40 y/o female heat exhaustion

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musicislife

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Back Story: You are standing by as a First Responder for a town biathalon. It is 80 degrees outside. You spot a runner on all fours, who is breathing fast and lightly. You investigate, and says she tired to drink water multiple times in the past 10 min, but it made her feel like vomiting. You radio for an EMT's assistance, who is ten min from your location.

Initial: Airway clear, Breathing. Fast and light Circulation: Cool, clammy skin. Fast pulse. No blood

Assessment: Signs: Cool, clammy skin. Fast pulse. Extreme nasuea. Fast, light breathing.
Allergies: None
Medications: None
Past History: History of fever related seizures? (would this be relavant?) None. No past heat emergencies.
Last oral intake: Drank a watter bottle about 4 hours ago that morning.
Events: Running a biathalon.

Vitals: BP 140/86 Pulse: 120 Respirations: 26 per min

Interventions (done while taking sample): Apply cold compress to forehead, back of neck, and underarms.

Do not transport, monitor patient.

Ongoing: 5 min later, she vomits a lot, and begins complaining of severe abdmonial pain. Skin turning red. Lay patient on strecher, transport to nearest facility.

Any differences? Comments?
 
Not to nitpick but I'd try to get under some shade and wet her down with water if you have a hose. (wet t-shirt contest anyone? :ph34r: just kidding ) Evaporation is a great tool. Coach her on slowing her breathing if you can.

Did she train for this event? Any stimulant use, I know she said no meds but people lie?

As a MFR you aren't going to be doing much more than what you listed. At more advanced levels I'd be initiating fluid replacement and possibly zofran to stop the vomiting.
 
NVRob said:
Not to nitpick but I'd try to get under some shade and wet her down with water if you have a hose. (wet t-shirt contest anyone? :ph34r: just kidding ) Evaporation is a great tool. Coach her on slowing her breathing if you can.

Did she train for this event? Any stimulant use, I know she said no meds but people lie?

As a MFR you aren't going to be doing much more than what you listed. At more advanced levels I'd be initiating fluid replacement and possibly zofran to stop the vomiting.
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we'll assume that shes went to the shade on her own. And would one spray the patient to cool them if possible?
 
I'm limited to moving patient to shade and possibly an A/C room and wetting them down.

Cold packs are a Paramedic skill here :glare:
 
musicislife said:
And would one spray the patient to cool them if possible?
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I would. Only if I was able to let her keep her dignity intact though. I'm not on a mission to embarrass or make someone uncomfortable.
 
Cool patient quickly. People can turn red facially from vomiting (enormous valsalva going on) but not red all over. Nausea is common with heat exhaustion but not with heat stroke, the dry red hot one.

The cold pack deal feels nice but is early a stopgap, got-nothing-better deal until you get them in front of a fan or AC, maybe lay them on a cold surface (concrete floor in the shade can be palpably colder than the surrounding air sometimes), and yes wet them down to enhance evaporative cooling.

Could be a hangover, food poisoning, pregnancy, or just primary heat exhaustion. Once nausea hits, you will probably need to get IV's in.
Sounds like it went well on your end.
 
Sounds like the right thing was done, applie ice packs to armpits groin back of knees fan and keep cool, start fluids if possible, monitor vitals treat/ be prepared for shock.
 
As a 1st Responder, I would be looking at using a cold compress or icepack under the neck, armpits, groin, etc. I would also place the patients in the shade on a cool surface, if possible. If I have a hose available with cool water, I would also use that. Being that her last oral intake was about 4 hours ago, with attempts to drink water in the past 10 min., resulting in nausea, I would also consider administering small sips of fluid as those are typically less irritating to the stomach, resulting in less nausea. Something else that I would consider is after the vomiting episode, depending upon the contents, I may restart the small sips of water. At a more advanced level of care, I would also consider starting an IV line and beginning rehydration therapy.
 
I would move her to shade/rig, admin high flow oxy via non-rebreather, apply cool packs & offer water. Once she began vomiting I would transport rapidly.
 
Notown said:
I would move her to shade/rig, admin high flow oxy via non-rebreather, apply cool packs & offer water. Once she began vomiting I would transport rapidly.
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Your plan is to put a mask over the mouth of somebody vomiting and then blow air in it?

Let me know how that works out for you...
 
musicislife said:
we'll assume that shes went to the shade on her own. And would one spray the patient to cool them if possible?
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Potentially. The problem is overdoing it and causing them to shiver, which you don't want!
 
Veneficus said:
Your plan is to put a mask over the mouth of somebody vomiting and then blow air in it?

Let me know how that works out for you...
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I was wondering the same thing.

That could be pretty comical watching someone puke into an NRB. Poppin out of the valves and what not.
 
We need a sticky title no thread required: "WHY HIGH FLOW NRB OXYGEN?"
 
mycrofft said:
We need a sticky title no thread required: "WHY HIGH FLOW NRB OXYGEN?"
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Who cares about high flow o2?

I just want to see somebody puke into the mask with some kind of compressed gas at 15lpm or greater blowing in it.
 
Correct me if I'm wrong but...As an EMTb aren't we supposed to transport any patient who is having gastric distress? I'm asking seriously not as a joke or anything.
 
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I would put her in the back of the ambulance, monitor vitals and transport. Simple enough?

I wouldn't put O2 on her because shes breathing adequately just exhausted. Ive packs are a good idea if no ambulance is on scene yet and like somebody said tell her to take deep breaths.
 
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Notown said:
Correct me if I'm wrong but...As an EMTb aren't we supposed to transport any patient who is having gastric distress? I'm asking seriously not as a joke or anything.
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You could I guess. But that doesn't mean to go rapidly, if at all.
 
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