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Author Topic: Cold water immersion for heat stroke  (Read 3637 times)
RNOfficer
Seasoned Member

Posts: 232

« on: July 25, 2016, 07:39:16 PM »

http://www.medscape.com/viewarticle/559753

Cold water immersion for heat stroke has long been a controversial topic in EMS. The verdict is that CWI is the preferred treatment and should be done immediately, even delaying transport if necessary.

IT was thought that cold water immersion could cause cardiac arrest but no cases have been found. A second criticism is:

"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."

NB: this treatment should be applied to a normally healthy individual. For a person with underlying relevant medical conditions, seek medical advice FIRST.

Also remember that HEAT stroke has NOTHING at all to do with a "stroke" (when blood flow to an area of brain is cut off) which is one reason EMS prefer to call a stroke a "brain attack".
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JayT
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Posts: 1,332

« Reply #1 on: July 25, 2016, 10:08:18 PM »

[quote author=RNOfficer
Also remember that HEAT stroke has NOTHING at all to do with a "stroke" (when blood flow to an area of brain is cut off) which is one reason EMS prefer to call a stroke a "brain attack".
[/quote]

Ah.....no we don't. Never seen that phrase outside of pato enter education material, and one CVA center that tried to push "brain attack."

Paramedic with a critical care certification here.
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"Eagerness and thrill seeking in others' misery is psychologically corrosive, and is also rampant in EMS. It's a natural danger of the job. It will be something to keep under control, something to fight against."
Eclipse
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« Reply #2 on: July 25, 2016, 10:16:56 PM »

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Pace
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« Reply #3 on: July 25, 2016, 10:19:57 PM »

Why not dump both terms and call it by it's true name?
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Lt Col, CAP
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Eclipse
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« Reply #4 on: July 25, 2016, 10:23:31 PM »

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Fubar
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Posts: 670

« Reply #5 on: July 25, 2016, 10:52:50 PM »

Why not dump both terms and call it by it's true name?

Because you're not tacticool unless you can use eight words with at least five syllables each to describe a condition that already has a handy two-syllable word label.
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LTC Don
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« Reply #6 on: July 26, 2016, 12:18:36 PM »

See the information at the Korey Stringer Institute.  I'm inclined to go with what the recommend:  http://ksi.uconn.edu/


http://ksi.uconn.edu/emergency-conditions/heat-illnesses/exertional-heat-stroke/


It's not how high the temp goes, it's how long you are at that temp that matters.  The faster you can definitively cool the victim down, the more likely they will recover without damage.



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Donald A. Beckett, Lt Col, CAP
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Gill Rob Wilson #1891
RNOfficer
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Posts: 232

« Reply #7 on: July 26, 2016, 05:14:26 PM »

[quote author=RNOfficer
Also remember that HEAT stroke has NOTHING at all to do with a "stroke" (when blood flow to an area of brain is cut off) which is one reason EMS prefer to call a stroke a "brain attack".

Ah.....no we don't. Never seen that phrase outside of pato enter education material, and one CVA center that tried to push "brain attack
[/quote]

Thanks for raising important matter. Of course it would be more accurate to say some EMS prefer to call a stroke a brain attack".

I prefer the term "brain attack because it conveys to the lay public that a "stroke" is a very serious emergency and EMS is required immediately.
« Last Edit: July 26, 2016, 05:29:49 PM by RNOfficer » Logged
RNOfficer
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Posts: 232

« Reply #8 on: July 26, 2016, 05:29:06 PM »

See the information at the Korey Stringer Institute.  I'm inclined to go with what the recommend:  http://ksi.uconn.edu/


http://ksi.uconn.edu/emergency-conditions/heat-illnesses/exertional-heat-stroke/


It's not how high the temp goes, it's how long you are at that temp that matters.  The faster you can definitively cool the victim down, the more likely they will recover without damage.

Yes a very good explanation of heat stroke, supporting the CWI. My only disagreement with the method presented is that it suggests the use of a rectal thermometer for signs and symptoms. Because most of us are unlikely to have a rectal thermometer, I always emphasize external signs: red, hot, dry skin, rapid breathing and heartbeat, headache, and altered mental state. Of course all these symptoms need not be present.

As the video shows COOL first TRANSPORT later. The less time the victim is overheated, the less likely will be organ damage.

My post was to dispose of counter-arguments against CWI and to empathize that advise often given: such as remove clothing, bring into an air-condition room are totally inadequate.

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LSThiker
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« Reply #9 on: July 26, 2016, 05:46:08 PM »

such as remove clothing, bring into an air-condition room are totally inadequate.

Unless that is all you can do.  Cannot really do CWI if you do not have the ability (i.e. hiking trails/backpacking).  :)
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Luis R. Ramos
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« Reply #10 on: July 26, 2016, 06:09:54 PM »

Or working a tarmac at an airshow.
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RNOfficer
Seasoned Member

Posts: 232

« Reply #11 on: July 26, 2016, 06:21:39 PM »

such as remove clothing, bring into an air-condition room are totally inadequate.

Unless that is all you can do.  Cannot really do CWI if you do not have the ability (i.e. hiking trails/backpacking).  :)

A good point.

The victim could be put into a stream or pond (carefully of course). If these are unavailable, you can still use the principle which is that heat dissipates ten times better from contact with water than from air. Move the victim into the shade, remove excess clothing then soak the victim's remaining clothing in water or flood his skin with a hose. Keep it up. When backpacking, prompt treatment is even more important because transport of the victim will obviously be delayed
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RNOfficer
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« Reply #12 on: July 26, 2016, 06:26:53 PM »

Or working a tarmac at an airshow.

There's often a ice bucket for soft drinks. There's always a hose. Even if the victim cannot be immersed, there's plenty of water to apply.
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LSThiker
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« Reply #13 on: July 26, 2016, 06:31:36 PM »

The victim could be put into a stream or pond (carefully of course). If these are unavailable, you can still use the principle which is that heat dissipates ten times better from contact with water than from air. Move the victim into the shade, remove excess clothing then soak the victim's remaining clothing in water or flood his skin with a hose. Keep it up. When backpacking, prompt treatment is even more important because transport of the victim will obviously be delayed

I have been places where there are 10-15 miles between streams with high heat.  Or places with no water (i.e. desert in SW US).  The water you carry is vital to keep yourself from heat stroke.  I have worried about these places because you cannot really use your water for anything other than drinking yourself.  To use it on anything else will probably mean you run out of water before your next spot (assuming the water is still there). 
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Luis R. Ramos
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« Reply #14 on: July 26, 2016, 06:43:37 PM »

Quote

...there's plenty of water to apply.


I never said there was no water to apply. Just that there is no place to immerse. Don't put words that are not there.
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Squadron Administrative Officer
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RNOfficer
Seasoned Member

Posts: 232

« Reply #15 on: July 26, 2016, 06:50:25 PM »

The victim could be put into a stream or pond (carefully of course). If these are unavailable, you can still use the principle which is that heat dissipates ten times better from contact with water than from air. Move the victim into the shade, remove excess clothing then soak the victim's remaining clothing in water or flood his skin with a hose. Keep it up. When backpacking, prompt treatment is even more important because transport of the victim will obviously be delayed

I have been places where there are 10-15 miles between streams with high heat.  Or places with no water (i.e. desert in SW US).  The water you carry is vital to keep yourself from heat stroke.  I have worried about these places because you cannot really use your water for anything other than drinking yourself.  To use it on anything else will probably mean you run out of water before your next spot (assuming the water is still there).

Yes, I've hiked in similar places, mountain ridges also.

I understand that water is heavy and one is disinclined to carry more than you think is necessary. But what if you were injured between water sources? How long could you survive on the water you're carrying ? It's always best to carry much more water than you think you will need even with the weight penalty. But, of course, it's your choice.
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Spam
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« Reply #16 on: July 26, 2016, 07:28:28 PM »

But what if you were carried off by a twister?
... attacked by a bear?
... shot by an armed bear (we preserve the right to arm bears)?


What if,
What if,
What if,

Jeez, already. Brain attack indeed.
/Spam

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Garibaldi
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Sandy Springs Cadet Squadron
« Reply #17 on: July 26, 2016, 07:31:39 PM »

But what if you were carried off by a twister?
... attacked by a bear?
... shot by an armed bear (we preserve the right to arm bears)?


What if,
What if,
What if,

Jeez, already. Brain attack indeed.
/Spam

Don't worry folks....I'll Gibbs-smack him at the meeting tomorrow.  :o
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You can't take the sky from me. Also, I can kill you with my brain. No power in the 'verse can stop me.
Spam
Salty & Seasoned Contributor

Posts: 1,055
Unit: GA-001

« Reply #18 on: July 26, 2016, 07:36:35 PM »

But what if you were carried off by a twister?
... attacked by a bear?
... shot by an armed bear (we preserve the right to arm bears)?


What if,
What if,
What if,

Jeez, already. Brain attack indeed.
/Spam

Don't worry folks....I'll Gibbs-smack him at the meeting tomorrow.  :o

Yeah, Cletus, you gonna walk over, but limp home (grin)

Sorry, but the hypothetical hand wringing was getting to me again.

Cheers,
Spam


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grunt82abn
Seasoned Member

Posts: 243

« Reply #19 on: July 26, 2016, 10:19:10 PM »

I would never delay transport even as a paramedic in CAP. Most squadrons don't carry the proper equipment to handle serious heat stroke, and CWI isn't always the correct solution. Every state, and the many medical regions with in states, have different treatment protocols to follow. If your willing to put your license on the line to start putting out treatment protocols to CAP members, that's on you, but you should at least have a caveat that you are just a MSO putting out geewiz information for knowledge base only, and not definitive care methods of treatment.

I haven't met a doctor or nurse, yet, in my 16 year career as a professional firefighter paramedic that would ever tell anybody to DELAY transport of a person having a medical emergency. Especially so that treatment can be done in the field by a layperson for someone in heat stroke or other medical emergency instead of getting the patient to the nearest emergency care facility. Your setting CAP members up for liability by putting this information out there. I know you don't like EMS first responders, but there is a reason we have 911, and that is so proper care can be provided in the pre-hospital setting and the patient can be brought to medical professionals who can fix the issues and hopefully prevent new ones from occurring. 


BTW, we call it a CVA, or Cerebrovascular Accident, and have stroke centers up here in Wisconsin and Illinois. I didn't coin the term, some big wig, supper smart brain doctor did.
« Last Edit: July 26, 2016, 10:40:24 PM by grunt82abn » Logged
Sean Riley, TSGT
US Army 1987 to 1994, WIARNG 1994 to 2008
DoD Firefighter Paramedic 2000 to Present
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CAP Talk  |  Operations  |  Safety  |  Topic: Cold water immersion for heat stroke
 


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