Archive for the ‘Anaphylaxis’ Category

New! From The Wilderness Medicine Newsletter

February 10, 2012

For decades the Wilderness Medicine Newsletter has provided up-to-date information to pre-hospital and definitive care providers. Since becoming an on-line journal, the readership of the WMN has become international. Now the WMN has it’s own web site:

Subscribers pay the same $15 a year subscription rate but have access to more than 165 articles from back issues as well as current issues. You can search the site either by category, or by key words making the Wilderness Medicine Newsletter site a much more useful reference for everything from reviewing splinting to the prevention and treatment of tropical diseases.

Check it out!

Wilderness Medicine by Paul S. Auerbach, MD, MS

April 9, 2007

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 and probably

Cold-Induced Urticaria

February 4, 2007

There was a recent comment regarding a rash that occurred when a person went into cold water up to their knees that rapidly evolved into full-blown anaphylaxis.  So, it seemed appropriate to take a moment and explain exactly what happened.

There are individuals who are literally allergic to the cold. It happens more commonly from exposure to cold water, but  it can  be caused by cold air.  A close friend and athlete decided to go out for a short run one cold day, when it was about -10 degrees F.   After a short jog he began to develop shortness of breath and tightness in his chest.  He also began to break out with a red, itchy rash on his face.  Fortunately for him, he was right next to the hospital ER, so he intelligently ran in.  He was quickly diagnosed and treated for cold-induced anaphylaxis that required IV Benadryl and epinephrine.

For some strange reason, in these people cold exposure causes their mast cells to degranulate.  This produces an overdose of histamine, which results in vasodilation, hypotension, tachycardia, and bronchoconstriction, causing the symptoms of the rash (urticaria), shortness of breath, wheezing, tightness in the chest, and eventually a loss of their airway.

Symptoms of anaphylaxis, regardless of the cause:
Rash – red, raised, itchy welts (urticaria)
Dyspnea – wheezing – stridor that can rapidly deteriorate into extreme difficulty breathing and airway obstruction from the bronchoconstriction.

Treatment of Anaphylaxis:
Antihistamine: such as Benadryl (diphenhydramine) 50mg po
If they develop difficulty breathing:Epinephrine 1:1000, 0.3cc IM, that comes in a pre-filled syringe, EpiPen
Oxygen 15lpm by non rebreather, if available
Evacuation to the closest ER

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