EMS World

AUG 2011

EMS World Magazine is the most authoritative source in the world for clinical and educational material designed to improve the delivery of prehospital emergency medical care.

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Page 32 of 71

ASSESSMENT TIPS ical death, although resuscitation may still be possible. Asystole or slow PEA are usually the presenting rhythms. Treatment for hypothermia in the fi eld consists of moving the patient to a warm environment, removing wet or cold clothing, and beginning passive rewarming with blankets. Active peripheral rewarming with hot packs is discouraged due to risk of burns and the phenomenon known as afterdrop, in which cold blood from the extremi- ties returns to the core, further cooling vital organs. Core rewarming is generally only necessary in severe hypothermia and consists of warmed IV fl uids, and possibly gastric and rectal lavage with warmed fl uids. During transfer of care to the ED, the paramedic jostles the patient while transferring him to the ED bed, and the patient immediately clenches his teeth and arches his back in what appears to be a seizure. The cardiac monitor, however, reveals ventricular fibrillation, and the patient is defibrillated twice without success before being moved to a resuscitation room. Later, the paramedic is approached by the ED physician, who asks if he wants to make a guess as to his patient’s core temperature. “No,” the paramedic replies, “but I have a feeling it’s not good since you’re asking me that question.” “82 degrees,” the physician confirmed. “Sometimes when you hear hoofbeats, it IS a zebra.” As the scenario demonstrates, assess- ment can sometimes be complicated by tunnel vision and comorbid factors. This scenario really happened. The patient did indeed have a GI bleed, but his main problem was hypothermia. The paramedic never considered the possi- bility of severe hypothermia and his treatment defi nitely made the patient worse. Assess your patients carefully, and assume nothing. Clinical Pearls • Handle your hypothermic patients carefully. Rough handling can induce VF. • Warmed and humidifi ed oxygen can help. Tape a couple of heat packs to your oxygen humidifi er. • Convection is your friend and your enemy. In heat stroke, it is the most effi cient way to cool your victim. It is also the most rapid means of heat loss for your victims at risk for hypothermia. Steven “Kelly” Grayson, NREMT-P, CCEMT-P, is a critical care paramedic for Acadian Ambulance in Louisiana. He has spent the past 14 years as a fi eld paramedic, critical care trans- port paramedic, fi eld supervisor and educator. He is the author of the book En Route: A Paramedic’s Sto- ries of Life, Death, and Everything In Between, and the blog A Day in the Life of An Ambulance Driver. William E. (Gene) Gandy, JD, LP, has been a paramedic and EMS educa- tor for over 30 years. He has imple- mented a two-year associate’s de- gree paramedic program for a community college, served as both a volunteer and paid paramedic, and practiced in both rural and urban settings. He lives in Tucson, AZ. EMS1108 For More Information Circle 17 on Reader Service Card See Us at EMS Expo Booth #2412 EMSWORLD.com | AUGUST 2011 33

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