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WILDERNESS MEDICINE

WILDERNESS MEDICINE. CLINICAL PEARLS. HIKING. AVOID GETTING LOST. Have a “fail safe” plan Look back at times when hiking out. CRITTERS. SNAKE BITE TREATMENT. No tourniquets No new incisions No sucking out venom

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WILDERNESS MEDICINE

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  1. WILDERNESS MEDICINE CLINICAL PEARLS

  2. HIKING

  3. AVOID GETTING LOST • Have a “fail safe” plan • Look back at times when hiking out

  4. CRITTERS

  5. SNAKE BITE TREATMENT • No tourniquets • No new incisions • No sucking out venom • If possible, clean out wound, cover with gauze, splint limb and go to a hospital

  6. POLYVALENT ANTI-VENOM • 5 Vials for mild symptoms • 10 Vials for moderate • 15 Vials for severe • Give 1/3 dose SQ near bite • 1/3 dose IM • 1/3 dose IV

  7. GENERAL POINTS • Never run from predators • OK to run from vegans

  8. WATER

  9. HEAT • Boiling not necessary to make potable water • Heating above 140 F for more than 5 minutes should be sufficient • If no fuels for a fire, can pour alcohol on top of water and light it. • New Big Auerbach box 61-6 p 1376

  10. UV LIGHT • All waterborne pathogens can be inactivated by UV light. • If you can read newsprint through a bottle, 5 hours should be enough to kill off pathogens • New Big Auerbach box 61-12 p 1395

  11. HYPOTHERMIA

  12. POTOMAC RIVER CRASHJANUARY 13, 1982

  13. CORE BODY TEMPERATURES • 99.6 F Normal rectal temperature • 93 Pre-hypothermia. Exhibits dysarthria, poor judgment • 88 Extinguished shivering • 82 V-fib. Unconscious • 66 Flat EKG • 57 Lowest adult hypothermia survival • Adapted from Auerbach PS, Weiss EA, Donner H. Field Guide to Wilderness Medicine

  14. ACTIVE INTERNAL REWARMING • Peritoneal lavage- 1-3 C/hr • Thoracic lavage- 3-5 C/hr • Cardiopulmonary bypass- 7-9 C/hr • Therma-rescue- 2.5 C/hr.

  15. FROSTBITE • Rewarm in warm water about 100-105 F • Vasodilators – nifedipine • Anticoagulants – heparin • Thrombolytics – streptokinase, TPA • Plasma volume expanders – low molecular weight dextran • NSAIDs - Ibuprofen

  16. FROSTBITE REFERENCES • Jenabzadeh K, Mohr W. Ahrenholz D. Frostbite: a single institution’s twenty year experience with intra-arterial thrombolytic therapy. J Burn Care Research. 2006;30: S103 • Twomey JA, Peltier GL, Zera RT. An open-label study to evaluate the safety and efficacy of tissue plasminogen activator in treatment of severe frostbite. J Trauma. 2005; 59: 1350-1354. • Cauchy E, Cheguillaume B, Chetaille E. A controlled trial of a prostacyclin and rt-PA in the treatment of severe frostbite. N Engl J Med. 2011; 364: 189-190. • Daum PS, Bowers WD Jr, Tejada J, Morehouse D, Hamlet MP. An evaluation of the ability of the peripheral vasodilator buflomedil to improve vascular patency after acute frostbite. Cryobiology. 1989;85-92. • Penn I, Schwartz SI. Evaluation of low molecular weight dextran in the treatment of frostbite. J Trauma. 1964;4: 784-790. • Rainsford KD. Ibuprofen: pharmacology, efficacy and safety. Inflammopharmacology. 2009;17:275-342. • Murphy JV, Banwell PE, Roberts AH, McGrouther DA. Frostbite: pathogenesis and treatment. J Trauma. 2000;48: 171-178.

  17. HYPERTHERMIA

  18. IMPORTANT POINTS IN HYPERTHERMIA • Heat exhaustion and heat stroke should not be thought of as separate entities but as a continuum • Signs: • malaise • tachycardia • increase LFTs • sweating (even in heat stroke) • altered mental status in heat stroke

  19. TREATMENT • Rapid cooling • Use warm water with a fan (not cold water) • Ice bags in neck, axillae, groin, scalp • Transport to an ER. Heat stroke is a life threatening emergency with a mortality of 30% to 80% • Do not use aspirin or tylenol for the increased temperature • Do not use beta blockers for the tachycardia

  20. ALTITUDE ILLNESS

  21. ACCLIMATION • It takes 4 days to acclimate • For an increase in RBC production it can take 4 to 8 weeks

  22. SIGNS AND SYMPTOMS • Can occur when over 7,000 ft • Headache • Nausea • Fatigue • Dizzyness • Insomnia • Similar to a hangover • Tachycardia • Dyspnea • Blood tinged sputum a late finding

  23. Can get cerebral edema and/or pulmonary edema

  24. Treatment • Descent • Hyperbaric chamber • Acetazolamide- 125 to 250 mg BID po • Dexamethasone- 4 mg QID po, IM or IV • Viagra- does not help in treatment but can be used to prevent pulmonary edema • Ginkgo and ibuprofen can help a little Wilderness and Environmental Medicine, 21, p 148 Table 2 (2010).

  25. LIGHTNING

  26. IF YOU CAN SEE A FLASH OR HEAR THUNDER YOU CAN BE HIT BY LIGHTNING

  27. HOW FAR AWAY • After seeing a flash count in seconds to the thunder. Divide by 5. That gives you distance in miles.

  28. LIGHTNING SAFETY • Do not lie down • Stay on feet, crouch down, cover ears. • OK to go under a thicket of trees but not a lone tree. • Shun all metal • Sit on and under anything insulating • Tents are OK in there is no metal • Lightning can travel through the ground

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