice cream – Use only organic products that do not contain bovine growth hormone
* Unfiltered water, including water you bathe in – Use reverse-osmosis filtered water such as Dazani or get your own filter
* Laundry detergent – Use white vinegar, baking soda, or tri-sodium phosphate (TSP)… According to some experts, avoid even the Seventh Generation and Eco brands
* Dryer sheets and fabric softeners – Use white vinegar is a marvelous natural fabric softener, no smell after it dries
* Avoid Primpro, DES, Premarin, Cimetidine (Tagamet), Marijuana, and Birth Control Pills.
* Hormone replacement therapy (HRT)
* Progesterone creams made with paraben preservatives
* Soy
* Ground flaxseed – If you’re looking for the Omega-3 effect, use fish oil instead
* No sunflower oil, no safflower oil, no cottonseed oil, no canola oil – Use olive oil or grapeseed oil
* Avoid Tea tree oil (melaleuca) – I know, I love tea tree oil, this one is tough
* No lavendar oil
* Avoid coffee and caffeine
* Sage and rosemary
* Shampoos, lotions, soaps, cosmetics that contain paraben or phenoxyethanol – Almost all contain them, you have to look far and wide. Be diligent, you’re getting hundreds of times more exposure through your skin than through your diet. So far, I’ve found Kiss My Face brands to be okay.
* Shampoos that purposely include estrogen (these are shampoos that cater to the African-American market)
* Avoid reheating foods in plastic or styrofoam containers
* Avoid drinking out of plastic cups and containers
* Air fresheners that contain pthalates
* Avoid naturally occurring plant estrogens:

* Coffee
* Clover, red clover tea, alfalfa sprouts
* Sunflower seeds
* Queen Anne’s lace (wild carrot)
* Pomegranate – The Greeks used this plant as a contraceptive!
* Dates
* Fennel
* Licorice, red clover, yucca, hops (beer) and motherwort
* Bloodroot, ocotillo, mandrake, oregano, damiana, pennyroyal, verbena, nutmeg, tumeric, yucca, thyme, calamus rt., red clover, goldenseal, licorice, mistletoe, cumin, fennel, chamomile, cloves

* 4-Methylbenzylidene camphor (4-MBC) (sunscreen lotions)
* butylated hydroxyanisole / BHA (food preservative)
* atrazine (weedkiller)
* bisphenol A (monomer for polycarbonate plastic and epoxy resin; antioxidant in plasticizers)
* dieldrin (insecticide)
* DDT (insecticide)
* endosulfan (insecticide)
* erythrosine / FD&C Red No. 3
* heptachlor (insecticide)
* lindane / hexachlorocyclohexane (insecticide)
* methoxychlor (insecticide)
* nonylphenol and derivatives (industrial surfactants; emulsifiers for emulsion polymerization; laboratory detergents; pesticides)
* polychlorinated biphenyls / PCBs (in electrical oils, lubricants, adhesives, paints)
* parabens (lotions)
* phenosulfothiazine (a red dye)
* phthalates (plasticizers)
o DEHP (plasticizer for PVC)

(http://endojourney.wordpress.com/2009/07/31/a-list-of-xenoestrogens/)

When we think about some of the complications of high estrogen levels in either gender, including increased risk of hormone sensitive cancers, increased cardiac inflammation(http://onlinelibrary.wiley.com/doi/10.1002/iub.48/pdf), blood clot risk increase, and men have the same with the addition of impotence and infertility.

I’m glad to see there are more studies confirming that we have an estrogen problem in society.  And along with this, we are going to see many more complications of disproportionate sex hormones and their effects.  etc.http://endojourney.wordpress.com/2009/07/31/a-list-of-xenoestrogens/

It looks like organic and natural living isn’t just for enthusiasts anymore.  It’s something we should all be more aware of and do our part to begin living a healthier and happier life.

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

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.

What Do I Tell My Friend To Do If They Have An Asthma Attack?

This question came in via RoyOnRescue email.  They asked, what should I tell my friend to do if they have an asthma attack?
Here’s my answer.  I hope it helps.
asthmaHi S,

Asthma stinks!  But what’s worse is when we have an attack.  There’s no better treatment than management to prevent an attack.  Avoiding triggers, maintaining regular preventative medications and always having a rescue inhaler available that is not expired and not empty.  If a person is having signs of an attack, it’s never a bad idea to call 911 and then begin to treat the symptoms with their medications.  If the attack ends, becomes manageable and everything is fine, then the ambulance leaves and there’s no problem.  If the attack is persistent and the medications don’t work, one will never regret having called for EMS backup.   Remember,  you can always send them away, but we can never make up for lost time.

If a person is having trouble with their asthma(wheezes in or out or both, short of breath, tightness, having small attacks, more albuterol use than normal, has congestion or feels like their not able to move as much air(maybe they have a peakflow meter and it’s reading lower than normal) they should call their doctor.  Again, if they’re having an attack, call 911.  Don’t rely on home remedies and cold air.  Hope this helps.

Roy

Can A Person Be Struck By Lightning On A Porch?

In this episode, we take a look at what areas are safe to watch a thunderstorm from.  A question was asked about the safety of watching lightning from under a porch attached to a house.  They wondered if it was grounded just like the porch.  After researching a bit, I found that it is no more safe than being in a tent, a shed, or under a tree.  Take a look at this vlog and find out why it’s not safe to be outside when you hear the roar of thunder.

Tourniquet Use Deemed A Lifesaver During Boston Bombing Incident

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.

You Just Got Drain Opener Splashed In Your Eye. Top 5 Things To Do.

Chemical in EyeI just received a question from one of our Power Rescue Fans.  They asked:

“I just went through a frightening and painful experience at work the other night. I got splashed in my eyes with an acid based cleaner. I know some chemicals that can become more corrosive if water is applied, although that doesn’t go for all of them. What do you do in the case of first aid when you get any type of chemical in your eyes? Is irrigation always the first line treatment?  Thanks!”

What a great question.  You’re right about the concept that some chemicals could actually cause more damage when water is added. Take the case of phosphorous pentoxide, which can burst into flames upon contact with water,  or in the case of other dry alkali chemicals they may actually begin a chemical reaction upon water contact.  In most cases “dry” chemicals should be brushed off as best as possible, prior to irrigating with water. When it comes to eyes, the rule of thumb for most chemicals, not the least acid, is flush with sterile or clean water for a minimum of 15 minutes.

Here’s a list of the top five actions to take after you realize there’s an eye emergency:

1.  Stay calm and calm the patient with confident words like,  I’m Going To Take Good Care of You!

2.  Is the scene safe? If not,  wait until it is or get personal protective equipment

3.  Determine what type of chemical you’re dealing with and read the label for first aid or read the MSDS sheet

4. If the chemical exposure calls for dilution, begin flushing the effected eye(s) with clean or sterile water for at least 15 minutes

5.  Tell EMS providers what chemical you’re dealing with, wow much the patient was exposed to, and what treatment has been provided and for how long

The “eye-dia” sorry…is that we manually keep the eyelids open while we flush the eye(s).  This should be done in a way that won’t cause cross contamination of the non effected eye.  In other words, flush from inside to outside away from the non-affected eye.  Activate EMS (911 in the US and 999 in the UK as well as many other countries).  The EMS personnel should continue the flushing with sterile water or saline for the duration of the trip to the hospital.  Remember, “the solution to pollution is dilution.  P.S.  Don’t let hysterics get in the way of your treatment. Your patient is going to be scared, blind and really upset.  Besides all that…it probably hurts like fire in the eyes, but as rescuers, we have to do what needs to be done and that means holding the eyelids open while flushing.

Keep on Rescuing!