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July 5, 2012

BehindTheMedspeak: An easy way to save a life in hot weather


I like medical interventions that anyone can do without worrying about whether they're doing things right.

The very best ones can't hurt and might help.

Yesterday's sweatfest 5K, in which I started out optimistic about doing sub-8-minute miles only to blow up around mile 1, then clock 8:43 and 9:58 for miles 2 and 3, pretty much jogging to the finish line and then just lying down in the shade for about 15 minutes with my legs up against a tree while dousing myself with water and drinking a couple of bottles, got me thinking about my 2010 Pittsburgh Half-Marathon experience, when I dropped out around mile 11 to help a runner who'd collapsed onto the street.

She was thrashing around and non-responsive and people were standing around not doing much of anything, no one having even called for a rescue team.

Obviously — to me — she had heat stroke; I couldn't feel a pulse, a sign that her blood pressure and cardiac output were way down.

I took her ankles and lifted them a couple feet into the air, which returned all the blood pooled in her legs — probably about a third of her total circulating blood volume — back to her central circulation where she needed it most, to perfuse her brain and heart.

That left me free to tell the people in the vicinity to start pouring whatever liquids they had on the woman's neck and chest, to cool her down and drop her likely elevated core temperature.

As I recall, they doused her with water, Gatorade, juice, all manner of fluids, it didn't matter, and that was just fine.

It took about 15 minutes for a rescue vehicle to get there and by that time her eyes were no longer rolling back up into her head and her twitching had stopped, though she was by no means back to normal.

I thought she was stable enough to let her go to the hospital with the rescue squad without riding along, since by then her pulse was strong and her breathing regular.

Turned out she went into temporary kidney failure as a result of decreased renal blood flow during that episode and spent a couple days in the ICU before being sent to the floor and, after 5-6 days total in the hospital, home.

A near miss.

I talked to her (she was in her early thirties, a young wife and mother) and her dad a week or so after she returned home and she'd apparently pretty much recovered, though she said she was still a little weak.

Anyhow, long story short: If someone appears to be overcome by heat, lift their legs into the air and keep them there while you wait for assistance.

It can't hurt and might help.

This simple maneuver is also potentially lifesaving if someone is having a heart attack or in cardiac arrest, for the same physiological reason: it returns blood to the central circulation so the heart can better perfuse critical organs like the brain, lungs, and kidneys, as well as its own muscle.

July 5, 2012 at 02:01 PM | Permalink


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Memorized and filed away. And sent to half a dozen people I know, or, truthfully, THE half dozen people I know. How's it gonna help me if I'm the only one who's bristling with preparedness...

Posted by: Flautist | Jul 5, 2012 11:44:03 PM

Thanks you so much for the information, Dr. Stirt! And so sorry the weather has been so nasty there on the east coast. Here in Los Angeles county, it's been in the upper 80's the last week or so. A big improvement over the typical 90-105 temperatures here in July!

Posted by: Marla | Jul 5, 2012 8:40:21 PM

Too wierd Joe! I was thinking of this (elevation of legs) just last night as a first, best step for a variety of conditions. (cue Twilight Zone music)

Avo, you're not alone! It's 70° in Seattle now and I'm sweating after washing the dishes...

Posted by: jim` | Jul 5, 2012 6:00:33 PM

Oh, Joe (flutters eyelids), you're my hero.

No. Srsly. And thanks for the information.

People with no electricity might be glad to know that there are such things as battery operated stand-up fans. I bought mine at Wal-Mart, waiting for the next Irene to happen. Because it will.

Posted by: Becs | Jul 5, 2012 5:19:47 PM

Aside from the personal fact that ay all times where the temperature is over 70f I feel a heat stroke coming on (I've been too hot in Anchorage, Ak in May!), this is a really valuable bit of information.

Here's my problem, I find it difficult explaining perfusion and diffusion to a layperson. I analogize perfusion to water passing through a sponge (albeit, that is really absorption, or adsorption, or a combination of the two) and I use dilution analogies for diffusion.

Well, Doc - can you come up with a good layperson's description of perfusion?

Posted by: 6.02*10^23 | Jul 5, 2012 4:22:11 PM

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