Q: Is there a connection between shellfish allergies and iodine?

Equating an allergy to shellfish with an allergy to iodine is a fairly common misconception.  Fish and radiographic contrast allergies are also erroneously equated with iodine allergies.

Iodine is essential for proper thyroid function.  Without it, people become ill with thyroid problems.  As it turns out, seafood and crops fertilized with seaweed are a good source of iodine.  As people moved from coastal areas inland, the incidence of thyroid deficiency increased.  Beginning in the 20th century, it became a common additive in many varieties of table salt.  As a result, now you have to work hard to completely avoid it.

The allergen in shellfish is a protein, not iodine.  Some people with iodine allergies really have a topical sensitivity to iodine (e.g., povidone iodine; Betadine), usually a much different kind of reaction than the immediate reaction found with anaphylaxis.

Bottom line: A shellfish allergy should almost never preclude the use of iodine for water disinfection. If you are concerned, get more information about the true nature of the allergy.  If the person has not had problems with other seafood (saltwater) or table salt, iodine is not the culprit.  There are, of course, other reasons for not using iodine as a water disinfectant.

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Where’s the Man?: Pacific Crest Trail, WA

WMA-certified Wilderness First Responder (WFR),  LT, sent us this photo of him cruising along with the man alongside the caption below. Thank you for making the trails a better place!

“The man soaring over White Pass, Washington.  He joined my crew and I as we performed 6 months of restoration work along the PCT from Washington to Southern California for the Pacific Crest Trail Association.”

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Where’s the Man?: Golan Heights of Northern Israel

Kevin Z., a WMA certified Wilderness First Responder, was hiking the Golan Trail and decided to take this photo of him next to a minefield (yes, a minefield). I don’t know if this would go beyond the first triangle in the Patient Assessment system.

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Send an email to webmaster@wildmed.com with a picture of you wearing your ‘Where’s the Man?’ t-shirt alongside a caption to be eligible to win. At the end of the year, we will select three entries to receive $50 gift certificates to our online gear store.

What is the best way to cool off a heat stroke victim?

The simple answer? Using the resources at hand, aggressively lower the person’s body temperature to 39°C (102.2°F) as quickly as possible.  Anything longer than 30 minutes has the potential to have more profound and long lasting pathophysiologic effects. The debate about treatment revolves around the efficacy and safety of cold water/ ice bath immersion versus the mist/ fanning method.  When feasible, I advocate cold water immersion. In fact, it is at least twice as fast as the best misting methods.  It appears to be as safe and maybe safer when one considers the relative rates of cooling.

How so? Cold water dissipates heat from the body 20 to 30 times faster than air does at the same temperature. Evaporation speeds cooling but not as much. People argue against cold immersion for fear that the cold will induce vasoconstriction and/or shivering and therefore inhibit cooling or even increase body temperature.  If these factors are important, one would expect to find clinically relevant support in the medical literature. I have never found any. (Jump into cold lake and see what your body temperature does!) In addition, some worry that cold immersion for heat stroke will precipitate a cardiac arrest.  Again, the literature does not appear to support this concern clinically, even in the elderly.  In the end, temperature height and duration are the key factors linked to morbidity and mortality in heat stroke.

The real question regarding treatment should revolve around what means are at hand to modify those factors that caused the heat stroke to begin with.  First, stop the heat stress by leaving the environment and resting. If there is insufficient cold water for immersion, apply water in small droplets, like mist from a spray bottle, and get the air moving.  The misted water will evaporate more quickly and probably cool better than pouring a bottle over your patient’s head.  A combination of techniques can work well, too.  On the other hand, ice bags in the groin and around the neck do not cut it.  Because the problem with heat stroke is related to increased heat production and/or decreased dissipation, not the thermostatic readjustment in the hypothalamus seen with a fever, don’t use antipyretics (e.g., ibuprofen, acetaminophen).  And don’t forget about appropriate volume replacement.

Greg Friese from CentreLearn sent me this link to a pretty good, non-scientific article about recovery from heat stroke.

Where’s the Man?: Boston, MA – Run of the Charles

Henry Chance was on hand in Boston, MA for the annual Run of the Charles Canoe Race. The only major medical incident that day was a collection of bruised egos.

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Send an email to webmaster@wildmed.com with a picture of you wearing your ‘Where’s the Man?’ t-shirt alongside a caption to be eligible to win. At the end of the year, we will select three entries to receive $50 gift certificates to our online gear store.