# 40 y/o female heat exhaustion



## musicislife (May 17, 2012)

Back Story: You are standing by as a First Responder for a town biathalon. It is 80 degrees outside. You spot a runner on all fours, who is breathing fast and lightly. You investigate, and says she tired to drink water multiple times in the past 10 min, but it made her feel like vomiting. You radio for an EMT's assistance, who is ten min from your location.

Initial: Airway clear, Breathing. Fast and light Circulation: Cool, clammy skin. Fast pulse. No blood

Assessment: Signs: Cool, clammy skin. Fast pulse. Extreme nasuea. Fast, light breathing. 
Allergies: None
Medications: None
Past History: History of fever related seizures? (would this be relavant?) None. No past heat emergencies. 
Last oral intake: Drank a watter bottle about 4 hours ago that morning.
Events: Running a biathalon. 

Vitals: BP 140/86 Pulse: 120 Respirations: 26 per min

Interventions (done while taking sample): Apply cold compress to forehead, back of neck, and underarms.

Do not transport, monitor patient. 

Ongoing: 5 min later, she vomits a lot, and begins complaining of severe abdmonial pain. Skin turning red. Lay patient on strecher, transport to nearest facility.

Any differences? Comments?


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## Handsome Robb (May 17, 2012)

Not to nitpick but I'd try to get under some shade and wet her down with water if you have a hose. (wet t-shirt contest anyone? h34r: just kidding ) Evaporation is a great tool. Coach her on slowing her breathing if you can. 

Did she train for this event? Any stimulant use, I know she said no meds but people lie?

As a MFR you aren't going to be doing much more than what you listed. At more advanced levels I'd be initiating fluid replacement and possibly zofran to stop the vomiting.


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## musicislife (May 17, 2012)

NVRob said:


> Not to nitpick but I'd try to get under some shade and wet her down with water if you have a hose. (wet t-shirt contest anyone? h34r: just kidding ) Evaporation is a great tool. Coach her on slowing her breathing if you can.
> 
> Did she train for this event? Any stimulant use, I know she said no meds but people lie?
> 
> As a MFR you aren't going to be doing much more than what you listed. At more advanced levels I'd be initiating fluid replacement and possibly zofran to stop the vomiting.



we'll assume that shes went to the shade on her own. And would one spray the patient to cool them if possible?


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## DesertMedic66 (May 17, 2012)

I'm limited to moving patient to shade and possibly an A/C room and wetting them down. 

Cold packs are a Paramedic skill here :glare:


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## Handsome Robb (May 17, 2012)

musicislife said:


> And would one spray the patient to cool them if possible?



I would. Only if I was able to let her keep her dignity intact though. I'm not on a mission to embarrass or make someone uncomfortable.


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## mycrofft (May 18, 2012)

Cool patient quickly. People can turn red facially from vomiting (enormous valsalva going on) but not red all over. Nausea is common with heat exhaustion but not with heat stroke, the dry red hot one.

The cold pack deal feels nice but is early a stopgap, got-nothing-better deal until you get them in front of a fan or AC, maybe lay them on a cold surface (concrete floor in the shade can be palpably colder than the surrounding air sometimes), and yes wet them down to enhance evaporative cooling.

Could be a hangover, food poisoning, pregnancy, or just primary heat exhaustion. Once nausea hits, you will probably need to get IV's in.
Sounds like it went well on your end.


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## Devil doc (May 19, 2012)

Sounds like the right thing was done, applie ice packs to armpits groin back of knees fan and keep cool, start fluids if possible, monitor vitals treat/ be prepared for shock.


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## Akulahawk (May 19, 2012)

As a 1st Responder, I would be looking at using a cold compress or icepack under the  neck, armpits, groin, etc. I would also place the patients in the shade on a cool surface, if possible. If I have a hose available with cool water, I would also use that. Being that her last oral intake was about 4 hours ago, with attempts to drink water in the past 10 min., resulting in nausea, I would also consider administering small sips of fluid as those are typically less irritating to the stomach, resulting in less nausea. Something else that I would consider is after the vomiting episode, depending upon the contents, I may restart the small sips of water. At a more advanced level of care, I would also consider starting an IV line and beginning rehydration therapy.


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## Notown (May 26, 2012)

I would move her to shade/rig, admin high flow oxy via non-rebreather, apply cool packs & offer water. Once she began vomiting I would transport rapidly.


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## Veneficus (May 26, 2012)

Notown said:


> I would move her to shade/rig, admin high flow oxy via non-rebreather, apply cool packs & offer water. Once she began vomiting I would transport rapidly.



Your plan is to put a mask over the mouth  of somebody vomiting and then blow air in it?

Let me know how that works out for you...


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## shfd739 (May 26, 2012)

Notown said:


> Once she began vomiting I would transport rapidly.



 Why?


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## NomadicMedic (May 26, 2012)

shfd739 said:


> Why?



So he wouldn't get a bunch of puke in the ambulance. 

Silly question.


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## shfd739 (May 26, 2012)

n7lxi said:


> So he wouldn't get a bunch of puke in the ambulance.
> 
> Silly question.



Lol

I really hope that isn't the answer but wont be surprised if it is.


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## medichopeful (May 26, 2012)

musicislife said:


> we'll assume that shes went to the shade on her own. And would one spray the patient to cool them if possible?



Potentially.  The problem is overdoing it and causing them to shiver, which you don't want!


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## Handsome Robb (May 26, 2012)

Veneficus said:


> Your plan is to put a mask over the mouth  of somebody vomiting and then blow air in it?
> 
> Let me know how that works out for you...



I was wondering the same thing. 

That could be pretty comical watching someone puke into an NRB. Poppin out of the valves and what not.


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## mycrofft (May 26, 2012)

We need a sticky title no thread required: "WHY HIGH FLOW NRB OXYGEN?"


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## Veneficus (May 26, 2012)

mycrofft said:


> We need a sticky title no thread required: "WHY HIGH FLOW NRB OXYGEN?"



Who cares about high flow o2?

I just want to see somebody puke into the mask with some kind of compressed gas at 15lpm or greater blowing in it.


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## Notown (May 26, 2012)

Correct me if I'm wrong but...As an EMTb aren't we supposed to transport any patient who is having gastric distress? I'm asking seriously not as a joke or anything.


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## CBentz12 (May 26, 2012)

I would put her in the back of the ambulance, monitor vitals and transport. Simple enough?

I wouldn't put O2 on her because shes breathing adequately just exhausted. Ive packs are a good idea if no ambulance is on scene yet and like somebody said tell her to take deep breaths.


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## shfd739 (May 26, 2012)

Notown said:


> Correct me if I'm wrong but...As an EMTb aren't we supposed to transport any patient who is having gastric distress? I'm asking seriously not as a joke or anything.



You could I guess. But that doesn't mean to go rapidly, if at all.


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## Anonymous (May 26, 2012)

could be possible hyponatremia...

Any headache? Altered?


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## Veneficus (May 26, 2012)

Notown said:


> Correct me if I'm wrong but...As an EMTb aren't we supposed to transport any patient who is having gastric distress? I'm asking seriously not as a joke or anything.



You don't have to over think it. 

It sounds like somebody who is overexerted in heat distress.

First, cooling is what is needed. Which may or may not be done in a hospital. 

If this is a sanctioned event, there is probably a mechanism for treating this sort of thing on scene.

Usually after a person vomits a few times they feel better. Often they will be observed, get some oral rehydration, maybe a meal, and be on their merry way.


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## mycrofft (May 26, 2012)

Veneficus said:


> Who cares about high flow o2?
> 
> I just want to see somebody puke into the mask with some kind of compressed gas at 15lpm or greater blowing in it.



You might be able to find vomitus with an otoscope, (as in "OTOscope") after that. Especially if they cough on the rebound.


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## Remo (Jun 3, 2012)

musicislife said:


> Back Story: You are standing by as a First Responder for a town biathalon. It is 80 degrees outside. You spot a runner on all fours, who is breathing fast and lightly. You investigate, and says she tired to drink water multiple times in the past 10 min, but it made her feel like vomiting. You radio for an EMT's assistance, who is ten min from your location.
> 
> Initial: Airway clear, Breathing. Fast and light Circulation: Cool, clammy skin. Fast pulse. No blood
> 
> ...




I am no expert as this is just the beginning of my EMS knowledge but I was under the impression that cooling a patients body too rapidly will cause shivering, which will actually cause a spike in core body temp. 
Slowly cooling the patient via shade or in the back of an air conditioned ambulance would be suffice. 

Her vitals signs are a bit elevated, so I would try to keep her calm by having a conversation with her, explain why this is happening to her and reassuring her that everything will be alright. 

*The use of oxygen would be beneficial to the patient for it REDUCES nausea and vomiting. 

*Transport the patient to the hospital where she will receive fluids and further care.


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## NomadicMedic (Jun 3, 2012)

Remo said:


> I am no expert as this is just the beginning of my EMS knowledge but I was under the impression that cooling a patients body too rapidly will cause shivering, which will actually cause a spike in core body temp.
> Slowly cooling the patient via shade or in the back of an air conditioned ambulance would be suffice.
> 
> Her vitals signs are a bit elevated, so I would try to keep her calm by having a conversation with her, explain why this is happening to her and reassuring her that everything will be alright.
> ...




I think we've beat this one to death, but for the last time, oxygen does NOT reduce nausea and vomiting. Antiemetics, like Zofran, do that. And yeah, if she wanted to go to the hospital I'd put her in a cool ambulance, start a line and give her Zofran. Other than that, she doesn't need much from EMS. (unless, of course, we want to play the "what if she had a cardiac event" game, but I don't think that's where the OP was going with this)


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## Veneficus (Jun 4, 2012)

Remo said:


> *The use of oxygen would be beneficial to the patient for it REDUCES nausea and vomiting.



Who told you that?

Edit: And ask them by what mechanism.


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## Remo (Jun 4, 2012)

Veneficus said:


> Who told you that?
> 
> Edit: And ask them by what mechanism.



No one told me that but... A lack of oxygen due to over overexertion may cause
 nausea as there is a change in the composition of blood being circulated
 through the body. If supplemental oxygen was given I only assumed it would
 help reverse the effect. I don't know, maybe it doesn't work that way. I was
 just thinking of a quick and simple intervention off the top of my head :unsure:


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## Veneficus (Jun 4, 2012)

Remo said:


> No one told me that but... A lack of oxygen due to over overexertion may cause
> nausea as there is a change in the composition of blood being circulated
> through the body. If supplemental oxygen was given I only assumed it would
> help reverse the effect. I don't know, maybe it doesn't work that way. I was
> just thinking of a quick and simple intervention off the top of my head :unsure:



Could I point you in the direction of Guyton's Medical Physiology.


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## FLdoc2011 (Jun 4, 2012)

Veneficus said:


> Could I point you in the direction of Guyton's Medical Physiology.



Still have my Guyton's text.


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## Doczilla (Jun 4, 2012)

I'm gonna get it on Amazon. I love me some physio.


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## AnthonyM83 (Jun 4, 2012)

Veneficus said:


> Who told you that?
> 
> Edit: And ask them by what mechanism.



I actually read that study back in 2005-ish or so.


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## NomadicMedic (Jun 5, 2012)

AnthonyM83 said:


> I actually read that study back in 2005-ish or so.



What study is that? One that says oxygen is an antiemetic? got any citations?


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## Melclin (Jun 5, 2012)

Surely a bit of common sense comes into this.

I've often told my first aid/FR chaps and chapettes that what they do is medically flavoured common sense. Mostly you just do what is reasonable and sensible and occasionally use a bit of extra learnin to know when to call an ambulance and what to do in the mean time. 

But its often a battle. It seems like you give a person a first aid cert and all of a sudden everything is massively over thought in some of the oddest and most confusing ways. "Oh he was pale and sweaty, so he was obviously going into shock. We wrapped him in blankets and put his legs up". "Ah...yeah cool...Soooo you don't think the fact he just came out of a mosh pit had anything to with the pallor and sweatiness?

Really guys, sink 9 beers and jump about to some absurdly loud music...run too far with too little water...during the heat...on a stomach full of curried sausages. See how good you feel. You'll chunder your guts up until you're ready for a another beer. Seriously has no one every done a bit of exercise and found themselves to be nauseated, flushed, tachy and hot..maybe had a bit of cramping. Its really no great mystery whats wrong. You can probably cancel the chopper. Give them a moment in the shade to grow a pair, cool down, drink a bit more water and send them on their way.


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## Doczilla (Jun 5, 2012)

Have my babies.


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## AnthonyM83 (Jun 5, 2012)

n7lxi said:


> What study is that? One that says oxygen is an antiemetic? got any citations?



Nope. Didn't think to save it and don't care enough to go lit searching 
But I do remember someone posted it in context for not just giving everyone O2...have a reason whether it be for hypoxia, hypoperfusion, nausea, etc.


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## Veneficus (Jun 5, 2012)

Melclin said:


> Surely a bit of common sense comes into this.



:rofl:

Common sense is an uncommon virtue.

At risk of sounding condecending, many providers of all stripes are educated to regurgitate information, not to extrapolate it.

This is especially true of EMS.

The best teachers I have ever had have taught me how to apply theory to practicality. 

The worst are the ones who professed practicality at the expense of theory.

Somewhere in the middle were the theorists who never mentioned the practical because they thought if you knew the theory the practical was so obvious it didn't need to be said.


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## AnthonyM83 (Jun 5, 2012)

Definitely something that we're lacking in current education models at least for EMTs. You get a crash course to barely learn the skills, then thrown in. Locally get 3-5 12hr shifts where you more just show basic functioning ability, and off you go to learn how to apply the theory and skills to the patient.


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## zzyzx (Jun 5, 2012)

True, but how much education do you really need to be an EMT in L.A.? For those that work on 911 cars, they always run calls with multiple paramedics on scene. And of course most EMT's working for the zillion ambulance companies in L.A never do anything but BLS transports.


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## NomadicMedic (Jun 5, 2012)

AnthonyM83 said:


> Nope. Didn't think to save it and don't care enough to go lit searching
> But I do remember someone posted it in context for not just giving everyone O2...have a reason whether it be for hypoxia, hypoperfusion, nausea, etc.



Yeah... I'm not a big fan of the "I read it somewhere" posts. If you're going to make a claim that it was published research, at least post the citation.


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## Anonymous (Jun 5, 2012)

n7lxi said:


> Yeah... I'm not a big fan of the "I read it somewhere" posts. If you're going to make a claim that it was published research, at least post the citation.



Everyone knows O2 is an antiemetic...._in patients older than 60 with minor trauma._

http://www.ncbi.nlm.nih.gov/pubmed/11794455


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## AnthonyM83 (Jun 6, 2012)

n7lxi said:


> Yeah... I'm not a big fan of the "I read it somewhere" posts. If you're going to make a claim that it was published research, at least post the citation.


True...but don't care about it enough to search. But enough to speak up when someoneelse mentioned it...


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## AnthonyM83 (Jun 6, 2012)

zzyzx said:


> True, but how much education do you really need to be an EMT in L.A.? For those that work on 911 cars, they always run calls with multiple paramedics on scene. And of course most EMT's working for the zillion ambulance companies in L.A never do anything but BLS transports.



Few ways to look at that

1) LA EMS murders people regularly so let's not use us as an example. Don't make the EMS community dumber because of us.

2) Since LACoFD BLS'es so many people, it's good for EMTs to understand what's going on even if the medics don't care to understand or act on it.

3) There's a HUGE "urgent BLS" industry with EMTs showing up at nursing homes for ER transports that are often pretty serious.

4) You're still first on-scene sometimes. Depending on location, can be majority of the time. And even if not, you can still get the mental exercise of evaluating the situation, even if a firefighter is going to show up and overrun you.

5) Even though they're FF's, there's still a number of EMTs on each call. They could use the critical thinking skills too....


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## Tigger (Jun 6, 2012)

AnthonyM83 said:


> True...but don't care about it enough to search. But enough to speak up when someoneelse mentioned it...



If I might suggest then not adding that there is not a study that proves your point if you do not care enough to post it. Not that you're doing this, but too many people attempt to prove their point by justifying it with a study that just doesn't exist, and that's a waste of everyone's time.


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## NomadicMedic (Jun 6, 2012)

AnthonyM83 said:


> True...but don't care about it enough to search. But enough to speak up when someoneelse mentioned it...



I wasn't the one who posted "I read it in a study" and then didn't post a citation. ;

You've been around for a while, you should know better. 

Post unsubstantiated crap, prepare to have your chops busted.


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## Veneficus (Jun 6, 2012)

Tigger said:


> If I might suggest then not adding that there is not a study that proves your point if you do not care enough to post it. Not that you're doing this, but too many people attempt to prove their point by justifying it with a study that just doesn't exist, and that's a waste of everyone's time.



After reading the study, it does not account for placebo and is largely based around reported pt. satisfaction.

I have to admit I have seen so many studies over so many years, sometimes I do not have nor have the time to look it up. (but I always disclaim those times)

I have not seen nearly as much of people who post about afictional study as I have people who post a single study and claim that it alone proves the point.


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## Veneficus (Jun 6, 2012)

found this too, pay particular attention to the concentrations and the effects.

Anesth Analg. 2001 Jan;92(1):112-7.

Ondansetron is no more effective than supplemental intraoperative oxygen for prevention of postoperative nausea and vomiting.

Goll V, Akça O, Greif R, Freitag H, Arkiliç CF, Scheck T, Zoeggeler A, Kurz A, Krieger G, Lenhardt R, Sessler DI.


Source

Department of Anesthesia and General Intensive Care, University of Vienna, Vienna, Austria.


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## wyomingearth (Jun 7, 2012)

*O2 for nausea*

I am glad I've been following this thread, while being trained as a new emt, I was told several times to give O2 for nausea, when I asked how that worked I was told " we don't know but it sure does work!". That didn't necessarily suffice for me but I filed it away in the "things that might help" file. I read the study posted by Veneficus, interesting and maybe the source of the belief? Or maybe oxygen use as sympathetic magic? I never saw it work myselfI, and I always hated the idea of something over the face of a vomiting patient. I'll add that it was the EMT-B trainer that was especially fond of this, the medic  I followed was not of the same idea.


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## Veneficus (Jun 7, 2012)

wyomingearth said:


> I am glad I've been following this thread, while being trained as a new emt, I was told several times to give O2 for nausea, when I asked how that worked I was told " we don't know but it sure does work!". That didn't necessarily suffice for me but I filed it away in the "things that might help" file. I read the study posted by Veneficus, interesting and maybe the source of the belief? Or maybe oxygen use as sympathetic magic? I never saw it work myselfI, and I always hated the idea of something over the face of a vomiting patient. I'll add that it was the EMT-B trainer that was especially fond of this, the medic  I followed was not of the same idea.



In one of the full articles on post op oxygen, the postulated mechanism is correction of gut ischemia. 

However, the thing I was trying to point out in the study I posted is that it refers to low concentration o2.

I don't think it is a "more is better" concept.


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## zzyzx (Jun 7, 2012)

Anthony wrote, "3) There's a HUGE "urgent BLS" industry with EMTs showing up at nursing homes for ER transports that are often pretty serious"

True. Thinking back on my days as an EMT in LA, there were a few BLS transports we were called to were the patient was actually pretty sick. One guy I remember was in SVT, another (who supposedly just had abnormal labs or something) was in severe respiratory distress.


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## zzyzx (Jun 7, 2012)

I always thought the oxygen for nausea thing was BS. Reports of its being effective sound to me like a classic case of the placebo effect.


That said, what would account for the possible effect of oxygen (and supposedly only high-flow oxygen) for cluster headaches?


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## Tigger (Jun 7, 2012)

Veneficus said:


> After reading the study, it does not account for placebo and is largely based around reported pt. satisfaction.
> 
> I have to admit I have seen so many studies over so many years, sometimes I do not have nor have the time to look it up. (but I always disclaim those times)
> 
> I have not seen nearly as much of people who post about afictional study as I have people who post a single study and claim that it alone proves the point.



Yes, one has to go further than just reading the conclusion and then deciding to accept the author's recommended action as best practice. The "fictitious study" comment referred more to the general population, and we certainly do not want to be lumped in with them and their research habits...


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## Doczilla (Jun 7, 2012)

Cluster headaches are a different story , because oxygen is a cerebral vasoconstrictor. Most migraine medications are vasoconstrictors of some sort, and oxygen would be the quickest way to gain releif. 

Gut ischemia would explain why zofran would not work in this case, because ischemic tissues depolarize erratically--- like PVC's , Charlie horses, seizures following head injury, etc. Depolarizing the gut would definitely male you hurl. When you look at how zofran works--- blocking peripheral 5ht (sereronin) receptors in the gut which stimulate vagus nerve terminals, this mechanism wouldn't nessesarily be tied in with ischemia. 

Promethzine works both peripherally on vagus nerve terminals , and centrally on the chemoreceptor trigger zone in the medulla. But antihistamines are contraindicated in heat injury.


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## Veneficus (Jun 7, 2012)

Doczilla said:


> Cluster headaches are a different story , because oxygen is a cerebral vasoconstrictor. Most migraine medications are vasoconstrictors of some sort, and oxygen would be the quickest way to gain releif.
> 
> Gut ischemia would explain why zofran would not work in this case, because ischemic tissues depolarize erratically--- like PVC's , Charlie horses, seizures following head injury, etc. Depolarizing the gut would definitely male you hurl. When you look at how zofran works--- blocking peripheral 5ht (sereronin) receptors in the gut which stimulate vagus nerve terminals, this mechanism wouldn't nessesarily be tied in with ischemia.
> 
> Promethzine works both peripherally on vagus nerve terminals , and centrally on the chemoreceptor trigger zone in the medulla. But antihistamines are contraindicated in heat injury.



To expand on this just a bit, I give to you:

http://en.wikipedia.org/wiki/Hagen–Poiseuille_equation

Long story short, flow through a vessle is most effected by diameter which is the 4th power of the radius in the equation. 

Reduction of flow = reduction of o2 delivery. 

Constriction of the vessle will increase the flow.

Interestingly enough, many people do not report relief from cluster headaches with opioids, and ketamine is the only anesthetic agent which does not cause clinically significant cadiovascular depression.


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## Doczilla (Jun 7, 2012)

I would guess this is why some migraine medications have a rebound effect --- but oxygen is given as a first line by some providers until they inevitably provide some combination of pain control with an antiemetic or phenothiazine antihistamine (phenergan) so they can sleep it off. oxygen can provide immediate relief though.

Im not sure how this equation ties into cerebral autoregulation (the mechanism that oxygne affects) in this case. Please school me up.


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## Veneficus (Jun 7, 2012)

Doczilla said:


> I would guess this is why some migraine medications have a rebound effect --- but oxygen is given as a first line by some providers until they inevitably provide some combination of pain control with an antiemetic or phenothiazine antihistamine (phenergan) so they can sleep it off. oxygen can provide immediate relief though.
> 
> Im not sure how this equation ties into cerebral autoregulation (the mechanism that oxygne affects) in this case. Please school me up.



Reduction of vascular volume increases rate of vascular flow.

If your problem is caused by vasodilation, constriction increases rate of oxygen delivery.

Promethazine is my favorite antiemetic to take or give. I don't see sedation as an unwanted side effect, I think it is a bonus.

Some countries have stopped using 1st generation antihistamines, it is tragic actually.


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## Doczilla (Jun 7, 2012)

Yeah I see what you mean. 

Isn't cluster syndrome (migraines/tension/ cluster headaches) thought to be vascular still? (At least partially) . I thought the treatment concept with vacoconstriction was merely reducing diameter , not neccesarily improving d02. I could be (and with my luck, probably am) wrong though. 

Then again ,its been suggested that inflammatory mediators play a role too; which might explain why toradol seems to be effective.


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## Veneficus (Jun 7, 2012)

Doczilla said:


> Yeah I see what you mean.
> 
> Isn't cluster syndrome (migraines/tension/ cluster headaches) thought to be vascular still? (At least partially) . I thought the treatment concept with vacoconstriction was merely reducing diameter , not neccesarily improving d02. I could be (and with my luck, probably am) wrong though.
> 
> Then again ,its been suggested that inflammatory mediators play a role too; which might explain why toradol seems to be effective.



Reducing the diameter does improve o2 delivery. Same concept as using pressors in septic shock.

It is a component of both. Inflammatory mediation causes vascular effects like epithelial release of NO. Bradykinin release, etc.

One of the things that I have discovered in shock management is that all of these processes are connected. They are simply taught seperately in order to make it easier to understand. 

People are not a vasculature, a heart, a kidney, a brain, inflammatory system, etc. 

All of these things interact for the benefit of homeostasis of the organism. It must be assessed and treated as a whole. 

It is also what makes it really hard to figure out exact mechanisms.


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## Doczilla (Jun 7, 2012)

That's why vasopressin is so good in sepsis . Blocks the uncontrolled NO release that causes the refractory hypotension. 

I love big picture medicine. What's what makes the difference between a clinician and a technician.


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## Veneficus (Jun 7, 2012)

Doczilla said:


> I love big picture medicine. What's what makes the difference between a clinician and a technician.



Unfortunately it is a dying art understood and practiced by very few.

Most Western medicine is all about charts and tables and hyperspecialization that requires almost no big picture knowledge.

It would work great if you presented to the ED, somebody sent your heart to cardio, your lungs to pulmonary, kidneys to nephro, etc.


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## Doczilla (Jun 7, 2012)

Sorry for the typos. Stupid phone.


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## JohnnyAndRoy (Jun 7, 2012)

Well I think we've missed the point here people.  Clearly, this runner's problem was an overdose.  Sudden onset of an altered level of consciousness, pale and diaphoretic skin and near-syncope.  This is a first time runner with a SERIOUS opiate problem.  Instead of worrying about cold packs and cool floors, let's focus on what really needs to be done.  I am not a fan of administering Narcan to overdose patients that are conscious.  It's just going to agitate them and may throw them into violent withdrawal.  I think the priorities are RSI (as quickly as possible), good oxygenation AND THEN we administer Narcan.  After that, we can calm her down with a benzodiazepine or barbituate.  Come on people, we are paramedics here.  we deliver ADVANCED life support, not cold pack life support.  I consider my rig a mobile ICU.  If they give us all of these meds, why shouldn't we use them?  Just my .02.


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## Veneficus (Jun 7, 2012)

JohnnyAndRoy said:


> Well I think we've missed the point here people.  Clearly, this runner's problem was an overdose.  Sudden onset of an altered level of consciousness, pale and diaphoretic skin and near-syncope.  This is a first time runner with a SERIOUS opiate problem.  Instead of worrying about cold packs and cool floors, let's focus on what really needs to be done.  I am not a fan of administering Narcan to overdose patients that are conscious.  It's just going to agitate them and may throw them into violent withdrawal.  I think the priorities are RSI (as quickly as possible), good oxygenation AND THEN we administer Narcan.  After that, we can calm her down with a benzodiazepine or barbituate.  Come on people, we are paramedics here.  we deliver ADVANCED life support, not cold pack life support.  I consider my rig a mobile ICU.  If they give us all of these meds, why shouldn't we use them?  Just my .02.



Is this a joke?


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## mycrofft (Jun 7, 2012)

I think she's rejecting her heart donation. Or she IS a heart donor.


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## usalsfyre (Jun 7, 2012)

Sincerely hope I missed the sarcasm in that...


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## STXmedic (Jun 7, 2012)

:nosoupfortroll:


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## AnthonyM83 (Jun 7, 2012)

n7lxi said:


> I wasn't the one who posted "I read it in a study" and then didn't post a citation. ;
> 
> You've been around for a while, you should know better.
> 
> Post unsubstantiated crap, prepare to have your chops busted.


You're right. There's still a few things out there that I learned as fact, but have never looked up, but got stored in my brain as true. Been slowly trying to flush those out.


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