Archive for the ‘Survival’ 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: www.wildernessmedicinenewsletter.com

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!

Advertisements

Book Review:

March 22, 2007

Hypothermia, Frostbite, and other Cold Injuries
Prevention, Survival, Rescue, and Treatment

By Gordon Giesbrecth, Ph.D., and James A. Wilkerson, M.D.

The book is published by The Mountaineers Books
They describe themselves as “Outdoor books by the experts” and in this case it is certainly true. The authors of this text are recognized experts in the field of cold-related injuries.

The authors have done an excellent job of describing and reviewing the various cold-related injuries. The text is up-to-date, comprehensive, well written, and applicable. This is a very useful body of knowledge for both the outdoor enthusiast as well as mountain rescue personnel. The authors have taken the time to provide information on the fundamentals of thermoregulation and clothing design as well as the recognition and management of cold-related injuries. I had the opportunity and honor of writing the chapter on non-freezing cold injuries.

If you enjoy the outdoors, or if you are a provider wilderness emergency medicine and rescue, this is a must read book. I think you will enjoy it.

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.

LIGHTNING – THE BEAUTY AND THE BEAST

March 7, 2007

Lightning # 8 – Emergency Care – Hospital

Further Office Evaluation:  If seen in the ER or by FP after the event:

Continue O2 & IV
EKG & continuous monitoring
Labs:   
electrolytes & calcium, magnesium
CBC
CK & CKMB & myoglobin
BUN & Cr
Coagulation profile
ABG
U/A for urinary myoglobin
Consider CXR, CT head, C-spine series or CT of the cervical spine
Consider EEG (long-term)

For more detailed information about lightning and lightning-related injuries see the Wilderness Medicine Newsletter, Lightning – Beauty & the Beast, July/August 2003.

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.

LIGHTNING – THE BEAUTY AND THE BEAST

March 3, 2007

Lightning # 7 – Emergency Care – Prehospital

Emergency Care for a Lightning Strike Victim – At the scene:

Survey the scene:

For immediate danger to you, others, and the victim.

Primary Survey:

Are they CONSCIOUS?
Are they BREATHING?  —>  If not, give ARTIFICIAL RESPIRATION!
Do they have a PULSE?  —>  If not, begin CPR!

Secondary Survey:

Vital Signs:

Paying particular attention to level of consciousness.
Monitor every 5 minutes until conscious and coherent.

Physical Exam – needs to be detailed:

Skin – check for burns.
Check ears for blood in the canal, and look for Battle’s sign.
Evaluate for spinal injuries.
Evaluate for sprains/strains and fractures.
Monitor peripheral pulses.

Evacuate— force fluids to help prevent late complications.
   
Treat Injuries & Transport:

Protect Airway
Protect Spine
O2 – NC at 6lpm
IV – NS at 500 – 1000cc/hr

For more detailed information about lightning and lightning-related injuries see the Wilderness Medicine Newsletter, Lightning – Beauty & the Beast, July/August 2003.

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.

LIGHTNING – THE BEAUTY AND THE BEAST

February 28, 2007

Lightning #6 – Prevention

“30 – 30” rule:

When you see lightning, count the time from the flash until you hear the thunder.
Speed of light – 186,000 miles per second.
Speed of sound – 700mph = 1000’/sec, or it travels 1 mile in 5 seconds.
Each 5 seconds between flash and thunder is 1 mile away.
If the time is 30 seconds or less, seek safe shelter or do a lightning drill.
Wait 30 minutes until after the last thunder clap before leaving safety.

Imminent Danger – Hints that you are about to be struck by lightning:

Hair standing up or tingling skin.
Light metal objects vibrating or seeing a corona discharge.
Hearing a crackling or “kee-kee” sound.

On the water or in the water:

If possible, get off the water; the risk is lightning and the squall line.
Get at least 100 yards back from the water’s edge.
Do not seek shelter under trees or open-roofed shelters without walls.
Risk of a direct strike is greater in salt water than fresh water.
If you have to stay on the water, put on life jackets.
Prepare for the winds of the squall line and the potential to be capsized.
If in a boat, sit in the center and stay away from the mast and metal shroud lines.

For more detailed information about lightning and lightning-related injuries see the Wilderness Medicine Newsletter, Lightning – Beauty & the Beast, July/August 2003.

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.

LIGHTNING – THE BEAUTY AND THE BEAST

February 24, 2007

Lightning #5 – Prevention

Prevention of a lightning strike & resulting injury:

When a thunderstorm approaches – go inside.
If in the outdoors, avoid the areas most likely to be struck:
 Anything high: mountain tops, hilltops, tall trees, towers.
 Anything metal: ski poles, pack frames, bicycles, fences.
Do not sit under trees to protect you from the rain.
Do not get under shelters that only have roofs.
 Get small, get low, do a lightning drill.
If on water, Get Off.  When on water, you are the highest object around.
Get at least 100 yards away from lakes, ponds, rivers, streams, the ocean.

Lightning drill:

Put on your rain gear and prepare for foul weather.
Get below tree line; if not possible, get away from summits and ridges.
Get away from anything tall– the tallest tree in the woods, towers.
Get away from the water’s edge, at least 100 yards.
Spread the group out; do not hold hands or sit back-to-back.
Sit on something insulated, such as an ensolite pad, with your legs crossed.
 Try to have only one point of contact on the ground.
 Try to avoid being a conductor of the ground current.

For more detailed information about lightning and lightning-related injuries see the Wilderness Medicine Newsletter, Lightning – Beauty & the Beast, July/August 2003.

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.

LIGHTNING – THE BEAUTY AND THE BEAST

February 21, 2007

Lightning #4 – Lightning-Related Injuries

Permanent sequelae:

Sleep disorders – Irritability
Fine psychomotor function difficulty – Sympathetic nervous system dysfunction
Paresthesias – Atrophic spinal paralysis
Generalized weakness
Post-traumatic stress disorder

Psychological dysfunction:

Memory disturbance – short term
Concentration disturbance – loss of focus, easily distracted
Difficulty coding new information
Difficulty accessing stored or old information
Cognitive powers – decreased mental manipulation, decreased problem-solving
High executive functioning – decreased multitasking

Behavior issues:  

Emotional liability
Sleep disturbance
Phobic behavior
Personality change

The Goal of Prevention – Don’t be a Conductor!

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.

 

LIGHTNING – THE BEAUTY AND THE BEAST

February 17, 2007

Lightning #3: Lightning-Related Injury

Injury can be caused by:

Direct effects of electricity on the nervous system.
Heat that is caused by the resistance of the current across or through the body.
Concussive effect of the shock wave of thunder.
Explosive force on other objects can hurl debris.  Water – steam expands 1700x’s.

Lightning-related injuries:

Minor: 

Confusion  – Amnesia ( hours to days )
Temporary deafness – Temporary blindness – Temporary loss of consciousness
Cutaneous burns – Contusions – minor blunt trauma & injuries
Paresthesias – Muscular pain
Tympanic membrane rupture
Mild transient hypertension
Cognitive damage to learning, thinking, or memory

Moderate: Temporary – to – permanent

Eyes – cataracts
Disoriented  – combative – comatose
Motor paralysis
Mottled skin
Diminished or absent pulses – Hypotension
Fractures – Spinal shock – spinal fractures
Temporary cardiopulmonary standstill or Respiratory arrest – can lead to cardiac arrest
Seizures
1st and 2nd degree thermal burns
Ruptured tympanic membrane – Hemotympanum – may indicate basilar skull fracture

Severe:

Cardiac arrest – asystole, ventricular fibrillation
Direct brain damage
Hematologic disorders – DIC
Basilar skull fracture

For more detailed information about lightning and lightning-related injuries see the Wilderness Medicine Newsletter, Lightning – Beauty & the Beast, July/August 2003.

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.

Heat Loss Through the Head and Hypothermia

February 14, 2007

The rate of heat loss, at rest, with exercise, and with hypothermia

Since there has been a fair amount of interest regarding Myth #2 in the Wilderness Medicine Newsletter – Frozen Mythbusters, Nov/Dec 2004 – the topic deserves more discussion.

MYTH #2 states.  “If your feet are cold, cover your head because you can lose up to 75% of your body heat through your head alone.

The problem is that the head is only about 10% of the body surface area.  Thus, the head would have to lose about 40 times as much heat per square inch or centimeter compared to the rest of the body.
 
Gordon had heard this statement one too many times and finally decided to see if this was indeed true.  So he took several test subjects, all volunteers, of course, (you have to wonder what problem they caused at the university), wired them to monitor their core temperatures, and discovered that we do indeed lose heat through any exposed part of the body and the amount of heat we lose depends on the amount of exposed surface area.  The rate of heat loss is relatively the same for any exposed part of the body not simply the head. You do not lose heat significantly faster through the scalp than any other portion of the body with the same surface area. 

It is still a good idea to put on a hat (a hood really – what insulation does a baseball hat have?) if your feet are cold.  But what is BUSTED is that there is nothing peculiar or unique about the head. The idea that we lose heat faster through out scalp, because of the constant blood supply to the brain, is simply a myth. (One that I personally have believed for many years.)”

UPDATE & DISCUSSION
 
#1 Heat loss via the head at rest, during exercise, and with hypothermia:

I did have the opportunity to speak with Dr. Murray Hamlet about this topic, and we hope this additional information will help to clarify heat loss in the hypothermia patient.

The cerebral blood flow is supplied via the carotid and vertebral arteries (4 in total) and is constant. The blood flow to the brain does not change as the demand for oxygen is constant. As a result, when you look at total heat loss, the head accounts for about 7% of the heat lost. 

The cerebral blood flow does, however, vary based on cardiac output – the harder your heart beats, the greater the blood flow to the brain.  And as you increase the blood flow to the brain, you also increase the percentage of heat loss.  As it turns out, when you begin to exercise, there is increased cerebral blood flow. This increases the percentage of heat lost through the head to about 50% of total body heat loss.  But as the person continues to exercise, the muscles demand more oxygen which increases blood flow. To ensure thermoregulation and maintain normal core temperature (exercises increases body heat), the skin vasodilates which increases blood flow to the skin to cool the blood. The net result is a decrease in the total blood flow to the brain and a decrease in percentage of total body heat lost through the head to about 10%.  Once sweating begins, the percent lost through the scalp returns to 7%.

In Gordon’s research his test subjects were at rest in cool water, and the researchers were comparing the rate of heat lost by monitoring core temperature through different body parts and quantities of skin exposed.  At rest, they found that the rate of heat loss only depended upon the amount of skin surface area exposed, and the percentage of heat lost through the head was the same as the rest of the body.

Research at the Army Research in Environmental Medicine labs showed that there was a temporary increase in heat loss through the scalp that returned to the baseline of 7% as the subjects continued to exercise.

Now, what about hypothermia and heat loss through the head? 
If the hypothermia victim is not shivering, they are at rest, and the heat loss through the head remains about 7%.  But, this is important, if they are shivering, the percent of heat loss via the scalp can increase to upwards of 55%, so protecting the head well is a very important part of treating the hypothermia patient.  And as you can imagine, the primary defense against the cold and hypothermia is vasoconstriction of the peripheral circulation, this shunts blood to the core, reduces circulation to the skin, and increases the percent of heat loss through the scalp.

The difference is that the shivering hypothermia patient is indeed exercising, but they do not vasodilate the peripheral circulation; the shivering muscles increase metabolic demand and cardiac demand so the patients do increase their cardiac output; therefore, they do increase cerebral circulation; therefore, they do increase the percent of blood loss through their head.

Treatment of the hypothermia victim:
Remove from the cold.
Get them dry and keep them dry.
Insulate from the ground.
Hypothermia wrap:
Re-insulate with dry insulation.
Cover and protect the head from further heat loss.
Cover and protect the hands and feet from frostbite.
 Surround with a windproof and waterproof layer.
If conscious, feed warm, sweet liquids.
If unconscious, evacuate and handle very gently to prevent ventricular fibrillation.

#2 How does being in water change the equation?

Life-preserver, personal flotation device (PFD), research has shown that when in the water, if your head and neck are wet, you cool faster.  This is why modern PFD’s hold the person in the water with their head and neck out of the water; even if unconscious, to decrease the rate of heat loss into the water.

#3 What difference does hair on your head or facial hair make?

None. 
In order for hair or fur to provide a protective thermal barrier, it has to be much denser than what we humans grow and it has to be in layers of different types of fur to provide a thermal barrier.  Beards are great, but they do not keep you any warmer. And bald is beautiful.

We at the Wilderness Medicine Newsletter appreciate the comments and discussion.
 

LIGHTNING – THE BEAUTY AND THE BEAST

February 14, 2007

Lightning #2 – The Physics of Lightning

The Physics of Lightning:
Direct current electricity.  ( DC, not AC like the current that feeds our houses.)
Very high voltage and high amperage: can exceed 100 million volts, 100,000 amps.
Very hot, 50,000C, hotter than the surface of the sun.
Very short duration – instantaneous; milliseconds.
Produces Ozone, O3, that protects the earth from the deadly effects of ultraviolet light.
Electricity travels over the surface of objects, unless there is an internal conductor.
Internal conductors – nerves & blood vessels (contain an electrolyte solution).

Formation of lightning:
Vertical acceleration of moist air, forms ice crystals, causes charge separation.
Areas of positively and negatively charged atoms occur throughout the cloud head.
Electrical discharge to stabilize charges created in cumulonimbus clouds.
The base is negatively charged with a positive shadow forming on earth.
Typically, lightning occurs under and along the leading edge of the cumulonimbus cloud.
It can occur as far as 10 miles away, a strike “out of the blue.”
Can travel horizontally over 60 miles; the longest recorded to date was at 118 miles long.

Lightning strike can be: 
Direct strike or streamer current.
Splash or surface arc.    
Step voltage or ground current.
The principle is don’t be a conductor!

For more detailed information about lightning and lightning-related injuries see the Wilderness Medicine Newsletter, Lightning – Beauty & the Beast, July/August 2003.

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.