The race series for the 2010 MedWAR events have been announced! MedWAR is a unique opportunity for you to learn about and test your wilderness survival and medical skills through a combination of wilderness medicine and adventure racing. These races usually sell out 3-4 weeks in advance.
I do not believe that you should have a particular concern regarding work at altitude because of the recent concussion per se.
Also frequently referred to as a traumatic brain injury (TBI), a concussion is commonly diagnosed clinically when a person experiences any loss of consciousness, confusion, or amnesia following a blow to the head. Increased intracranial pressure (increased ICP) or brain swelling is the anticipated problem or what we worry about afterward. The swelling results from bleeding or the accumulation of edema (fluid) in brain tissue. The early symptoms of increased ICP include persistent vomiting, worsening headache and deterioration of one’s mental state. It does not sound like you had these symptoms or have this problem now.
Do you have any other symptoms now? Frequently, following a blow to the head, even without ever experiencing a concussion, people can develop a post concussive syndrome (PCS). The symptoms of PCS include headache, insomnia, feeling more tired than usual, blurry vision, light sensitivity, difficulty concentrating, feeling off balance, and emotional liability. These are not signs of increased ICP; they can last for weeks. If you have any of these, they could get worse at altitude and thereby potentially make you more accident prone.
People who go to altitude, especially over 3000 m (9800 ft), are at risk to develop altitude-related increased ICP called high altitude cerebral edema (HACE). This is related to the lower oxygen levels and in part, to the resulting reflex increase in brain perfusion or blood flow. Theoretically, I suppose, if you were continuing to have a slow blood leak from your injury, it could increase in size more quickly as a result of going to 3100 m. But without ICP symptoms now, this seems very unlikely…unless you sustain another TBI.
I do not know whether a TBI with or without PCS makes one more susceptible to HACE. I doubt it but I could find no substantive references one way or the other.
If you are feeling fine, go for it and have a great time. Remember, the best way to minimize altitude symptoms is to ascent gradually, especially over 2500 m (8200 ft). In addition, increase your physically activity as you acclimate to the new environment. Some good rules include:
1. If you can, before sleeping above 3000 m, spend a night above 1500 m (5000 ft).
2. Above 3000 m, don’t sleep higher than 300 – 500 m (1000 to 1650 ft) above your previous night’s sleeping altitude.
3. With each 1000 m (3300 ft) in altitude gain, add a rest day and/or sleep at the same altitude for 2 consecutive nights.
If you want more information on altitude, check out The International Society of Mountain Medicine. They have a nice summary.
It took us, in the WMA office, a long time of pawing through these amazing photographs to finally decide one which ones to select for the three $100 cash prizes, but we have come to our decision. Thank you to the many contestants who submitted photos and shared your stories!
Click on the photos above to see their full entry.
Thank you to Josh Martin and Paul Cunningham at Northern Cairn who submitted the very first entry and came with the idea of holding this great contest. What a wonderful way for instructors, students, and others to interact and compete for some cash!
Several times each year someone asks in class about the relative danger of an envenomation from a small versus a large crotaline (aka pit viper). Some people are insistent that smaller snakes are more dangerous. This idea has always felt counterintuitive to me. The explanations seem fanciful at best. Usually, people argue that larger (and therefore older) snakes possess some sort of volume control. They argue that larger snakes hold back venom against humans because we are not food for them. These larger snakes want to warn us with a strike but preserve venom for when it matters, like a meal. I have been unable to find any science and none of the experts that I have spoken with can give a definitive answer one way or the other. With the publication of a recent study, perhaps this theory will disappear.
This past December the Annals of Emergency Medicine published an article by Herbert and Hayes (2009; Volume 54 #6: p 831) in which they argue that a protective layer of denim over the skin may help to decrease the severity of an envenomation from a defensive strike by a southern Pacific rattlesnake. (I leave you to view the details and decide for yourselves.) In their study, after provoking a test snake, they presented it a latex glove filled with warm water, one time bare and another time covered with a denim glove. After a bite, they measured the venom in the water within the latex glove and, when used, on the denim glove. The order of the trials were randomized and occurred 2 weeks apart. They found that the amounts of venom measured were consistently and significantly greater from the larger (greater than 66 cm in length) versus the smaller (less than 55cm) snakes.
In the discussion section, they point out the volume differences as well as information from other sources that argue against the smaller is more dangerous theory. Included are the facts that larger snakes are more likely to strike and that their strikes are more accurate. Large snakes have longer fangs with larger hollow spaces allowing for deeper penetration and more venom flow. They cite references (that I did not check) that claim that larger snakes cause more serious envenomations. Herbert and Hayes state:
Thus, the more effective antipredator deterrent of bites from larger snakes may explain why they resort to biting more readily than smaller snakes.
And maybe Homo sapiens don’t learn to stand back.
Although the results from this study do not definitively answer the question about size it does lend some scientific basis for debunking an unfounded belief. Practically, of course, it does not really matter. The anticipated problem of a venomous snake bite is an envenomation. There is no good way to predict beforehand who will be envenomated, and if so, how bad it will be. We treat what we see. By the way, some skin covering, like denim, seems better than none.
There is a curious post on ems1.com’s web page today. It relates a story about a record setting effort by a group of 8th graders in Texas.
No it was not a pie eating contest or sporting event. Apparently they were certified by the Guinness folks for holding the world’s largest CPR class – 4626 students.
“As expected with thousands of junior high students, there was plenty of goofing around during the lesson. Giggling was common when they first gave their inflatable mannequins mouth-to-mouth resuscitation, and more than a few decided to head butt or slap their Mini Anne CPR dummies. But most appeared to take the lesson seriously.
Cluck (the mayor who helped organize the CPaRlington program)walked several laps around the field during the lesson, and he said most participants understood the techniques and could resuscitate someone if needed. Each student is now required to take the dummies home and teach four other people.”
Although not specifically mentioned, 30 minutes and inflatable CPR dummies sound a lot like the American Heart Association’s (AHA) CPR Anytime. Regardless of whose curriculum, I am assuming that this was not a certifying course.
The CPR Anytimeis a real departure from where the AHA was even 5 years ago. There was a time when everyone taking one of their courses was hovered over by a hypervigilant instructor making sure that each student’s compressions and ventilations were within an upper and lower limit. Skill testing success or failure was determined by lines on a piece of graph paper spit out from the side of the testing dummy. Everyone knew that you had to modify your technique for the testing mannequin used, in order to pass.
Most instructors led their students to believe that if their technique varied in anyway from the norm, those efforts would hasten a patient’s demise. Everyone assumed that the AHA knew what it was doing and as a result no one else (other than the American Red Cross and a few others) could be trusted to teach CPR. Now these courses are more user friendly and accessible, engineered to train the masses. These self-directed offerings are a convenient way for people to learn a skill that could enhance survivability following a cardiac arrest without having to take a course. No one knows whether or not this new approach will make a difference. Others of us have been allowed to use our own curricula and ideas to teach this once sacred procedure. It seems that AHA mantra has become, do something. Over the years, anecdotal stories suggest that an untrained person doing something is potentially beneficial and not harmful. Science shows us that early intervention does make a difference. I agree
Still, this rock concert-like event makes me cringe. Why not do it right? Is the time spent in school classrooms so valuable that they don’t have time for this or practical First Aid? The AHA hopes people taking self-directed courses will in turn teach someone else. Would these kids do a better job teaching their parents after a course like the one noted above or after a proper course, esepically one that utilized a variety of teaching methodolgies (e.g., fun) and was integrated in with what they are leaning in school?
This is not a criticism of these kids. This is what they know. Kudos to them not for the record but for the initiative and sense of civic concern. But with a little guidance and effort, think about how much more could be done.
Click here to view the Avalanche POV video clip.
I viewed the link below this PM and am still shaking my head. The introduction to this clip notes:
“This is simply a very sobering and unbelievable video. However, you should take away from this video all the positive things that you can learn from it. Yes there are risks to the backcountry – but with proper gear, training, and guide(s) with avalanche and EMT training – you can greatly lower your chances of getting caught in an avalanche in the first place … and coming back alive if you ever were to get caught in a slide.”
I always thought that we were supposed to AVOID getting swept up in avalanches by steering clear of high risk areas.
David Johnson
Wilderness Medical Associates to be a Exhibitor at the 2009 Wilderness Risk Management ConferenceIn addition to four Wilderness Medical Associates’ instructors presenting at the conference, the company will staff a booth in the vendor hall.
Please stop by to say hello and find out what’s new at WMA. Anne Rugg, the WMA General Manager, is looking forward to talking with current or potentially new sponsors and WMA grads!
- View a list of the WRMC workshops
- WRMC Website
- Follow WRMC on Twitter
- Follow Wilderness Medical Associates on Twitter
- Subscribe to WMA blog via email
- View the invitation letter from Chair
Bill Frederick, WMA lead instructor and Safety Director for School for Field Studies, will be conducting a presentation on navigating risk in international locales. Bill will review the hazard landscape, research that is available, and best practices.
Toxicologist Frank Walter published this report in the Clinical Toxicology Journal. The report reviews snakebite incident data collected over several years by the American Academy of Poison Control Center.
The story:
A 40 year old female tripped while descending a companionway amidships of a sailboat. Witnesses reported that she landed on her back on a salon table at the base of the stair, rolled onto the floor, and was found gasping for breath. As her companions started their assessment at 1100, the pts. respiratory distress quickly improved and the pt. stated that she had the wind knocked out of her in the fall. The patient complained of lower back pain but had no other complaints. She stated that she remembered tripping and falling and did not think she hit her head or neck. She had tenderness in the left flank but no bruising was noted. The abdomen was found to be soft and non-tender. The spine exam was unremarkable and she had normal CSM in all four extremities. She had no allergies, took no regular medications, and had breakfast that morning about 3 hrs. prior to the fall. Her Pulse: 98, Respirations: 22 and easy, B/P: 122/78, Skin: pale, and she was alert and anxious.
Put the appropriate information from the story above into the correct spaces provided in the SOAP note.
After you’ve completed the Subjective and Objective sections, develop an Assessment for 1100hrs. with Anticipated Problems and an appropriate Treatment Plan listed in the columns to the right.
At 1130, the pt. reported that her pain had diminished somewhat although a repeat exam revealed persistent left flank tenderness with some developing bruising. Her abdomen remained soft and non-tender. Vitals were repeated: Pulse 72, Skin: warm and normal in color, Respirations 14, B/P: 116/76, and her AVPU: AOx4.
Again, transfer any appropriate information to the SOAP note and update the Assessment as needed. Be sure to note the time when you update any information.
Questions:
1. Do you feel more or less comfortable with your patient at 1130?
2. If the patient did suffer significant internal bleeding from her kidney injury, what early signs might you notice during your assessment?
3. If evacuation to shore was delayed for days, what options might you have for dealing with you patients’ potential spine injuy?
