Wilderness Medicine by Paul S. Auerbach, MD, MS

Once again, Paul Auerbach has managed to provide us with a tome that holds an absolute wealth of information. He has not only updated all the information contained in the previous edition, but he has also called upon more experts in the field who have added a wide variety of new topics. The list of contributing authors reads like a Who’s Who in Wilderness Medicine and Rescue. This text is a true accomplishment and a marvelous contribution to the wild side of medicine.

The Fifth Edition, 2007, consisting of 2316 pages is divided into 97 chapters, written by 157 contributing authors. A myriad of charts, tables, and spectacular photography complement the well-written text.

Needless to say, I have not had the time to read the entire book, but the several chapters I have read were packed with valuable information for all of us who are interested in or participate in wilderness medicine and rescue work.

Paul, a personal thanks. Great job! What a tremendous contribution this text will make to emergency medicine that is practiced in the extended care environment.

Wilderness Medicine, Fifth Edition, by Paul S. Auerbach, MD, MS is published by Mosby, ISBN 978-0-323-03228-5 and available through www.elsevier.com and probably amazon.com.

High Altitude Resources

There have been requests for some resources on more information about high altitude physiology and medicine.  Here are several resources that we have found to be very informative.

References:  

www. ISMMED.org  (International Society of Mountain Medicine) 

www.High-Altitude-Medicine.com

www.altitudephysiology.org

Paul Auerbach, MD, his text: Wilderness Medicine (The 5th Edition will be out soon.)

Charlie Houston, MD, his text:  Going Higher

Two excellent articles are:

www.emedicine.com/emerg/topic795.htm - Emedicine article on HAPE

www.emedicine.com/EMERG/topic22.htm - Emedicine article on HACE

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Emergency First Aid Kit for High Altitude Expeditions

Post #6 of 6:

Emergency First Aid Kit for High Altitude Expeditions

The most recent issue of the Wilderness Medicine Newsletter, Nov/Dec 2006, is dedicated to the recognition and management of high altitude illnesses.  To follow is a series of postings regarding high altitude illnesses, recognition and management.

Drugs specific to high altitude illnesses:

For a group of 8 - 10, carry 2 full doses of each medication.
Diamox (Acetazolamide) 250mg tablets, #30
Procardia, Adalat (nifedipine) 10mg tablets, #40 or SR 30mg tablets #30
Decadron (dexamethasone) 8mg tablets, #20
8mg tablets can be split in ½ to make 4mg, or can carry 4mg tablets as well)
IM dosing: 24mg/ml, available in 5ml vials. 

Oxygen, nasal cannula, PEEP
Pulse Oximeter & spare battery
Emergency Rescue High Altitude Pressure Chambers:

Gamow bag, Cretec bag, PAC bag:
For information go to High-Altitidue-Medicine.com and check on hyperbaric treatment for links on how to purchase or rent.

This blog is powered by the Wilderness Medicine Newsletter, now celebrating 20 years of publication. The WMN is published and distributed online six times each year by TMC Books, and subscriptions cost as little as $10 per year. To find out more, or to subscribe online, click here.

HIGH-ALTITUDE PULMONARY EDEMA (HAPE)

Post #4 of 6:

The most recent issue of the Wilderness Medicine Newsletter, Nov/Dec 2006, is dedicated to the recognition and management of high altitude illnesses.  To follow is a series of postings regarding high altitude illnesses, recognition and management.

HIGH-ALTITUDE PULMONARY EDEMA (HAPE)
HAPE = Fluid in the lungs.

Signs & Symptoms: Acute Mountain Sickness plus

Extreme fatigue
Shortness of breath at rest
Fast shallow breathing
Pulmonary crackles
Persistent cough with or without sputum
Dyspnea not relieved with rest
Chest tightness, pressure, congestion
No pain (if pain present, suspect injury, acute MI, or costochondritis)
Cyanosis of the lips and fingernail beds
Drowsiness

Treatment:

IMMEDIATE DESCENT - at least 500 - 1000 meters
If unable to descend, then place in pressure bag, Gamow, Certec, or PAC
Administer O2 if available, will relieve symptoms within minutes
Hydrate
Monitor SaO2 by pulse oximeter

Drugs:

Nifedipine (Adalat, Procardia), this is a calcium channel blocker that aids in HAPE by causing pulmonary vasodilation.
Nifedipine 10mg po every 6 hours, may use Nifedipine SR (slow release form) 30mg po every 8-12 hours, total dose not to exceed 90 - 120mg/day.
Acetazolamide (Diamox), is a carbonic anhydrase inhibitor helps to accelerate acclimatization.  It may used help prevent AMS and HAPE but, it is not effective for the treatment of HAPE.

This blog is powered by the Wilderness Medicine Newsletter, now celebrating 20 years of publication. The WMN is published and distributed online six times each year by TMC Books, and subscriptions cost as little as $10 per year. To find out more, or to subscribe online, click here.

HIGH-ALTITUDE CEREBRAL EDEMA (HACE)

Post #5 of 6:

The most recent issue of the Wilderness Medicine Newsletter, Nov/Dec 2006, is dedicated to the recognition and management of high altitude illnesses.  To follow is a series of postings regarding high altitude illnesses, recognition and management.

HIGH-ALTITUDE CEREBRAL EDEMA (HACE)
The majority of cases of HACE occur because they continued to ascend while they still had the symptoms of Acute Mountain Sickness.
Signs & Symptoms: Severe AMS plus

Change in mentation or the ability to think and solve simple problems
Loss of coordination - ataxia, can be subtle but cannot tandem-gait walk
Possible hallucinations
Drowsiness
Coma
Cheyne-stokes respirations
Signs of increasing Intracranial Pressure (ICP)

Treatment:

IMMEDIATE RAPID DESCENT at least 500 - 1000 meters
If unable to descend, place in pressure bag, Gamow, Cretec, or PAC bag
Administer O2 if available, 4-6 lpm by nasal cannula or with PEEP
Hydrate if conscious
Monitor SaO2 by pulse oximeter

Drugs:

Dexamethasone (Decadron), 8mg po or IM stat, then 4mg po or IM q6h
Oxygen, 4-6lpm by nasal cannula or with PEEP, titrate as needed

This blog is powered by the Wilderness Medicine Newsletter, now celebrating 20 years of publication. The WMN is published and distributed online six times each year by TMC Books, and subscriptions cost as little as $10 per year. To find out more, or to subscribe online, click here.

THE GOLDEN RULES OF ASCENT

Post #2 of 6:

THE GOLDEN RULES OF ASCENT:

1. If you are ill at altitude, it is altitude illness until proven otherwise.
   Ill at altitude = altitude illness!
   
2. Never ascend with symptoms of AMS.
   Don’t go up until the symptoms go down!
   
3. If you are getting worse (or have HAPE or HAPE), go down at once.
   Continue down until you have relief of symptoms!
   
4. Gain no more than 1000 ft of sleeping altitude per day
   Climb high and sleep low!

This blog is powered by the Wilderness Medicine Newsletter, now celebrating 20 years of publication. The WMN is published and distributed online six times each year by TMC Books, and subscriptions cost as little as $10 per year. To find out more, or to subscribe online, click here.

High Altitude Illness

Post #1 of 6:

The most recent issue of the Wilderness Medicine Newsletter, Nov/Dec 2006, is dedicated to the recognition and management of high altitude illnesses. To follow is a series of postings regarding high altitude illnesses, recognition, and management.

What is High Altitude?
The scientific consensus for the definitions of altitude are:

High altitude: 1500 - 3500m (5000 - 11500ft)
Very High Altitude: 3500 - 5500m (11500 - 18000ft)
Extreme High Altitude: above 5500m (18000ft)
18,000′ (5500m) is ½ atmosphere

What are the RISKS of HIGH ALTITUDE MOUNTAINEERING?

As you go Higher it gets COLDER & DRYER, less and less OXYGEN, and more and more UV LIGHT that combing to CAUSE:

Dehydration (exhale 250cc of water per hour or 6 liters per day)
Hypothermia (may need up to 6000 calories per day)
Frostbite (dehydration contributes to the risk of frostbite)
Snow blindness (UV light concentration increases 4% every 1000′)
Severe sunburn (UV light concentration increases 4% every 1000′)
Acute Mountain Sickness (signs of lack of acclimatization)
High Altitude Pulmonary Edema (wet lungs)
High Altitude Cerebral Edema (wet brain)

This blog is powered by the Wilderness Medicine Newsletter, now celebrating 20 years of publication. The WMN is published and distributed online six times each year by TMC Books, and subscriptions cost as little as $10 per year. To find out more, or to subscribe online, click here.