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May 5, 2010

BehindTheMedspeak: Why my half-marathon in Pittsburgh this past Sunday ended at mile 11

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On Monday, May 3, 2010, at 9:21 PM, CC wrote:

Hi Joe,

Thank you so much for helping me. They determined I had heat stroke and I am currently still in the hospital. My friend T said you were very kind and helpful. I hope to get home tomorrow! Hope you did well in the race and I didn't ruin your time!

Sincerely,

CC

Sent from my Verizon Wireless BlackBerry

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From: Joe Stirt <bookofjoe@gmail.com> 

On: Monday, May 3, 2010 11:33:53 PM EDT

To: CC

Subject: Re: Thank you

CC,

I cannot tell you how pleased I am to hear from you as I did just now, for several reasons which I'll get into.

But first, before I forget โ€” you're most welcome.

None of the other people present for the first 15 or so minutes I was with you had any idea how unstable you were.

When I stopped and examined you, you were unconscious and unresponsive even to pain; had no palpable pulse; were jerking and twitching (legs, arms, and eyelids) most likely due to low potassium and impaired neuromuscular transmission; breathing shallowly and irregularly; and gradually lost your skin's normal color and became pale and somewhat ashen, both lips and fingernail beds. Also, your airway was becoming obstructed.

Though I'm an anesthesiologist and not a diagnostician/ER physician, and never formed a diagnosis of heat stroke in the formal sense (thought that's undoubtedly what you had), I pointed out to those around you that you were very likely volume depleted, potassium depleted, and had low blood sugar, as well as being overheated with unstable cardiorespiratory function.

In short, you were in a state of circulatory shock, which can be fatal.

We treated the symptoms, doing the following: elevated your legs to return about 1/3 of your blood volume to the central circulation/heart; commandeered water and any fluids we could from everyone around to douse you in an effort to lower your core temperature; elevated your mandible to clear your airway.

Over that period of time your pulse came back, rapid and strong; your breathing became regular; your color improved; you gradually stopped twitching and jerking. You were still unconscious and unresponsive.

After 15 minutes or so it became clear you had to go to the hospital for IV hydration/observation, but it took another 15 minutes till the emergency vehicle arrived.

By that time we'd decided to take you directly to the hospital in someone's SUV rather than continue waiting fruitlessly. As we lifted you into the SUV, just as we were about to slide you into the back, you started having a lot of emesis of yellow liquid, I'd estimate probably 1-2 quarts, large streams of stuff.

We held you in the air on your side so you wouldn't aspirate, which would've been an unfortunate coda. I don't think you would have done so but you still weren't responsive and conscious so it was much better to be overly protective of your airway since it was unclear just how functional its protective reflexes were.

In summary, I think that had things not happened the way they did, you could have had a cardiac arrest and possibly died right there on the street.

I've attended enough Code Blues in my career to know what they look like before the Code, and you were very unstable and borderline.

The fact you're lucid enough to email me as you did means there's no brain damage, always a feared thing with heat stroke; the fact they're keeping you at least a second night makes be believe you indeed had major physiological derangement, enough that it wasn't correctable with a IV/good-bye sort of approach.

In closing, I must add I'm envious that you and your friend were pretty far ahead of me.

After they took you to the hospital I finished the race.

I know I was at 1:58 at 11 miles and that's good enough for me.

Hope your recovery is uneventful from here.

Regards,

Joe

May 5, 2010 at 10:01 AM | Permalink


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Comments

I started reading your blog when I worked as an anesthesia tech at the University of Alabama Hospital. 6 years later, I am still reading and learning from you. Great information on heat stroke. I love your blog. You come in second; after CNN, I read you.
That was a wonderful thing you did for a fellow runner.

Posted by: Rebecca | May 8, 2010 10:48:24 AM

As a native 'burgher and an avid joehead, I wish I had known you were in the race. I sat through the rain to cheer on many friends, including a Joe.

It just wasn't the right Joe.

::sigh::

But I still hope you enjoyed our beautiful city.

Posted by: Katy | May 7, 2010 6:15:05 PM

There's an appointed time and an appointed place. Thanks to Dr. Joe, his time was not up.

On a narrow mountain road, coming in the opposite direction, a motorcyclist rounded the curve, crossed the yellow lines, and crowded me to the shoulder. We missed each other.

I said, "Death just passed me by."

Posted by: Kay | May 6, 2010 7:44:43 PM

Remind me never do a marathon unless you are also running in it Joe.

And to stay ahead of you at all times.

Better yet,

remind me not to run in marathons.

Posted by: Rocketboy | May 6, 2010 7:05:27 AM

Well done! Good man, Doctor Feelgood. But I knew that all the time.
Lucky, lucky, lucky runner. My luck, I would've passed out cold and been surrounded by accountants and trombone players.

Now, is this right? Heat exhaustion is when you just slap run out of fluids, and heat stroke is when you get overly hot and something in your brain just goes kablooey and your body temperature goes up and up? If it's the fluid thing, can a person pass out with that, too?

Posted by: Flautist | May 5, 2010 9:14:18 PM

Joe, I salute you!

In my back yard being a good Samaritan!

Using my Poetic license card!

Posted by: JoePeach | May 5, 2010 5:07:57 PM

Ya know, I'd been wavering on my decision to go into med -- do the easy thing and finish the phd in psych -- and this sorta thing is exactly why I want to do it. Ok...I guess I sign up for the prereq courses this summer again :(

Joe -- you rock...

Posted by: clifyt | May 5, 2010 4:59:30 PM

Great that you related this story to us. Great that you were there to help. No wonder Joe and Hero rhyme!

Posted by: Virginia | May 5, 2010 1:23:23 PM

Nicely done. Seeing fellow members of the profession do great things makes me proud to be a doc.

Posted by: Dan | May 5, 2010 1:04:42 PM

Wow Joe, that's the most amazing thing - kudos to you. I've had emergency situations myself and it is rare that you get such a blow by blow account of exactly what happened to you! ususally you are just told you were unconcious. I wonder what his reaction was on reading your mail??

Posted by: jo | May 5, 2010 12:30:41 PM

Good Mitzvah Joe! Lucky (or fated) for him/her? that you were there.

Posted by: tamra | May 5, 2010 11:59:01 AM

Good thing you forgot that race bib.

;)

Posted by: Erik | May 5, 2010 11:19:06 AM

Well done. Glad you happened to be there and recognized just how dire his status was.

Posted by: Albert | May 5, 2010 10:51:25 AM

You must really be a good person if you helped out someone who was beating you pretty badly in the race. I'm glad to hear that it looks like he'll make a recovery. I think in college it would take me a day or so after I had an emesis of a yellow liquid we called pabst.

Posted by: Matthew | May 5, 2010 10:39:25 AM

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