# LT Collapses, Later Dies, At Ranger School



## CDG (Jul 29, 2016)

Soldier Dies After First Day Of Ranger School

Reported cause of death was hyponatremia. RIP LT.


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## Ooh-Rah (Jul 29, 2016)

Oh no!

I guess I'd have to go back and look, but my perception is that  SOF training deaths have increased recently. Specifically the SEAL candidate who drowned, the Airman who died during SERE, and now this.


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## DocIllinois (Jul 29, 2016)

Such a shame.  My sympathies go out to the Parros family.


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## x SF med (Jul 29, 2016)

Hyponatremia on the first day of Ranger School....  there is other etiology here... 

RIP LT, you died trying.


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## AWP (Jul 29, 2016)

x SF med said:


> Hyponatremia on the first day of Ranger School....  there is other etiology here...
> 
> RIP LT, you died trying.



In my case, I wasn't conditioned for the heat of Benning (this is OCS, NOT Ranger school) when I had hyponatremia. Given the similarity in signs and symptoms the medics can easily misdiagnose you. They tried to push a standard saline IV. I was peeing frequently and it was clear and pointed out that I might try some Gatorade first. Problem solved. If the medics had their way that story could have a different ending.


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## Red Flag 1 (Jul 29, 2016)

Rest In God's Own Peace, Lt.



Freefalling said:


> In my case, I wasn't conditioned for the heat of Benning (this is OCS, NOT Ranger school) when I had hyponatremia. Given the similarity in signs and symptoms the medics can easily misdiagnose you. They tried to push a standard saline IV. I was peeing frequently and it was clear and pointed out that I might try some Gatorade first. Problem solved. If the medics had their way that story could have a different ending.




With all that is known today by those doing serious training, replacing lytes with Gatorade, or other such drinks, is the norm. I'm a little surprised to see this happen, particularly in the military.


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## DocIllinois (Jul 29, 2016)

Red Flag 1 said:


> Rest In God's Own Peace, Lt.
> .



I agree with what @x SF med stated: there may have been something pathalogical at work here.

An undiagnosed salt losing nephropathy or nephrotic syndrome, or hypothyriodism?  Primary polydipsia? The kid just came off a horrendous bout of diarrhea?

A moot point, at this point.


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## Red Flag 1 (Jul 29, 2016)

Many times these are found to have been an undiscovered cardiac event.


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## AWP (Jul 29, 2016)

Red Flag 1 said:


> With all that is known today by those doing serious training, replacing lytes with Gatorade, or other such drinks, is the norm. I'm a little surprised to see this happen, particularly in the military.



This was in 2000. I think they lost a basic trainee in the previous year or so which made the medic's decision all the more surprising. I happened to see a story about it in the paper or else I wouldn't know because no one told us. It wasn't on the Army's radar back then.


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## Gunz (Jul 29, 2016)

Very sad. RIP Lt.


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## policemedic (Jul 30, 2016)

Freefalling said:


> In my case, I wasn't conditioned for the heat of Benning (this is OCS, NOT Ranger school) when I had hyponatremia. Given the similarity in signs and symptoms the medics can easily misdiagnose you. They tried to push a standard saline IV. I was peeing frequently and it was clear and pointed out that I might try some Gatorade first. Problem solved. If the medics had their way that story could have a different ending.



Sounds like cookbook medicine and a clear lack of critical thinking.


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## Viper1 (Jul 30, 2016)

That sucks. Rest in Peace LT.


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## Muppet (Jul 30, 2016)

Rest easy sir.

Makes me wonder if an ISTAT was used for POC testing. Seems, these days, everybody I see and bring into an ED gets POC testing (ISTAT is similar to a glucometer / think sugar checks. ISTAT can check labs, I have used em as a USAR medic, checking potassium, sodium and other labs.

M.


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## Muppet (Jul 30, 2016)

Red Flag 1 said:


> Many times these are found to have been an undiscovered cardiac event.



You man like long Qt,maybe because of mag issues doc?

M.


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## DocIllinois (Jul 30, 2016)

Muppet said:


> You man like long Qt,maybe because of mag issues doc?
> 
> M.



Or a sodium deficiency/ processing pathology leading to a cardiac event.


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## Muppet (Jul 30, 2016)

DocIllinois said:


> Or a sodium deficiency/ processing pathology leading to a cardiac event.



Yes sir.  I have seen marathon runners drop, sudden arrest, extended resuscitation yields favorable results.

M.


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## SpitfireV (Jul 31, 2016)

Sorry for the boneheaded question in advance guys. Are you saying a lack of salt can lead to a cardiac event?


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## DocIllinois (Jul 31, 2016)

SpitfireV said:


> Sorry for the boneheaded question in advance guys. Are you saying a lack of salt can lead to a cardiac event?



Someone who is normoatremic and has a pre-existing, perhaps asymptomatic, heart issue increases their risk of cardiac mortality if they progress to hyponatremia.


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## SpitfireV (Aug 1, 2016)

OK thanks Doc. I learned some wordz today too  


Cheers mate, much appreciated.


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## Red Flag 1 (Aug 1, 2016)

Muppet said:


> You man like long Qt,maybe because of mag issues doc?
> 
> M.



If you are looking for abnormalities, you may turn something up. If you are using a snap shot look at a young healthy person, you usually get a young healthy person.

But then: Sudden death in young people: Heart problems often blamed - Mayo Clinic.


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## Red Flag 1 (Aug 1, 2016)

The physical I got when getting cleared for dive chamber rides was extensive. It included X-rays of everything, bone marrow (OUCH), EKG,EEG, treadmill, CAT scans, etc. They stopped at invasive stuff, though they talked about heart cath. They were looking for reasons to DQ people. The routine physicals for recruits do miss some things.


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## DocIllinois (Aug 1, 2016)

Red Flag 1 said:


> The physical I got when getting cleared for dive chamber rides was extensive. It included X-rays of everything, bone marrow (OUCH), EKG,EEG, treadmill, CAT scans, etc. They stopped at invasive stuff, though they talked about heart cath. They were looking for reasons to DQ people. *The routine physicals for recruits do miss some things.*



Bone marrow, geez.  Okay, never doing dive stuff.  


When I went through my Ranger physical it was a little more extensive than the "normal" version, but still kind of... hurried.  The CTMC was fairly crowded on that day, though.


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## Red Flag 1 (Aug 1, 2016)

DocIllinois said:


> Bone marrow, geez.  Okay, never doing dive stuff.
> 
> 
> When I went through my Ranger physical it was a little more extensive that the "normal" version, but still kind of... hurried.  The CMTC was fairly crowded on that day, though.



My kids are all qualified divers, and physicals were non issues. My job was to accompany patients on chamber dives for medical reasons. They picked Surgery and Anesthesia residents because we were good with our hands, and were pretty good at following directions.  A lot of applicants were turned down even before we got to the physicals. The bone Marrow study just about had me walking out the door. We were often required to give meds, and pull some blood samples, etc., during the dives. Everything we gave a patient had to be double checked with staff outside the chambers. We dove with patients from just about every specialty, and some for  decompression sickness. Those for decompression were usually on call cases, some taking 200 to near 300 minutes of chamber time @ 60'. Yup, another call list rotation; I was never home. One of the risks of chamber dives was oxygen toxicity. When I was diving, we did not have the luxury of PulseOx technology that is so common place today.


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## policemedic (Aug 1, 2016)

Red Flag 1 said:


> If you are looking for abnormalities, you may turn something up. If you are using a snap shot look at a young healthy person, you usually get a young healthy person.
> 
> But then: Sudden death in young people: Heart problems often blamed - Mayo Clinic.



It would have been instructive to see the presenting rhythm when the LT coded.  It would have been better to have identified an issue prior to the code. 12-leads, iStats and clinical judgment can often turn the tide when used early.


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## policemedic (Aug 1, 2016)

Red Flag 1 said:


> The physical I got when getting cleared for dive chamber rides was extensive. It included X-rays of everything, bone marrow (OUCH), EKG,EEG, treadmill, CAT scans, etc. They stopped at invasive stuff, though they talked about heart cath. They were looking for reasons to DQ people. The routine physicals for recruits do miss some things.



I'd call bone marrow testing invasive...fuck that.


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