40 y/o female heat exhaustion

[AnthonyM83]

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...

 

[AnthonyM83]

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....

 

[Tigger]

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.

 

[NomadicMedic]

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.

 

[Veneficus]

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.

 

[Veneficus]

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.

 

[wyomingearth]

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.

 

[Veneficus]

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.

 

[zzyzx]

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.

 

[zzyzx]

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?

 

[Tigger]

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...

 

[Doczilla]

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.

 

[Veneficus]

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.

 

[Doczilla]

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.

 

[Veneficus]

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.

 

[Doczilla]

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.

 

[Veneficus]

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.

 

[Doczilla]

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.

 

[Veneficus]

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.

 

[Doczilla]

Sorry for the typos. Stupid phone.