Meth Lab Explosion: Considerations for Pre-Hospital Care and Transport Rodney Logan, RN, BSN, CMTE Program Manager, Memorial MedFlight
Labs
Labs
Labs
Meth Labs
OBJECTIVES MethAmphetamine Prevalence Cooking Blast Injuries Burn Patient Assessment Transport Considerations
OBJECTIVES
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
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
Methamphetamine Prevalence Through the years WWII 1938 Legal to Illegal California 1980 s Midwest 1990 s Indiana
Methamphetamine Prevalence Through the years Indiana Lab Seizures/discoveries 2005...992 2006...766 2007...820 2008...1,059
Methamphetamine Prevalence Through the years Indiana Lab Seizures/discoveries 2005...992 2006...766 2007...820 Pseudo-ephedrine control 2008...1,059
Methamphetamine Prevalence *Missouri 1784 *Indiana 1267 Miss. 714 *Kentucky 707 *Michigan 648 Arkansas 486 *Illinois 400
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
Methamphetamine Prevalence What Happened? Jobs $$ Evolution
Real Meth Labs
Meth Labs
Meth Labs
Meth Labs
Meth Labs
Meth Labs Cooking No longer only BIG Super labs Attempts to Regulate Adaptation Backpack Mobile Labs Risky behavior
Meth Labs Cooking Household Items Adaptation The Cook One wrong move
Explosion-Blast Injuries Primary (the blast) Gas filled structures Secondary (debris) Penetrating trauma Tertiary (striking) similar to ejection Quaternary (related injuries) burns, exacerbations
The Meth Lab Burn Profile... Burn Center statistics Ages 21-48 mean of 35.5 Male:Female ratio 10:1 Face, hands Vague, non-specific, story
Burn Basics: First Degree Second Degree Third Degree
Manage the Burn (Assess the Burn) BSA (Rule of Nines)
Patient Assessment...stick to the basics Airway Breathing Circulation Disability Environment/Expose
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
Patient Assessment Breathing Rate and Depth Presence of wheezes, rales, rhonchi SOB Chest Burns Pulse Oximetry???
Patient Assessment Circulation Pulses (quality), rate, rhythm Capillary refill Obvious signs of bleeding
Patient Assessment Disability AVPU Pupils Movement of extremities
Patient Assessment Environment/Expose Remove clothing and jewelry Keep patient warm Cover (sterile sheet)
Patient Treatment Airway/Breathing Maintain a patent Airway Administer O2/Support Ventilations Circulation Provide fluid resuscitation/manage pain Disability Provide psychological support
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...
Manage the Burn Time of the Burn
Dr. Charles R. Baxter The Parkland Formula
Dr. Charles R. Baxter The Parkland Formula
The Parkland Formula 4cc X Wt in kg X %BSA of Burns
4cc X Wt in kg X %BSA of Burns PRACTICE... 35 Year Old Male 70kg patient with Burns to bilateral hands and arms, head, and upper chest
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%
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
Transport Considerations Hazmat Scene Safety PPE Decontamination Water Trauma-vs-Burn
Meth Lab Explosion... Friday Family Night at the FireHouse Sept. 2010 Pizza Kids play Watch TV
Patient Presentation: Scene... Walk-in Mid 40 s obese Female with second and third degree burns to face, arms, hands and upper chest
Patient Presentation: Crying for help Story was vague and contradictory to Aunt who waited in car Constantine MI 27 miles Bristol 9 miles
OBJECTIVES MethAmphetamine Prevalence Cooking Blast Injuries Burn Patient Assessment Transport Considerations
Works Cited Faulstich, Jason. Indiana State Police Detective: Bremen, Indiana. Interview 7 March 2011. MethResources.gov Campbell, John Emory. International Trauma Life Support for Prehospital Providers Sixth Edition 2008. pgs 238-267. Emergency Nurses Associtation, Trauma Nursing Core Course Provider Manual, Sixth Ed. 2007. Pgs206-217,260-263, 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. 425-429 Burke et al, Journal of Burn Care & Research, Volume 29, Number 4 pgs. 574-579 Santos et al, Journal of Burn Care & Rehabilitation, Volume 26, Number 3 pgs. 228-232 Heraldtimesonline.com 15 Feb, 2011, Record Indiana Meth Lab Seizures Records State Police Records Show.