# Off duty treatment for possible heat exhaustion?



## jjesusfreak01 (Aug 28, 2010)

I ran into a situation today where a girl had collapsed in a snack line at an athletic event. I had expected that they would have sent over an athletic trainer to take care of her, but when I stopped by the only person giving care was an athletic training student I know and who had witnessed the fall. I stopped to help until EMS arrived to do a full checkup on her, but I am wondering what the best treatment is here before they arrive. 

The trainer had placed ice behind her neck when I arrived (she did collapse right in front of the snack stand), and a moist towel on the forehead. Her hands seemed a little clammy, but skin turgor and cap refill were both fine, and she claimed normal feeling in her extremities, and did not feel hot to touch. She briefly lost consciousness when she fell for a few seconds, and the trainer reported that she hit her head hard on the concrete surface. I checked and did not feel any hematomas on the back of the head. When medics arrived, they did a 3 position orthostatic BP test, and she was great in all positions. They found no step offs on the back or neck, and presumably nothing in the neuro test, because they observed her and then let her leave with another individual.

I asked the last time she had had anything to drink and she replied, "this morning", fall was around 1pm, so I had suspected dehydration due to the heat, but i'm not sure if any of the other signs pointed to dehydration. I'm not even sure if the medics had her drink anything before they let her go. 

Any thoughts on this situation? I am new to EMS, so i'm really looking for what you would check if you had no equipment and what you would do in caring for this patient.

Thanks!


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## clibb (Aug 28, 2010)

I've had a similar case happen to me when off duty.
Had an older lady (80s) who passed out on a river bank and hit her head while falling. I was the only EMT-B since the rafting company were only first responders. We c-spined and back boarded. Did a rapid exam on her. Found some bleeding in the back of the head. Nothing that's going to get too much of my attention. This was at around 10 am and she had coffee earlier in the day, that's all. So dehydration and heat exhaustion is the two things I suspected. I did a FAST stroke exam on her and she scored great. I put cold towels in her arm pits, by her lower extremities and one on her head. It helped her a little bit, but I was pretty much naked without equipment until the ambulance came.


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## Akulahawk (Aug 28, 2010)

I'd want to know how long she had been standing in line, and how warm the location was. If she'd been standing there for quite a while, and if it was a little warm... I'd expect that she just simply DFO'd like so many people do when they stand in one place, lock their knees and promptly decrease venous return. 

Given that her physical exam was OK and the 3 position orthos were fine, perhaps all she need is something to drink and perhaps a meal.


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## Seaglass (Aug 28, 2010)

I've had it happen a handful of times to me.

Without tools, there's really not much you can do. I've found that the most valuable thing you can do, in most cases, is to reassure the patient, make sure dispatch gets coherent information, and otherwise manage the scene. Then give a good report to the local responding agency when they arrive, confirm transfer of care, and get out of the way unless they want your help. 

Of course, assessments and whatever interventions you have available can be helpful. Just don't go overboard (like carrying a jump kit unless you actually get dispatched in your POV), get in the way of local responders (which people who carry that kind of stuff tend to do), or go beyond your scope of practice. 

If you just do first aid stuff, you're probably less likely to get sued or anything crazy. Most of the time, it seems like you won't really need to identify yourself as an EMT, either. People respond pretty well to anyone who seems like they know what they're doing.


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## jjesusfreak01 (Aug 28, 2010)

Akulahawk said:


> I'd want to know how long she had been standing in line, and how warm the location was. If she'd been standing there for quite a while, and if it was a little warm... I'd expect that she just simply DFO'd like so many people do when they stand in one place, lock their knees and promptly decrease venous return.
> 
> Given that her physical exam was OK and the 3 position orthos were fine, perhaps all she need is something to drink and perhaps a meal.



Hmm, I didn't know a DFO could be caused by something as simple as that, i'll remember that little piece of info. Would you expect that could happen even with a college age student? I don't think she had been in line all that long, and the snack area was a good bit cooler than the exposed bleachers (only because it was under the bleachers). The outside temp at the time was 85, but humidity was around 60%, so pretty nasty on the heat index. 

We also had athletic department officials there, and they were very adamant about no one helping unless they were certified. I was talking to the girl, and they were all like, "Don't do anything unless you're certified", and I was like, "I'm an EMT", and they were like, "A North Carolina EMT?", and I was like, "No, a Norwegian EMT...yes North Carolina" (ok, maybe I didn't say that last part, but I was thinking it). 

Like I said, all I ended up doing was turgor, cap refill, and a quick check for hematoma. I of course had immediately guessed dehydration before I even looked at the patient, so I was very happy for all indications to come back negative on that. After that I just babysat until EMS got there to do a better assessment.

I saw a girl at a track meet a few months ago pass out after a long distance race in the hot sun (it was the hottest day in memory that we had run the state meet). Actually, I saw her collapse twice, once after each of two races, but thats another argument for another thread. She was badly dehydrated and overheated, and 5 hours later when she left with her parents, she still wasn't totally with it, so I really really didn't want to see anything like that happen again.


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## JPINFV (Aug 28, 2010)

When I worked at a waterpark we had mild heat exaustion and mild dehydration all the time. Best thing to do is get them into the shade (inside with AC if possible), let them lay down, and get them something to drink. Take a few sets of vital signs and 99.99% of the time it all works out fine. Short of a BP cuff and stethoscope, there's really not much equipment you need for something like this.


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## LondonMedic (Aug 31, 2010)

jjesusfreak01 said:


> she was great in all positions.


I bet she was! Cheeky little minx. ^_^


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## clibb (Aug 31, 2010)

LondonMedic said:


> I bet she was! Cheeky little minx. ^_^



Haha, only someone from Europe would point that out.


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## Aidey (Aug 31, 2010)

Akulahawk said:


> I'd want to know how long she had been standing in line, and how warm the location was. If she'd been standing there for quite a while, and if it was a little warm... I'd expect that she just simply DFO'd like so many people do when they stand in one place, lock their knees and promptly decrease venous return.
> 
> Given that her physical exam was OK and the 3 position orthos were fine, perhaps all she need is something to drink and perhaps a meal.



AGA or Acute gravity attack. 

I have to admit the first time I heard "done fell out" I thought "fell out of what?!?!?!".


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## SauceyEMT (Aug 31, 2010)

LondonMedic said:


> I bet she was! Cheeky little minx. ^_^



But more importantly, was the girl attractive?


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## reaper (Aug 31, 2010)

jjesusfreak01 said:


> Hmm, I didn't know a DFO could be caused by something as simple as that, i'll remember that little piece of info. Would you expect that could happen even with a college age student? I don't think she had been in line all that long, and the snack area was a good bit cooler than the exposed bleachers (only because it was under the bleachers). *The outside temp at the time was 85, but humidity was around 60%, so pretty nasty on the heat index. *
> 
> .



Haha, High on the heat index!

I agree that she may have been a little overheated, but most likely just DFO'ed. Happens all the time. Take some vitals, check for injuries, and let her rest. If no prior hx, advise to see her Dr and let her go on her way.


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## Akulahawk (Aug 31, 2010)

jjesusfreak01 said:


> I saw a girl at a track meet a few months ago pass out after a long distance race in the hot sun (it was the hottest day in memory that we had run the state meet). Actually, I saw her collapse twice, once after each of two races, but thats another argument for another thread. She was badly dehydrated and overheated, and 5 hours later when she left with her parents, she still wasn't totally with it, so I really really didn't want to see anything like that happen again.


I'd have been far more worried about her than the DFO chick. I've seen athletes in similar situations... and one memorable one came just short of heat stroke. She got her groin, armpits, nape of the neck packed with ice bags. She also got IV fluids. Active cooling plus fluid in a timely manner prevented her from going into heat stroke. Seriously. If it had been any warmer out or she had to run any further (she was refusing water for the return leg of the race), she would have gone into heat stroke. She was VERY lucky we got to her as quickly as we did. Everyone involved in her care had sports med experience. Including the MD. That was his specialty.


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## jjesusfreak01 (Aug 31, 2010)

Akulahawk said:


> I'd have been far more worried about her than the DFO chick. I've seen athletes in similar situations... and one memorable one came just short of heat stroke. She got her groin, armpits, nape of the neck packed with ice bags. She also got IV fluids. Active cooling plus fluid in a timely manner prevented her from going into heat stroke. Seriously. If it had been any warmer out or she had to run any further (she was refusing water for the return leg of the race), she would have gone into heat stroke. She was VERY lucky we got to her as quickly as we did. Everyone involved in her care had sports med experience. Including the MD. That was his specialty.



That one still doesn't sit well with me. I had not yet taken my EMT class, so I really didn't have any medical knowledge, and we had two certified athletic trainers on the scene, so I couldn't do anything but defer to them. Seems to me that she was much worse off than the trainers wanted to believe, and we may have narrowly lucked out on that one.


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## Akulahawk (Sep 1, 2010)

jjesusfreak01 said:


> That one still doesn't sit well with me. I had not yet taken my EMT class, so I really didn't have any medical knowledge, and we had two certified athletic trainers on the scene, so I couldn't do anything but defer to them. Seems to me that she was much worse off than the trainers wanted to believe, and we may have narrowly lucked out on that one.


There's a reason why I'd be more worried about her than the DFO chick. I do NOT think she was in Heat Stroke, but she was clearly in danger. She probably could have used IV rehydration, but that's not typically in the ATC scope of practice. Chances are very good that she was evaluated by the team doc tat day too. She probably narrowly lucked out in not going into heat stroke.

I did sports med for 7 years prior to becoming a Paramedic. That's one reason why I have a MUCH wider breadth of knowledge than most Paramedics I've met. Very, very few medics that I've heard of were eligible or have sat for the NATABOC exam.


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