WILDERNESS
MEDICINE
CLINICAL PEARLS
HIKING
AVOID GETTING LOST
 Have a “fail safe” plan
 Look back at times when hiking out
CRITTERS
SNAKE BITE TREATMENT
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No tourniquets
No new incisions
No sucking out venom
If possible, clean out wound, cover with
gauze, splint limb and go to a hospital
POLYVALENT ANTIVENOM
 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
GENERAL POINTS
 Never run from predators
 OK to run from vegans
WATER
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
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
HYPOTHERMIA
POTOMAC RIVER CRASH
JANUARY 13, 1982
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
ACTIVE INTERNAL
REWARMING
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Peritoneal lavage- 1-3 C/hr
Thoracic lavage- 3-5 C/hr
Cardiopulmonary bypass- 7-9 C/hr
Therma-rescue- 2.5 C/hr.
FROSTBITE
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Rewarm in warm water about 100-105 F
Vasodilators – nifedipine
Anticoagulants – heparin
Thrombolytics – streptokinase, TPA
Plasma volume expanders – low
molecular weight dextran
 NSAIDs - Ibuprofen
FROSTBITE REFERENCES
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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 rtPA 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.
HYPERTHERMIA
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
TREATMENT
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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
ALTITUDE ILLNESS
ACCLIMATION
 It takes 4 days to acclimate
 For an increase in RBC production it can
take 4 to 8 weeks
SIGNS AND SYMPTOMS
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Can occur when over 7,000 ft
Headache
Nausea
Fatigue
Dizzyness
Insomnia
Similar to a hangover
Tachycardia
Dyspnea
Blood tinged sputum a late finding
Can get cerebral edema
and/or pulmonary edema
Treatment
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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).
LIGHTNING
IF YOU CAN SEE A FLASH OR
HEAR THUNDER YOU CAN
BE HIT BY LIGHTNING
HOW FAR AWAY
 After seeing a flash count in seconds to
the thunder. Divide by 5. That gives you
distance in miles.
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