rhabdomyolysis “new mascot of first responders?”€¦ · 19/05/2018 · (working in extreme...
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14th Annual North State Pre-hospital Conference 2018 May 19, 2018
Presented by Bill Masten, Retired Los Angeles County Fire Chief 1
Rhabdomyolysis“New Mascot of First Responders?”
“RATTLESNAKE BITES AT 12 YEAR HIGH IN CALIFORNIA”
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14th Annual North State Pre-hospital Conference 2018 May 19, 2018
Presented by Bill Masten, Retired Los Angeles County Fire Chief 2
Rhabdomyolysis
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14th Annual North State Pre-hospital Conference 2018 May 19, 2018
Presented by Bill Masten, Retired Los Angeles County Fire Chief 3
Rhabdomyolysis
What is Rhabdo?
Rhabdo= StriatedMyo= Muscle
Lysis= Breakdown
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14th Annual North State Pre-hospital Conference 2018 May 19, 2018
Presented by Bill Masten, Retired Los Angeles County Fire Chief 4
Rhabdomyolysis• Condition where injured muscles
release harmful substances into the bloodstream.
• These substances include potassium, phosphate, creatine kinase, and myoglobin.
• Large amounts of these substances may damage your kidneys and other organs.
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14th Annual North State Pre-hospital Conference 2018 May 19, 2018
Presented by Bill Masten, Retired Los Angeles County Fire Chief 5
RhabdomyolysisWhat are some causes?
• Crush Injury• Compartment Syndrome• Electrical Shock• Burns• Snake Bites & Spider Bites• Prolonged Physical Exertion
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14th Annual North State Pre-hospital Conference 2018 May 19, 2018
Presented by Bill Masten, Retired Los Angeles County Fire Chief 6
RhabdomyolysisRisk Factors
•Overexertion.
• Poor conditioning.
•Heat stress/stroke (working in extreme heat).
• Dehydration.
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14th Annual North State Pre-hospital Conference 2018 May 19, 2018
Presented by Bill Masten, Retired Los Angeles County Fire Chief 7
RhabdomyolysisRisk Factors
• Prescription medications such as cholesterol-lowering statins and antidepressants.
• Over-the-counter medications such as antihistamines.
• NSAID’s.
• Excessive caffeine intake.
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14th Annual North State Pre-hospital Conference 2018 May 19, 2018
Presented by Bill Masten, Retired Los Angeles County Fire Chief 8
RhabdomyolysisWhat can make you more susceptible?
• Pre-work out supplements.
• Energy Drinks.
• Hydration Strategy.
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14th Annual North State Pre-hospital Conference 2018 May 19, 2018
Presented by Bill Masten, Retired Los Angeles County Fire Chief 9
Rhabdomyolysis
Pre-Workout Supplements
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14th Annual North State Pre-hospital Conference 2018 May 19, 2018
Presented by Bill Masten, Retired Los Angeles County Fire Chief 10
RhabdomyolysisSports/Energy drink brand Caffeine (milligrams)• AMP Tall Boy Energy Drink, 16 ounces (oz.) 143• Enviga, 12 oz. 100• Full Throttle, 16 oz. 144• Full Throttle Fury, 16 oz. 144• Monster Energy, 16 oz. 160• No Name (formerly known as Cocaine), 8.4 oz. 280• Red Bull, 8.3 oz. 76• Rockstar, 16 oz. 160• SoBe Adrenaline Rush, 16 oz. 152• SoBe No Fear, 16 oz. 174
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14th Annual North State Pre-hospital Conference 2018 May 19, 2018
Presented by Bill Masten, Retired Los Angeles County Fire Chief 11
RhabdomyolysisEXHAUSTION
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14th Annual North State Pre-hospital Conference 2018 May 19, 2018
Presented by Bill Masten, Retired Los Angeles County Fire Chief 12
RhabdomyolysisEXHAUSTION
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14th Annual North State Pre-hospital Conference 2018 May 19, 2018
Presented by Bill Masten, Retired Los Angeles County Fire Chief 13
Rhabdomyolysis
SN’s
Sx’s
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14th Annual North State Pre-hospital Conference 2018 May 19, 2018
Presented by Bill Masten, Retired Los Angeles County Fire Chief 14
Rhabdomyolysis
Discolored UrineTea Cola
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14th Annual North State Pre-hospital Conference 2018 May 19, 2018
Presented by Bill Masten, Retired Los Angeles County Fire Chief 15
RhabdomyolysisEKG Progression of Hyperkalemia
Mild(5.5-6.5 mEq/L)
Moderate(6.5-8.0 mEq/L)
Severe( 8.0 mEq/L)
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14th Annual North State Pre-hospital Conference 2018 May 19, 2018
Presented by Bill Masten, Retired Los Angeles County Fire Chief 16
RhabdomyolysisHow is rhabdomyolysis treated?• Oral hydration.• IV fluids (0-9% normal saline)• Evacuation to ED for evaluation.
– Serum CPK (Creatine Phosphokinase)– Serum +K– Urine pH– Cardiac Monitor
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14th Annual North State Pre-hospital Conference 2018 May 19, 2018
Presented by Bill Masten, Retired Los Angeles County Fire Chief 17
Rhabdomyolysis
Physicians Handout
www.wildfiretoday.com/documents/Rhabdo_5_9_16.pdf
Rhabdomyolysis in Wildland FireA review of reported cases
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14th Annual North State Pre-hospital Conference 2018 May 19, 2018
Presented by Bill Masten, Retired Los Angeles County Fire Chief 18
RhabdomyolysisVariations of Myoglobin and CPK during Rhabdomyolisis
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14th Annual North State Pre-hospital Conference 2018 May 19, 2018
Presented by Bill Masten, Retired Los Angeles County Fire Chief 19
RhabdomyolysisPrevention is the key
• Conditioning• Hydration• Nutrition• Listening to your body
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14th Annual North State Pre-hospital Conference 2018 May 19, 2018
Presented by Bill Masten, Retired Los Angeles County Fire Chief 20
Rhabdomyolysis
Hydration Strategy
2 - waters
1– Hydration Solution
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14th Annual North State Pre-hospital Conference 2018 May 19, 2018
Presented by Bill Masten, Retired Los Angeles County Fire Chief 21
Rhabdomyolysis
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14th Annual North State Pre-hospital Conference 2018 May 19, 2018
Presented by Bill Masten, Retired Los Angeles County Fire Chief 22
Rhabdomyolysis
Osmolarity is important for keeping proper electrolytic balance in the blood stream.
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14th Annual North State Pre-hospital Conference 2018 May 19, 2018
Presented by Bill Masten, Retired Los Angeles County Fire Chief 23
RhabdomyolysisReturning to work
Phase One1. Rest for 72 hours-oral hydration2. Sleep 8 hours each night3. Avoid excessive heat or cold4. Follow up within 72 hours to repeat blood and urine tests (CPK levels)
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14th Annual North State Pre-hospital Conference 2018 May 19, 2018
Presented by Bill Masten, Retired Los Angeles County Fire Chief 24
RhabdomyolysisReturning to work
Phase Two1.If tests normal, begin light activity, no strenous
physical activity.2.Gradually increase light activity at your own pace
for one week.3.Follow up with PMD to assess full activity,
(asymptomatic and normal blood/urine values).
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14th Annual North State Pre-hospital Conference 2018 May 19, 2018
Presented by Bill Masten, Retired Los Angeles County Fire Chief 25
RhabdomyolysisReturning to work
Phase Three1.Gradually return to full physical activity, monitor
for any return of symptoms.
High risk factors for Rhybdo reoccurrence•CPK levels over 100,000.•Heat stroke/exhaustion.•Kidney injury•Longer then normal recovery times.•Muscle cramps and tenderness frequency.•Suffered compartment syndrome.
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14th Annual North State Pre-hospital Conference 2018 May 19, 2018
Presented by Bill Masten, Retired Los Angeles County Fire Chief 26
Rhabdomyolysis
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14th Annual North State Pre-hospital Conference 2018 May 19, 2018
Presented by Bill Masten, Retired Los Angeles County Fire Chief 27
RhabdomyolysisTest Questions:
1. Rhabdomyolisis is caused by an injury to a long bone. (T) (F)
2. A sign of Rhabdo may be discolored urine. (T) (F)
3. Physical exertion can cause Rhabdo. (T) (F)
4. Energy drinks help prevent Rhabdo. (T) (F)
5. Rhabdo can cause high potassium levels. (T) (F)
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14th Annual North State Pre-hospital Conference 2018 May 19, 2018
Presented by Bill Masten, Retired Los Angeles County Fire Chief 28
RhabdomyolysisTest Questions:
1. Rhabdomyolisis is caused by an injury to a long bone. (T) (F)
2. A sign of Rhabdo may be discolored urine. (T) (F)
3. Physical exertion can cause Rhabdo. (T) (F)
4. Energy drinks help prevent Rhabdo. (T) (F)
5. Rhabdo can cause high potassium levels. (T) (F)
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14th Annual North State Pre-hospital Conference 2018 May 19, 2018
Presented by Bill Masten, Retired Los Angeles County Fire Chief 29
Rhabdomyolysis
Thank You!