Need some advice for a call I went on the other day (heat exhaustion)

[Dan216]

The other day I was staged at a bike ride event with a fellow volunteer who is also a basic. This was both our first time away from the paid guys. At the very end of the day we had a patient who experienced nausea, headache, and light headedness/dizziness. I chalked it up to heat exhaustion since she had rode her bike 135 miles in the last two days in the hot sun. She stated she had drank lots of water. She was on no meds, no past medical history.

My treatment plan: I immediately took vitals. Everything was within normal ranges. B/P 122/78, pulse 89, O2 Sat 98. I moved her to some shade, and placed her in Trendelenburg position. I also put on O2 via N/C at 4 LPM and placed ice packs under her armpits.

Her vitals never really changed, other than her O2 sat went up to 100%.

When she stood up, she felt dizzy and we moved her to the air conditioned chase vehicle and she signed a refusal of transport.

Did I do everything right? What would you have done differently?

I was told afterwards by the AEMT's at my station that they did away with the shock position (elevating the legs), but I just read in my AEMT AAOS book that it was still there.

Also, would this be a situation where you would want to check blood sugar? Maybe her glucose levels were low from the bike ride?

I appreciate the help in advanced, and apologize if I posted this in the wrong category.

 

[Medic Tim]

The other day I was staged at a bike ride event with a fellow volunteer who is also a basic. This was both our first time away from the paid guys. At the very end of the day we had a patient who experienced nausea, headache, and light headedness/dizziness. I chalked it up to heat exhaustion since she had rode her bike 135 miles in the last two days in the hot sun. She stated she had drank lots of water. She was on no meds, no past medical history.

My treatment plan: I immediately took vitals. Everything was within normal ranges. B/P 122/78, pulse 89, O2 Sat 98. I moved her to some shade, and placed her in Trendelenburg position. I also put on O2 via N/C at 4 LPM and placed ice packs under her armpits.

Her vitals never really changed, other than her O2 sat went up to 100%.

When she stood up, she felt dizzy and we moved her to the air conditioned chase vehicle and she signed a refusal of transport.

Did I do everything right? What would you have done differently?

I was told afterwards by the AEMT's at my station that they did away with the shock position (elevating the legs), but I just read in my AEMT AAOS book that it was still there.

Also, would this be a situation where you would want to check blood sugar? Maybe her glucose levels were low from the bike ride?

I appreciate the help in advanced, and apologize if I posted this in the wrong category.

the "shock position" is now considered placing the pt supine.... the AEMTs were right..... it can take a while for texts to catch up sometimes. BGL would also be indicated.

I would have started them on oral fluids (water and Gatorade 50/50) as tolerated and depending on the severity IV fluids and zofran. All this after getting her out of the sun/heat.my treatment would not include O2

what was here temp? was she dry? diaphoretic? was the pulse regular or irregular? strong or faint? dry mucous membranes? skin turgor? did she have any soda or energy drinks? pre-workout drinks or supplements? Input and output (fluids and foods/waste) is also good to get on these pt's

 

[medichopeful]

Input and output (fluids and foods/waste) is also good to get on these pt's

As are orthostatic vital signs, though those aren't necessarily terribly accurate.

 

[Mariemt]

No elevation of legs anymore.

No need for o2.
Fluids, small sips as tolerated. Did you get a temp on her? What was it? What was her skin? Was it sweaty? Dry? Red? Pale?

Watch the ice packs, too fast of a temp drop can trigger had things. Ac is best with removal of any clothing not needed.

 

[TheLocalMedic]

Ever do standby for marathons before? Physicians often warn to actually withhold additional fluids from patients unless it is a cardiac arrest. The problem is that runners (and bikers) are over-hydrating themselves! Many carry their own water supply that they are frequently using, as well as passing by stations on the route that hand out even more water. All the sip sip sipping they do makes them take on lots of excess water, so much that they may weigh 1-5 pounds heavier after a race just from water! That coupled with them sweating out electrolytes which aren't being replaced by plain water, they end up very hypo-everything in their blood and are at a higher risk for pulmonary edema as well.

Cooling this patient is absolutely appropriate, but I wouldn't even bother laying them down. Have them sit in the shade, cool them and also encourage them to eat something (bananas and power bars are good). Also encourage gatorade or some of the power gel type of stuff to help replace electrolytes and remind them not to overdo the fluids.

 

[Dan216]

Thanks for the replies guys. Yeah looking back on it I think it would've been best to put her in a position of comfort for her. Thanks too for clearing up the shock position question.

It would've been good to get her b/g too! Always helps to be able to run scenarios by others to learn from them!

 

[Anonymous]

Ever do standby for marathons before? Physicians often warn to actually withhold additional fluids from patients unless it is a cardiac arrest. The problem is that runners (and bikers) are over-hydrating themselves!

This.......

 

[VFlutter]

My treatment plan: I immediately took vitals. Everything was within normal ranges. B/P 122/78, pulse 89, O2 Sat 98. I moved her to some shade, and placed her in Trendelenburg position. I also put on O2 via N/C at 4 LPM and placed ice packs under her armpits.

Aside from the fact that Trendelenburg is worthless why would you use it on a non-hypotensive patient?

 

[TheLocalMedic]

Aside from the fact that Trendelenburg is worthless why would you use it on a non-hypotensive patient?

+1 You win 100 internet points!

 

[MSDeltaFlt]

Granted there may have been a treatment or two that might not have been fully indicated. But I'm not going to dink you or your partner on your first assignment on your own since neither treatments did any harm.

Normal BP, normal HR, normal RR, and normal SpO2 generally need nothing more than a calming environment and observation.

Endurance athletes who complain of nausea, headache, and dizziness are complaining due to dehydration. And it'll be acute due to the endurance event so they won't necessarily have poor skin turgor or delayed cap refill.

Which is why, I'm suspecting, that your lady got up and signed a refusal after a few minutes of rest.

Heat exhaustion. That's what I would've called it as well. Good job.

 

[Akulahawk]

I would also call this heat exhaustion. No need for oxygen. Just move to a cool place, allow her to cool down, sip some water or water/gatorade mix and when her dizziness disappears, then she's good to go. In the future, I would also suggest adding temperature to the list of vitals you take.

If you see her again, I would suggest that she check her weight daily, and better before and after an exercise bout, because it's going to last a while. If she's down some weight, for every pound she's lost, she should replace about 12 oz water. If she's "heavy" some water, she won't need more.

On the whole, you didn't make things worse and you provided her some needed cooling measures. Good job!

 

[the_negro_puppy]

To be good in this job you need to know when not to do or give something.

Theres no point putting someone on 02 or in the leg-raised position just to look like you are doing something. Why did you do these? what were you hoping to achieve? She had no problem with her BP or oxygenation.

Dizzy or pre-syncopal? sure sit or lay them down, but no point raising the legs.

Considering their activity and heat would consider over exertion / mild heat exhaustion.

Get a history of their oral intake include water, food and electrolytes. Imbalances might be occurring. Rest in a cool area with perhaps electrolyte drink.

Observe and see hows she goes.

 

[EMT B]

do sporting events get their own protocols? i would get shot in the butt by multiple people if i ever gave a patient oral liquids

 

[chaz90]

do sporting events get their own protocols? i would get shot in the butt by multiple people if i ever gave a patient oral liquids

What does the patient need? You can give them oral glucose, so what's the difference in giving them oral fluids when necessary? If it helps for your documentation, the patient chose to rehydrate himself. You didn't open his mouth and pour it in. If you weren't there and the patient finished a race with these symptoms, they'd likely drink some Gatorade, cool off, and feel better. Just because we're there doing a standby doesn't mean we have to throw common sense out the window, start an IV, and transport to an ED for all complaints that don't need it.

 

[Tigger]

do sporting events get their own protocols? i would get shot in the butt by multiple people if i ever gave a patient oral liquids

If the patient does not wish to go to the hospital I am more than happy to watch them eat or drink whatever they want until they decide they are well enough to part ways. If after drinking water or Gatorade or whatnot they still feel like going to the hospital then I take them there. No one says anything. Why would I force someone not to drink water if they are dehydrated?

 

[Medic Tim]

do sporting events get their own protocols? i would get shot in the butt by multiple people if i ever gave a patient oral liquids

Many states...Maine included, have oral fluids in their protocols for heat exhaustion.

 

[EMT B]

it appears i do not get into the yellow section of my protocol book that much :unsure: it must just be a department thing

 

[Tigger]

it appears i do not get into the yellow section of my protocol book that much :unsure: it must just be a department thing

You don't need protocols for common sense.

 

[EMT B]

after texting my Lt it is a department policy that we do not administer fluids orally because the water is supposed to be for the firefighters in rehab.

 

[STXmedic]

Patient with active heat complications? Lets give him some wat-Wait! What if our firefighters get thirsty?! Nope. That stuff is expensive!

Brilliant.