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Someone recently shared a post asking about howto treat hyperthermic patients. In a military training setting, as well as manyathletic or sporting events, heat casualties are probably the most common.
Prevention is key- Hydration should bestressed. This doesn’t meansimply drinking gallons of water (this is generally well known, and most drinkenough). Most the Pts i see go down are due to skipping a meal.
Typically, severe cramping will take place, andwhen the cramping reaches the abdominals, you know they’re about to go down if they continue exerting themselves.Most Mil. Medics bring ice chest with soaked bedsheets.
If below 104, we cover them in ice sheets, specifically inthe neck, groin, axilla. Activecooling stops at 102 to prevent rebound hypothermia. If above 104 and they havea decreased mental state, we transport to ER and establish IV with cool fluids.
There’s no need to overthink this. You can argue allday about gradual v. Aggressive, butevery military and sports medic knows that cooling them as fast as possibleworks best. Thousands of pts have proven this with no issues. Usually well eventhrow them back into training once we cool them.
ACCEPTED ANS
That wasme that asked about cooling! That's awesome thank you. I'm working at afestival at the moment with lots of MDMA-induced hyperthermia and a variety ofdifferent cooling techniques being used.
【Discussion】
MedicalStudent
ACCEPTEDANSWER
Thatwas me that asked about cooling! That's awesome thank you. I'm working at afestival at the moment with lots of MDMA-induced hyperthermia and a variety ofdifferent cooling techniques being used.
Reply
Hows itworking out?
Reply-MedicalStudent
850patients in total (of all types), only 31 required transport to hospitaloffsite in the end. We had a field hospital on site staffed with a criticalcare team including doctors, and a crit care outreach team if patients inoutlying medical posts were too unstable for transport. No fatalities :)
Reply-EMT
Yeah,hyponatremia is no good. One of my patients at the marathon had severe crampingand was tremulous and vomiting. She needed 3% saline. Theinexperienced runners will drink gallons of water and then eat just a granolabar for breakfast.
Reply-Paramedic
Yep. It’s unbelievable what a difference the foodmakes another thing ill run into is that we will issue ORS (oral rehydrationsalts). It’s meant to be diluted in 2L of water, andsipped on gradually through the day. Some guys will just down it, which leadsto the same result. But if you ate enough food, then the ORS in unnecessary, soi just make sure everyone eats.(edited)
Reply-RegisteredNurse
Greatshare. Thx
Reply
Twomethods that work on the "heat deck", the buritto and taco method.Burrito method consists of ice cooled sheets and wrap the patient up into aburrito, pouring the ice cooler on them and spraying with water. The tacomethod is you pull the sheets to creat a "taco" and dump the icecooler again and continue to spray water. And like he said, at 102, transport.
Reply
Hello,I have extensive experience working at a Boy Scout camp. For prevention of heatrelated illnesses we stress mixing electrolytes with water to increasehydration but in the case of the illness we usually slowly rehydrate then andin worse case we run a chilled saline drip. for hypothermia we slowly heat upwith blankets and warn liquids.
Reply-Paramedic
I'mright there with you. I love using white cotton blankets doused in waterutilized for evaporative cooling. Lucky for me, I live in the desert so thewhite repels heat and water evaporates quickly and as a result my patients coolquickly.
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