Follow-up on questions, clarifications, etc for our sim

Heat stroke

Regarding the treatment, I could not find the treatment algorithm from IM Tremblant but :

As per my friend Marc Gosselin, ER and sports medicine physician, who was the medical supervisor for 10+ Ironman events in Tremblant :

• Cool as fast as possible, this is priority number one
• Aim for cooling of 0,1-0,2 °c/minute, which is what the bath does
• If no bath available : put patient on a large plastic tarp then cover with ice.
• If no tarp, just cover with ice and clean the mess after
• In the initial steps, airway is not the main issue, focus on cooling
• Fan and mist will not cool enough, NEED ICE

TCA poisoning

ECG pattern you need to know :

• Sinus tachycardia
• QRS≥100 msec 
• RSR´ in AVR

If QRS widening or ventricular arrhythmia, give sodium bicarbonate 1-2 meq/kg, could repeat after 5 minutes.

Chest tube

One thing I forgot to mention, if you put a chest tube in a trauma, cover with one dose of the antibiotic, such as cefazolin. It decreases the risk of empyema from 7% to 1% as per this meta-analysis.

Regarding the technique and how to secure the tube, EM:RAP steals the show again. Please watch, it lasts less than 5 minutes.