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September 15, 2017

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.

The other day I got to 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 very likely significantly 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 me riding along, since by then her pulse was strong and her breathing regular and she was somewhat responsive.

Turned out she went into 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.

September 15, 2017 at 12:01 PM | Permalink


I should add that if you're going to collapse in a race, it's best to do it near an MD! My dad (a physician) helped a soldier that fell off a truck on the NY thruway back in the 60s...

Posted by: Greg Perkins | Sep 16, 2017 7:09:48 PM

Thank you, again, both for using your knowledge to save a life, and this illustrative tale to help teach the lifesaving technique.

Posted by: Matt Penning | Sep 15, 2017 6:17:19 PM

Bravo Joe! Good to know too, I hope I never have to use it!

Posted by: Greg | Sep 15, 2017 3:51:06 PM

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