September 4th, 2009 by Paul Auerbach, M.D. in Uncategorized
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Michael Kilbourne and colleagues recently published an article entitled “Hemostatic Efficacy of Modified Amylopectin Powder in a Lethal Porcine Model of Extremity Arterial Injury”( Annals of Emergency Medicine 2009;53:804-810). The purpose of the study described in this article was to investigate the blood-stopping ability of a modified amylopectin powder in an animal (pig) model of severe limb bleeding created by an injury to the femoral artery.
Following creation of the injury, animals were treated either with regular gauze with manual compression or with specially modified amylopectin powder and manual compression. Some of the endpoints measured in the study were total blood loss, survival, and time to bleeding cessation.
Post-treatment blood loss in the amylopectin powder-treated group was much less (approximately 0.275 liter) than in the gauze group (approximately 1.3 liters). Bleeding was stopped in approximately 9 minutes in the amylopectin group, and never stopped in the gauze group. 100% of the amylopectin animals survived, and none of the gauze animals survived.
While this study was directed to improve care for victims of major trauma (including wartime situations), the applicability to situations in the outdoors is direct. Many blood-stopping bandages have come to the civilian market, and they are quite useful. I carry them with me whenever I’m going into the wilderness, and often when I cover athletic events as the team doctor. They’re useful for nosebleeds and cuts, not just for severe injuries. Some of the product names include HemCon Bandage, QuickClot, BleedArrest, QR, Celox, and BloodStop. There will undoubtedly be improvements in these products, in particular the delivery systems, be they bandages or powders.
image courtesy of www.instructables.com
This post, Amylopectin Powder’s Amazing Ability Top Stop Hemorrhaging Fast, was originally published on
Healthine.com by Paul Auerbach, M.D..
August 25th, 2009 by Paul Auerbach, M.D. in Better Health Network, Health Tips
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We are still in fire season in the U.S., and with persistent hot, dry and windy conditions, may see quite a few more conflagrations this summer and into the autumn. The fires that can be attributed to human behavior occur for the same reasons year in and year out, whether they are accidental or intentional. So, we will face them, and knowing what to do before they happen can be a prerequisite for survival.
Of course, fires occur worldwide, and there is much to learn from the experience of others. Some months back, there was an interesting commentary in the news during fire season in Australia that pondered the question, “Why did so many die in Australian bushfires?” Here is a paraphrasing of the response:
“Yes this is awful – devastating to the psyche. For Australia, this is bigger than the twin towers and we cannot blame an external agency. Much of it we did ourselves. All over central Victoria, it was the worst fire weather by far that has ever been experienced. Temperatures were above 40 degrees centigrade (105 degrees fahrenheit) for days, there was no significant rain for months, and there were strong to gale force winds straight out of the central desert for days.
It seems that most people who died actually did so trying to flee at the last moment. They died on the open or in cars, especially in crashes along the roads or running into fallen trees. Even before the fires hit, it was so hot that eucalyptus trees were dropping large branches everywhere.
Many who survived in the fire storm did so in prepared or ad hoc refuges and bunkers or inside their houses, leaving their homes only when the houses were burning but the main fire had passed.
The problem was that in some areas the winds were so strong that houses were torn apart by the wind, leaving no option but to be in the open. As usual, many of the injured did not have suitable clothing. For some, the attire of shorts and thongs may have been fatal. The fires were so hot that they melted alloy wheels on cars. Many, if not most, people living in the area at least evacuated their children, and the elderly and sick. Most houses were relatively well prepared for ‘normal’ fires. This is a semi-rural area, so people had water, pumps, mobile and fixed sprays, and plans. The problem was that they had no chance to use them, because everything happened so fast and was so intense.
The area was beautiful-the sort of dangerous beauty that comes from houses situated amongst trees. The area is a mountain ash forest. Many of the trees around the houses are stringy barks and cyprus pines, all of which become explosive in fires. There was ember spotting as many as five miles ahead of the main fire front. The actual fire winds were over 100 kilometers per hour. At times, the main fire front moved at 30 to 40 kilometers per hour.
Some persons commented that one of the most bewildering aspects of ‘Black Saturday’ was the disconnect between the general and, ultimately, prophetic warnings issued by authorities beforehand and the absence of specific information when the fires overwhelmed communities. But really! There is not some celestial fire watcher able to communicate with everyone and tell them what to do! Phones were out, the emergency call (000) was overwhelmed (1800% over normal call volume) and the operators were actually listening to people die without being able to help.
There have been so many extraordinary stories of bravery and good luck, but it is really difficult to put it all into perspective. People everywhere seem to be really quiet and depressed. There is a constant barrage of awful vision on the TV that keeps on reinforcing the horror. Really well known people are dead. So many kids and complete families.”
Key points for those who will one day face the prospect of encountering a wildland fire:
1. The thermal intensity of a wildland fire is beyond imagination. It is far better to be away from the heat than to try to shelter within it and try to survive. Escape routes should not be left to serendipity or improvisation. Anyone who lives in an area that is vulnerable to wildfire should have a plan for when and how to escape.
2. One needs to understand fire behavior, and how to avoid panic. Last minute attempts at self rescue are often marked by tragedy.
3. The wildland-urban interface is growing. The minority of homeowners subject to wildland fire risk have properly cleared their property of remediable fire hazards, and likely are not completely prepared to protect their lives and dwellings.
4. Warning systems are not infallible, and resources are easily overwhelmed. Everyone needs to take personal responsibility for being on the lookout for wildfire, and for his or her response to an encroaching blaze.
5. The aftermath of most natural catastrophes can be as devastating as the event. Entire communities and populations are affected, so we share the responsibility to prevent fires, report them promptly, protect our family and friends, and assist response teams in doing their jobs to suppress fires.
This post, How To Survive A Wildfire: Lessons From Australia, was originally published on
Healthine.com by Paul Auerbach, M.D..
August 18th, 2009 by Paul Auerbach, M.D. in Better Health Network
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I’m often asked about technologies that are amenable to research applied in outdoor or wilderness settings. A company called Cantimer has developed and made available one of these technologies.
Cantimer is a privately–held, development–stage company commercializing a patented, proprietary, sensor technology platform based on a convergence of micro electromechanical systems (MEMS) technology and advanced polymer science. According to the website, the Company’s first commercial product will be an innovative, hand–held device for non-invasive measurement and monitoring of human hydration status from the osmolality of saliva.
This past October (2008), there was a press release issued by the Company. To paraphrase:
“Cantimer, Inc. Delivers First Alpha Instruments for Real-Time, Non-Invasive, Incident-Scene Assessment of Dehydration in Firefighters
Devices to be used for field testing in structural fire environments and search and rescue operations.
Cantimer, Inc. announced that it has shipped ten alpha instruments for real-time, non-invasive assessment of human hydration to the U.S. Government’s Technical Support Working Group (TSWG). The units will be used for incident-scene assessment of dehydration in firefighters. Dr. Christina Baxter, from TSWG, commented, ‘The focus over the last several months has been on laboratory work that adds to the body of knowledge regarding salivary osmolality as a useful measure of human hydration or dehydration status. That work has gone very well. We are now looking forward to using these new devices for actual field testing in structural firefighting or search and rescue operations – with more of an emphasis on implementation, ergonomics and the user experience.’
Maintaining an optimal level of hydration is a major health concern for firefighters and other emergency scene first responders. Progressive acute dehydration associated with physical exertion in heat-stressed environments significantly increases the risks of temperature-related health problems, with resulting losses of productivity and, in some cases, death. It has been shown that fluid losses of as little as 2% of total body weight (3.5 pounds in a normally 175 pound individual) can lead to noticeable compromises in physical and cognitive performance.
Dehydration and resulting temperature-related health problems among firefighters are preventable through adequate on-scene hydration management. Cantimer’s devices, incorporating the Company’s proprietary sensing technology, enable convenient, field-deployable, real-time measurement, and therefore management, of hydration status from an easily-obtained sample of saliva.
Although easy to treat if identified early, dehydration is a pervasive condition that contributes to a large number of preventable hospitalizations in the U.S. every year. Cantimer believes that the availability of a hand-held device that aims to make it as easy to determine a person’s state of hydration as it is to take their body temperature will have significant benefits, not only for the health and safety of firefighters and other first-responders, but for military personnel, athletes at all levels, the elderly, the very young and those suffering from a wide range of medical conditions.”
The wilderness and outdoor medicine literature is replete with opinions and arguments about conditions predisposing to dehydration and the determination of hydration status. We presume dehydration in the field by clinical diagnosis (e.g., signs and symptoms), but do not generally deploy an actual quantifiable measurement to determine its presence. So, with the advent of the technology espoused by Cantimer, we may finally have a convenient tool with which to begin to diagnose, as opposed to predict, dehydration, during virtually any activity for which the physical environment will allow its use. This will hopefully also allow us to test different hydration/rehydration strategies, including various fluids, electrolyte concentrations, and so forth.
This post, Spit Test To Determine Hydration Status, was originally published on
Healthine.com by Paul Auerbach, M.D..
July 17th, 2009 by Paul Auerbach, M.D. in Health Tips
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In the May 14, 2009 issue of the New England Journal of Medicine, in an article entitled “Antivenom for Critically Ill Children with Neurotoxicity from Scorpion Stings,” Dr. Leslie Boyer and colleagues report the results of a study in which the efficacy of scorpion-specific F(ab)’2 antivenom was compared to placebo in the treatment of 15 children ages 6 months to 18 years who were admitted to a pediatric intensive care unit with clinically significant signs of scorpion envenomation (N Engl J Med 2009;360:2090-8). The primary clinical end point was the resolution of the clinical syndrome within 4 hours after administration of the study drug. Secondary end points included the total dose of concomitant midazolam (Versed) – a sedative – and quantitative plasma (bloodstream) venom levels, before and after treatment.
The results showed that the clinical syndrome resolved more rapidly among recipients of the antivenom than among recipients of placebo, with a resolution of symptoms in all 8 antivenom recipients versus one of 7 placebo recipients within 4 hours after treatment. More midazolam was given to the placebo recipients (by necessity to treat symptoms) than in the antivenom recipients. Plasma venom concentrations were undetectable in all 8 antivenom recipients, but in only one placebo recipient one hour after treatment, which indicates that the antivenom neutralized circulating antivenom.
The conclusions are very helpful for clinicians treating scorpion envenomation syndromes with neurotoxic manifestations in critically ill children. They are that intravenous administration of scorpion-specific F(ab)’2 antivenom resolved the clinical syndrome within 4 hours, reduced the need for concomitant sedation with midazolam, and reduced the levels of circulating unbound venom.
This is very important new information. It is estimated that in North America, predominately in Mexico, more than 250,000 people per year are stung by scorpions. The major culprits are of the genus Centruroides. The antivenom used in this study was scorpion-specific F(ab)’2 antivenom (Anascorp, Centruroides [scorpion] immune F(ab)2 intravenous [equine], Instituto Bioclon).
The authors note that there has never been an approved, marketed antivenom therapy for scorpion envenomation in the United States. The only previously available scorpion antivenom in the U.S. was a goat-derived whole IgG (immunoglobulin G) preparation that has not been produced since 1999. Based on the current study, it now appears that there is a relatively safe product for treatment of critically ill children. Its use for critically ill adults and for children and adults with non-critical scorpion envenomation syndromes remains to be studied with the degree of rigor necessary to suggest its regulatory approval for use in the U.S.
image courtesy of about.com: Phoenix
This post, At Last: An Antidote For Scorpion Stings, was originally published on
Healthine.com by Paul Auerbach, M.D..
June 11th, 2009 by Paul Auerbach, M.D. in Better Health Network
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At Beneath the Sea I had the opportunity to walk the show floor and check out some new products intended for divers. One that immediately caught my eye was the Aqua Pencil, which is an innovative underwater pencil designed for divers, kayakers, boaters and researchers who will be underwater or wet. Because of its properties, it can be used when one needs to write in the rain, sleet or snow, such as out in the field or during a rescue. I tested it and it performs as advertised.
The Starter Kit includes an Aqua Pencil, Tether, Lead Pack (writing leads) and Eraser. The tethers are available in different colors, and the pencil is advertised to work well with any slate and to write well on waterproof paper.
According to the company, which is named Xit 404, it was formed to fulfill the need for specialized products and to develop ideas that are overlooked by other companies.
The Aqua Pencil Kit retails for $21.95.
This post, Aqua Pencil, was originally published on
Healthine.com by Paul Auerbach, M.D..
Michael Kilbourne and colleagues recently published an article entitled “Hemostatic Efficacy of Modified Amylopectin Powder in a Lethal Porcine Model of Extremity Arterial Injury”( Annals of Emergency Medicine 2009;53:804-810). The purpose of the study described in this article was to investigate the blood-stopping ability of a modified amylopectin powder in an animal (pig) model of severe limb bleeding created by an injury to the femoral artery.
