DOCSLIB.ORG

Hypothermia, Drowning and Cold-Water Survival

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Hypothermia, Drowning and Cold-Water Survival PVSSPVSS ConferenceConference Hypothermia,Hypothermia, DrowningDrowning andand ColdCold--WaterWater SurvivalSurvival By RADM Alan M. Steinman USPHS / USCG (Ret) DisastersDisasters atat SeaSea AircraftAircraft DitchingDitching atat SeaSea FallingFalling OverboardOverboard WashedWashed OverboardOverboard Understand Cold Exposure: Immersion vs Submersion Immersion - Head Out! Submersion = Head In !! PhysiologicalPhysiological ResponsesResponses toto SuddenSudden ImmersionImmersion inin ColdCold WaterWater Responses to Cold Water Immersion • Cold Shock (0-2 min) • Functional Disability (2-15 min) • Hypothermia (> 15-30 min) • Peri-Rescue Collapse ColdCold--ShockShock ResponseResponse OccursOccurs immediatelyimmediately uponupon entryentry LastsLasts upup toto 22 minutesminutes CausedCaused byby stimulationstimulation ofof truncaltruncal skinskin nervenerve endingsendings TheThe coldercolder thethe water,water, thethe strongerstronger thethe responseresponse ColdCold--ShockShock ResponseResponse GaspGasp reflexreflex HyperventilationHyperventilation DifficultyDifficulty holdingholding youryour breathbreath TachycardiaTachycardia (rapid(rapid heartheart rate)rate) HypertensionHypertension (elevated(elevated bloodblood pressure)pressure) When and How You Can Die in Cold Water 1) Cold Shock Response (0-2 minutes) Gasp Æ Drown (Keep head out of water) Hyperventilation Faint Æ (Don’t panic, keep calm) Æ Drown à Cardiac Work Æ Cardiac Arrest (If existing heart problems) IncapacitationIncapacitation inin ColdCold WaterWater DifficultyDifficulty swimmingswimming LossLoss ofof functionalfunctional abilityability IncreasedIncreased viscosityviscosity ofof coldcold waterwater LossLoss ofof manualmanual dexteritydexterity MuscleMuscle crampingcramping SwimmingSwimming speedsspeeds onsetonset ofof hypothermiahypothermia When and How You Can Die in Cold Water Local Cooling Decreases Performance Or Functional Disability (2-15 minutes) • If you can’t get out in 5-15 minutes, you might not get out on your own power! • If so, prepare to survive. • Widen window of opportunity for rescue. • Thrashing around will - increase heat loss - cause exhaustion (Drowning) When and How You Can Die in Cold Water Onset of Hypothermia (>30 minutes on) • Cooling to UNCONSCIOUSNESS • If head goes under, Drowning (30-120 minutes). • If head above water… • Cooling to CARDIAC ARREST, Death (90-180 minutes or more, depending on water temp, body size, etc.) SummarySummary ofof ColdCold WaterWater RisksRisks ColdCold ShockShock (0(0--22 minutes)minutes) FunctionalFunctional disabilitydisability (2(2--3030 minutes)minutes) HypothermiaHypothermia (>30(>30 minutes)minutes) RoleRole ofof FlotationFlotation PFDs,PFDs, immersionimmersion suits,suits, etc.etc. cancan assistassist inin survivingsurviving coldcold--shockshock && swimswim failurefailure RoughRough seasseas remainremain aa significantsignificant risk,risk, eveneven withwith flotationflotation assistanceassistance ImmersionImmersion suitssuits cancan assistassist inin preventionprevention ofof hypothermia,hypothermia, ifif properlyproperly donneddonned HypothermiaHypothermia inin ColdCold WaterWater AirAir isis anan ExcellentExcellent InsulatorInsulator Body Fat is an Excellent Insulator HeatHeat isis lostlost fromfrom thethe bodybody inin proportionproportion toto itsits surfacesurface areaarea Large,Large, fatfat peoplepeople coolcool farfar moremore slowlyslowly thanthan dodo small,small, thinthin oror lankylanky peoplepeople AdultsAdults coolcool moremore slowlyslowly thanthan dodo childrenchildren HypothermiaHypothermia resultsresults whenwhen moremore heatheat isis lostlost fromfrom thethe bodybody thanthan isis producedproduced (through(through metabolismmetabolism andand shivering)shivering) andand retainedretained (through(through bodybody--fat,fat, clothing,clothing, andand behavioralbehavioral adaptation).adaptation). WaterWater isis anan ExcellentExcellent ConductorConductor ofof HeatHeat PhysiologyPhysiology ofof HypothermiaHypothermia HypothermiaHypothermia defineddefined asas corecore temptemp << 9595 degdeg F.F. EveryEvery organorgan systemsystem isis affectedaffected (e.g.,(e.g., similarsimilar toto multiplemultiple trauma)trauma) PhysiologyPhysiology ofof HypothermiaHypothermia ConstrictionConstriction ofof surfacesurface bloodblood vesselsvessels ColdCold sensationsensation andand shiveringshivering PhysicalPhysical impairmentsimpairments (motor(motor skills)skills) MentalMental impairmentimpairment ColdCold--inducedinduced urinationurination PhysiologyPhysiology ofof HypothermiaHypothermia AbnormalAbnormal heartheart beatsbeats andand slowingslowing ofof thethe heartheart raterate DecliningDeclining bloodblood pressurepressure DecreasedDecreased metabolismmetabolism CessationCessation ofof shiveringshivering LossLoss ofof consciousnessconsciousness VentricularVentricular fibrillationfibrillation // CardiacCardiac arrestarrest ClassificationClassification ofof HypothermiaHypothermia 3535--3737 degdeg C:C: coldcold--sensation,sensation, shivering,shivering, constrictionconstriction ofof surfacesurface bloodblood vesselsvessels 3232--3535 degdeg C:C: MildMild hypothermiahypothermia;; physicalphysical andand mentalmental impairmentsimpairments ClassificationClassification ofof HypothermiaHypothermia 2828--3232 degdeg C:C: ModerateModerate hypothermiahypothermia;; cessationcessation ofof shivering,shivering, abnormalabnormal heartheart beats,beats, lossloss ofof consciousnessconsciousness <28<28 degdeg C:C: SevereSevere hypothermiahypothermia;; vitalvital signssigns reducedreduced oror absent;absent; spontaneousspontaneous ventricularventricular fibrillationfibrillation oror cardiaccardiac arrestarrest BloodBlood VesselVessel ConstrictionConstriction onon ImmersionImmersion inin ColdCold WaterWater HHiigghh HHeeaatt LLoossss AArreeaass iinn HHyyppootthheerrmmiiaa DoDo NOTNOT DrownproofDrownproof HELPHELP PositionPosition HuddleHuddle TechniqueTechnique ShouldShould youyou SwimSwim forfor Shore?Shore? HHeeaatt LLoossss AArreeaass AAfftteerr SSwwiimmmmiinngg iinn CCoolldd WWaatteerr PhysiologyPhysiology ofof DrowningDrowning LossLoss ofof breathbreath--holdingholding abilityability AspirationAspiration ofof waterwater Coughing,Coughing, violentviolent strugglestruggle toto reachreach surfacesurface LaryngospasmLaryngospasm (vocal(vocal cordcord constriction)constriction) PhysiologyPhysiology ofof DrowningDrowning LowLow levelslevels ofof oxygenoxygen LossLoss ofof consciousnessconsciousness ReflexReflex swallowingswallowing VentricularVentricular fibrillationfibrillation DeathDeath PathophysiologyPathophysiology ofof DrowningDrowning SubmersionSubmersion inin coldcold--waterwater isis associatedassociated withwith aa significantlysignificantly higherhigher survivalsurvival raterate RapidRapid coolingcooling ofof thethe brainbrain increasesincreases thethe abilityability toto survivesurvive lowlow oxygenoxygen levelslevels HigherHigher probabilityprobability ofof successfulsuccessful resuscitationresuscitation EvenEven upup toto 6060 minutesminutes submersion!submersion! PracticalPractical ApplicationsApplications ofof StudiesStudies inin ColdCold--WaterWater ImmersionImmersion HypothermiaHypothermia TestTest SubjectsSubjects RoughRough WaterWater vs.vs. CalmCalm WaterWater TestTest GarmentsGarments FSFS FlightFlight SuitSuit (control)(control) BCBC BoatBoat CrewCrew CoverallCoverall (Stearns(Stearns worksuitworksuit)) ACAC AircrewAircrew CoverallCoverall (Mustang(Mustang worksuitworksuit)) WSWS FullFull WetWet SuitSuit SWSSWS ShortShort WetWet SuitSuit FCFC FloatFloat CoatCoat ISIS ImmersionImmersion SuitSuit DSDS DryDry SuitSuit (working(working deckdeck suit)suit) TestTest ConditionsConditions 5050 degreedegree F.F. waterwater CalmCalm SeasSeas –– testtest performedperformed atat docksidedockside RoughRough SeasSeas –– 44--66 ftft waveswaves everyevery 3030 secssecs;; CalmCalm WaterWater TestTest –– 5050 deg.deg. F.F. RoughRough WaterWater TestTest –– 5050 deg.deg. F.F. CalmCalm vs.vs. RoughRough WaterWater ResultsResults Cooling Rates in degrees C. per hour 4 3.5 3 2.5 2 Calm 1.5 Rough 1 0.5 0 FS FC SWS AC BC WS DS IS SurvivorSurvivor LocationLocation inin ColdCold Water:Water: TestTest ConditionsConditions RoughRough SeasSeas -- 55 footfoot breakingbreaking waveswaves 4343 deg.deg. F.F. waterwater 4646 deg.deg. F.F. airair 1515 knotknot windwind CapsizedCapsized boatboat SurvivorsSurvivors inin thethe waterwater nextnext toto thethe boatboat SurvivorsSurvivors atopatop thethe boatboat exposedexposed toto windwind andand waveswaves SurvivorsSurvivors inin aa oneone--personperson liferaftliferaft WhatWhat wouldwould youyou do?do? GetGet outout ofof thethe water,water, sitsit atopatop thethe boat,boat, andand thusthus bebe exposedexposed toto windwind--chillchill andand waves;waves; OROR StayStay inin thethe water,water, hanghang ontoonto thethe boat,boat, andand thusthus bebe exposedexposed toto waveswaves andand coldcold--waterwater TestTest GarmentsGarments FSFS FlightFlight SuitSuit WSWS WetWet SuitSuit BCBC BoatcrewBoatcrew coverallcoverall ACAC AircrewAircrew coverallcoverall NINI NavyNavy flightflight ensembleensemble –– intactintact NXNX NavyNavy flightflight ensembleensemble ---- torntorn 55 Ft.Ft. BreakBreak onon aa 2020 Ft.Ft. wavewave TestTest GarmentsGarments FSFS FlightFlight SuitSuit WSWS WetWet SuitSuit BCBC BoatcrewBoatcrew coverallcoverall ACAC AircrewAircrew coverallcoverall NINI NavyNavy flightflight
Load more

Recommended publications
  • Hypothermia Brochure
    Visit these websites for more water safety and hypothermia prevention in- formation. What is East Pierce Fire & Rescue Hypothermia? www.eastpiercefire.org Hypothermia means “low temperature”. Washington State Drowning When your body is exposed to cold tem- Prevention Coalition Hypothermia www.drowning-prevention.org perature, it tries to protect itself by keeping a normal body temperature of 98.6°F. It Children’s Hospital & tries to reduce heat loss by shivering and Regional Medical Center In Our Lakes moving blood from your arms and legs to www.seattlechildrens.org the core of your body—head, chest and and Rivers abdomen. Hypothermia Prevention, Recognition and Treatment www.hypothermia.org Stages of Hypothermia Boat Washington Mild Hypothermia www.boatwashington.org (Core body temperature of 98.6°— 93.2°F) Symptoms: Shivering; altered judg- ment; numbness; clumsiness; loss of Boat U.S. Foundation dexterity; pain from cold; and fast www.boatus.com breathing. Boat Safe Moderate Hypothermia www.boatsafe.com (Core body temperature of 93.2°—86°F) Symptoms: Semiconscious to uncon- scious; shivering reduced or absent; lips are blue; slurred speech; rigid n in muscles; appears drunk; slow Eve breathing; and feeling of warmth can occur. mer! Headquarters Station Sum Severe Hypothermia 18421 Old Buckley Hwy (Core body temperature below 86°F) Bonney Lake, WA 98391 Symptoms: Coma; heart stops; and clinical death. Phone: 253-863-1800 Fax: 253-863-1848 Email: [email protected] Know the water. Know your limits. Wear a life vest. By choosing to swim in colder water you Waters in Western Common Misconceptions Washington reduce your survival time.
    [Show full text]
  • Heat Stroke Heat Exhaustion
    Environmental Injuries Co lin G. Ka ide, MD , FACEP, FAAEM, UHM Associate Professor of Emergency Medicine Board-Certified Specialist in Hyperbaric Medicine Specialist in Wound Care The Ohio State University Wexner Medical Center The Most Dangerous Drug Combination… Accidental Testosterone Hypothermia and Alcohol! The most likely victims… Photo: Ralf Roletschek 1 Definition of Blizzard Hypothermia of Subnormal T° when the body is unable to generate sufficient heat to sustain normal functions Core Temperature < 95°F 1979 (35°C) Most Important Temperatures Thermoregulation 95°F (35° C) Hyper/Goofy The body uses a Poikilothermic shell to maintain a Homeothermic core 90°F (32°C) Shivering Stops Maintains core T° w/in 1.8°F(1°C) 80°F (26. 5°C) Vfib, Coma Hypothalamus Skin 65°F (18°C) Asystole Constant T° 96.896.8-- 100.4° F 2 Thermoregulation The 2 most important factors Only 3 Causes! Shivering (10x increase) Decreased Heat Production Initiated by low skin temperature Increased Heat Loss Warming the skin can abolish Impaired Thermoregulation shivering! Peripheral vasoconstriction Sequesters heat Predisposing Predisposing Factors Factors Decreased Production Increased Loss –Endocrine problems Radiation Evaporation • Thyroid Conduction* • Adrenal Axis Convection** –Malnutrition *Depends on conducting material **Depends on wind velocity –Neuromuscular disease 3 Predisposing Systemic Responses CNS Factors T°< 90°F (34°C) Impaired Regulation Hyperactivity, excitability, recklessness CNS injury T°< 80°F (27°C) Hypothalamic injuries Loss of voluntary
    [Show full text]
  • Title: Drowning and Therapeutic Hypothermia: Dead Man Walking
    Title: Drowning and Therapeutic Hypothermia: Dead Man Walking Author(s): Angela Kavenaugh, D.O., Jamie Cohen, D.O., Jennifer Davis MD FAAP, Department of PICU Affiliation(s): Chris Evert Children’s Hospital, Broward Health Medical Center ABSTRACT BODY: Background: Drowning is the second leading cause of death in children and is associated with severe morbidity and mortality, most often due to hypoxic-ischemic encephalopathy. Those that survive are often left with debilitating neurological deficits. Therapeutic Hypothermia after resuscitation from ventricular fibrillation or pulseless ventricular tachycardia induced cardiac arrest is the standard of care in adults and has also been proven to have beneficial effects that persist into early childhood when utilized in neonatal birth asphyxia, but has yet to be accepted into practice for pediatrics. Objective: To present supportive evidence that Therapeutic Hypothermia improves mortality and morbidity specifically for pediatric post drowning patients. Case Report: A five year old male presented to the Emergency Department after pool submersion of unknown duration. He was found to have asphyxial cardiac arrest and received bystander CPR, which was continued by EMS for a total of 10 minutes, including 2 doses of epinephrine. CPR continued into the emergency department. Upon presentation to the ED, he was found to have fixed and dilated pupils, unresponsiveness, with a GCS of 3. Upon initial pulse check was found to have return of spontaneous circulation, with sinus tachycardia. His blood gas revealed 6.86/45/477/8/-25. He was intubated, given 2 normal saline boluses and 2 mEq/kg of Sodium Bicarbonate. The initial head CT was normal.
    [Show full text]
  • Resident Scholarly Work
    RESIDENT SCHOLARLY WORK Process Improvement 2020-2021 CPIP Curriculum Ongoing Projects: Alexander Gavralidis, Stephanie tin, Matthew Macey, Allisa Alport, Beenish Furquan, Justin Byrne • Unnecessary laboratory draws in patients at a Community Hospital - evaluating whether inpatients at Salem Hospital staying overnight for a social reason undergo unnecessary laboratory draws Daria Ade, Mayuri Rapolu, Usman Mughal, Eva Kubrova, Barbara Lambl, Patrick Lee • Procalcitonin utilization to tailor antibiotic use at Salem Hospital- part of Antibiotic Stewardship program Sneha Lakshman, Arturo Castro, Ashley So, George Kavalam, Hassan Kazmi, Daniela Urma, Patrick Gordan • Development of a standardized ultrasound guided central venus catheter insertion curriculum Nupur Dandawate, Farideh Davoudi , Usama Talib, Patrick Lee • Inpatient Echo utilization – guidelines updates Anneris Estevez, Usmam Mughal, Zach Abbott, Evita Joseph, Caroline Cubbison, Faith Omede, Daniela Urma • Decrease health disparities for Hispanic community at Lynn NSPG by standardizing diabetes education referral patterns and patient education Imama Ahmad, Usama Talib, Muhammad Akash, Pablo Ledesma, Patrick Lee • Inpatient Telemetry Utilization Usman Mughal, Anneris Estevez, Patrick Lee, Barbara Lambl • Health Disparities & Covid-19 Impact on Minorities, sponsored by Dr. Patrick Lee, Chair of Medicine, Dr. Barb Lambl, Infectious Disease 2017-2020 Alexander Gavralidis, Emre Tarhan, Anneris Estevez, Daniela Urma, Austin Turner, Patrick Lee • Expanded Access to Convalescent Plasma for the Treatment of Patients with COVID-19 – 5/2020 implementing use of Convalescent Plasma to MGB Salem hospital in collaboration with research team. Arturo Castro-Diaz, Dr. Daniela Urma • Improving Hospital Care and Post - acute Care of SARS CoV2 patients 4/2020- 8/2020 Caroline Cubbison, Sohaib Ansari, Adam Matos • Code Status Documentation for admitted patients at Salem Hospital - Project accepted to SHM national meeting to be presented in April 2020 Caroline Cubbison, Coleen Reid, Dr.
    [Show full text]
  • Hypothermia – Signs and Symptoms Aside from the Cold That Is Felt and the Shivering That May Occur, Initially Mental Function Is Most Affected
    December 2010 – ISSUE 123 DIRECTOR’S NOTE As we prepare to embark on a new year, I would like to take a moment to highlight a few of the forestry transportation safety improvements and initiatives that took place in BC in 2010; The establishment of District wide Road Safety Committees throughout the province. Provincial standardization of radio calling procedures and resource road signage. The expansion of the Council’s Trucksafe program to include issues relating to marine and air transportation safety. Moving forward into 2011, further gains in transportation safety awareness and improved results can be expected through the following initiatives; The identification and development of a Log Truck Driver training program. The establishment of provincial level Trucking Safety Technical Advisory Committees. The development of Passenger Safety Guides for helicopter, float plane and marine transportation of forestry workers. Research and development of programs targeted towards improving the health and wellness of drivers. We look forward to your continued interest and support of this publication and the other safety improvement initiatives carried out by the BC Forest Safety Council. Thank you and have a safe 2011 Chuck Carter, RPF Now that winter is in full force, ensuring preparedness and response for the cold and sometimes extreme conditions while working can make a big difference in your day. Vehicles and equipment are susceptible to break down in freezing temperatures. It’s necessary to ensure proper clothing is worn for the outside temperatures but also it is also important to ensure that there are the resources to keep warm for extended exposure within the vehicle.
    [Show full text]
  • Failure of Hypothermia As Treatment for Asphyxiated Newborn Rabbits R
    Arch Dis Child: first published as 10.1136/adc.51.7.512 on 1 July 1976. Downloaded from Archives of Disease in Childhood, 1976, 51, 512. Failure of hypothermia as treatment for asphyxiated newborn rabbits R. K. OATES and DAVID HARVEY From the Institute of Obstetrics and Gynaecology, Queen Charlotte's Maternity Hospital, London Oates, R. K., and Harvey, D. (1976). Archives of Disease in Childhood, 51, 512. Failure of hypothermia as treatment for asphyxiated newborn rabbits. Cooling is known to prolong survival in newborn animals when used before the onset of asphyxia. It has therefore been advocated as a treatment for birth asphyxia in humans. Since it is not possible to cool a human baby before the onset of birth asphyxia, experiments were designed to test the effect of cooling after asphyxia had already started. Newborn rabbits were asphyxiated in 100% nitrogen and were cooled either quickly (drop of 1 °C in 45 s) or slowly (drop of 1°C in 2 min) at varying intervals after asphyxia had started. When compared with controls, there was an increase in survival only when fast cooling was used early in asphyxia. This fast rate of cooling is impossible to obtain in a human baby weighing from 30 to 60 times more than a newborn rabbit. Further litters ofrabbits were asphyxiated in utero. After delivery they were placed in environmental temperatures of either 37 °C, 20 °C, or 0 °C and observed for spon- taneous recovery. The animals who were cooled survived less often than those kept at 37 'C. The results of these experiments suggest that hypothermia has little to offer in the treatment of birth asphyxia in humans.
    [Show full text]
  • The Post-Mortem Appearances in Cases of Asphyxia Caused By
    a U?UST 1902.1 ASPHYXIA CAUSED BY DROWNING 297 Table I. Shows the occurrence of fluid and mud in the 55 fresh bodies. ?ritfinal Jlrttclcs. Fluid. Mud. Air-passage ... .... 20 2 ? ? and stomach ... ig 6 ? ? stomach and intestine ... 7 1 ? ? and intestine X ??? Stomach ... ??? THE POST-MORTEM APPEARANCES IN Intestine ... ... 1 Stomach and intestine ... ... i CASES OF ASPHYXIA CAUSED BY DROWNING. Total 46 9 = 55 By J. B. GIBBONS, From the above table it will be seen that fluid was in the alone in 20 LIEUT.-COL., I.M.S., present air-passage cases, in the air-passage and stomach in sixteen, Lute Police-Surgeon, Calcutta, Civil Surgeon, Ilowrah. in the air-passage, stomach and intestine in seven, in the air-passage and intestine in one. As used in this table the term includes frothy and non- frothy fluid. Frothy fluid is only to be expected In the period from June 1893 to November when the has been quickly recovered from months which I body 1900, excluding three during the water in which drowning took place and cases on leave, 15/ of was privilege asphyxia examined without delay. In some of my cases were examined me in the due to drowning by it was present in a most typical form; there was For the of this Calcutta Morgue. purpose a bunch of fine lathery froth about the nostrils, all cases of death inhibition paper I exclude by and the respiratory tract down to the bronchi due to submersion and all cases of or syncope was filled with it. received after into death from injuries falling The quantity of fluid in the air-passage varies the water.
    [Show full text]
  • Respiratory Physiology for the Anesthesiologist
    REVIEW ARTICLE Deborah J. Culley, M.D., Editor ABSTRACT Respiratory function is fundamental in the practice of anesthesia. Knowledge of basic physiologic principles of respiration assists in the proper implemen- tation of daily actions of induction and maintenance of general anesthesia, Respiratory Physiology delivery of mechanical ventilation, discontinuation of mechanical and pharma- cologic support, and return to the preoperative state. The current work pro- Downloaded from http://pubs.asahq.org/anesthesiology/article-pdf/130/6/1064/455191/20190600_0-00035.pdf by guest on 24 September 2021 for the Anesthesiologist vides a review of classic physiology and emphasizes features important to the anesthesiologist. The material is divided in two main sections, gas exchange Luca Bigatello, M.D., Antonio Pesenti, M.D. and respiratory mechanics; each section presents the physiology as the basis ANESTHESIOLOGY 2019; 130:1064–77 of abnormal states. We review the path of oxygen from air to the artery and of carbon dioxide the opposite way, and we have the causes of hypoxemia and of hypercarbia based on these very footpaths. We present the actions nesthesiologists take control of the respiratory func- of pressure, flow, and volume as the normal determinants of ventilation, and Ation of millions of patients throughout the world each we review the resulting abnormalities in terms of changes of resistance and day. We learn to maintain gas exchange and use respiration compliance. to administer anesthetic gases through the completion of (ANESTHESIOLOGY 2019; 130:1064–77) surgery, when we return this vital function to its legitimate owners, ideally with a seamless transition to a healthy post- operative course.
    [Show full text]
  • Prioritization of Health Services
    PRIORITIZATION OF HEALTH SERVICES A Report to the Governor and the 74th Oregon Legislative Assembly Oregon Health Services Commission Office for Oregon Health Policy and Research Department of Administrative Services 2007 TABLE OF CONTENTS List of Figures . iii Health Services Commission and Staff . .v Acknowledgments . .vii Executive Summary . ix CHAPTER ONE: A HISTORY OF HEALTH SERVICES PRIORITIZATION UNDER THE OREGON HEALTH PLAN Enabling Legislatiion . 3 Early Prioritization Efforts . 3 Gaining Waiver Approval . 5 Impact . 6 CHAPTER TWO: PRIORITIZATION OF HEALTH SERVICES FOR 2008-09 Charge to the Health Services Commission . .. 25 Biennial Review of the Prioritized List . 26 A New Prioritization Methodology . 26 Public Input . 36 Next Steps . 36 Interim Modifications to the Prioritized List . 37 Technical Changes . 38 Advancements in Medical Technology . .42 CHAPTER THREE: CLARIFICATIONS TO THE PRIORITIZED LIST OF HEALTH SERVICES Practice Guidelines . 47 Age-Related Macular Degeneration (AMD) . 47 Chronic Anal Fissure . 48 Comfort Care . 48 Complicated Hernias . 49 Diagnostic Services Not Appearing on the Prioritized List . 49 Non-Prenatal Genetic Testing . 49 Tuberculosis Blood Test . 51 Early Childhood Mental Health . 52 Adjustment Reactions In Early Childhood . 52 Attention Deficit and Hyperactivity Disorders in Early Childhood . 53 Disruptive Behavior Disorders In Early Childhood . 54 Mental Health Problems In Early Childhood Related To Neglect Or Abuse . 54 Mood Disorders in Early Childhood . 55 Erythropoietin . 55 Mastocytosis . 56 Obesity . 56 Bariatric Surgery . 56 Non-Surgical Management of Obesity . 58 PET Scans . 58 Prenatal Screening for Down Syndrome . 59 Prophylactic Breast Removal . 59 Psoriasis . 59 Reabilitative Therapies . 60 i TABLE OF CONTENTS (Cont’d) CHAPTER THREE: CLARIFICATIONS TO THE PRIORITIZED LIST OF HEALTH SERVICES (CONT’D) Practice Guidelines (Cont’d) Sinus Surgery .
    [Show full text]
  • MECAP News April 2021
    U.S. Consumer Product Safety Commission MECAPnews MEDICAL EXAMINERS AND CORONERS ALERT PROJECT April 2021 MECAP Reports | Page 2 Asphyxia/Suffocation Carbon Monoxide Poisoning Submersion MECAP Reports | Page 3 Fire All-Terrain Vehicles (ATVs) Electrocution Fatalities Involving Other Hazards MECAP Contact | Page 4 The following pages summarize MECAP reports Yolanda Nash received by CPSC selected for follow-up Program Analyst investigation. The entries include a brief Division of Hazard and Injury Data description of the incident to illustrate the type and Systems Directorate for Epidemiology nature of the reported fatalities. This important information helps CPSC carry out its mission to U.S. Consumer Product Safety protect the public from product-related injuries and Commission deaths. 4330 East-West Highway Bethesda, MD We appreciate your support; please continue to 20814 report your product-related cases to us. [email protected] 1-800-638-8095 x7502 or 301-504-7502 *Cases selected for CPSC follow-up investigation Asphyxiation/ down to sleep in a toddler basement stairs. The Suffocation bed with multiple heavy electric power had been blankets. The next morning, shut off, and the generator *A 7-year-old female was the mother found the was used to provide power. discovered by her mother decedent positioned face EMS measured the carbon unresponsive in bed with a down in the soft bedding monoxide level at 500 ppm. balloon pulled over her face. and blankets. Despite The cause of death was The decedent became emergency efforts, the carbon monoxide poisoning. entangled with a helium infant was pronounced dead balloon tied to her bed and at the hospital.
    [Show full text]
  • Thermoregulatory Correlates of Nausea in Rats and Musk Shrews
    www.impactjournals.com/oncotarget/ Oncotarget, Vol. 5, No. 6 Thermoregulatory correlates of nausea in rats and musk shrews Sukonthar Ngampramuan1, Matteo Cerri2, Flavia Del Vecchio2, Joshua J. Corrigan3, Amornrat Kamphee1, Alexander S. Dragic3, John A. Rudd4, Andrej A. Romanovsky3, and Eugene Nalivaiko5 1 Research Center for Neuroscience and Institute of Molecular Bioscience, Mahidol University, Bangkok, Thailand; 2 Department of Biomedical and Motor Sciences, University of Bologna, Bologna, Italy; 3 FeverLab, Trauma Research, St. Joseph’s Hospital and Medical Center, Phoenix, AZ, USA; 4 School of Biomedical Sciences, Chinese University of Hong Kong, Hong Kong, China; 5 School of Biomedical Sciences and Pharmacy, University of Newcastle, Newcastle, NSW, Australia. Correspondence to: Eugene Nalivaiko, email: [email protected] Correspondence to: Andrej A. Romanovsky, email: [email protected] Keywords: nausea, chemotherapy, temperature, hypothermia. Received: December 21, 2013 Accepted: February 21, 2014 Published: February 22 2014 This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. ABSTRACT: Nausea is a prominent symptom and major cause of complaint for patients receiving anticancer chemo- or radiation therapy. The arsenal of anti-nausea drugs is limited, and their efficacy is questionable. Currently, the development of new compounds with anti-nausea activity is hampered by the lack of physiological correlates of nausea. Physiological correlates are needed because common laboratory rodents lack the vomiting reflex. Furthermore, nausea does not always lead to vomiting. Here, we report the results of studies conducted in four research centers to investigate whether nausea is associated with any specific thermoregulatory symptoms.
    [Show full text]
  • Near Drowning
    Near Drowning McHenry Western Lake County EMS Definition • Near drowning means the person almost died from not being able to breathe under water. Near Drownings • Defined as: Survival of Victim for more than 24* following submission in a fluid medium. • Leading cause of death in children 1-4 years of age. • Second leading cause of death in children 1-14 years of age. • 85 % are caused from falls into pools or natural bodies of water. • Male/Female ratio is 4-1 Near Drowning • Submersion injury occurs when a person is submerged in water, attempts to breathe, and either aspirates water (wet) or has laryngospasm (dry). Response • If a person has been rescued from a near drowning situation, quick first aid and medical attention are extremely important. Statistics • 6,000 to 8,000 people drown each year. Most of them are within a short distance of shore. • A person who is drowning can not shout for help. • Watch for uneven swimming motions that indicate swimmer is getting tired Statistics • Children can drown in only a few inches of water. • Suspect an accident if you see someone fully clothed • If the person is a cold water drowning, you may be able to revive them. Near Drowning Risk Factor by Age 600 500 400 300 Male Female 200 100 0 0-4 yr 5-9 yr 10-14 yr 15-19 Ref: Paul A. Checchia, MD - Loma Linda University Children’s Hospital Near Drowning • “Tragically 90% of all fatal submersion incidents occur within ten yards of safety.” Robinson, Ped Emer Care; 1987 Causes • Leaving small children unattended around bath tubs and pools • Drinking
    [Show full text]