Meth Lab Explosion: Considerations for Pre-Hospital Care and Transport. Rodney Logan, RN, BSN, CMTE Program Manager, Memorial MedFlight
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1 Meth Lab Explosion: Considerations for Pre-Hospital Care and Transport Rodney Logan, RN, BSN, CMTE Program Manager, Memorial MedFlight
2 Labs
3 Labs
4 Labs
5 Meth Labs
6 OBJECTIVES MethAmphetamine Prevalence Cooking Blast Injuries Burn Patient Assessment Transport Considerations
7 OBJECTIVES
8 MethAmphetamine...what is it? Powerful upper Psychologic Stimulant Increases metabolism Decreases Appetite Increases heart rate Produces Euphoria Effects last 8-24 hours Increases Aggression and Risky behavior
9 Methamphetamine...Street Names Poor Man s Cocaine Crank CR Meth Wire Speed Crystal Biker s Coffee Chalk Chicken Feed Crystal Meth Glass Go-Fast Mehtlies Quick Shabu Stove Top Trash Yellow Barn
10 Methamphetamine Prevalence Through the years WWII 1938 Legal to Illegal California 1980 s Midwest 1990 s Indiana
11 Methamphetamine Prevalence Through the years Indiana Lab Seizures/discoveries ,059
12 Methamphetamine Prevalence Through the years Indiana Lab Seizures/discoveries Pseudo-ephedrine control ,059
13 Methamphetamine Prevalence *Missouri 1784 *Indiana 1267 Miss. 714 *Kentucky 707 *Michigan 648 Arkansas 486 *Illinois 400
14 Methamphetamine Prevalence In 2010 Indiana State Police reported nearly 1,400 Methamphetamine Labs (766 in 2006) Three of the top 8 Counties are local Elkhart Kosciusko Marshall
15 Methamphetamine Prevalence What Happened? Jobs $$ Evolution
16 Real Meth Labs
17 Meth Labs
18 Meth Labs
19 Meth Labs
20 Meth Labs
21 Meth Labs Cooking No longer only BIG Super labs Attempts to Regulate Adaptation Backpack Mobile Labs Risky behavior
22 Meth Labs Cooking Household Items Adaptation The Cook One wrong move
23 Explosion-Blast Injuries Primary (the blast) Gas filled structures Secondary (debris) Penetrating trauma Tertiary (striking) similar to ejection Quaternary (related injuries) burns, exacerbations
24 The Meth Lab Burn Profile... Burn Center statistics Ages mean of 35.5 Male:Female ratio 10:1 Face, hands Vague, non-specific, story
25 Burn Basics: First Degree Second Degree Third Degree
26 Manage the Burn (Assess the Burn) BSA (Rule of Nines)
27 Patient Assessment...stick to the basics Airway Breathing Circulation Disability Environment/Expose
28 Patient Assessment Airway Stridor Facial Burns Soot in nose or mouth Singed facial/nasal hair Edema of lips/oral cavity Coughing Hoarse voice Neck Burns
29 Patient Assessment Breathing Rate and Depth Presence of wheezes, rales, rhonchi SOB Chest Burns Pulse Oximetry???
30 Patient Assessment Circulation Pulses (quality), rate, rhythm Capillary refill Obvious signs of bleeding
31 Patient Assessment Disability AVPU Pupils Movement of extremities
32 Patient Assessment Environment/Expose Remove clothing and jewelry Keep patient warm Cover (sterile sheet)
33 Patient Treatment Airway/Breathing Maintain a patent Airway Administer O2/Support Ventilations Circulation Provide fluid resuscitation/manage pain Disability Provide psychological support
34 Managing the BURN Stop the burning process Move rapidly to safety Place on ground/floor (roll to smother flames) Remove clothing (bag it) How did the Burn happen? and...
35 Manage the Burn Time of the Burn
36 Dr. Charles R. Baxter The Parkland Formula
37 Dr. Charles R. Baxter The Parkland Formula
38 The Parkland Formula 4cc X Wt in kg X %BSA of Burns
39 4cc X Wt in kg X %BSA of Burns PRACTICE Year Old Male 70kg patient with Burns to bilateral hands and arms, head, and upper chest
40 4cc X Wt in KG X %BSA of Burns 35 Year Old Male 70kg patient with burns to bilateral hands and arms, head, and upper chest Arms 18% Head 9% Chest 9% 36%
41 35 Year Old Male 70kg patient with burns to bilateral hands and arms, head, and upper chest 4cc X 70 X 36= 10,080cc 1/2 of the 10,080 (5,040cc) first 8 hours from burn Remaining 5,040cc delivered over 16 hours Therapy driven by urine output
42 Transport Considerations Hazmat Scene Safety PPE Decontamination Water Trauma-vs-Burn
43 Meth Lab Explosion... Friday Family Night at the FireHouse Sept Pizza Kids play Watch TV
44 Patient Presentation: Scene... Walk-in Mid 40 s obese Female with second and third degree burns to face, arms, hands and upper chest
45 Patient Presentation: Crying for help Story was vague and contradictory to Aunt who waited in car Constantine MI 27 miles Bristol 9 miles
46 OBJECTIVES MethAmphetamine Prevalence Cooking Blast Injuries Burn Patient Assessment Transport Considerations
47 Works Cited Faulstich, Jason. Indiana State Police Detective: Bremen, Indiana. Interview 7 March MethResources.gov Campbell, John Emory. International Trauma Life Support for Prehospital Providers Sixth Edition pgs Emergency Nurses Associtation, Trauma Nursing Core Course Provider Manual, Sixth Ed Pgs , , Society of Critical Care Medicine, Fundamentals of Critical Care Support, Fourth Ed., 2007, Chapter 9. Danks et al, Journal of Burn Care & Rehabilitation, September/October 2004 pgs Burke et al, Journal of Burn Care & Research, Volume 29, Number 4 pgs Santos et al, Journal of Burn Care & Rehabilitation, Volume 26, Number 3 pgs Heraldtimesonline.com 15 Feb, 2011, Record Indiana Meth Lab Seizures Records State Police Records Show.
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