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Iced Saline in the field Mast pants of 2009, or here to stay? Paul Davidson M.D. Centura EMS
Concepts you will hear about ,[object Object],[object Object]
Concepts you will hear about ,[object Object],[object Object],[object Object]
Concepts you will hear about ,[object Object],[object Object],[object Object],[object Object]
Standard of Care, 2005 ,[object Object],[object Object],[object Object]
Colorado Rule 500 update *Effective 4/30/09
In case you missed it…
In case you missed it….. ,[object Object],[object Object],[object Object],[object Object],[object Object]
Why dead dogs/rats etc. say it works ,[object Object],[object Object],[object Object]
Newsweek, July 2007
European study 2002
Neurological outcome/mortality  at 6 months--Europe 56/137(41%) 76/138(55%) Death 75/136(55%) 54/137(39%) Favorable neurologic outcome HYPOTHER- MIA NORMO-THERMIA OUTCOME
Australia study 2002
Concept #2. Is faster better when it comes to cooling? ,[object Object],[object Object],[object Object]
Sterz, 1991 results
Conclusions-Sterz ,[object Object],[object Object],[object Object]
Concept #3-Delayed cooling leads to less favorable outcome ,[object Object],[object Object],[object Object],[object Object]
Kuboyama-data
Kuboyama-conclusions ,[object Object],[object Object],[object Object]
More delayed cooling… ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Nozari, data
Nozari, conclusions ,[object Object],[object Object],[object Object]
Iced saline before/during CPR defibrillation? ,[object Object],[object Object],[object Object]
Abella, 2004 ,[object Object],[object Object],[object Object],[object Object],[object Object]
Abella, 2004
Abella, 2004
Abella, conclusions ,[object Object],[object Object]
Boddicker, 2005 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Boddicker, 2005
Boddicker 2005
Boddicker, 2005
Boddicker, conclusions ,[object Object],[object Object]
Concept #5 ,[object Object],[object Object],[object Object]
38 Bucks at Target
20 Bucks at Target
About $3 online
Cooler experiment
Cooler experiment
Bernard’s iced saline study 2002 ,[object Object],[object Object],[object Object],[object Object]
Kim, Seattle, 2007 ,[object Object],[object Object],[object Object],[object Object]
Kim, Seattle, 2007 ,[object Object],[object Object],[object Object],[object Object]
Cool fast-90 min to 33 degrees C
Concept #6 ,[object Object],[object Object],[object Object]
Wake County EMS data
Survival – All Rhythms 4.6% 7.3% 8.2% 11.6% * when compared with baseline P<0.05*
Comparison of Outcomes Hypothermia vs. Baseline * P <0.05 when compared with baseline * * * *
Concept #7-Do no harm ,[object Object],[object Object],[object Object],[object Object],[object Object]
Discussion-who, what, why, etc.. ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Who gets cooled?  ,[object Object],[object Object]
What does protocol look like? ,[object Object],[object Object],[object Object],[object Object]
 
 
Where is the destination? ,[object Object],[object Object],[object Object],[object Object]
Colorado Rule 500 update *Effective 4/30/09
Destination ,[object Object],[object Object],[object Object]
Cooling and STEMI Coma Pts. 0.15 83% 97% Favorable neuro outcome for survivors 0.075 47% 65% Survival at D/C P-value Cooling only non STEMI Cooling +cath lab STEMI
When to start iced saline? ,[object Object],[object Object],[object Object],[object Object],[object Object]
Why not? Reasons cited for EMS not doing it ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
How? ,[object Object],[object Object],[object Object]
Kim’s fridge, Seattle 2007
Engel Model 15 ,[object Object],[object Object]
Refrigeration devices ,[object Object]
Fridge in supervisor’s SUV
Blue ice/ice-28-30F for 30 hours
[object Object],[object Object],[object Object],[object Object],Set up and use
[object Object],[object Object],[object Object],[object Object],[object Object]
Arctic Blast update ,[object Object],[object Object],[object Object],[object Object],[object Object]
Colorado Springs  ,[object Object],[object Object],[object Object]
Colorado Springs
Temperature probes in the field ,[object Object],[object Object],[object Object],[object Object]
Esophageal probes $10 each disposable, or $60  reusable, cidex
Esophageal thermometer $130
38 Bucks at Target ,[object Object],[object Object]
Shivering control-Paralytics ,[object Object],[object Object],[object Object],[object Object]
Shivering control ,[object Object],[object Object],[object Object],[object Object]
Closing thoughts ,[object Object],[object Object],[object Object],[object Object],[object Object]
What agencies need to do ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

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