You are the ED doc in a small “tourist” town which has been hosting an annual “Early Bird Polar Plunge” swim for the past 10 years. Participants enter the water in limited attire and swim 100 yards as fast as they can.
You happen to be working in this “tourist” town ED (aka “sleeping for dollars”) when you receive an early morning (7am) EMS call.
A 25 year old male was found unresponsive in the water minutes after entering the frozen bath. He was pulled from the water by rescuers and CPR was initiated. ACLS protocols were followed: CPR was initiated and he received one dose of epinephrine and 1 shock.
Pt arrives intubated with a faint pulse. EMS has warming blankets in place.
Rectal Temp: 98.1 degrees fahrenheit
1. What Would You Do?
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CPR is continued and Rectal Temp in noted to be 24 degrees Celsius
iStat is essentially normal: K is 5.5. venous pH 7.25
2. Would you continue resuscitating this patient?
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3. What is your goal core temperature before terminating this resuscitation?
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4. How would you warm this patient?
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Your shift is complete and you elect to go winter camping on your day off. You come across another camper who appears confused and half clothed.
5. Who would you least like to personally save by direct, body to body, (aka “skin on skin”) re-warming…think up close and cozy in a sleeping bag?
-Marilyn Manson
-Jocelyn Wildenstein
-Shane MacGowan
-Kelly Osbourne
-Steven Tyler
-Tori Spelling
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6. Can you identify the General in this famous picture:
This picture is held up as a depiction of "Victory Disease": Victory disease denotes when in military history, because of complacency or arrogance brought on by a victory or series of victories, anengagement ends disastrously for a commander and his forces.[1]
A commander may disdain the enemy, and believe his own invincibility, leading his troops to disaster. That commander may employ strategies which, if effective in earlier combats or maneuvers, prove catastrophic against a new or smarter enemy; the commander afflicted by "victory disease" may also fail to anticipate a new enemy may use tactics different from those of old enemies. Anoverconfident commander may disregard military intelligence which would enable the commander to realize that new tactics are needed.
Though "victory disease" does not inevitably foretell defeat, it often precedes it. The term is also applied outside the military world.
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ReplyDeleteFrom WK: 1. I would consult the big city hospital Telemedicine program only to find that the program was off line due to staff shortages. Then I would try the Mayo system but the patient would by that time already be dead.
ReplyDelete2. I would call the big city hospital and ask for Cardiac Bypass, but it would be after hours or on the weekend and it would take too much time, so I would call the Mayo but by that time the patient would already be dead. But in the meantime I would try everything else except thoracic lavage because I don't know how to do that. I actually really don't know how to do peritoneal lavage either, but it won't matter.
3. All of these people are either dead, should be dead, or risen from the dead.
4. Napoleon Bonaparte on his winter retreat from Russia. He is already dead too, though he lives on in the spirit of a few people we know.
1. None of the above... the only thing you have done is rule out hypothermia as cause for arrest -- Hypertermia, Hypovolemia Hyper/hypokalemia, toxins and all other H's and T's still within the differential... Oh by the way his friend said he spent the last 2 hours in a sauna before he jumped in the cold water... was that important? (not that I have any experience with such a situation...
ReplyDelete2. Yes.
3. 32-35, wouldn't pronounce until I hit 35.
4. Would place intra femoral catheter to warm, Warm humidified air +/- tube if they needed to be intuabated, warm packs on axilla and groin, Bair Hugger, keep feet and hands exposed to room air.
Napoleon... (Another little white guy)
Mercifully EMRAP was on hypothermia this month so I feel super smart
ReplyDelete1) I would treat him like a regular cardiac arrest and cool him (C)
2) Yes, resuscitate
3) 32-35
4) All the simple warming stuff (fluids, O2, blankie) maybe bladder lavage, but he really needs to get to the big city and get on bypass
5) Please never post a picture of marylin manson without a warning first, I will need to pray not to see that face in my dreams tonight