October 20th, 2009 by Paul Auerbach, M.D. in Better Health Network, News
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Every one in a while, an inventor comes up with something remarkable, not only in its ingenuity, but in its simplicity and applicability. Whenever I see something like that, I usually mutter or marvel, “I wish I had thought of that.” Such is the case with the original ski pole Slishman Splint, invented by my friend Dr. Sam Slishman.
Wilderness medical types are familiar with the difficulties managing long bone fractures in the backcountry. A femur fracture can be a devastating, and even life-threatening, injury. It’s common knowledge that realigning the bony fragments and stabilizing the femur are important to control blood loss and pain, and to facilitate victim extrication and transport. There are numerous traction splints for this purpose on the market, but many of them are heavy, bulky and unwieldy in a remote setting. Sam intended to solve that problem. Read more »
This post, Leg Splints Made From Ski Poles, was originally published on
Healthine.com by Paul Auerbach, M.D..
October 2nd, 2009 by Paul Auerbach, M.D. in Better Health Network, Health Tips
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Swimmer’s ear (otitis externa) is an affliction that affects scuba divers, swimmers, windsurfers, surfers, kayakers and many others who spend considerable time in the water. The prevailing opinion is that the most effective measure to prevent swimmer’s ear is to dry out the ears after each entry into the water, to eliminate the moisture that promotes maceration of skin and proliferation of infection-causing bacteria. This can be done mechanically by blowing warm air into the external ear canal, or by instilling liquid drops (such as a combination of vinegar and rubbing alcohol) that change the pH within the ear canal and evaporate readily, leaving behind a relatively dry environment. It is generally advised to not stick any foreign object, such as a cotton-tipped swab, into the ear, avoid traumatizing the external ear canal or, worse yet, the eardrum.
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This post, How To Remove Water From Your Ears Safely, was originally published on
Healthine.com by Paul Auerbach, M.D..
September 21st, 2009 by Paul Auerbach, M.D. in Better Health Network, Health Tips
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This is the next post based upon a presentation given at the Wilderness Medical Society Annual Meeting held in Snowmass, Colorado from July 24-29, 2009. The presentation was about trauma and orthopedics. It was delivered by Douglass Weiss, MD of Teton Orthopaedics in Jackson Hole, Wyoming.
Utilizing some fabulous images, including those of Lanny Johnson, Dr. Weiss made some important points. Many of these are familiar to seasoned medical practitioners, but they merit repeating. First, when approaching a victim, always attend to the “ABCs” first – airway, breathing, and circulation (including bleeding) – so that a life can be saved. Then, if possible, take into account other injuries, including those of bones – save the limb, save the joint, and restore function.
Here are two good pointers. First, your field evaluation of the victim may be the only complete one, so do your best to examine the entire victim, and also to document in writing what you discover. Examine and establish the airway, listen for breath sounds, observe chest movements, feel for pulses and observe skin color, etc. Within the constraints of the situation and environment, “expose” the victim in order to evaluate bony and other injuries. The, move on to the “secondary” survey, which will include examination of the neck, back, pelvis, arms and legs, looking for swelling, bruises, scrapes, cuts, bleeding and deformities. If you feel inappropriate motion (e.g., broken or dislocated bones or joints), be prepared to apply splints.
Always try to roll the patient (using a logroll technique if necessary) to examine the victim’s back.
For the benefit of doctors reading this post, remember that if a fracture is identified, suspect an injury to the joint above and below the fracture, and be sure to splint these for the comfort and protection of the victim.
The application of splints is an art form, so should be practiced prior to your expedition. Any limb that is obviously deformed or that demonstrates excess motion (where there should be none) should be immobilized immediately. If a helper(s) is available, use assistance. Be sure to pad all splints very well to avoid pressure injuries to the tissue underneath. Depending on the rescue, the splint may be in place longer than you anticipate.
If a broken bone (fracture) is “open” (the bone has poked through the skin), then apply a wet (preferably normal saline or disinfected water) dressing and apply a splint. If you have an all-purpose antibiotic (e.g., cephalexin, amoxicillin or ciprofloxacin) and the victim is capable of purposeful swallowing, administer a dose.
Fractures of the pelvis generally imply that a very significant force was applied, so they carry a high risk for associated life threatening injuries. The victim should be evacuated as soon as possible. It is commonly taught that a broken femur (the long bone of the thigh) can cause bleeding in excess of a liter into the limb. This can be dangerous, so these injuries should be promptly splinted, preferably with a pre-fashioned or improvised traction splint.
Compartment syndrome occurs when tissue pressures within inelastic soft tissue compartments of the limbs (commonly the forearm or lower leg exceed perfusion pressure, that is, the pressure necessary to allow blood to circulate freely through the tissues and provide energy and remove waste products. Symptoms include extreme pain, loss of pulses, pale skin color, weakness or paralysis of the muscle, and numbness and tingling. If the pain is severe and the skin feels tight, a compartment syndrome may be developing. If a compartment syndrome is felt to be impending or present, keep the limb elevated and seek immediate medical attention, because an operation may be required to open the compartment and release the pressure before the onset of permanent tissue damage.
Thanks to Dr. Weiss for his contribution to wilderness medicine education.
This post, Tips For Evaluating Injured People In The Outdoors, was originally published on
Healthine.com by Paul Auerbach, M.D..
September 17th, 2009 by Paul Auerbach, M.D. in Better Health Network, Opinion
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This past December (2008), there was a report in Healthcare IT (Information Technology) News that got me thinking, of all things, about medical situations in outdoor wilderness environments. The substance of the report was that researchers at Vanderbilt University (I worked there in the late ’80s as Chief of the Division of Emergency Medicine) “found that physicians who receive training in a technology-rich environment, but go on to work in a less modern facility feel they can’t provide safe, efficient care.”
The study related to information technology, but is probably applicable to many other modes of technology. As it was reported, the Vanderbilt study included more than 300 medical training graduates. Of those who “were working in an environment with less IT,” some 80 percent reported “feeling less able…to work efficiently, to share and communicate information, and to work effectively within the local system.” The lead investigator Kevin Johnson, MD explained that “going from being a medical student where somebody is always watching after you to a role where you could potentially make a mistake that could actually harm a patient is already hard enough.” But “when you get there and realize that the systems they have are less functional and less pervasive…there is an entirely new set of challenges.”
To all medical students, residency graduates, or anyone else who moves from a highly supervised environment to one where you are on your own, welcome to the club. The whole point of learning how to be self-sufficient is to be able to go it alone when the need arises. What is most striking about wilderness medicine is the notion that one moves to a setting that is austere and resources (people, technology, supplies, communication, etc.) are frequently limited. This can be very unsettling for experienced practitioners, and is even more so for neophytes.
We live in an age of technological imperative. Doctors train in hospitals with large, complex intensive care units. The emergency department is equipped with all the latest gadgets, and specialists are on call 24 by 7 to help out when a difficult or puzzling situation arises. That is not the case in the wilderness, on the battlefield, or out at sea. Expectations change from perfection to doing enough to get the patient to a higher level of care, or just to make it through the hour, let alone the next day.
Think about it. Take your favorite medical instrument(s) and think about how you would practice if you didn’t have access to it. Could you diagnose heart failure without a stethoscope and pulse oximeter? High altitude cerebral edema without a CT scan? Septic shock without a blood pressure monitor, central venous catheter, arterial blood gas measurements, and a battery of laboratory tests? I think the answer is “yes” if you were properly trained.
Technology is good. In fact, it is great. Patients are better off for the ability of health care professionals to apply all manner of diagnostic and interventional devices and techniques. However, I believe that at the same time we are all taught how to do things in the city, we should learn how we must sometimes do them in the country.
image courtesy of cdneverest2008.com
This post, Physicians Should Learn How To Practice Medicine With And Without Technology, was originally published on
Healthine.com by Paul Auerbach, M.D..
September 9th, 2009 by Paul Auerbach, M.D. in Better Health Network, Health Tips
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The Wilderness Medical Society held its Annual Meeting in Snowmass, Colorado from July 24-29, 2009. The meeting was very well attended and once again demonstrated that the Society is the hub organization devoted to advancing the science and clinical practice of wilderness medicine. The format this year was to add a great number of presentations suggested by, and in many cases, delivered by members. In this and subsequent posts, I will present some of the wisdom offered in these presentations. For each post, I will put up a photograph I took while hiking in the Maroon Bells Scenic Wilderness Area.
Wayne Askew, Ph.D. and his colleagues taught on the topic of planning and preparing food for wilderness expeditions. Their goals were to allow the participants to develop an appreciation for the role that food and food planning plays in successful and enjoyable backcountry recreation; understand the similarities and differences between small and large group food planning; estimate energy and other nutrient requirements for individuals and groups; review guidelines for planning nutritional support for backcountry expeditions and recreation; and observe demonstration of recipes and preparation techniques for some useful backcountry food items.
A number of terrific observations were made. In no particular order:
1. Food planning is very important in outdoor activities, with emphasis on the word “planning.” One can enhance backcountry travel and survival with good nutrition.
2. Food planning is also important for morale. If people are hungry, malnourished, or unsatisfied, they are not “happy campers.”
3. The food planner for a trip or expedition should be chosen carefully, and should take care to take into account the dietary preferences of the participants.
4. Energy requirements for specific activities related to physical performance and caloric expenditure can be calculated and taken into account for food and meals planning.
5. There are sometimes foods for special needs (e.g., such as allergies, deficiencies, diseases, etc.). While many of the participants can handle their own needs, whomever is managing food should be aware.
6. There are persons who specialize in wilderness nutrition planning. They advise expedition planners on food, water and logistics; plan menu and food supplies for backpackers, wilderness tour groups and expeditions; assist in search and rescue operations; consult with food companies specializing in backpacking foods; and cook food.
7. If a person wants to accomplish nutrition planning, he or she should have a basic knowledge of human nutrition, understand human physiology and the role of food nutrients in extreme environments, know how to utilize food item selections to provide recommended nutrient intakes, and be a good cook in the outdoors.
Food planning by definition means thinking about food in advance. Dr. Askew and his colleagues recommended answering the following questions:
How much room is in your pack?
How much weight can you carry?
How long will you be traveling?
Where are you going?
How much fuel will you need and will you have access to water?
With whom will you be traveling?
Factors that affect food choices in the backcountry are food preferences; weight, perishability, taste and texture of foods; space in the pack; duration of trip; availability of water and fuel for food preparation; environmental conditions; experience with food preparation; special dietary needs; and personal beliefs.
This was a terrific educational experience, with terrific information such as this Planning Guide Nutritional Standards for Backpacking Food for One Person for One Day, based upon U.S. Army AR 40-25 Nutritional Standards for Operational Rations:
http://www.army.mil/usapa/epubs/pdf/r40_25.pdf
Energy (kcal) 3600 (will vary depending upon activity level)
Protein (g) 100
Carbohydrate (g) 440
Fat (g) 160
Vitamin A (RE) 1000
Vitamin C (mg) 60
Vitamin E (mg) 10
Calcium (mg) 800
Iron (mg) 18
Sodium (mg) 5000-7000
Fiber (g) 20-35
Finally, consider the following recipe for energy bars. This is one way to prepare less expensive and more nutritious (than store-bought) bars for personal use. As recommended by Askew and colleagues, you can be creative with this recipe, and use a variety of fruit, nuts, and grains. It is sufficient to make approximately 20 small bars.
Preheat oven to 350°
½ cup brown sugar
1 egg
¼ cup peanut butter
2 tsp vanilla extract
½ cup apple juice (unsweetened)
1 cup whole wheat flour
1 cup quick cooking oats
½ cup wheat germ
½ tsp baking powder
½ tsp baking soda
¼ tsp salt
½ tsp ground cinnamon
½ cup dried fruit (raisins, apricots, dried cranberries, etc.)
½ cup chopped nuts (walnuts, almonds, peanuts, etc.)
½ cup semi-sweet or dark chocolate chips
Mix dry ingredients in one bowl, wet ingredients and added “goodies”
(chocolate chips, raisins, nuts, etc.) in another, then combine. Spread the batter over a lightly greased cookie sheet about ½ -¾ inch thick. Use a spoon dipped in hot water to press the batter into the sheet and shape to the proper thickness. Bake for 10-15 minutes. Allow the pan to cool completely before cutting into bars. The bars can be refrigerated or frozen for longer shelf life.
Nutrition Information: calories 140, protein 5 grams, carbohydrates 20 grams, fiber 2 grams, fat 6 grams (saturated 1 gram) (% of calories from carbohydrates = 52%)
Tags: food, food preparation, wilderness expedition, wilderness medicine, outdoor medicine, healthline
This post, What Food To Bring With You On Wilderness Expeditions, was originally published on
Healthine.com by Paul Auerbach, M.D..
Every one in a while, an inventor comes up with something remarkable, not only in its ingenuity, but in its simplicity and applicability. Whenever I see something like that, I usually mutter or marvel, “I wish I had thought of that.” Such is the case with the original ski pole Slishman Splint, invented by my friend Dr. Sam Slishman.
