Responding to Hypothermia

Part 2 of a 2 part series. (Part one is here.)

In our last post we looked at some of the causes of hypothermia, both typical and atypical. Then we talked a bit about the recognition of the hypothermia progression and what patients might look, feel and act like as they progress through their hypothermic condition.

Now let’s look at some of the guidelines for treating our hypothermia victims.

On the surface, treating hypothermia might seem deceptively simple. The treatment of mild hypothermia often is simple. Bring them in, stop the cooling and rewarm them. But as we progress into moderate and severe hypothermia, things get more complicated. Here are 12 guidelines to consider when the patient is more than just a little chilled.

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Mastering The Head-To-Toe Assessment

You probably practiced your head-to-toe assessment a bunch in your EMT class. Maybe more than any other skill in the EMT curriculum. If your class was or is anything like mine (as a student or a teacher) you performed the head-to-toe assessment again and again.

As much as we practice this skill in EMT class, I often wonder why so many EMT’s have such bad head-to-toe skills out on the street. It seems that, once we get out on the street, the systematic, thorough head-to-toe assessment falls out of favor and quickly gets replaced with the faster, more direct focused assessment.

That works just fine most of the time. If it didn’t, I figure it probably wouldn’t be such a universal phenomenon. (For the record, have you ever worked somewhere where this wasn’t the case? Neither have I.) The downside is that when the patient arrives who really needs a, honest-to-goodness, rapid, complete head-to-toe, we’re not up to the task.

I happen to believe that patient assessment skills are one of the defining qualities of a talented EMT. Here are seven tips to keep your head-to-toe in top form.

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Medicine Between The Frames

One of my favorite bloggers, Seth Godin, recently introduced me to the work of Scott McCloud, an author who’s written several classic books on understanding comic books. Scott dissects the comic medium and explains the ongoing allure of the comic book to the uninitiated.

One of Scott’s observations is that comic books require imagination on the part of the reader because, in all great comic books, the action occurs between the frames. The artist only shows you snapshots of action and dialogue. Most of the story takes place in our heads. The real story is the stuff that we invent that happened in-between the frames.

Medicine works in much the same way. We assess, we ask our questions, we do our head-to-toe and we make a guess (educated) about what’s going on. Then we make a change, and the medicine begins, after we make the change, not before.

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The E-Book is Coming!

OK, I can’t keep this to myself any longer. It’s time for the big announcement. With the final draft still in the mail from my editorial team and the final design still lacking a few details, it would probably be best to just keep this under wraps for a few more weeks, but I can’t wait.

My first E-book is scheduled for release on January 21st, one week from today. The e-book will be free and it will be available right here at The Spot.

The Book is called The Non-Conformists Guide to EMS Success. This book is the culmination of two decades of EMS experiences, mistakes, failures, trials, and errors that lead to my ultimate success. My goal was to write something that would be useful to EMTs at any stage in their career. And I didn’t hold anything back. This is my road map to finding true success and fulfilment in EMS work.

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CPR Right Now

I helped teach CPR to our latest EMT class this past week. This class is always a good reminder of how fast emergency medicine changes.

Here in their first week, the new students are beginning to hear our warnings.

“You are going to hear about many different ways to perform this skill. Some are older methods than the ones we are teaching you today. Some are newer. Some things you are learning will quickly go away. New methods, new machines and new research are all in progress. That doesn’t mean what you are learning right now is wrong. It is an imperfect method. Prepare for change.”

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6 Reasons Why You Should Be a Better EMT

Sure, this site isall about being a better EMT, but perhaps you’ve asked yourself, “Why?” OK, granted, it was probably one of your more cynical moments. Perhaps you had a bad day, a couple of frustrating calls or a less than optimal interaction with a patient, your partner, another agency, your boss … or perhaps all of the above.

Then you went out and threw down your stethoscope. Or maybe you didn’t throw it down because you remembered it was a Littmann and a gift from your aunt, but you raised it over your head and thought about it. And while that stethoscope dangled over your head in your clenched fist you thought, “Why? Why do I work so hard to try to be better at a job that pays so little and offers so little in return?”

“Why?”

We’ve all had these moments. Moments when we contemplated, “Why don’t I just phone it in? The bad EMT’s make the same amount of money as the good ones. I clearly already meet the minimum standard. Nobody’s really pushing me to be any better. Nobody seems to recognize my growth or effort. So why do it?”

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The Art of The Nasopharyngeal Airway

I would surely rank the nasopharyngeal airway (NPA) as one of the most under-rated / under-utilized pieces of equipment in the EMT bag of tricks. They’re useful, simple and versatile. As a group, we tend to do a pretty good job oxygenating our patients, but I think we drop the ball on BLS airway adjuncts.

Most of our unresponsive or semi-responsive patients should be arriving at the ER with an NPA in place. If you’re bagging a patient they should have one … maybe two NPAs in place.

They’re fast, they’re friendly, they work much better on the semi-conscious and they don’t stimulate the gag reflex quite like their cousin the oropharyngeal airway. They also stay in place better, leaving the mouth open for examination and advanced airway techniques.

I’ve often had EMTs explain that they didn’t drop a basic airway adjunct because they knew I was right around the corner and I’d be intubating. That’s a poor excuse. When I arrive on scene I’d like to see that the EMT at the head has managed the BLS airway aggressively.

So let’s bone up on our NPA skills. Once you’re comfortable with these little beauties, they only take a few seconds to drop. You don’t need to make it a big production. Grab the right size, squirt a clump of KY on the end and go.

So let’s break it down and make you an NPA, quick draw, master.

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Staked Down With a Twig

Circus elephants present a containment problem. It’s hard to keep a big elephant cage around wherever you go. So when baby circus elephants are trained, they are staked down to a pole with a chain. The young elephants pull and struggle against the chain for a while and then learn the limitations of the situation.

Soon the elephant can be staked down with a wooden stick. The elephant could easily break the confinement but it doesn’t try. It’s already learned what it can and can’t do. To add further insult to the awesome, unrecognized power of the beast, by adulthood many of the elephants can be training to pull up their own stake and move it on command and then remain in the spot that they re-staked themselves too.

I think about the circus elephant staking itself down often. Mostly when I hear my colleagues and friends talk about the obstacles that prevent them from recognizing their goals. You know what I’m talking about. All that stuff we’re waiting for before we can start really moving toward our vision for our life.

When I look at the awesome human potential that we carry around within us and then I consider the little, insignificant things we chose to see as barriers, I think about the elephant.

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What Is Ketosis Anyway?

The carb craze may be responsible for thrusting the term ketosis into the mainstream vernacular. Before that, it was a word you rarely heard outside of medicine. Before Dr. Atikins and the low carb evangelists came along, you could relegate ketosis to a power point slide in an occasional diabetes lecture and be done with it.

Now it seems like ketosis is the in-word with soccer moms and zone dieters alike. And, while its conceptual popularity has grown, there’s still a lot of misunderstanding floating around about what ketosis is and what it means for your body. Much like belly button lint and the popularity of boy-bands, the ketosis phenomenon is well known yet somewhat mysterious and difficult to explain. So let’s review.

If you don’t have time for the long answer, here’s the short and sweet version:

• Ketosis is the term for abnormally high levels of ketone bodies in the blood.
• Ketones are created when the body breaks down fat for energy.

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Test For Unconsciousness: The Sternal Rub

Ahhh the embattled sternal rub. Revered, reviled … the sternal rub is the Ann Coulter of medical interventions. Abrasive, annoying, loved by many, hated by many more. The subject of the usefulness of the sternal rub is bound to cause controversy in any EMS forum.

In other words … it’s a great subject for The Spot.

Like many controversial assessments and treatments, the sternal rub (sometimes referred to as the sternum rub) got its bad-boy reputation more from its misuse than from its own shortcomings. Never-the-less, the technique does have its shortcomings.

Like so many other tools, it has its place when used appropriately and it has its potential for misuse. So let’s make sure you understand its uses and limitations.

If you’ve never encountered this technique, the sternal rub is a test for unconsciousness. It’s a popular form of painful or noxious stimuli designed to illicit a response from a conscious or semi-conscious person. Establishing an unresponsive patients ability to respond and remove noxious stimuli is perfectly medically appropriate.

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