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Interviewer: Dr. Scott Youngquist is an emergency room physician. First of all, let's just talk about, I'm out in the heat, what are the symptoms that I might have started to get heat stroke?

Dr. Youngquist: Well, mild symptoms may feel like a mild flu-like illness. All the way up to severe symptoms, such as confusion, trouble breathing, chest pain, abdominal pain.

Interviewer: All right. So it's degrees, not just a singular condition?

Dr. Youngquist: Exactly.

Interviewer: All right. And the kind of . . . I'm trying to recall when I thought maybe I might have had heat stroke. I remember feeling a little nauseous, I think, a little light headed, really tired and fatigued. And then after about a half hour, 45 minutes, that kind of went away after I got out of the sun. Is that pretty normal?

Dr. Youngquist: Yeah, that would describe someone with a mild heat related illness, I would say, and not severe hyperthermia or heat stroke.

Interviewer: All right. And did I do the right thing just by getting out of the sun? Should there have been other things that I did at that point?

Dr. Youngquist: No, you did exactly the right thing. You want to stop any exertional activity that generates metabolic heat, such as running, jogging, forceful exertion. Get out of the heat and get to a cool environment. And then replenish any fluid losses through sweating or from the heat alone by drinking water or an electrolyte solution.

Interviewer: And I imagined once you start feeling those light symptoms, you should really take that as a warning so it doesn't get more severe. Explain what could potentially happen if you didn't?

Dr. Youngquist: Absolutely. There are all sorts of problems that can arise from heat related illness if it's not treated early. And those include things like liver failure, shock, hemodynamic collapse, things that cause you to go ultimately into cardiac arrest and death.

Interviewer: So it's something to take very seriously. If it's a mild case and I get better after about a half hour, I'm good, how long should I wait, though, before maybe, even in that mild case if the symptoms aren't going away before, maybe, I consider seeing a doctor?

Dr. Youngquist: Well, I think in your case, you know, if it's 30 to 45 minutes after you've treated the mild symptoms, if they're resolving or they've resolved completely, you don't need to go see a doctor for that.

Interviewer: All right. And if you do go see a doctor, what types of treatments would you give me then at that point?

Dr. Youngquist: Well, you'll get a careful history and physical examination. And then the treatment from there will depend on the severity of the case, but may include intravenous fluids, it may include passive or active cooling measures, and investigation into evidence of end organ damage.

updated: June 15, 2021
originally published: June 26, 2019

Interviewer: You got into some poison ivy. Should you worry and what should you do? That's next on The Scope.

Announcer: Health tips, medical news, research and more for a happier healthier life, from University of Utah Health Sciences, this is The Scope.

Interviewer: Dr. Scott Youngquist is an emergency room physician at University of Utah Health. As a kid, I was terrified of getting into poison ivy and personally, I never have, but I know that it does happen. Should somebody be terrified about getting into it first of all?

Dr. Youngquist: Well, I was terrified of it too, Scott, and I never got into it either. But you shouldn't be too terrified. It just causes a very annoying, itchy rash when you contact it on your skin.

Interviewer: All right. And is poison ivy and poison oak, are they kind of similar?

Dr. Youngquist: Yeah. There are three main problems in North America, poison ivy, poison oak, and poison sumac, which all cause the same type of reaction.

Interviewer: All right. And what does that look like on your skin?

Dr. Youngquist: Well, it starts out itchy and turns into a red rash that can become blisters as well and as people scratch at it, as they're prone to do because it's so itchy, can turn into scabs.

Interviewer: All right. And once you kind of get into it, how long until you start seeing some of those symptoms. Is it immediate or . . . ?

Dr. Youngquist: No. It's a delayed hypersensitivity reaction is what we call it in medicine, meaning the symptoms show up minutes to hours later and maybe half a day later before somebody notices that they came in contact with the poison ivy.

Interviewer: Okay. And are there other kinds of variables as to how severe it might be? Like I've heard that if it's wet that it might be worse. Is that true?

Dr. Youngquist: I don't know about wetness per se. Any part of the plant can cause a hypersensitivity reaction. But only 85% of people are sensitive to it. So there's 15% of the population that will not react, and that's sort of like their super power.

Interviewer: Okay. And then if it's scratches you, you know, because sometimes you might go through there with your bare legs. Could it be more dangerous if it gets into your bloodstream? Is that something that can happen, or is it really just a skin thing for the most part?

Dr. Youngquist: It's mostly a skin thing. The main problem with scratches is that they can become infected with other organisms. So it's a portal of entry for bacteria, usually can't get a large enough dose of the poison and poison ivy to cause a problem just from a scratch.

Interviewer: All right. And what are the treatments? If I get into it what should I start doing?

Dr. Youngquist: First thing you want to do is wash with cold water any parts of your body that have come in contact with the plant or the oak and remove any clothing that's come in contact with it as well. You can get the material on clothing or on anything else that's touched it, and then it will sit there for a while. It doesn't degrade. So you could pick up a rake from last season when you're raking up some of that stuff and touch it and get an exposure that way as well.

Interviewer: So if it gets on your clothes and you touched your clothes or your dog?

Dr. Youngquist: Yeah. That's been reported to come in . . . the dog can come in from the forest and bring the poison ivy with him or her.

Interviewer: All right. So wash it off with some cold water, some mild soap?

Dr. Youngquist: Yep, mild soap.

Interviewer: Okay.

Dr. Youngquist: And then the waiting begins to see if you react. If you do react, most of the problem is due to itching, and some people it drives nuts. You can try over-the-counter Benadryl and some calamine lotion, some oatmeal baths. That usually helps with the itchiness.

Interviewer: But otherwise not a major danger where you get into the trouble as if you really start scratching and damaging your skin.

Dr. Youngquist: Yeah. That's the main problem. Although I did have a friend who was camping with his family and they picked out poison oak as the branches they would use to roast their marshmallows, so they all ended up with swollen lips and tongues and had to go to the emergency department.

Interviewer: Wow.

Dr. Youngquist: So don't eat the stuff.

Interviewer: Okay. Some good advice. All right. And probably don't rub your eyes.

Dr. Youngquist: Right. Don't rub your eyes.

Interviewer: It could be pretty bad. So is there a point where you would need to see a doctor?

Dr. Youngquist: Well, doctors can prescribe steroids, of course. So if the Benadryl and the calamine and other treatments aren't cutting it for your itchiness, then, of course, steroids may help with that subjective sense of itchiness. Otherwise, there's not much that can be done.

Interviewer: All right. And how long does it take to run its course?

Dr. Youngquist: Well, it can take a few days to a week.

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Interviewer: It's a new technique that some emergency rooms are using to save lives. Learn about eCPR. That's next on The Scope.

Announcer: Health tips, medical news, research and more, for a happier, healthier life. From University of Utah Health Sciences, this is The Scope.

Interviewer: So you've heard of CPR, what happens when you throw an E in front of it and you get eCPR? Well, it's a new technique that we're going to learn a little bit more about from an emergency room physician, Dr. Scott Youngquist. What is eCPR? What does that stand for?

Dr. Youngquist: eCPR stands for extracorporeal cardio pulmonary resuscitation, and the idea is that instead of pressing on the chest rhythmically to circulate blood, you actually withdraw blood from the patient and using a mechanical pump, pump it back into the patient, fully oxygenated and under pressure.

Interviewer: All right. What was this born out of?

Dr. Youngquist: Well, this goes back decades to really the 1930s with the development of heart-lung bypass. This heart-lung bypass was used in the operating room to allow cardio-thoracic surgeons to perform blue baby operations and to perform coronary bypass. So it's been used there extensively and has been very expensive.

Interviewer: All right. And now, it's being used in the emergency room. It's kind of old technology, new application. Why is it coming to emergency rooms?

Dr. Youngquist: Well, for several reasons. One is that the cardiac arrest survival rates have not moved much in the last 30 years. So we've kind of reached the pinnacle of resuscitation using closed chest compressions and defibrillation. And unfortunately, we only get about seven and a half percent of patients out of the hospital neurologically intact and whom we attempt usual care, namely, chest compressions and defibrillation.

Interviewer: Yeah. So you're looking to up that percentage a little bit.

Dr. Youngquist: Absolutely. So one of the rationales for using this external pump is that it provides much better blood flow than just pressing on the chest.

Interviewer: And how is it doing? Is it doing better than 7%?

Dr. Youngquist: It's doing better than 7%. Several centers are reporting that in carefully selected patients, 50% of these victims are surviving once they're placed on pump and recall that these are patients in whom the standard measures have already failed.

Interviewer: Right. Because this is somebody who's had a cardiac arrest in the field, they've been put on an ambulance, the compression is probably all the way to the hospital, then they get put on more compressions at the hospital before the machine comes on? I mean how does that process even work?

Dr. Youngquist: Yeah, absolutely. So the resuscitation has to go seamlessly from the field where bystanders hopefully start chest compressions till when EMS arrives. They continue chest compressions and defibrillation attempts, identify the patient as suitable for ECMO possibly and move them to the emergency department. And then the ED, in the emergency department, we continue compressions while we try to get access for placing the patient on pump. So usually, it takes somewhere between 45 and 60 minutes at best to get the person on the pump.

Interviewer: So why aren't we putting the pumps in the ambulances for the first responders?

Dr. Youngquist: Well, that's a good question. It's a highly tactical skill, so right now it requires a physician to place the patient on the pump. And some places are actually doing this, places like Paris, France, where physicians ride on ambulances and take this machine to the field where they can insert catheters and place the patient on pump, in places like the Louvre even or a supermarket.

Interviewer: Yeah, and what are their percentages? Is it much better than the way it's currently here in the United States?

Dr. Youngquist: Well, it's too early to tell. They haven't reported fully on their outcomes, but this is an ongoing trial in Europe.

Interviewer: And the difference is there are doctors on those ambulances that can actually do that. Here in the United States, we don't have that. So when you get back to the emergency room, it's not the emergency room personnel that are actually hooking people up, it's cardiologists.

Dr. Youngquist: Well, it depends. At our institutions, it's cardiothoracic surgeons. In some locations, it's cardiologists working with the emergency physicians, and in some locations it's actually emergency physicians doing the whole thing, putting them on the pump and then admitting them to the ICU.

Interviewer: And you said people have to be screened whether or not they're going to be even eligible at this point. So they make it back to the emergency department, then there's additional criteria to determine if this pump can be used. What are those?

Dr. Youngquist: Well, we're not sure exactly which patients will benefit the most, but we have some good idea. We think it's patients that initially have a shockable rhythm and don't have a lot of comorbidities. So people who already have advanced cancer or heart failure, cirrhosis of the liver, renal failure, those patients aren't likely to benefit from this life extending care which is really heroic.

Interviewer: Yeah. So another good reason to try to stay as healthy as possible I suppose where you can.

Dr. Youngquist: Absolutely.

Interviewer: What's the future of this technology from what you're seeing right now?

Dr. Youngquist: Well, we're seeing a year-by-year expansion in use and availability of eCPR to cardiac arrest victims in the United States and elsewhere. There is a large registry called ELSO which tracks this and this has been going up exponentially each year. And part of that tracks with the scale and cost of the equipment coming down over time.

Interviewer: And then at the end of the day, you mentioned 50%, like is it a 50% increase?

Dr. Youngquist: It's about 50% of patients who go on the pump who survive, and this is a case series that's selected from patients who have already failed at least 60 minutes of usual care. In those cases, continuing CPR may result in a few survivors but it's usually less than 5%.

Interviewer: Okay. So is there a point where you have to look at the expense, the necessary equipment versus the survival rate? Is 50% a pretty good number to offset the balance of the other aspects of providing this care?

Dr. Youngquist: Yeah. I would say that's a great number considering the overall survival at that time period is less than 5%. So we've given the person a tenfold increase in survival by providing this therapy.

Interviewer: All right. And we have this technology here at University of Utah Health?

Dr. Youngquist: Yes, we do. For a couple of years, we've been providing this therapy to select patients who meet our criteria.

Interviewer: But there are some places still without it but hopefully, someday soon.

Dr. Youngquist: Yes.

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Interviewer: Dehydration. When should you really worry? We'll talk about that next with Dr. Scott Youngquist on The Scope.

Announcer: Medical news and research from University Utah physicians and specialists you can use for a happier and healthier life. You're listening to The Scope.

Interviewer: In the summer months you hear a lot about dehydration, and I've actually even heard that when you're thirsty it's too late. You're already dehydrated. So we're going to talk about that and other things about dehydration with Dr. Scott Youngquist. He's an emergency room physician at University of Utah Health Care. First of all, is there any truth to that, "When you're thirsty it's too late?" I'm already dehydrated?

Dr. Youngquist: There's some truth to that. That's not way too late, but it's a sign that you are dehydrated. That cotton-mouth, thirsty feeling is your body telling you it's time to get some more water.

Interviewer: I remember when I was younger nobody carried water bottles anywhere. You'd go out on hikes. My dad was a rancher. He'd go out and work all day and never take any water with him. Nowadays, you can't go anywhere without somebody having water. Is that silly or is that actually good?

Dr. Youngquist: That's a good question. One recent study suggested that children, at least, get not enough water during the day. So they're not drinking enough water for their regular needs and probably are going around in a state of constant dehydration.

Interviewer: I think I saw that study. They get a lot of juices and stuff like that but not actual water. Like a lot of kids don't ever drink pure water.

Dr. Youngquist: Yeah, absolutely. And some of those juices that are high in sugar actually cause you to be more dehydrated. So they will cause what's called a diuresis or cause you to urinate more fluids than you actually took in. So they can actually be a negative in terms of overall hydration status. And I think that some of the mild symptoms in kids, that are probably true for adults as well, are feeling tired, lethargic, not able to concentrate. Those may be signs that you are dehydrated.

And most adults like to start their day with a drink of coffee or several coffees during the course of the morning, which is also diuretic. Caffeine is something that causes you to urinate and it's also sort of a negative fluid. In other words, you'll pee out more than you took in with coffee alone.

Interviewer: So on a day-to-day basis, if I'm not necessarily super active or out in the sun working, am I probably not getting enough fluid and dehydrated? And is that a problem?

Dr. Youngquist: Yeah. It's only a problem if it causes impaired function for your day. So if you're feeling, like I said, excessively tired, trouble concentrating, and things like that, you may try drinking water.

Interviewer: So that's interesting. That seems like something I would never consider. I think, "Well, maybe I had too big of a lunch, or I didn't get enough sleep." But it could actually be water.

Dr. Youngquist: Yeah. Water could be a part of it. And a lot of people will get into a cycle of treating that with additional doses of coffee or Diet Coke or something like that. They're actually making their hydration status worse rather than better. So consider taking more water as one possible solution to that feeling you get in the afternoon.

Interviewer: All right, let's go outside for a second. On a 90 degree day, for example, I like to cycle or hike or do something like that. When should I start worrying if I don't have water? Like if I'm doing a ten-mile bike ride and I don't take water with me, is that a problem?

Dr. Youngquist: That's going to vary depending on how much water you had beforehand. So when you start out in the morning, actually, you haven't had anything to drink all night long. If you think about it, even fasted. You haven't had anything to drink. And most of your hydration status is actually come from mobilizing that's in your soft tissues. It's kind of accumulated in your feet and legs during the day through gravity. And that gets reabsorbed back into the vascular space while you're sleeping. But you can quickly become dehydrated in the morning without having enough hydration because of that, and you're actually have just urinated, not taken in any fluids at all.

Interviewer: So on a hike, say a couple miles, if for the most part I'm drinking water and I don't take water on that hike, and it's a hot day and I'm out in the sun for a couple hours, I'm probably going to be fine. It's just getting back to everybody's got water with them at all times.

Dr. Youngquist: Yeah absolutely. So it's going to depend on the duration of exercise, the amount of heat that you're exposed to, and your pre-exercise hydration status.

Interviewer: At what point should I start being concerned as a general rule, if I'm relatively well-hydrated most of the time?

Dr. Youngquist: Well, I'll give you just a general rule of thumb. I would say anything more than a couple of miles, you should probably bring some water.

Interviewer: Okay. And how much water should I be drinking every day? It tends to vary a lot. Like I've heard ten cups. I've heard as much as a gallon. Is there a general rule on that?

Dr. Youngquist: Yeah there is, and I don't know off the top of my head unfortunately, but there is.

Interviewer: Maybe ten cups is a gallon.

Dr. Youngquist: There is a calculation you could do, and you could look this up online, but there are various numbers given for the amount of appropriate fluids. We tend to calculate people's fluids on a maintenance basis when they come into the hospital and have to go without food or water because they're preparing for surgery or something like that. And for an adult we tend to go around 125 to 200 milliliters per hour as a maintenance fluid.

Interviewer: So what does that translate into in ounces then?

Dr. Youngquist: That's somewhere between four to eight ounces. So one half to a whole cup of water per hour is about what your maintenance requirement is.

Interviewer: While I'm awake?

Dr. Youngquist: Yes.

Interviewer: Wow, really? And how much should that increase when I'm exercising?

Dr. Youngquist: So you could probably at least double that when you're exercising. People tend to, instead of maintaining that fluid status, tend to get behind and catch up with a lot of water, and then get behind and catch up. So we don't consume that evenly throughout the course of the day, and it's probably impossible to do so. But that's why we have kidneys. Kidneys are good about conserving water when we need it and getting rid of it when we've got excess.

Interviewer: Can you drink too much?

Dr. Youngquist: You can, certainly. Yeah there's a phenomenon known as "water intoxication." You can get very sick from it. In fact, there have been some high-profile deaths from water consumption contests. There was a famous one, I think in California, where a radio station sponsored a water consumption contest, and I believe it was a female participant died shortly thereafter from water intoxication. So yes, you can drink too much.

Interviewer: But beyond that, I've heard that you could wash out all the good vitamins and minerals if you're drinking too much water. You could flush too much of the good stuff out of your body. Is there any validity to that?

Dr. Youngquist: I don't know about vitamins. It depends on if they're water soluble or not, but yes most of the time if you take supplemental vitamins most of it ends up in your urine anyway, regardless of how much water you take. And that's why you take some B12 vitamins and you'll notice that your urine becomes distinctly kind of dark yellow-orange in color, and it's not because you're suddenly dehydrated. It's because of the concentration of those vitamins.

Interviewer: So as long as you're doing about four to eight ounces, you're good.

Dr. Youngquist: Yeah. On average per hour.

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Interviewer: So the question is, can you build up a tolerance to heat exhaustion or even getting heat stroke as the summer progresses.

We're with Dr. Scott Youngquist. He's an emergency room doctor at University of Utah Health Care. So the question is, can you build up that tolerance or is it just always the same.

Dr. Youngquist: The short answer, Scot, is yes, you can build up tolerance to heat exposure, and this has been shown for some time now, experimentally, with human volunteer subjects, that you can take them and, typically, under conditions of exercise. So you put one group into an area where they're going to exercise under heat conditions, around 37 degrees Celsius or 98.6 degrees Fahrenheit. You have them exercise for 20 minutes and then have a 10-minute cool-down period, and you do this for 6 days, and they will tolerate passive heat exposure much better than somebody who exercises in the cold. So you can develop this.

When you're exposed to heat, a couple of things happen to try to cool your body and adjust to the heat stress. One of those is, you start to hyperventilate and that will reduce blood flow to your brain. So you start to lose the amount of blood going to your brain. That's why people can get altered mental status with heat stroke. We call it heat stroke, not because they're actually having a stroke, but because, sort of like a stroke, their brain is deprived of essential nutrients and oxygen. So that occurs.

You also have a diversion of blood flow toward the skin, so you sweat and also your skin heats up so you can radiate heat from the body and try to lose heat that way. But that also reduces your circulating blood volume and so you get a drop in your blood pressure, and that can be, in cases of severe heat stroke, that drop in blood pressure can lead to cardiovascular collapse.

And so you have a couple of compensatory mechanisms when you're exposed to heat, and at a cellular level, there are these proteins called heat shock proteins. The heat shock proteins are produced in response to this, and give you this tolerance. So people who are exposed to exercise under conditions of heat build up this tolerance by producing these heat shock proteins. And what you find is that they hyperventilate less, there's increased blood flow to the brain compared to the group that hasn't developed tolerance, and so they're able to compensate much better. They also increase their plasma volume, so they hold onto water a little bit more, anticipating they're going to be sweating and things like that.

Interviewer: So at the beginning of the summer when I feel like, "Oh man, I'm just having a hard time handling the heat," versus the end of the summer, where I'm running and cycling, and it doesn't bother me at all, all those things are happening inside my body.

Dr. Youngquist: Exactly. That's why you feel better as the summer goes along in the same amount of heat.

Interviewer: And I would imagine that everybody's a little bit different. Some people probably have a natural higher tolerance, right?

Dr. Youngquist: Yeah, absolutely. So if you are obese or overweight, it's going to make it harder for you to develop heat tolerance because you've got that extra layer of insulation.

Interviewer: If I'm interested in building up heat tolerance because I want to compete in some sort of an athletic event, is there a systematic way I should go about it, or is it just about getting out for longer and longer periods of time?

Dr. Youngquist: There are several protocols you can look at online. So if you do a Google search, you'll find several proposed heat tolerance regimens that you can adopt. But experimentally it's usually just a small amount of exercise, about 20 minutes a day for 6 days straight, in the heat, being careful to hydrate yourself well and to stop if you're feeling dizzy or excessively tired, and that should do it.

Interviewer: All right. Well, thank you very much. Indeed, you can build up a tolerance to heat exhaustion.

updated: July 16, 2021
originally published: August 6, 2015

Announcer: Is it bad enough to go to the emergency room or isn't it? Find out now. This is ER or Not on The Scope.

Interviewer: Dr. Scott Youngquist with the University of Utah Hospital, are you ready for ER or Not?

Dr. Youngquist: I'm ready.

Interviewer: All right. Here we go. Here's the situation. You wake up and you can't stand up straight because your stomach hurts so much. ER or not?

Dr. Youngquist: In most cases ER.

Interviewer: Really?

Dr. Youngquist: Yes. The reason is there could be some very bad things causing that abdominal pain. So in some way it depends. If this is a chronic issue obviously it may not require any treatment in the emergency department at all, and some people unfortunately suffer from abdominal pain on a daily basis. But I'm going to assume this is new, you've never had this before and you woke up with abdominal pain so severe that you couldn't stand up. So what could it be?

If you're a young and otherwise healthy person, the most likely cause is appendicitis. And usually if you've got appendicitis you've started with some mild abdominal pain; it's often located around the belly button and then tends to migrate to the right lower quadrant of your abdomen and gets severe over time. It can perforate if it's not treated surgically and cause a large intra-abdominal infection or sepsis or even death from infection.

Interviewer: It's nasty because it releases all that nasty stuff into your body that it would normally contain in the appendix.

Dr. Youngquist: Absolutely. People don't feel well when they've got it. They feel sick all over and it's all coming from their appendix.

Now the other things that can cause this particularly in middle aged older people are gallbladder disease. So you could have a gallstone that is obstructing the common bile duct or even causing perforation or infection of the gallbladder. And that also requires emergency treatment sometimes and removal of the gallbladder or at least antibiotics.

Interviewer: Got you. I'd be afraid that I was just a little bloated or gassy or had some sort of a weird cramp.

Dr. Youngquist: It could be, but that should resolve in a matter of minutes, seconds to minutes.

Interviewer: Okay.

Dr. Youngquist: It shouldn't last hours.

Interviewer: Okay.

Dr. Youngquist: So if you want to wait a little bit and see if it goes away that's probably fine. But if it's lasting for minutes/hours, then you need to come in and see somebody about it.

Announcer: Have a question about a medical procedure? Want to learn more about a health condition? With over 2,000 interviews with our physicians and specialists, there’s a pretty good chance you’ll find what you want to know. Check it out at TheScopeRadio.com.

updated: June 28, 2018
originally published: June 29, 2014

Interviewer: What do you do if you break a bone in the back woods? That's coming up next on E.R. or Not.

Intro: Is it bad enough to go to the emergency room, or isn't it? Find out now. This is ER or Not on the scope.

Interviewer: What do you do if you break a bone in the backwoods? That's today ER Not with Dr. Scott Youngquist from the Emergency Department here at the University of Utah Hospital. So it could happen, right, you're out hiking?

Dr. Youngquist: It does happen sometimes.

Interviewer: And somebody breaks a bone like yourself or somebody you're with. What do you do at that point?

Dr. Youngquist: Yeah. We've had this happen to some of our residents before when they're out mountain biking and breaking a bone, or even some of our faculty members. There's not much you can do to fix the problem, obviously, out in the wilderness. So the main consideration is how do you get out to definitive medical care?

Interviewer: Got you.

Dr. Youngquist: So the question is where's the bone? If it's one of your legs, can be very hard to get out of there, unless you can limp on one leg or something like that. Main treatment in the backwoods is to try to splint it for comfort, so you can mobilize and get out, get to the emergency department. And you can use just about anything, as splinting device.

Interviewer: Sure.

Dr. Youngquist: You can use a stick, or something like that, that's wrapped around your leg. Something that will hold the bone in . . . or hold the limb in some sort of position of comfort while you move, so that it doesn't wiggle around so much and hurt so much. And that's about all you can do.

Interviewer: So that's a comfort thing. It's not even necessarily a practical thing, huh?

Dr. Youngquist: It's just a comfort thing. It's trying to keep...all the way up.

Interviewer: Interesting.

Dr. Youngquist: If you've got an open fracture, or fracture in which a bone is poking out of the skin or something like that, if you got moist gauze, you can put that over the exposed bone and cover the wound. That's something that's going to require antibiotics and possibly surgery to wash out that area, because it quickly becomes contaminated with bacteria. So you want to avoid contamination as much as possible. Keep that covered. If you don't have gauze, wet gauze or something like that, whatever you have to keep it covered is important. You don't want dirt and things like that . . .

Interviewer: Okay.

Dr. Youngquist: To get into the womb. That's the main other consideration.

Interviewer: Got you. Are there any considerations, say break a leg, and you said getting out it's the important thing. Can you do some serious damage to that broken bone, just trying to get out?

Dr. Youngquist: You could. You could make a bad fracture worse. You could turn a fracture that's a close fracture, or there's nothing poking out of the skin into an open fracture where the bone pokes out, particularly if you got you know, if your shin bone is broken, your tibia, and it's tempting the skin or something like that. And you're trying to walk on that, you can make things worse by applying pressure to it and moving it around too much.

Interviewer: So what would you do if you were in that situation?

Dr. Youngquist: Well I'd... first thing I'd do is check my cell phone. And I'd be looking for bars on my cell phone.

Interviewer: Sure.

Dr. Youngquist: See if I can have somebody come and get me. Unless there's someone there with me who could help me out. If I'm all by myself, which I don't recommend you being in the backwoods by yourself, but if you're all by yourself, you got to try and get somebody out there to help you if you can't move obviously. Air Med every year will go out and do some rescues out in the backwoods for people just like this, who can't get out in a timely fashion and can't move, can't walk or whatever and are stuck in the backwoods.

Interviewer: Would it be better if you were somebody to have that somebody go and get help and leave the person with the broken bone there. Especially if it's like a leg there or something that really inhibit their mobility?

Dr. Youngquist: Yeah if there's no way you can move, even without the help of another person, then sending them onto get some help is probably the only way you're going to get any help.

Interviewer: And calling Air Med is okay. Calling 911 for something like this is all right?

Dr. Youngquist: Yeah, that's what we're here for.

Interviewer: We're your daily dose of science, conversation, medicine. This is the Scope. University of Utah Health Science Radio.

Interviewer: The pool covers are starting to come off the pool. It's time to think about drowning and drowning safety. We'll talk about that next on The Scope. Medical news and research from University of Utah physicians and specialist you can use for a happier and healthier life. You're listening to The scope. Have you ever thought for a second what would you do if somebody was drowning? I mean what would you do after you got them out of the water and back up on the pool deck? We're going to find out right now with Dr. Scott Youngquist. He's in the emergency department here at University of Utah Hospital. Drowning, somebody drowns, the get their lungs filled with water. You pull them up on the deck. What then?

Dr. Youngquist: Bring them up and lay them on a flat surface, hard surface and if they're not breathing on their own begin CPR and mouth-to-mouth resuscitation.

Interviewer: All right.

Dr. Youngquist: There are some groups that actually recommend doing the Heimlich maneuver. We don't recommend that.

Interviewer: Interesting.

Dr. Youngquist: And the idea being that maybe you can force some water out of their lungs by doing the Heimlich maneuver which is basically applying a firm upward thrust to upper abdomen. And it works great if you've choked on a piece of chicken or something like that, but there's no evidence that it benefits patients whose lungs are full of water. It kind of makes sense that it wouldn't work as well because you've just got this column of water that you're pushing on. There's not really anything behind it, sort of like a piece of chicken that's got an airbag behind it.

Interviewer: Yeah.

Dr. Youngquist: And patients need immediate oxygenation and circulation of blood so the recommendation is that you begin CPR and mouth-to-mouth resuscitation. The other consideration though is that if the patient has dived into the pool and struck the bottom, and if the drowning is caused by a spinal injury then you want to be careful not to manipulate the neck too much while you're performing mouth-to-mouth resuscitation. So that's why we say lay them out on a flat surface. Try not to move them while help arrives. Have somebody call 911 and begin CPR.

Interviewer: So number one, call 911.

Dr. Youngquist: Yes.

Interviewer: Number two, if they're not breathing, CPR.

Dr. Youngquist: Yes, with mouth-to-mouth.

Interviewer: With mouth to mouth. Because I thought that the current standard was you didn't do the mouth-to-mouth anymore.

Dr. Youngquist: That's correct. In all cases except for causes of respiratory arrest. So if somebody's drowned then we'd begin mouth-to- mouth resuscitation in addition to CPR. It's one of those special cases.

Interviewer: Got you. Does that help clear the water out? I mean what happened to that water? I'd never thought of that.

Dr. Yongquist: Yeah. The idea is that some of that water is going to be absorbed into your circulation. Some of it they're going to choke back up. And the idea is you're trying to ventilate any unfilled parts of the lung, segments of the lung so that you can get some oxygenation in there. With enough airway pressure, a lot of times it comes up and either goes down the back of their throat or it'll be coughed out of the mouth.

Interviewer: Got you. But nothing you can actively do other than just providing CPR with mouth-to-mouth.

Dr. Youngquist: Yeah. The CPR will also drive some water out of the lungs as well.

Interviewer: OK. And then other than that, that sounds like about it, huh?

Dr. Youngquist: Yeah, wait for help to arrive. There's nothing else you can do.

Interviewer: All right. You bring up an interesting point, and it is the last question. So if they did hit their head on the bottom, are there any consideration actually getting them up and out of the pool or is the goal at that point just get them up and out of the pool.

Dr. Youngquist: Yeah. The goal is pretty much to get them out to do CPR as quickly as possible. If you can be careful about manipulating the neck. But the number one priority is getting them oxygenation and circulation restarted so whatever you have to do to get them out of the pool to a place where you can begin to perform resuscitation, that's the number one priority.

Announcer: We're your daily dose of science, conversation, medicine. This is The Scope, the University of Utah's Health Sciences radio.