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#204474 - 07/09/10 11:19 PM Re: Timely information on 'How not to fry'. [Re: Glock-A-Roo]
MarkO Offline
Member

Registered: 03/19/10
Posts: 137
Loc: Oregon
Originally Posted By: Glock-A-Roo
Originally Posted By: MarkO
Originally Posted By: Art_in_FL


Myth: You can send someone into shock if you cool them off too fast. This is false. Having ice dumped on you is not comfortable in normal conditions but most people barely feel it if they are dangerously overheated.


The Paramedics I take my MRT class from always advise against this.


That's what was taught in the past, and is still sometimes taught today in EMS education. But it is wrong.


Maybe but that's the way I'm taught and I'm expected to respond to incidents according to my training and scope of practice.

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#204507 - 07/10/10 09:43 PM Re: Timely information on 'How not to fry'. [Re: MarkO]
Art_in_FL Offline
Pooh-Bah

Registered: 09/01/07
Posts: 2432
Quote:
Maybe but that's the way I'm taught and I'm expected to respond to incidents according to my training and scope of practice.


You might want to bring this up with a representative on the policy and procedures board. They may want to modify standards to incorporate the improved understanding in their next update evolution. As medical knowledge and equipment evolve over time policy, procedure, and training have to be updated and most EMS bureaucracies have a board or committee established to keep up.

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#204508 - 07/10/10 09:54 PM Re: Timely information on 'How not to fry'. [Re: Art_in_FL]
MarkO Offline
Member

Registered: 03/19/10
Posts: 137
Loc: Oregon
And how fast do bureaucracies usually move ?? wink

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#204513 - 07/10/10 11:46 PM Re: Timely information on 'How not to fry'. [Re: MarkO]
Hikin_Jim Offline
Sheriff
Pooh-Bah

Registered: 10/12/07
Posts: 1804
Loc: Southern California
Originally Posted By: MarkO
And how fast do bureaucracies usually move ?? wink
That wooshing noise you just heard was a glacier passing a bureaucracy.

Good article. Of course wet cloths, fans (if there's power), a dip in the bathtub (or whatever) will help cool you down. I believe someone mentioned misting systems, but I don't believe anyone mentioned personal misters. They don't require electrical power (they do require water). I bought one of this brand: http://www.mistymate.com/ *

I didn't pay anywhere near those prices though. eek I don't know that this is the best mister out there; this is just the one I happen to have. Works well in a relatively dry climate like S. California. Not so sure this would work in that soup that some call air along the gulf coast.

HJ

*I have no connection to or financial interest in said brand.
_________________________
Adventures In Stoving

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#204520 - 07/11/10 01:28 AM Re: Timely information on 'How not to fry'. [Re: Glock-A-Roo]
Susan Offline
Geezer

Registered: 01/21/04
Posts: 5163
Loc: W. WA
"The gold standard for treating hyperthermia is full immersion in an icewater bath. This is what the top athletic trainers do, both at the world class and local high school levels.

"The only valid exceptions are people who are very aged or who have seriously pathological cardiac dysrhythmia problems. In just about everyone else, rapid cooling via water at or just above freezing is the gold standard."

"But I didn't know he had a heart problem... so, Doc, how fast does rigor mortis set in in ice water?"

Maybe it's true, maybe the overheated sports people are in great shape except for being stupid enough to get themselves into hyperthermia, but... why does shocking the body like that make me so uncomfortable?

Sue

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#204524 - 07/11/10 03:13 AM Re: Timely information on 'How not to fry'. [Re: Susan]
nurit Offline
Member

Registered: 03/27/08
Posts: 191
Loc: NYC
"but... why does shocking the body like that make me so uncomfortable?"

That's my instinct too. Wouldn't you want to cool the person down more gradually? This sounds something like forcing a dehydrated person to drink several quarts of ice-cold water in rapid succession. Doesn't seem right.


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#204811 - 07/16/10 07:07 PM Re: Timely information on 'How not to fry'. [Re: Glock-A-Roo]
Glock-A-Roo Offline
Old Hand

Registered: 04/16/03
Posts: 1076
Originally Posted By: Glock-A-Roo
The gold standard for treating hyperthermia is full immersion in an icewater bath.


I remembered seeing this same wording somewhere in the literature, and today I found it on MedScape (registration is free if you don't have a login there):

Cold Water Immersion: The Gold Standard for Exertional Heatstroke Treatment

"Recently (in a historical sense, i.e., 50 to 100 yrs or so ago), a widely circulated opinion has encouraged some in the medical community to avoid using cold water immersion (CWI) for the acute treatment of heatstroke.[19,30] This line of thinking has reached the medical community, including athletic trainers, team physicians, emergency department physicians, emergency medical technicians, registered nurses, first aid-trained coaches, and others. The number one criticism of CWI is that patients will actually heat up (or at least not cool down) in CWI because of peripheral vasoconstriction (PVC) and shivering. However, scientific evidence strongly refutes this criticism. Evidence from basic physiological studies looking at the effect of CWI on cooling rates in hyperthermic individuals and treatment of actual EHS victims clearly shows that CWI has cooling rates superior to any other known modality.[2,10,11,21,22]

We have recently stated, "it is quite difficult, if not impossible, to kill an otherwise healthy athlete experiencing EHS if rapid cooling via cold/ice water immersion is implemented within a few minutes after collapse".[9]


Originally Posted By: nurit
Wouldn't you want to cool the person down more gradually? This sounds something like forcing a dehydrated person to drink several quarts of ice-cold water in rapid succession. Doesn't seem right.


From the above link: "Any delay in the process of rapidly cooling an individual experiencing EHS, whether it is caused by a delay in the initiation of treatment or the use of an inferior coding modality, can dramatically increase the likelihood of morbidity and mortality associated with the condition."

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#204814 - 07/16/10 09:11 PM Re: Timely information on 'How not to fry'. [Re: Glock-A-Roo]
nurit Offline
Member

Registered: 03/27/08
Posts: 191
Loc: NYC
Glock-A-Roo, thanks for providing the quotes, and the link.

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#204821 - 07/16/10 11:50 PM Re: Timely information on 'How not to fry'. [Re: nurit]
Art_in_FL Offline
Pooh-Bah

Registered: 09/01/07
Posts: 2432
People worried that cooling a person down too fast by packing on ice or ice-water immersion causing heart attack or that shivering or vasoconstriction might slow cooling should consider that there are situations where people find themselves in ice-water. A well known, and well studied, situation is the effect on survivors of a sinking or aircraft ditching in cold water.

Consider that people who abandon ship and step off into freezing water without protection don't tend to die of heart attacks, nor does vasoconstriction or shivering make much difference. The heat-sink effect of ice-water is so profound that shivering and vasoconstriction don't seem to make much difference on how long you survive.

In fact if vasoconstriction was effective in protecting your core from heat loss there would be no significant advantage to the Heat Escaping Lessening Posture (HELP) where you ball up form fists and tuck your arms in tight. The fact is that the HELP posture works and can significantly increase the time you stay alive in cold water. Which conversely suggests that vasoconstriction isn't very effective.

Of course ice-water immersion is only indicated if the person is at or very near 106F. Lesser cooling methods are entirely acceptable for less drastic situations and heatstroke is always best handled by prevention.

A person drifting into full-on heatstroke represents a massive and protracted failure to take action to control their body temperature. Except in a few rare cases it takes a considerable amount of time to progress to heatstroke. Intervention, by any handy means, at any earlier time will almost always prevent heatstroke. Something as simple as moving a person into the shade, having them rest, and having them sip water can often eliminate the problem before it becomes a medical emergency. Moistening the clothing and fanning can help speed cooling.

But if and when a person crosses the line into heatstroke you need to pull out the biggest guns you have. The biggest and most reliable gun we have for dropping core temperature is ice-water immersion. If you have ice on hand there is no reason to not use it. If there is no ice available use whatever method you can make happen with the materials you have. The goal has to be to drop their core temperature by the most effective means available.


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#204849 - 07/17/10 07:29 PM Re: Timely information on 'How not to fry'. [Re: Art_in_FL]
philip Offline
Addict

Registered: 09/19/05
Posts: 639
Loc: San Francisco Bay Area
I grew up in Texas on a farm, so we had heat and humidity. Our home had a window refrigerated A/C in one room. We had a whole-house fan that exhausted into the attic. We ran that at night. Basically, we just sweated.

My wife and I camp at Burning Man every year, and it hits the hundreds on occasion and nineties most days, but there's no humidity. We have a shade tarp with flaps to the ground on 2 sides. This shades us from exposure to the sun without blocking any air flow. This means we stay ambient temperature, but not higher. I drink copious amounts of water and stay out of the sun during the heat of the day. We have water misters (those spray bottles for misting plants or your clothes if you iron by hand), and we spray each other to cool off occasionally. We bring a plastic tub and soak our feet in it - it's surprising how cooling that is, just sticking your feet in a tub of ambient temp water. Basically, we just sweat.

The good thing about the location at Burning Man is that it's high desert so it gets cool at night.

Drinking a lot of plain water may bring on hyponatremia, so at Burning Man we watch our electrolyte intakes to make sure we're getting enough. We drink juices and eat salty food.

Many people run around naked, but I have vitiligo, so I keep my skin covered in cotton and breathable fabrics that soak up sweat and evaporate it. I wear a hat any time I'm out in the sun instead of a cap. The hat has a reasonably broad brim and a stampede string so it doesn't blow off.

If you can conserve sweat, you can do fairly well. Spraying a mist on the skin can be shockingly cold and take your breath away if you do it right. There's no way to stay cool if you have no power, so shade that doesn't block breezes and trap heat, keeping hydrated (with electrolytes), and managing my activities is the way I handle it.

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