Auerbach's Wilderness Medicine, 2-Volume Set (2024)

descrission

Auerbach's Wilderness Medicine, 2-Volume Set, Seventh Edition (2017) 3097pp. 978-0-323-35942-9
Front Cover 1
IFC_Expert Consult page 2
Auerbach's Wilderness Medicine, 2-Volume Set 3
Copyright Page 6
Contributors 7
Foreword 21
References 23
Preface 25
Table Of Contents 27
Video Contents 31
Photo Credits 33
Front and Back Cover, Spine, Part 17 33
Parts 1 to 5, 9, 12, 14, 16 33
Part 6 33
Parts 7, 15 33
Part 8 33
Part 10 33
Part 11 33
Part 13 33
1 Mountain Medicine 35
1 High-Altitude Physiology 36
Definitions 36
High Altitude (1500 to 3500 meters [4921 to 11,483 feet]) 36
Very High Altitude (3500 to 5500 meters [11,483 to 18,045 feet]) 36
Extreme Altitude (higher than 5500 meters [18,045 feet]) 36
The Environment of High Altitude 36
Acclimatization to High Altitude 36
Ventilation 38
Circulation 38
Systemic Circulation 38
Pulmonary Circulation 39
Cerebral Circulation 39
Blood 39
Hematopoietic Responses to Altitude 39
Oxyhemoglobin Dissociation Curve 40
Tissue Changes 41
Exercise 41
Training at High Altitude 42
References 42
References 43
2 High-Altitude Medicine and Pathophysiology 42
High-Altitude Syndromes 42
Acute Cerebral Hypoxia 42
High-Altitude Headache 45
Pathophysiology 46
Prevention and Treatment 46
Acute Mountain Sickness 46
Epidemiology and Risk Factors 46
Diagnosis 48
Differential Diagnosis 48
Pathophysiology 49
Mechanisms of Acute Mountain Sickness. 49
The Tight-Fit Hypothesis. 49
Intracranial Pressure. 49
Treatment 49
Prevention 51
Acetazolamide Prophylaxis. 52
Dexamethasone Prophylaxis. 52
Other Preventive Agents. 53
High-Altitude Cerebral Edema 53
Clinical Presentation 53
Pathophysiology 54
Treatment and Prevention 55
Focal Neurologic Conditions without Acute Mountain Sickness or Cerebral Edema 55
Cerebrovascular Accident (Stroke) 55
Cognitive Changes at High Altitude 55
High-Altitude Pulmonary Edema 56
Clinical Presentation 56
Hemodynamics 57
Laboratory Studies 57
Radiographic Findings 57
Pathologic Findings 57
Mechanisms of High-Altitude Pulmonary Edema 58
Role of Pulmonary Hypertension. 58
Overperfusion and Capillary Leak. 59
Alveolar Fluid Balance. 59
Control of Ventilation. 59
Susceptibility to High-Altitude Pulmonary Edema 59
Genetics of High-Altitude Pulmonary Edema 60
Treatment 60
Prevention 61
Problems of Lifelong or Long-Term Residents of High Altitude 61
Reentry Pulmonary Edema. 61
Chronic Mountain Sickness. 61
Symptomatic High-Altitude Pulmonary Hypertension. 62
Children at High Altitude 62
Other Medical Concerns at High Altitude 62
Carbon Monoxide Poisoning 62
High-Altitude Deterioration 62
High-Altitude Syncope 63
Alcohol at High Altitude 63
Thrombosis: Coagulation and Platelet Changes 63
Peripheral Edema 64
Immunosuppression 64
Sleep at High Altitude 64
Periodic Breathing 64
Pharmaceutical Aids for Sleep 64
High-Altitude Pharyngitis, Bronchitis and Cough 65
References 65
References 66
3 High Altitude and Preexisting Medical Conditions 65
A General Framework for Evaluating Travelers with Underlying Medical Conditions 75
Mitigating Risk with Planned Ascent 75
Specific Medical Conditions at High Altitude 75
Respiratory Diseases 75
Chronic Obstructive Pulmonary Disease 75
Interstitial Lung Disease 77
Asthma 77
Cystic Fibrosis 77
Pulmonary Hypertension 78
Sleep-Disordered Breathing 78
Cardiovascular Conditions 78
Hypertension 78
Coronary Artery Disease 79
Heart Failure 79
Congenital Heart Disease 80
Arrhythmia 80
Hematologic Diseases 80
Hypercoagulable States 80
Hemoglobinopathy 81
Anemia 81
Polycythemia Vera 81
Neurologic Disorders 81
Headaches 81
Seizures 81
Cerebrovascular Diseases 81
Diabetes Mellitus 81
Acclimatization and Risk of Altitude Illness 81
Insulin Requirements and Glycemic Control 82
Glucometer Function 82
Insulin Pumps 82
Retinal Disease 82
Obesity 82
Gastrointestinal Diseases 83
Gastrointestinal Bleeding 83
Cirrhosis 83
Ophthalmologic Conditions 83
Refractive Error Surgery Patients 83
Glaucoma 83
Pregnancy 83
Medication Considerations in High-Altitude Travelers with Underlying Medical Problems 84
References 84
References 85
4 Avalanches 88
Properties of Snow 88
Snow Climates 88
Physical Properties 88
Kinetic Metamorphism 90
Equilibrium Metamorphism 90
Avalanche Types 91
Slab Avalanche Formation 91
Mechanical Properties: How Snow Deforms on a Slope 92
Avalanche Dynamics 93
Identifying Avalanche Terrain 95
Slope Angle 95
Orientation 95
Avalanche Terrain Paths 95
Vegetation 96
Factors That Contribute to Avalanche Formation 96
Snowfall 96
Snowfall Intensity 96
Rain 96
New Snow Density and Crystal Type 96
Wind Speed and Direction 96
Temperature 97
Depth of Snow Cover 97
Weak Layers 97
Safe Travel in Avalanche Terrain 98
Identifying Avalanche Terrain 98
Route Finding 98
Crossing Avalanche Slopes 98
Stability Evaluation Tests 98
Avalanche Rescue Equipment 101
Shovel 101
Probe 101
Avalanche Rescue Transceiver 101
Avalanche Airbag 102
AvaLung 105
Avalanche Rescue 106
Individual Rescue (Self-Rescue) 106
Escaping to the Side 106
Actions during the Slide 106
Small-Team Rescue (Companion Rescue) 106
Calling for Help 106
Marking the Last-Seen Area 106
Initiate Search and Scan for Clues 106
Rescue Transceivers 106
Probing after Transceiver Search 107
Shoveling Techniques 107
Strategic Shoveling. 107
V-Shaped Conveyor Belt. 107
Calling for Professional Resources 107
Professional Rescue 107
Incident Command System 107
Organized Probing Search Techniques 108
Avalanche Rescue Dogs 109
RECCO 109
The Avalanche Victim 109
Statistics of Avalanche Burials 110
Rescue Statistics 112
Avalanche Victim Physiology and Medical Treatment after Rescue 113
Morbidity and Mortality 113
Respiratory Physiology of Avalanche Burial 114
Medical Treatment and Resuscitation of Avalanche Burial Victims 115
Hypothermia in the Avalanche Burial Victim 117
Summary 118
Acknowledgments 119
References 119
References 120
5 Lightning-Related Injuries and Safety 119
Historical Overview 119
Modern Lightning Myths and Misconceptions 122
Lightning Lore 122
Medical Myths and Misconceptions 123
Meteorologic Lore 124
Myths Regarding Electric Current Conduction 124
Miscellaneous Lore 125
Other Specific Myths and Misconceptions 125
Incidence of Injury 126
U.S. Lightning Casualties and Lightning 126
Global Lightning Casualties and Lightning 127
Trends in Lightning Fatalities 128
Conclusions 130
Early Scientific Studies and Invention of the Lightning Rod 130
Physics of Lightning Stroke 132
Lightning Discharge 132
Diameter and Temperature of Lightning 133
Forms of Lightning 133
Thunder 133
Mechanisms of Injury by Lightning* 134
Electrical Injury Physics Revisited 134
Concepts in Electricity 134
Technical Electricity Supply vs. Lightning Current 134
Mechanisms of Injury 134
General Conduction Effects 134
Specific Strike Mechanisms 136
Direct Strike. 136
Contact (Touch Potential) Injury. 136
Side Flash. 136
Earth Potential Rise. 136
Upward Streamers. 136
Barotrauma and Blunt Injury from Lightning 137
Pathophysiology of Lightning Injury 138
Electrical Injury Physics Revisited 138
Electric Field Effects 138
Characteristics of Lightning Current vs. Industrial Electricity 139
Estimation of Lightning Currents 140
Estimates of Streamer Currents 141
Behavior of Electric Current in Tissue 141
Magnetic Field Effects 142
X-Ray and Gamma Ray Effects 142
The Faraday Cage 142
Injuries From Lightning 142
Initial Presentation Model 143
Minor Injury 143
Moderate Injury 143
Severe Injury 143
Neurologic Outcome Model 143
Immediate and Transient Symptoms 143
Immediate and Prolonged or Permanent Symptoms 143
Possible Delayed Neurologic Syndromes 143
Lightning-Linked Secondary Trauma from Falls or Blast 144
Cardiopulmonary Arrest and Cardiac Injuries* 144
Cardiac Arrest 144
Other Cardiac Injuries 144
Pulmonary Injuries 144
Neurologic Injuries 144
Central Nervous System Injury 145
Peripheral Nerve Injury* 145
Autonomic Nervous System Injury 145
Posttraumatic Headache 145
Burns 145
Entry, Exit, and Types of Burns 145
Blunt, Concussive, and Explosive (Blast) Injuries 148
Eye Injuries* 149
Ear Injuries 149
Fetal Survival 149
Hematologic Abnormalities 150
Endocrine and Sexual Dysfunction 150
Psychological and Neurocognitive Dysfunction* 150
Functional Issues 150
Memory Disturbance. 150
Concentration Disturbance (Adult Attention Deficit Disorder). 150
Cognitive Function. 150
Higher Executive Functioning. 150
Behavioral Issues 150
Emotional Lability and Aggression. 150
Sleep Disturbance. 150
Phobic Behavior. 150
Depression. 150
Other Behavioral Issues. 151
Recognition and Acute Treatment of Lightning Injuries 151
Diagnosis 151
Initial First Aid and Triage of Victims 151
History and Physical Examination 152
Laboratory Tests and Radiographic Examination 152
Treatment 152
Fluid Therapy 152
Fasciotomy Not Needed 152
Antibiotics and Tetanus Prophylaxis 152
Cardiovascular Therapy 152
Central Nervous System Injury* 153
Burns 153
Eye Injuries* 153
Ear Injuries 153
Pregnant Victims 153
Other Considerations 153
Pronouncing the Victim Dead 153
Long-Term Care‡ 153
Pain Control 154
Psychological Problems and Cognitive Deficits 154
Referral to Support Groups and Other Information Sources 154
Forensic Investigation 154
Case History 154
Scene Investigation 154
Environmental Signs of Direct Lightning Strike 155
Structural Signs of Direct Lightning Strike 155
Trace Evidence Signs of Direct Lightning Strike 155
Physical and/or Autopsy Examination 155
Special Procedures 156
Diagrams and Photographs 156
Radiographs 156
Histologic Examination 156
Toxicologic Studies 156
Collection of Evidence 156
Collation 156
Precautions for Avoiding Lightning Injury 156
Lightning Safety Guidelines* 156
Lightning Safety Plan 156
An Approaching Thunderstorm 157
End of Thunderstorm 158
Safe Places Inside 158
Buildings 158
Vehicles 158
Always Unsafe Outside 159
The Difficulty of Wilderness Situations 159
Safety of Large Groups 159
Lightning Protection in Situ 160
Controversies and Ongoing Research in Lightning Injury 160
Problems with Expert Reporting 162
Totality of the Injury 162
Presumption of Site of Injury 162
Limits to Reporting 162
Research Methodology Problems 162
Bias in Research 162
Experimental Vehicles 163
Equipment Requirements 163
Survival Statistics 163
Remote and Psychological Symptoms 163
Technical Matters 163
Electroporation 164
Sites of Injury in the Body 164
Predictability of Lightning and Forecasting 164
Lightning Danger Warnings 164
Lightning Exposure and Safety Behavior 164
Lightning Safety Research 164
Building and Vehicle Safety 164
Safe Distance to Lightning 165
Demographics 165
Lightning Detection and Data Applications 165
Detection 165
Applications 165
Direct Threat from Lightning 166
Indicator Lightning 166
Substitute Lightning 166
Covariate Lightning 166
References 166
References 167
2 Cold and Heat 175
6 Thermoregulation 176
Conceptualizing the Thermoregulatory System 176
Basics of Core Temperature 176
Consequences of Altered Core Temperature 177
Monitoring Temperature of the Core and Other Sites 178
Monitoring the Core Temperature 178
Types of Thermometers 178
Measurement Sites 178
Estimating Mean Body Temperature 179
Physical Factors That Govern Heat Exchange: the Heat Balance Equation 179
Conductive Heat Exchange 179
Convective Heat Exchange 180
Radiative Heat Exchange 180
Evaporative Heat Exchange 180
Thermoregulatory Network 180
Peripheral Thermal Sensors 180
Central Thermal Sensors 182
Central Neural Structures Responsible for Controlling the Level of Body Temperature 183
Effector Responses 184
Vascular Adjustments 184
Central Signal 184
Local Modulation 185
Evaporative Cooling 185
Central Signal 185
Local Modulation 185
Metabolic Adjustments 185
Central Signal 186
Local Modulation 186
Behavioral Adjustments 186
Central Signal 186
Local Modulation 187
Important Modifications of Thermoregulatory Responses 187
Normal Variations in Regulated Temperature and Ability to Maintain Body Temperature 187
Level of Activity 187
Circadian Changes 187
Interindividual Differences 187
Age 187
Sex and Reproductive Hormone Status 188
Induced Alterations of the Regulated Temperature 188
Fever 188
Alcohol, Anesthetics, and Toxins 189
Severe Hypoxia and Endotoxin Shock 189
Altered System Responsiveness and Capacities 189
Thermal Acclimation 189
Competition with Other Homeostatic Systems 190
Alcohol, Drugs, Anesthetics, and Toxins 190
References 190
References 191
7 Accidental Hypothermia 196
Epidemiology 196
Classifications 196
Normal Physiology of Temperature Regulation 196
Pathophysiology 196
Nervous System 196
Cardiovascular System 197
Core Temperature Afterdrop 200
Respiratory System 200
Renal System 200
Coagulation 201
Predisposing Factors 201
Decreased Heat Production 201
Increased Heat Loss 202
Impaired Thermoregulation 202
Central Effects 202
Peripheral Effects 202
Pharmacologic or Toxicologic Effects 203
Recurrent Hypothermia 203
Predisposing Infections or Conditions 203
Trauma 203
Presentation 203
Laboratory Evaluation 204
Acid-Base Balance 204
Hematologic Evaluation 205
Treatment 206
Prehospital Life Support 208
Management in the Emergency Department 209
Temperature Measurement 209
Initial Stabilization 209
Fluid Resuscitation 210
Rewarming Options 210
Passive External Rewarming 210
Active Rewarming 211
Active External Rewarming 211
Forced-Air Surface Rewarming 211
Immersion 211
Arteriovenous Anastomosis Rewarming 211
Active Core Rewarming 212
Airway Rewarming 212
Heated Infusions 212
Heated Lavage 213
Gastrointestinal Lavage 213
Mediastinal Lavage 213
Thoracic Lavage 213
Peritoneal Lavage 214
Endovascular Warming 215
Extracorporeal Blood Rewarming 215
Hemodialysis 216
Continuous Venovenous Rewarming 216
Continuous Arteriovenous Rewarming 216
Cardiopulmonary Bypass 216
Diathermy 218
Cardiopulmonary Resuscitation 218
Respiratory Considerations 219
Blood Flow During Chest Compressions 219
Cerebral Resuscitation 220
Resuscitation Pharmacology 220
Thyroid 220
Corticosteroids 221
Resuscitation Complications 221
Atrial Arrhythmias 221
Ventricular Arrhythmias 221
Sepsis 222
Forensic Pathology 222
Prevention 222
Outcomes 223
References 223
References 224
8 Immersion into Cold Water 223
History and Epidemiology 230
Recreational Activities and Cold Water 230
Commercial Activities on Cold Water 230
Military Activities and Cold Water 233
Vehicular Activities on Ice 233
Physiologic Responses to Cold-Water Immersion with the Head Above Water 234
Phase 1: The Cold Shock Response (0 to 2 Minutes) 234
Phase 2: Cold Incapacitation (5 to 15 Minutes) 236
Phase 3: Onset of Hypothermia (Immersion for Longer Than 30 Minutes) 236
Phase 4: Circum-Rescue Collapse 237
Factors That Affect Cooling of the Body’s Core 239
Water Temperature and Sea State 240
Thermal Protection 240
Body Morphology (Size and Composition) 243
Amount of Body Immersed 243
Head Immersion 243
Behavior and Posture of the Body in Cold Water 247
Exercise 247
Shivering 247
Nonthermal Factors 248
Cold-Water Survival 249
Ability to Control the Cold Shock Response 249
Ability to Swim and Maintain Airway Freeboard 250
Behavior of the Survivor in the Water 250
Decision to Swim for Shore or to Wait for Rescue 252
Survival Modeling 252
Signals 254
Physiologic Responses to Cold-Water Submersion with the Head Under Water 254
Mechanisms for Brain and Body Cooling 255
Mechanisms for the Protective Effect of Brain Cooling 255
Implications for Survival 256
Rescue (Self-Initiated or Assisted) 256
Self-Rescue From Open Water or an Ice Hole 256
Assisted Rescue of a Victim Who Has Fallen Through the Ice 257
Recognize the Danger 257
Assess the Situation 257
Follow the Rescue Sequence 257
Untrained-Bystander Rescue 257
Talk 257
Throw 257
Reach 257
Rescue by Trained Personnel 257
Rescue from Open Water 258
Medical Management 259
Examination, Triage, and Life Support 259
Insulation, Stabilization, and Rewarming 261
Packaging 261
Spontaneous Rewarming 262
Inhalation Warming 262
Warmed Intravenous Fluids 262
Body-to-Body Rewarming 262
Heating Pads 262
Arteriovenous Anastomoses Rewarming 263
Forced-Air Warming 263
Transportation 263
References 264
References 265
9 Frostbite 264
History of Frostbite 264
Epidemiology 269
Civilian 269
Military and Occupational 269
Mountaineering 269
Anatomy and Physiology 269
Pathophysiology of Frostbite 270
Direct Cellular Injury 270
Indirect Cellular Damage/Progressive Dermal Ischemia 270
Definitions and Classifications 271
Contributing Factors 272
Temperature and Windchill 272
Conduction 274
Altitude 274
Coolants 274
Clothing 274
Skin Wetness/Unwashed Skin 275
Altered Mental Status (Alcohol, Drugs, Mental Illness) 275
Fatigue 275
Tobacco Smoking 276
Comorbidities 276
Previous Frostbite Injury 276
Immobility 276
Genetic Predisposition 276
Clinical Presentation 276
Field Treatment 277
Self-Rescue in the Freezing Environment 277
Treatment in the Prehospital Freezing Environment 277
Definitive Treatment (Immediate Treatment) 278
Evaluation and Treatment in the Hospital 279
Overall Strategy 279
Initial Assessment of Frostbite and Other Injuries 279
Principles 279
Patient Care 280
Specialist Nursing Care 280
Techniques to Evaluate Tissue Perfusion 280
Duplex Ultrasonography 280
Magnetic Resonance Angiography 280
Technetium-99m Scanning 280
Medical Management 281
Tetanus Prophylaxis 281
Heparin 281
Indications and Recommendations for Antibiotics 281
Topical Aloe vera 282
Antiprostaglandin Agents 282
Vasodilators 282
Iloprost. 283
Reserpine. 283
Pentoxifylline. 283
Buflomedil. 283
Blood Viscosity: Low-Molecular-Weight Dextran 284
Endovascular Interventions 284
Thrombolysis with Tissue Plasminogen Activator 284
Current Strategy for Imaging and Thrombolysis in Acute Phase of Frostbite 285
The Patient. 285
Tissue Plasminogen Activator in the Field. 285
The Hospital Unit. 286
Choice of Imaging in the Patient Presenting within 24 Hours of Injury. 286
Choice of Imaging in the Patient Presenting after 24 Hours of Injury. 286
Papaverine 286
Iloprost versus Tissue Plasminogen Activator 286
Adjunctive Treatments 287
Sympathectomy 287
Hyperbaric Oxygen Therapy 287
Epidural Spinal Cord Stimulation 288
Surgical Treatment 289
Amputation 289
Telemedicine 290
Long-Term Sequelae of Frostbite 290
Prediction of Individuals at Risk 290
Prevention 291
Strategy to Prevent Frostbite 291
Chemical or Other Warmers 292
Potential Future Developments: Preventive Strategies 292
Possible Future Treatments 292
Timing of IntraArterial Thrombolysis for Frostbite 292
Ultrasound-Accelerated Thrombolysis 293
Antiplatelet Agents 293
Tumor Necrosis Factor-α 293
Vacuum-Assisted Closure Therapy 293
Frostbite Management Registry and the Internet 293
References 293
References 294
10 Nonfreezing Cold-Induced Injuries 293
Epidemiology 293
Military 298
Ethnicity 298
Prevalence 298
Civilian 298
Personal Factors 298
Civilian Case Reports 298
Physiology 298
Skin: a Thermoregulatory Organ 298
Orthostasis 299
Cold-Induced Vasodilation 299
Pathophysiology 299
Nerve Injury 300
Vascular Injury 300
Animal Models 300
Risk Factors 302
Clinical Presentation 302
Prehyperemic Phase 302
Hyperemic Phase 302
Posthyperemic Phase 304
Treatment 305
Hypothermia 305
Rewarming 305
Sympathectomy 305
Tissue-Freezing Complications 305
Drugs 305
Occupational Medicine 305
Assessing Injury Severity 306
Special Investigations 306
Prevention 306
More Severe Injuries 307
Trench Foot (Immersion Foot) 307
Pernio (Chilblains) 307
Raynaud’s Phenomenon 307
Prevalence 308
Pathogenesis 308
Diagnosis 308
Management 308
Cryoglobulinemia 308
Cold Urticaria 308
References 309
References 310
11 Polar Medicine 309
The Distinction between Arctic and Antarctic Medicine 309
Importance of Polar Medicine 313
Increases in Tourism and Expeditions 313
Geopolitical Concerns 313
Increases in Research Activities 314
Brief History of Human Habitation in Polar Regions 314
Arctic Medical Problems 314
Effects of Cultural and Demographic Transition 314
Environmental and Occupational Health Problems 315
Psychosocial Health Problems 315
Current and Future Trends 316
Antarctic Medical Practice 316
National Antarctic Programs 316
Medical Stations in Antarctica 316
Somatic Health Problems 319
Cold-Related Problems 319
Altitude Illnesses 320
Nutritional Studies 320
Infection and Epidemiology 321
Circadian Rhythms, Endocrine Studies, and Sleep Research 321
Environmental Health Issues 321
Occupational Health and Injury Prevention 321
Fire Safety 322
National Programs’ Responsibilities for Tourist Safety 322
Air Safety 322
Psychosocial Health Problems 323
Alcohol Abuse 323
Psychoneuroimmunology 323
Small-Group Dynamics 323
Winter-Over Syndrome 323
Seasonal Affective Disorder 323
Beneficial Effects of Isolation 324
Screening and Selection 324
Tourists 324
Medical Problems 324
Polar Thigh 324
Skier’s Thumb 325
Kite Skier’s Toe 325
Overview and Future Developments 325
Issues of Methodology and Medical Epistemology 326
Fourth World Medical Decision Making 326
Use of Frozen Medications 326
Acknowledgments 326
References 326
References 327
12 Pathophysiology of Heat-Related Illnesses 330
Heat Stress and Thermoregulation 330
Four Avenues of Heat Exchange 330
Body Temperature Control 330
Mechanisms of Heat Dissipation during Thermal Stress 332
Dehydration and Electrolyte Imbalance 332
Heat Illnesses 333
Compensable Versus Uncompensable Heat Stress 335
Heatstroke Epidemiology and Risk Factors 335
Skin Disorders 337
Pathophysiology of Heatstroke 337
Body Temperature Responses 337
Immune Responses 338
Coagulation 340
Tissue Injury 340
Cytokines 342
Heat Shock Proteins 342
Heatstroke Treatments (See Chapter 13) 344
Cooling 344
Fluid Resuscitation (See Chapter 89) 345
Anticoagulants 345
Anticytokine Therapies 345
Heatstroke Prevention 346
Heat Acclimatization 346
Genetic Polymorphisms 347
Single Nucleotide Polymorphisms 347
Malignant Hyperthermia 348
References 348
References 349
13 Clinical Management of Heat-Related Illnesses 348
Exertional Heat Illness 348
Clinical Manifestations 355
Acute Phase 355
Hematologic and Enzymatic Phase 355
Enzymes 356
Late Phase 356
On-Site Emergency Medical Treatment 356
Emergency Medical Services Treatment 357
Hospital Emergency Medical Treatment 357
Induced Hypothermia 358
Dantrolene 358
Antibiotic Therapy 358
Sequelae 358
Return to Activity 358
Current Civilian Recommendations 359
Prevention 359
Awareness of Host Risk Factors 359
Adaptation to Environmental Conditions 360
Clothing 360
Activity 360
Conditioning 361
Acclimatization 361
Research 361
Acknowledgments 361
References 361
References 362
3 Burns, Fire, and Radiation 364
14 Wildland Fires 365
Wildland Fire Management and Technology 365
Wildland Fire Management Policies 367
Prescribed Fire and Wildland Fire Use 369
Wildland-Urban Interface: New Look at a Historical Problem 369
Nature of the Problem 370
Wildland-Urban Interface Lessons Learned 376
What Some Organizations Have to Offer the General Public 376
Wildland Fire Behavior 377
Urban and Wildland Fire Threats 377
Fire Behavior Knowledge: a Wildland Fire Early-Warning System 378
Physical Principles of Heat Transfer 379
Fundamental Wildland Fire Behavior Characteristics 381
Environmental Factors Influencing Wildland Fire Behavior 383
Fuel. 383
Weather. 383
Topography. 384
Extreme Fire Behavior 384
Wind-Driven Crown Fire. 387
Plume-Dominated or Convection-Dominated Crown Fire. 387
Value of Fire Danger Ratings 387
Fire-Related Injuries and Fatalities 388
Common Denominators of Fire Behavior on Fatality Fires 389
Nature of Injuries and Fatalities 390
Wildland Fires, Air Toxins, and Human Health 392
Wildland-Urban Interface Fire Survival: Principles and Techniques 393
LCES: the Key to Safe Procedures in Wildland Fire Environments 393
Eighteen “Watch Out!” Situations in the Wildland Fire Environment 394
Fifteen Structural “Watch Out!” Situations for the Wildland-Urban Interface 395
Taking Refuge in Vehicles, Buildings, and Protective Fire Shelters Used by Wildland Firefighters 395
Vehicles 395
Buildings 396
Protective Fire Shelters Used by Wildland Firefighters 398
Emergency Procedures during a Wildland Fire Entrapment or Burnover 399
Survival Option 1: Retreat From the Fire and Reach a Safe Haven 401
Survival Option 2: Burn Out a Safety Area 401
Survival Option 3: Hunker in Place 401
Survival Option 4: Pass Through the Fire Edge Into the Burned-Out Area 402
Wildland Fires and Human Behavior 402
Proper Clothing 404
Water Intake 405
Personal Gear 405
How to Report a Wildland Fire to Local Fire Protection Authorities 405
Portable Fire Extinguishers 405
Basic Wildland Fire Materials, Training Courses, and Other Information Resources 406
Concluding Remarks 406
Acknowledgments 407
References 407
References 408
15 Emergency Care of the Burned Patient 418
Epidemiology 418
Physiology 418
Types of Burns 419
Scald Burns 419
Flame Burns 419
Flash Burns 420
Contact Burns 420
Electrical Burns 420
Chemical Burns 420
Clinical Presentation 421
Estimation of Burn Size 421
Depth of Burn 422
First-Degree Burns 422
Superficial Partial-Thickness Burns 422
Deep Partial-Thickness Burns 423
Full-Thickness Burns 423
Fourth-Degree Burns 423
Treatment 423
Care at the Scene 423
Flame Burns 423
Scalds and Grease Burns 423
Airway 423
Other Injuries and Transport 424
Cold Application 424
Swelling 424
Electrical Burns 424
Chemical Burns 424
First Aid at the Scene for Smaller Burns 424
Technique of Burn Wound Debridement. 425
Emergency Department Care 426
Resuscitation 426
Escharotomy 427
Burn Wound Management 428
Outpatient Burns 428
First-Degree Burns 428
Superficial Partial-Thickness Burns 429
Deep Partial-Thickness and Full-Thickness Burns 429
Rehabilitation 429
Inhalation Injury 430
Carbon Monoxide Poisoning 430
Pathophysiology 430
Clinical Presentation 430
Therapy 430
Thermal Airway Injury 430
Pathophysiology 430
Clinical Presentation 430
Therapy 430
Smoke Poisoning 430
Pathophysiology 430
Clinical Presentation 431
Therapy 431
Other Considerations 432
Burn Severity and Categorization 432
Transport and Transfer Protocols 433
International Resources 433
References 434
References 435
16 Exposure to Radiation from the Sun 434
Solar Radiation 434
Electromagnetic Spectrum 434
Environmental Influences on Ultraviolet Radiation Exposure 434
Ozone Depletion and Ultraviolet Radiation Exposure 437
Acute Effects of Ultraviolet Radiation on Skin: Sunburn and Tanning 438
Ultraviolet C Radiation 438
Ultraviolet B Radiation 438
Ultraviolet A Radiation 438
Infrared Radiation 438
Phototrauma 438
Natural Defenses and Skin Type 438
Sunburn 439
Sunburn Treatment 439
Tanning 439
Photoaging 439
Sun and Skin Cancer 440
Molecular Basis of Photocarcinogenesis 440
Photobiology 440
Photoimmunology 441
Nonmelanoma Skin Cancer 441
Basal Cell Carcinoma 441
Squamous Cell Carcinoma 441
Melanoma 443
Photoprotection 444
Sunscreens 444
Sunscreen Vehicles 445
Sun Protection Factor 445
Sunscreen Application 445
Ultraviolet A Radiation Protection Factors 446
Sunscreen Regulation 446
Labeling. 446
Issues Not Finalized. 446
Substantivity 446
Stability 447
Sunscreen Prevention of Chronic Photodamage 447
Sunscreens and Nonmelanoma Skin Cancer 448
Actinic Keratoses and Squamous Cell Carcinoma. 448
Basal Cell Carcinoma. 448
Sunscreens and Melanoma 448
Sunscreen Side Effects 450
Role of Vitamin D 450
Other Sources of Sun Protection 451
Clothing Protection 451
Sun Avoidance 451
Sunless Tanning 451
Bronzers 451
Spray Tan 452
Tanning Booth 452
Unique Photoprotectants 452
Antioxidants 452
Botanicals 452
Synthetic Molecular Structures 452
Attitudes Toward Photoprotection 452
Photosensitivity Disorders 453
Endogenous Photosensitivity Disorders 453
Phototoxicity 454
Photoallergy 454
Tips for the Wilderness Enthusiast 454
References 454
References 455
17 Volcanic Eruptions, Hazards, and Mitigation 461
Mt Vesuvius, ad 79 464
Volcanoes and Their Global Distribution 465
Theory of Plate Tectonics 466
Types of Volcanoes 467
Generally Explosive Volcanoes 467
Composite Volcanoes 467
Calderas 468
Generally Nonexplosive Volcanoes 468
Shield Volcanoes 468
Subglacial Volcanoes 468
Flood-Basalt Plateaus 469
Undersea Volcanoes 469
Volcano Hazards 470
Hazards from Explosive Volcanoes 470
Pyroclastic Flows and Surges 471
Mitigation. 472
Lahars (Volcanic Mudflows) 472
Mitigation. 475
Tsunamis 475
Mitigation. 475
Debris Avalanches 476
Mitigation. 476
Tephra 476
Ballistic Ejecta. 476
Volcanic Ash. 476
Mitigation. 478
Volcanic Gases 479
Mitigation. 480
Hazards from Nonexplosive Volcanoes 480
Lava Flows 480
Mitigation. 480
Jökulhlaups 480
Posteruption Hazards 480
Risk Reduction from Volcanic Hazards 481
Volcano Monitoring 481
Eruption Prediction and MT Pinatubo: Effective Volcanic-Emergency Response 482
Coordination between Volcanologists and Health Care Professionals 482
Emergency Medical Response 483
Geotourism 483
References 483
References 484
4 Trauma 486
18 Wilderness Trauma and Surgical Emergencies* 487
Wilderness Trauma Emergencies Overview 487
History of Wilderness Medicine 487
Establishing Priorities in the Wilderness 487
Universal (Body Fluids) Precautions in the Wilderness 488
Primary Survey 488
Airway 488
Breathing and Ventilation 488
Circulation 489
Disability and Neurologic Assessment 489
Exposure and Environmental Control 489
Secondary Survey 489
History 489
Adjuncts to Surveys 489
Advances in Wilderness Care Adapted From Combat Medicine 490
Vascular Access 490
Prehospital Hemorrhage Control 490
Tourniquets 490
Hemostatic Dressings 491
Junctional Tourniquet 491
Wound Closure Device 491
Damage Control Resuscitation: Directly Addressing the Lethal Triad 491
Fresh Whole Blood 492
Organization of Walking Blood Bank 492
Collection of Fresh Whole Blood 493
Injuries to the Head, Face, and Neck 493
Head Injuries 493
Anatomy of the Head 493
Pathophysiology of Traumatic Brain Injury 493
Diagnosis of Head Injury 494
Head Injury Classification 495
Physical Examination for Head Injury 495
Resuscitation with Head Injury 495
Further Management of Head Injury 496
Skull Fracture 497
Penetrating Head Injuries 497
Evacuation of Patients with Head Injury 497
Neck Injuries 497
Blunt Neck Injuries 497
Anatomy of the Neck. 498
Classification and Recognition. 498
Physical Examination. 498
Spinal Cord Syndromes. 498
Immobilization. 499
Treatment. 499
Penetrating Neck Injuries 499
Injuries to the Thorax 499
Specific Thoracic Injuries 500
Rib Fractures 500
Pneumothorax 501
Chest Tube Placement. 501
Hemothorax 501
Flail Chest 501
Blunt Cardiac Injuries 502
Traumatic Asphyxia 502
Penetrating Chest Wounds 502
Injuries to the Abdomen 503
Blunt Abdominal Trauma 503
Anatomy of the Abdomen 503
Diagnosis 503
Physical Examination 503
Penetrating Abdominal Trauma 503
Gunshot Wounds 503
Shotgun Injuries 503
Stab Wounds 503
Pelvic Trauma 504
Extremity Trauma 504
Vascular Injuries 504
History of the Injury 505
Physical Examination 505
Treatment of Vascular Injuries 505
Traumatic Amputation 505
Crush Injuries and Rhabdomyolysis 505
Wilderness Surgical Emergencies 506
Acute Appendicitis 507
Acute Cholecystitis and Biliary Colic 507
Peptic Ulcer Disease 507
Diverticulitis 507
Mechanical Small Bowel Obstruction 507
Incarcerated Abdominal Wall Defect 508
Anal Fissure and Hemorrhoids 508
Urologic Emergencies 508
Renal Colic 508
Urinary Retention 509
Acute Scrotum 509
Prostatitis 509
Urinary Tract Infection 509
Skin and Soft Tissue Infections 510
Cellulitis 510
Lymphangitis 510
Cutaneous Abscess 510
Community-Acquired Methicillin-Resistant Staphylococcus Aureus Infections 510
Wound Myiasis (Maggot Infestation) 511
Sterility in the Austere Environment 511
Anesthesia in the Wilderness 512
References 512
References 513
19 Emergency Airway Management 512
Airway Anatomy 512
The Decision to Intubate 512
Failure of Airway Protection 512
Failure of Ventilation or Oxygenation 516
Anticipated Clinical Course 516
Basic Airway Management 517
Head Positioning 517
Recovery Position 517
Manual Airway Techniques 517
Head Tilt and Chin Lift 517
Jaw Thrust 517
Mechanical Airway Adjuncts 518
Oropharyngeal Airway 518
Nasopharyngeal Airway 518
Improvised Nasopharyngeal Airway 519
Airway Obstruction From a Foreign Body 519
Suction 519
Supplemental Oxygen 519
Ventilation 519
Mouth-to-Mouth Ventilation 520
Mouth-to-Nose Ventilation 520
Mouth-to-Mask Ventilation 520
Bag-Valve-Mask Ventilation 520
Advanced Airway Management 520
Predictors of Airway Difficulty 521
Predicting Difficult Direct Laryngoscopy with the LEMON Mnemonic 521
Predicting Difficult Bag-Mask Ventilation with the MOANS Mnemonic 522
Predicting Difficult Extraglottic Device Placement with the RODS Mnemonic 522
Predicting Difficult Cricothyrotomy with the SMART Mnemonic 522
Immediate Oral Intubation (“Crash” Intubation) 522
Rapid Sequence Intubation 522
Preparation 522
Preoxygenation 522
Pretreatment 523
Paralysis with Induction 523
Induction Agents. 523
Neuromuscular Blockade. 523
Positioning 523
Placement 524
Proof (Confirmation of Endotracheal Tube Placement) 524
Clinical Assessment 524
Pulse Oximetry 525
End-Tidal Carbon Dioxide Detection 525
Aspiration Devices 525
Postintubation Management 525
Alternative Strategies for the Difficult Airway 525
Awake Oral Intubation 525
Nasotracheal Intubation 525
Alternative Airway Adjuncts and Techniques 526
Laryngeal Mask Airway 526
Combitube 526
King LT 527
Video Laryngoscopy 527
Fiberoptic Intubation 528
Digital Intubation 528
Surgical Airway Management 528
Cricothyrotomy 528
Standard Surgical Cricothyrotomy 528
Rapid Four-Step Cricothyrotomy 530
Improvised Cricothyrotomy 530
Needle Cricothyrotomy with Percutaneous Transtracheal (Translaryngeal) Jet Ventilation 530
Airway Equipment for the Wilderness 531
References 531
References 532
20 Management of Facial Injuries 533
History and Examination of Facial Injuries 533
Diagnosis and Treatment of Facial Injuries 533
Temporomandibular Joint Disorders 533
Temporomandibular Joint Dislocation 533
Diagnosis. 534
Treatment. 534
Internal Derangements of the Temporomandibular Joint 536
Diagnosis. 536
Treatment. 536
Epistaxis 536
Evaluation 537
Treatment 537
Facial Bone Fractures 538
Upper Face Fractures 539
Nasal Fractures. 539
Frontal Sinus Fractures. 541
Naso-Orbito-Ethmoid Fractures. 542
Midface Fractures 542
Orbital Fractures. 542
Zygomaticomaxillary Complex Fractures (Malar Fractures). 542
Zygomatic Arch Fractures. 542
Le Fort Fracture of the Maxilla. 542
Lower Face Fractures 543
Fractures of the Mandible. 543
Soft Tissue Injuries 544
Treatment 544
Injuries to the Lips 545
Tongue Lacerations 545
Injuries to the Eyelid 545
Injuries to the Nose 546
Injuries to the Ear 546
Injuries to the Cheek 548
Foreign Bodies in the Nose and Ear 550
Wilderness Medical Kit for Facial Trauma 552
Prevention of Facial Trauma 552
References 553
References 554
21 Wound Management 553
Types of Wounds and Definitions 553
Clinical Presentation 555
Treatment 556
Cleansing Techniques 556
Vascular Injuries 557
Anesthesia 558
Wound Closure Techniques 559
Dressings and Aftercare 562
Complications 563
Wound Care Kit 564
References 564
References 565
22 Wilderness Orthopedics 564
Scope of the Problem 567
Physical Examination 567
Vascular Function 567
Nerve Function 567
Skeletal Function 567
Joint Function 568
Potentially Life-Threatening Musculoskeletal Injuries 569
Spinal Injuries 569
Cervical Spine Injuries 569
Thoracolumbar Spine Injuries 569
Spinal Assessment (Clearing the Spine) 570
Spinal Immobilization 570
Pelvic Injuries 571
General Considerations in Extremity Injuries Techniques for Managing Extremity Injuries 571
Splinting Techniques 571
Reduction and Relocation Maneuvers 574
Traction Pins 574
External Fixators 575
Open Fractures of the Extremities 577
Classification of Open Fractures of the Extremities 577
Type I Fracture 577
Type II Fracture 577
Type III Fracture. 577
Subtype IIIA Fracture. 577
Subtype IIIB Fracture. 577
Subtype IIIC Fracture. 577
Management of Open Fractures of the Extremities 578
Significant Soft Tissue Injuries of the Extremities 578
Tourniquets for Extremity Injuries 578
Amputation of Injured Extremities 578
Compartment Syndrome 578
RICE Principle 579
Upper Extremity Injuries 579
Shoulder Girdle Injuries 579
Clavicular Fracture 579
Scapular Fracture 580
Sternoclavicular Joint Dislocation 580
Acromioclavicular Joint Dislocation 580
Glenohumeral Joint Dislocation 581
Arm and Elbow Fractures 583
Proximal Humeral Fracture 583
Humeral Fracture 584
Fracture Around the Elbow (Distal Humerus, Olecranon, Radial Neck or Head) 584
Elbow Dislocation 586
Forearm, Wrist, and Hand Fractures 587
Radial Fracture 587
Ulnar Fracture 587
Wrist and Carpal Fractures 588
Metacarpal Fracture 588
Metacarpophalangeal Joint Dislocation 589
Fractures of the Phalanges 590
Soft Tissue Injuries of the Wrist, Hand, and Digits 591
Hip and Leg Injuries 591
Femoral Fracture 591
Hip Dislocation 592
Knee and Lower Leg Injuries 593
Distal Femoral or Patellar Fracture 593
Knee Dislocation 594
Tibial and Fibular Fractures 594
Ankle and Foot Injuries 595
Ankle and Foot Fractures 595
Ankle Dislocation or Sprain 595
Hindfoot Dislocation 597
Midfoot Dislocation 597
Tarsal Fracture 598
Metatarsal Fracture 598
Fracture of the Phalanges of the Toes 598
Metatarsophalangeal and Interphalangeal Joint Dislocations 598
Other Soft Tissue and Musculoskeletal Injuries 599
Intraarticular Knee Disruption 599
Achilles Tendon Rupture 600
Hamstring Strain or Tear 600
Joint or Bursal Effusions 600
Overuse Syndromes and Special Considerations 600
Plantar Fasciitis 600
Carpal Tunnel Syndrome 600
Stress Fractures 601
Bursitis, Inflammation, and Irritation 601
Spinal Disorders 601
Corticosteroid Injections 602
Corticosteroid Medications 603
Risks and Side Effects of Corticosteroid Injections 603
Knee Joint Injection 603
Shoulder Injections 603
Subacromial Joint Injection 603
Glenohumeral Joint Injection 603
Acromioclavicular Joint Injection 604
Trochanteric Bursitis Injection 604
Olecranon Bursitis Injection 604
Medial and Lateral Epicondylitis Injection 604
Iliotibial Band Injection 604
Pes Anserine Bursitis Injection 604
Prepatellar Bursitis Injection 605
Plantar Fasciitis Injection 605
Field Block 605
Hematoma Block 605
Returning to the Wilderness after Total Joint Replacement 605
Prosthetics in the Wilderness 606
New Technologies for Casting and Bracing 607
Decisions About Evacuation 608
References 608
References 609
23 Splints and Slings 608
Spine Immobilization 608
Indications for Spine Immobilization 608
Benefits of Spine Immobilization 610
Risks of Spine Immobilization 610
Contraindications for Spine Immobilization 611
Guidelines for Spine Immobilization 611
Cervical Spine Immobilization Technique 611
C-Spine Immobilization Device 612
Special Considerations 612
Improvisational Techniques 612
Thoracolumbar Immobilization 613
Full Spine Immobilization 613
Splinting of the Extremities 616
Upper Extremity Splinting 616
Lower Extremity Splinting 616
Types of Extremity Splints 617
Rigid Splints 617
Soft Splints 619
SAM Splints 620
Improvised Extremity Splints 620
Techniques of Splinting 620
Pelvic Splinting 620
Hip and Femur Splinting 621
Ankle Splinting 622
Shoulder Dislocation 622
Humerus Shaft Injury 622
Elbow Dislocation 622
Elbow Fracture 622
Wrist Fracture 622
Metatarsal Fractures 622
Thumb Injuries 622
Finger Injuries 622
Femoral Fracture 622
Knee Injuries 622
Leg Fractures 634
Ankle and Foot Injuries 634
References 634
References 635
24 Taping and Bandaging 634
Taping 636
Types of Tape 636
Skin Preparation 636
Ankle Taping 637
Toe Taping 637
Lower-Leg Taping 637
Knee Taping 637
Patella Taping 637
Finger Taping 637
Thumb Taping 639
Wrist Taping 639
Elbow Taping 639
Shoulder Taping 639
Bandaging 641
Types of Bandages 641
Securing Bandages 641
Ankle and Foot Bandaging 641
Knee Bandaging 641
Thigh and Groin Bandaging 641
Wrist and Hand Bandaging 646
Finger Bandaging 646
Thumb Bandaging 646
Shoulder Bandaging 646
Scalp Bandaging 646
Ear or Side of Head Bandaging 650
Eye Bandaging 650
References 650
References 651
25 Foot Problems and Care 652
Blisters of the Foot 652
Pathophysiologic Findings 652
Blister Prevention 652
Reduction of Movement Within the Footwear System 653
Increasing Movement Within Footwear Systems 654
Minimizing Moisture 654
Foot Preparation 654
Blister Prevention Compounds 654
Preventive Taping and Pads 655
Antiperspirants and Powders 656
Lubricants 657
Blister Treatment 657
General Taping Rules 657
Basic Blister Treatment 658
Open Blister Treatment 659
Toe Blisters 659
Heel Blisters 660
Ball-of-Foot Blisters 661
Subungual Hematomas 662
Advanced Blister Care Treatments 663
Blood-Filled Blisters 664
Infected Blisters 664
Subcallus Blisters 664
Common Foot and Ankle Injuries 665
Ligament Injuries 665
Soft Tissue Injuries 666
Achilles Tendinopathy 666
Plantar Fasciitis 666
Bone Injuries 666
Stress Fractures 666
Sesamoiditis 666
Orthotics 667
Bunions 667
Tinea Pedis 667
Plantar Warts 667
Hyperhidrosis 668
References 668
References 669
26 Hunting and Fishing Injuries 668
Hunting Injuries 668
Hunting in the United States 671
Types of Injuries Encountered 671
Tree Stand Injuries 672
Arrow Injuries 672
Injuries From Firearms 673
Nonpowder Firearms. 673
Powder Firearms. 674
Trap Injuries 677
Treatment of Hunting Injuries 677
Arrow Injuries 679
Gunshot Wounds 679
Myths About Gunshot Wounds. 679
Emergency Department Care. 679
Prevention of Hunting Injuries 680
Fishing Injuries 681
Fishhook Injuries 681
Fishing Spear Injuries 684
Other Fishing Injuries 684
References 684
References 685
27 Tactical Medicine 684
History of Tactical Medicine 688
Shared Principles of Military Tactical Combat Casualty Care and Civilian Tactical Medicine 690
Care Under Fire 690
Tactical Field Care 691
Combat Casualty Evacuation Care 692
Principles of Civilian Tactical Medicine 692
Team Health Management 695
Operational Casualty Care 695
Tactical Medical Equipment 695
Communication 696
Entry and Breaching Tools 696
Weapons Systems 696
Vision 698
Medical Threat Assessment 698
Forms and Documentation 699
Medical Personal Protective Equipment 700
Personal Supply Module 700
Basic Medical Module 700
Intermediate Medical Module 701
Advanced Medical Module 701
Major Trauma Module 701
Support Vehicle Module 702
Chemical, Biologic, Radiologic, or Nuclear Specialty Modules 703
The Tactical Mission 703
Reserve Programs 703
Uniforms and Personal Protective Gear 703
Education and Training Programs 703
Future of Tactical Medicine 704
References 704
References 705
28 Combat and Casualty Care 707
Background 707
Battlefield Medicine Versus Standard Civilian Prehospital Care 707
The Basics of Military Medicine 707
Joint Theater Trauma System and Registry 707
Military Medical Echelons of Care 708
Scopes of Practice for Military Medical Personnel 709
Medical Equipment Unique to the Military 709
Blast Injuries 709
Primary Blast Injury 709
Secondary Blast Injury 710
Tertiary Blast Injury 710
Quaternary Blast Injury 710
Quinary Blast Injury 711
Tourniquets and Hemostatic Agents 711
Management of the Airway in Combat and Civilian Trauma 712
Chest Trauma 713
Fluid Resuscitation 713
General Principles 713
Vascular Access 713
Fluid Selection and Dosing 713
Medication 714
Burns 714
Mild Traumatic Brain Injury 714
Initial Approach to Wound Care 715
Pain Management 715
Unique Aspects of Military Triage and Mass Casualties 716
Traumatic Emotional Stress: the Continuum of Effects 716
Clinical Aspects of Psychological Trauma 716
Sources of Personal Trauma 716
How are Military Stress Reactions Characterized? 716
Combat and Operational Stress Reaction 716
Acute Stress Disorder 716
Posttraumatic Stress Disorder 717
Which Treatments Work? 717
Telemedicine 717
Unexploded Ordnance 717
Death 718
Acknowledgment 718
References 718
References 719
29 Injury Prevention 718
Principles of Wilderness Injury and Prevention 720
The Injury Field: Basic Principles 720
The Continuum of Injury Prevention 721
Epidemiologic Factors: Human or Host, Agent, and Environment 721
Conceptual Models 721
Haddon’s Ten Strategies for Reducing Injuries 721
Environmental, Educational, and Enforcement Approaches to Injury Prevention 721
Environmental Approach 722
Educational Approach 722
Enforcement Approach 722
Social-Ecologic Model 722
Risk and Effect Modification in Injury Prevention Epidemiology 723
Active Versus Passive Injury Prevention Strategies 723
Morbidity and Mortality Statistics for Wilderness Injury 723
Putting Injury Prevention Into Practice 724
Planning 724
Preparation 724
Physical Preparation. 724
Mental Preparation. 724
Equipment Preparation. 724
Problem Anticipation 724
Physical Disabilities 724
Individual Factors and Injury Prevention 725
Specific Tools for Planning and Preparation in the Wilderness 725
Maps and Orienteering 725
Global Positioning System Devices 725
Communication Devices 725
Protective Gear 726
Clothing. 727
Foot and Hand Wear. 727
Helmets. 728
Goggles. 728
Body Armor. 728
Mouth Guards. 728
Avalanche-Specific Protective Gear. 728
Training and Education 729
Supervision and Buddy Systems. 730
Problem Anticipation: Acute Illness and Injury 731
First-Aid Training. 731
Medical Clearance. 731
Vaccinations and Prophylaxis. 731
First-Aid or Emergency Medical Supplies. 731
Medications. 731
Improvisation in Treatment. 731
Injury Prevention for the Genitourinary Tract. 731
Injury Prevention for the Feet. 732
The Physical Environment and Injury Prevention 732
Ultraviolet Exposure 732
Temperature Extremes 733
Cold Injury 733
Heat Illness 734
Immersion (Trench) Foot and Pernio (Chilblains) 734
Wind and Rain 734
Water 735
Snow 735
Hydration 736
Altitude 738
Bites and Stings 738
Toxic Exposures 740
Water, Germs, and Hygiene 741
Unique Risks of Select Wilderness Activities 741
Backpacking 741
Backpacks with External Frames 741
Backpacks with Internal Frames 741
Backpack Lifting 741
Backpacks and Children 741
Hiking 741
Hammock Safety 742
Hunting 742
Horseback Riding 742
Climbing 742
References 742
References 743
5 Animals and Zoonoses 746
30 Bites and Injuries Inflicted by Wild and Domestic Animals 747
General Epidemiology 747
Typical Victim 748
Circ*mstances Surrounding and Prevention of Animal Bites: Animal Behavior 749
Basic Principles for Avoiding Animal Bites 749
Evaluation and Treatment of Injuries 751
Out-of-Hospital Care 751
Hospital Care 752
Wound Management 753
Wound Closure and Infection Risk Factors 753
Bites of the Hand 753
Puncture Wounds 754
Facial and Scalp Wounds 754
Follow-Up Care 754
Infection: Zoonoses and Rabies 754
Rabies 754
Other Neurotropic Infections 755
Indications for Wound Culture 755
Prophylactic Antibiotics 755
Tetanus Prophylaxis 755
General Complications 756
Septic Complications 756
Allergic Reactions 756
Psychiatric Consequences of Animal Attacks 756
Wild Animal Attacks 756
Canines 757
Coyotes 757
Wolves 757
Foxes 758
Hyenas 758
Other Canines 758
Felines 758
Tigers 759
Lions 759
Leopards 760
Jaguars 760
Cougars 760
Bobcats 761
Primates 761
Herbivores and Ungulates 762
Wild Swine 762
African Buffalo 762
American Bison 762
Elephant 763
Hippopotamus 764
Rhinoceros 764
Tapir 764
Moose and Elk 764
Deer 765
Yak and Dzo 765
Guanaco and Llama 765
Other Wild Herbivores 765
Bears 765
Kangaroos 765
Large Birds 765
Raccoons 766
Porcupines 766
Coatis 766
Quokkas 766
Opossums 766
Skunks 767
Bats 767
Venomous Mammals 767
Large Reptiles (See Chapters 35 and 36) 768
Marine Mammals 768
Seals 769
Walruses 769
Sea Lions 769
Elephant Seals 769
River Otters 769
Domestic Animal Attacks 770
Dogs 770
Cats 770
Rodents 771
Rats, Mice, and Other Small Rodents 771
Rabbits 771
Ferrets 771
Domestic Herbivores and Ungulates 772
Horses and Donkeys 772
Cattle 772
Camels 773
Domestic Swine 773
Birds 774
Medicolegal Considerations 774
Documentation of the Injury 774
References 774
References 775
31 Rabies 774
Current Status 774
The Rabies Virus 782
Other Lyssaviruses 782
Rabies Burden of Disease 782
Rabies IN the United States 783
Incidence In Humans 783
Rabies In Wild Terrestrial Animals 784
Rabies In Bats 785
Rabies In Domestic Animals 786
Sources of Human Infection 786
Rabies In Other Countries 789
Epidemiology 789
Sources of Human Infection 791
Features of Human Rabies 793
Mortality 793
Incubation Period 794
Pathogenesis of Central Nervous System Infection 794
Clinical Features 795
Subclinical Rabies 796
Undiagnosed Rabies 796
Basic Transmission 797
Risk Factors Associated with Disease Transmission 797
Laboratory Diagnosis of Rabies 797
Rabies In Attacking Animals 797
Therapy 798
PreExposure Prophylaxis 798
Postexposure Prophylaxis 799
Identifying Exposure 799
Initial Wound Management 800
Further PEP Measures Following Wound Care 801
Rabies Immune Globulin 801
Rabies Vaccines 802
Human Vaccination 803
Immunocompromised Individuals 804
PreExposure Vaccination 804
Rabies Therapy In Developing Countries 805
Rabies Considerations for Travelers 806
Wound Cleansing 806
Immune Globulin 806
Vaccine 806
PreExposure Vaccination 806
Children 806
Obtaining Medical Care 807
Other Lyssaviruses 807
Current Rabies Developments 808
Rabies Eradication In Wild Animals 808
Vaccine Developments 809
Replacements for Rabies Immune Globulin 809
Simpler Laboratory Tests for Rabies 809
Rabies Remains a Neglected Global Public Health Crisis 809
Acknowledgment 809
References 809
References 810
32 Bear Behavior and Attacks 815
North American Bears 815
Grizzly Bears 815
Black Bears 818
Polar Bears 819
Bears on Other Continents 819
Prevention and Risk Reduction 821
Avoiding an Encounter 821
Avoid Provoking an Attack 823
Reducing the Severity and Extent of Injuries 823
Preventing Predatory Behavior 824
Special Considerations 824
Menstruation 824
Sexual Activity 824
Pepper Spray 825
Firearms 825
Dogs 825
Horses 826
Hunter Safety 826
Bear-Induced Injuries 826
Wound Management 827
Antibiotic Therapy 827
Rabies 827
Acknowledgment 827
References 827
References 828
33 Alligator and Crocodile Attacks 829
Characteristics, Lifestyle, and Habits 829
Feeding and Predation Habits 829
Overview of Attacks 830
Treatment of Crocodilian Bites 832
First Aid 832
Hospital Management 833
Microbiology and Antimicrobials 833
Prevention of Crocodilian Attacks 833
If an Attack Occurs 834
References 834
References 835
34 Wilderness-Acquired Zoonoses 834
Anthrax 836
Bacteriology 836
Epidemiology 837
Transmission 837
Presentation and Symptoms 837
Diagnosis 837
Treatment 838
Prevention 838
Bartonella Infections 838
Bacillary Angiomatosis 838
Epidemiology 838
Symptoms 838
Diagnosis 839
Treatment 839
Prevention 839
Cat-Scratch Disease 839
Epidemiology 839
Transmission 839
Symptoms 839
Diagnosis 840
Treatment 840
Brucellosis 840
Bacteriology 840
Epidemiology 840
Symptoms 841
Diagnosis 841
Treatment 841
Glanders 841
Bacteriology 841
Epidemiology 842
Transmission 842
Symptoms 842
Equids 842
Humans 842
Diagnosis 842
Treatment 842
Prevention and Control 843
Leptospirosis 843
Bacteriology 843
Epidemiology 843
Transmission 844
Symptoms 844
Diagnosis 845
Treatment 846
Prevention 846
Melioidosis 846
Bacteriology 846
Epidemiology 846
Transmission 847
Symptoms 847
Diagnosis 847
Treatment 848
Prevention and Control 848
Rat-Bite Fever 848
Epidemiology 848
Streptobacillary Type 848
Symptoms 848
Diagnosis 848
Treatment 848
Spirillar Type 849
Symptoms 849
Diagnosis and Treatment 849
Plague 849
Bacteriology 849
Epidemiology 850
Transmission 850
Symptoms 852
Diagnosis 852
Treatment 853
Prophylaxis 853
Prevention 854
Tularemia 854
Bacteriology 854
Epidemiology 854
Transmission 855
Symptoms 855
Diagnosis 856
Treatment 856
Prevention 856
Avian/Swine Influenza 856
Virology 856
Epidemiology 857
Transmission 857
Symptoms and Diagnosis 857
Treatment and Prevention 857
Cowpox and Monkeypox Infections 858
Hantavirus Pulmonary (Cardiopulmonary) Syndrome 858
Virology 858
Epidemiology 858
Transmission 859
Symptoms 859
Diagnosis 859
Treatment 859
Prevention 860
Hendra Virus 860
Virology 861
Epidemiology and Transmission 861
Symptoms 861
Diagnosis and Treatment 861
Prevention and Control 861
Nipah Virus 861
Virology 861
Transmission 861
Symptoms 861
Diagnosis and Treatment 861
Cysticercosis (Taeniasis) 861
Parasitology and Transmission 862
Taenia solium 862
Taenia saginata 863
Epidemiology 863
Symptoms 863
Diagnosis 863
Treatment 864
Prevention and Control 864
Echinococcosis 865
Parasitology and Transmission 865
Epidemiology 866
Echinococcus granulosus 866
Echinococcus multilocularis 866
Echinococcus vogeli and E. oligarthrus 866
Symptoms 866
Echinococcus granulosus (Cystic Hydatidosis) 866
Echinococcus multilocularis (Alveolar Hydatidosis) 866
Echinococcus vogeli and E. oligarthrus 866
Diagnosis 866
Echinococcus granulosus 867
Echinococcus multilocularis 867
Treatment 867
Prevention and Control 867
Trichinellosis 867
Historical Aspects 867
Life Cycle 868
Epidemiology and Transmission 868
Symptoms 869
Diagnosis 870
Treatment 870
Prevention 870
Variant Creutzfeldt-Jakob Disease 870
Historical Aspects 870
Biology 871
Epidemiology 871
Transmission 871
Symptoms and Diagnosis 871
Treatment and Prevention 871
Acknowledgment 871
References 871
References 872
35 Bites by Venomous Reptiles in Canada, the United States, and Mexico 879
Venomous Snakes 879
Scope of the Problem 879
Anatomy 884
Pit Vipers 884
Coral Snakes 886
Venoms 887
Pit Vipers 887
Coral Snakes 889
Clinical Presentation 889
Pit Vipers 889
Coral Snakes 891
Management 891
Prehospital Care 891
Pit Vipers. 891
Coral Snakes. 893
Hospital Care 893
Pit Vipers 893
Initial Management. 893
Analgesia and Wound Care. 895
Disposition. 896
Coral Snakes. 896
General Concepts of Antivenom Therapy 898
Brief History 898
Antivenom Production 898
Indications for Antivenom 900
Antivenom Administration 901
Adverse Reactions to Antivenoms 901
Special Snakebite Scenarios 901
Allergy to Reptile Venom 901
Bites in Children 901
Bites in Pregnant Women 901
Exotic Snakebites 902
Injuries Caused by Giant Snakes 902
Morbidity and Mortality 902
Pit Vipers 902
Coral Snakes 907
Venomous Lizards 908
Scope of the Problem 908
Anatomy 908
Venoms 908
Clinical Presentation 908
Management 909
Prehospital Care 909
Hospital Care 909
Morbidity and Mortality 910
Considerations before Going Into the Wilderness 910
References 910
References 911
36 Bites by Venomous and Nonvenomous Reptiles Worldwide 910
Dangerous Reptiles 910
Venomous Snakes 910
Taxonomic Revolution 910
Identification of Venomous Snakes 916
Distinguishing Snakes From Legless Lizards, Amphibians, and Snake-Like Fish 916
Distinguishing Venomous From Nonvenomous Snakes 917
Mimics, Misidentification, and Mismanagement 919
Fangs and Venom Apparatus 921
Colubroidea: Natricidae, Colubridae, Dipsadidae 921
Elapoidea: Lamprophiidae, Subfamily Atractaspidinae 923
Elapoidea: Elapidae 923
Spitting Elapids. 924
Viperidae 924
Venom Composition 924
Enzymes 924
Necrotoxins 925
Neurotoxins 925
Postsynaptic Three-Finger-Fold Neurotoxins 925
Presynaptic Phospholipase A2 Neurotoxins 925
Mamba Toxins 925
Krait Bungarotoxins 925
Cardiovascular Toxins 925
ACE Inhibitors and Bradykinin-Potentiating Peptides 925
Sarafotoxins 925
Natriuretic Peptides 925
Pain-Producing Toxins 925
Biogenic Amines 925
Venom Potency and Lethality 925
Variations in Quantity and Composition of Venom Injected by Snakebite 926
Intraspecies Variation in Venom Composition 927
Effect of the Site, Depth, and Number of Bites 927
Epidemiology of Snakebite 927
Snake Species Responsible for Most Bites 927
Distribution of Venomous Snakes 928
Snakebite Mortality and Morbidity 929
Americas (Central, South, and the Caribbean) 929
Brazil 931
Costa Rica 931
Asia 931
Bangladesh 931
India 931
Japan 932
Myanmar (Burma) 932
Sri Lanka 932
Thailand 932
Africa 932
Burkina Faso 932
Nigeria 932
Senegal 932
Kenya 932
South Africa 932
Oceania 932
Europe 932
Snakebite as an Occupational Disease 932
Bites by Snakes Kept in Captivity 933
Risk to Wilderness Travelers 933
Circ*mstances in Which Snakebites Occur 933
Clinical Features of Envenoming and Pathophysiologic Mechanisms 934
Local Signs at the Site of the Bite 934
Pathophysiology 934
Signs of Systemic Envenoming 934
Hypotension and Shock 934
Pathophysiology. 935
Bleeding and Clotting Disturbances 935
Pathophysiology. 935
Procoagulant Enzymes. 935
Thrombin-like Enzymes. 936
Anticoagulant Activity. 936
Platelet Activation or Inhibition and Thrombocytopenia. 936
Hemorrhagins. 938
Complement Activation. 938
Neurotoxicity 938
Pathophysiology. 938
Myotoxicity 939
Pathogenesis. 939
Acute Kidney Injury 939
Pathophysiology 939
Clinical Pattern of Envenoming by Different Taxa of Venomous Snakes 941
Colubroidea (Back-Fanged Snakes) 941
Species Capable of Causing Fatal Envenoming 941
Other Species Capable of Causing Systemic Envenoming 942
Species Capable of Causing Local Envenoming 943
Atractaspidinae, Genus Atractaspis (Burrowing Asps or Stiletto Snakes) (See Figures 36-30 and 36-38) 943
Elapidae 944
Neurotoxic Elapidae 944
Envenoming by Asian Nonspitting Cobras (Naja naja, N. kaouthia , N. oxiana, N. philippinensis, N. atra, etc.) and Spitting Cobras 945
Envenoming by Mambas (Genus Dendroaspis) 945
Envenoming by African Neurotoxic Cobras (Naja anchietae, N. annulifera, N. haje, N. melanoleuca, N. nivea, and N. senegalensis) (Figure 36-71) 946
Envenoming by the King Cobra (Ophiophagus hannah) (See Figure 36-15) 946
Envenoming by Asian Kraits (Genus Bungarus) (See Figures 36-20B and C, and Figure 36-21B) 946
Envenoming by Australian and New Guinean Elapids (Figure 36-75) 947
Envenoming by American Coral Snakes (See Figures 36-23 and 36-25) 948
Envenoming by Sea Snakes (Hydrophiinae) and Sea Kraits (Laticaudinae) (Figures 36-78 and 36-79; see also Figures 36-46 to 36-48) 948
Cytotoxic Elapidae 949
Envenoming by African Spitting Cobras (Genus Naja) (Figure 36-80; See Figures 36-10 and 36-33). 949
Envenoming by Asian Cobras (Genus Naja) (Figure 36-82). 949
Snake Venom Ophthalmia. 949
Viperidae (Old World Vipers and Adders, Asian and Latin American Pit Vipers) 950
Systemic Envenoming: Hemostatic Abnormalities 950
Circulatory Shock (Hypotensive) Syndromes 953
Neurotoxicity 953
Viperinae 953
Europe 953
Envenoming by European Vipers (Figure 36-86). 953
Clinical Features of the European Adder (Vipera berus) Bite. 954
Africa 956
Envenoming by Saw-Scaled or Carpet Vipers (Genus Echis) (Figure 36-88; see also Figures 36-14A and 36-18C). 956
Envenoming by African Puff Adders (Bitis arietans) (Figure 36-90; see also Figure 36-11). 956
Envenoming by Giant Rain Forest Vipers or Adders (Bitis gabonica, Bitis rhinoceros, and Bitis nasicornis) (Figure 36-92; see also Figure 36-34B). 958
Envenoming by the Berg Adder (Bitis atropos). 958
Envenoming by Bush Vipers (Genera Atheris, Proatheris, and Others) (Figure 36-94). 958
Envenoming by Desert Vipers (Genus Cerastes) (Figure 36-95). 960
Asia 960
Envenoming by Saw-Scaled or Carpet Vipers (Genus Echis) (See Figure 36-89A to C). 960
Envenoming by Western and Eastern Russell’s Vipers (Daboia russelii and D. siamensis) (See Figure 36-13). 961
Sri Lanka. 962
India. 962
Myanmar. 963
Thailand. 964
Pit Vipers (Crotalinae) 964
Envenoming by Japanese and Chinese Mamushis (Gloydius [Agkistrodon] blomhoffii, G. brevicaudus, and others) (Figure 36-98) 964
Envenoming by the Malayan Pit Viper (Calloselasma rhodostoma) (Figure 36-99) 964
Envenoming by Asian Arboreal Pit Vipers (Genera Trimeresurus [Trimeresurus], Trimeresurus [Viridovipera], Trimeresurus [Craspedocephalus], Protobothrops, and Others) (See Figures 36-40 and 36-41) 965
Envenoming by Latin American Pit Vipers (Genera Bothrops, Bothriopsis, Crotalus, Lachesis) 965
Agkistrodon, Bothrops (Bothriopsis), and Others (Figure 36-102; see also Figures 36-7, 36-22E and 36-34A). 965
Crotalus (Figure 36-104; see also Figure 36-16). 966
Lachesis (See Figure 36-36). 966
Course and Sequelae of Envenoming 967
Risk of Envenoming: The “Dry Bite” Phenomenon 967
Risk of Death 967
Interval between Bite and Death 967
Rate of Evolution and Recovery of Envenoming 967
Chronic Sequelae of Snakebite 969
Laboratory Investigations 970
Hematology 970
Twenty-Minute Whole-Blood Clotting Test 970
Other Tests of Hemostasis 970
Evidence of Muscle Damage 971
Evidence of Intravascular Hemolysis 971
Evidence of Renal Dysfunction and Acid-Base Imbalance 971
Electrocardiographic Abnormalities 971
Chest Radiography 971
Imaging 971
Ultrasound 971
Immunodiagnosis 971
Management of Snakebite 971
First-Aid Treatment 971
Principles of First Aid 971
Pressure-Immobilization Methods 971
Anker’s (Monash) Pressure-Pad Method (Figure 36-108A). 971
Sutherland’s Pressure-Immobilization Bandage Method (Figure 36-108B). 972
Transcutaneous Glyceryl Trinitrate 972
Rejected or Controversial First-Aid Methods 973
Dangers of Tight Tourniquets 973
Treatment before Patient Reaches the Hospital 973
Early Symptoms 973
Local Pain. 973
Vomiting. 973
Syncopal Attacks and Anaphylactic Shock. 973
Respiratory Distress. 974
Examination of Pregnant Women 974
Medical Treatment in the Hospital 974
Need for Rapid Assessment and Resuscitation 974
Clinical Assessment 974
Early Clues That a Patient May Be Severely Envenomed 975
Antivenom 975
Indications for Antivenom 975
Systemic Envenoming 975
Severe Local Envenoming 975
Special Indications for Antivenom in Specific Areas 975
Europe (Adder [Vipera berus] and Other European Vipera). 975
Contraindications to Antivenom Treatment 975
Choice of Antivenom in a Particular Case: Monovalent and Polyvalent Antivenoms 975
Conservation of Antivenom and Expiration Dates 975
Supply of Antivenoms 977
Antivenom Reactions 977
Early Anaphylactic Type of Reactions. 977
Pyrogenic Reactions. 978
Late (Serum Sickness–Type) Reactions. 978
Prediction of Antivenom Reactions. 978
Prevention of Early Antivenom Reactions. 978
Antivenom Administration 978
Route of Administration. 978
Snakebite in Remote (Wilderness) Locations. 978
Dose of Antivenom. 978
Recurrent Envenoming. 978
Repeated Dosing. 978
The “6-Hour Rule.” 978
Supportive Treatment 979
Neurotoxic Envenoming 979
Artificial Ventilation. 979
Bulbar and Respiratory Muscle Paralysis. 979
Anticholinesterase Drugs.* 979
Hypotension and Shock 980
Acute Kidney Injury 980
Local Infection 980
Snake-Bitten Limbs 980
Surgical Management 980
Compartment Syndrome and Fasciotomy. 980
Inappropriate Treatments 980
Treatment of Snake Venom Ophthalmia 981
Prevention of Snakebite 981
Venomous Lizards 981
Dangerous Large Reptiles 982
Giant Pythons (Family Boidae) 982
Komodo Dragon (Monitor) 982
References 983
Internet Resources 983
Snakebite Management and Antivenoms 983
Antivenoms Only 983
Venomous Snake Taxonomy Updates 983
References 984
37 Ranch and Rodeo Medicine 983
Ranch Medicine 983
History and Perspective 983
Epidemiology of Agricultural Disease and Injury 983
Pediatric Injuries 991
Emergency Medical Services and Triage 991
Identification and Understanding of Illness and Injury 991
Local Medical Care and Regional Tertiary Care Centers 991
Emergency Medical Services Activation 991
Unique Injuries and Medical Management 992
Confined Spaces 992
Simple Asphyxiants 992
Manure Pits and Grain Bins. 992
Silos. 992
Clinical Presentation. 992
Differential Diagnosis. 992
Treatment. 993
Sequelae and Aftercare. 993
Pulmonary Irritants (Manure Pits, Silos, Grain Bins) 993
Manure Pits. 993
Silo Filler’s Disease 993
Clinical Presentation. 993
Differential Diagnosis. 993
Diagnostic Tests. 993
Treatment. 994
Sequelae and Aftercare. 994
Prevention. 994
Grain Storage Bin Entrapment 994
Clinical Presentation. 994
Diagnostic Tests. 995
Grain Bin Rescue. 995
Sequelae and Aftercare. 995
Hypersensitivity Pneumonitis 995
Clinical Presentation. 995
Differential Diagnosis. 995
Diagnostic Tests. 995
Treatment. 995
Organic Dust Toxic Syndrome 995
Clinical Presentation. 996
Differential Diagnosis. 996
Diagnostic Tests. 996
Treatment and Prevention. 996
Sequelae and Aftercare. 996
Lacerations 996
Clinical Presentation. 996
Differential Diagnosis. 996
Diagnostic Tests. 996
Treatment and Prevention. 996
Sequelae and Aftercare. 996
Farm Equipment 996
All-Terrain Vehicles 996
Prevention. 997
Tractors 997
Clinical Presentation. 997
Rescue. 997
Treatment. 997
Prevention. 997
Drivelines, Augers, and Power Takeoffs 997
Clinical Presentation. 998
Treatment. 998
Sequelae and Aftercare. 998
Prevention. 998
Farm Supplies 998
Chemicals 998
Fertilizer 998
Anhydrous Ammonia. 998
Clinical Presentation. 998
Differential Diagnosis. 998
Diagnostic Tests. 998
Treatment. 998
Sequelae and Aftercare. 998
Prevention. 999
Pesticides 999
Herbicides 999
Glyphosate. 999
Clinical Presentation. 999
Diagnostic Tests. 999
Treatment. 999
Sequelae and Aftercare. 999
Insecticides 999
Organophosphates and Carbamates. 999
Pharmacology. 999
Clinical Presentation. 999
Management. 999
Antidotes. 999
Sequelae and Aftercare. 999
Pyrethroid Pesticides 999
Clinical Presentation. 999
Diagnostic Tests. 1000
Treatment. 1000
Rodeo Medicine 1000
History and Perspective 1000
Health Care Providers and Medical Coverage at Rodeos 1000
Justin Sportsmedicine Team 1000
Epidemiology of Rodeo Injury 1001
Injury Incidence by Rodeo Event 1001
Injury by Body Region 1001
Upper-Body Injuries 1001
Pectoralis Major Ruptures in Steer Wrestling 1001
Clinical Presentation. 1001
Differential Diagnosis. 1002
Diagnostic Tests. 1002
Treatment. 1002
Sequelae and Aftercare. 1002
Prevention. 1002
Latissimus Dorsi Muscles in Steer Wrestling 1002
Clinical Presentation. 1002
Differential Diagnosis. 1002
Diagnostic Tests. 1002
Treatment. 1004
Sequelae and Aftercare. 1004
Prevention. 1004
Distal Biceps Tendon Rupture 1004
Clinical Presentation. 1004
Differential Diagnosis. 1004
Diagnostic Tests. 1004
Treatment. 1005
Sequelae and Aftercare. 1005
Prevention. 1005
Thumb Amputation 1005
Clinical Presentation. 1005
Diagnostic Tests. 1005
Treatment. 1005
Prevention. 1005
Head Injury and Concussion 1005
Protective Headgear 1006
References 1006
References 1007
38 Emergency Veterinary Medicine 1011
Dogs 1011
Canine Physiology and Physical Examination 1011
Temperature 1011
Cardiac Evaluation 1011
Mucous Membrane Color 1011
Capillary Refill Time 1011
Pulse 1011
Hydration Status 1011
Canine First-Aid Kit 1011
Basic Dog-Handling Techniques 1011
Administering Oral Medications 1011
Muzzle 1012
Manual Restraint 1012
Bandaging Techniques 1012
Covering Open Wounds 1012
Bandaging of Feet 1012
Bandaging of Limbs 1012
Bandaging of Trunk 1013
Tie-Over Bandages 1013
Splints and Casts 1014
Toenail Injuries 1015
Lacerations 1015
Stapling, Suturing, and Gluing Wounds 1016
Tail Injuries 1016
Spinal Injuries 1016
Fractures 1016
Myelopathies 1016
Ocular and Periocular Injuries 1016
Gunshot Wounds 1016
Fluids 1016
Endotracheal Intubation 1017
Cardiopulmonary Resuscitation 1017
Chest Compression Techniques 1017
Small Dog. 1017
Medium or Large Dog. 1017
Respirations 1017
Toxicity 1017
Common Canine Toxins 1017
Xylitol 1017
Mushroom Toxicosis 1017
Blue-Green Algae Intoxication 1018
Castor Bean Toxicosis 1018
Ethylene Glycol (Antifreeze) Toxicosis 1018
Grape/Raisin Toxicosis 1018
Lead Toxicosis 1018
Oleander Toxicosis 1018
Onion Toxicosis 1018
Palm (Sago/Cycad) Toxicosis 1018
Toad Intoxication 1018
Sled Dogs 1019
Heatstroke 1019
Snakebite 1019
Laryngeal Paralysis 1019
Porcupine Quills 1019
Grass Awns 1020
Anaphylaxis 1020
Drowning 1020
Frostbite 1020
Gastric Dilation and Volvulus (“Bloat”) 1020
Infectious Diseases 1021
Rabies 1021
Botulism 1021
Tetanus 1021
Tick Paralysis 1021
Leptospirosis 1021
Rocky Mountain Spotted Fever 1021
Giardiasis 1021
Large Animals 1021
Use and Care of Large Animals in the Wilderness 1021
Loading Guidelines for Large Animals 1023
Physical Examination 1023
Food and Water Requirements 1025
Large-Animal Restraint 1025
Local Anesthesia 1025
Medication Guidelines 1026
Tracheostomy 1026
Limb-Bandaging and Limb-Splinting Techniques 1027
Wounds 1028
Saddle, Cinch, and Rigging Sores 1029
Musculoskeletal Injuries and Lameness 1029
Colic 1029
Esophageal Obstruction 1030
Internal and External Parasites 1030
Respiratory System 1031
Gunshot Wounds 1031
Drowning 1031
Heat Stress 1031
Hypothermia and Frostbite 1031
Altitude 1032
Toxic Plants 1032
Euthanasia of Large Animals 1033
Infectious Diseases 1033
Neurologic Diseases 1033
Lyme Disease 1034
Rabies 1034
Botulism 1034
Tetanus 1034
Leptospirosis 1034
Potomac Horse Fever 1034
Snakebite 1034
Ophthalmologic Emergencies 1034
References 1034
References 1035
6 Insects and Arachnids 1036
39 Mosquitoes and Mosquito-Borne Diseases 1037
Mosquitoes 1037
Mosquito Anatomy 1037
Mosquito Life Cycle 1037
Mechanism of Mosquito Bites 1037
Pathophysiology and Clinical Manifestations of Mosquito Bites 1038
Diseases Caused by Mosquitoes 1039
Dengue 1039
Epidemiology and Transmission 1039
Clinical Presentation 1041
Diagnosis 1042
Treatment and Prevention 1043
Yellow Fever 1043
Epidemiology and Transmission 1043
Clinical Presentation 1045
Diagnosis. 1045
Treatment and Prevention 1046
Japanese Encephalitis 1047
Epidemiology and Transmission 1047
Clinical Presentation 1048
Diagnosis 1048
Treatment and Prevention 1048
West Nile Virus 1049
Epidemiology and Transmission 1049
Clinical Presentation 1049
Diagnosis 1050
Treatment and Prevention 1051
Surveillance and Reporting. 1051
St Louis Encephalitis 1051
Epidemiology and Transmission 1051
Clinical Presentation 1051
Diagnosis 1051
Treatment and Prevention 1051
Eastern Equine Encephalitis 1051
Epidemiology and Transmission 1051
Clinical Presentation 1052
Diagnosis 1052
Treatment and Prevention 1052
Surveillance and Reporting 1052
Murray Valley Encephalitis 1052
Epidemiology and Transmission 1052
Clinical Presentation 1052
Diagnosis 1052
Treatment and Prevention 1052
California (LA Crosse) Encephalitis 1053
Epidemiology and Transmission 1053
Clinical Presentation 1053
Diagnosis 1053
Treatment and Prevention 1053
Ross River Virus 1053
Epidemiology and Transmission 1053
Clinical Presentation 1053
Diagnosis 1053
Treatment and Prevention 1053
Jamestown Canyon Virus 1054
Chikungunya Virus 1054
Epidemiology and Transmission 1054
Clinical Presentation 1054
Diagnosis 1055
Treatment and Prevention 1055
Zika Virus 1055
Modes of Transmission 1055
Clinical Manifestations 1055
Acute Illness. 1055
Microcephaly. 1055
Testing 1055
Pregnant Mothers and Their Partners. 1055
Infants. 1056
Prevention and Treatment 1056
Mosquito Control 1056
General Guidelines for Individual Protection 1056
Global Eradication Programs for Mosquitoes 1056
Acknowledgements 1057
References 1057
References 1058
40 Malaria 1063
Epidemiology 1063
Malaria Parasite 1063
Mosquito Vector 1063
Life Cycle 1063
Recurrent and Persistent Infections 1072
Other Modes of Transmission 1072
Clinical Manifestations and Pathogenesis 1072
Susceptible Populations 1072
Major Clinical Findings 1073
Complications of Infection with P. falciparum 1073
Complications of Infection with P. vivax and P. ovale 1076
Complications of Infection with P. malariae 1077
Complications of Infection with P. knowlesi 1077
Diagnosis 1077
History 1077
Blood Smears 1077
Blood Smear Preparation 1077
Blood Smear Examination 1078
Parasite Density 1083
Antibody-Based Rapid Diagnostic Tests 1083
Other Diagnostic Methods 1083
Prevention 1084
Counseling 1084
Personal Protective Measures 1085
Chemoprophylaxis 1085
Medications Used for Malaria Chemoprophylaxis 1086
Atovaquone-Proguanil. 1089
Chloroquine and Hydroxychloroquine. 1089
Doxycycline. 1090
Mefloquine. 1090
Primaquine. 1090
Travelers to Areas with Mainly P. vivax Malaria 1090
Travelers to Areas with Chloroquine-Sensitive Malaria 1090
Travelers to Areas with Chloroquine-Resistant Malaria 1090
Travelers to Areas with Mefloquine-Resistant Malaria 1090
Prevention of Relapses with P. vivax and P. ovale 1090
Chemoprophylaxis for Infants, Children, and Adolescents 1090
Chemoprophylaxis during Pregnancy 1091
Chemoprophylaxis While Breastfeeding 1091
Changing Medications during Chemoprophylaxis Because of Side Effects 1091
Medications Acquired Overseas 1091
Treatment 1091
Reliable Supply Regimens for Presumptive Self-Treatment 1091
Treatment of Uncomplicated Malaria 1094
P. falciparum, or a Species Not Identified, Acquired in Areas with Chloroquine-Sensitive Malaria 1094
P. falciparum, or Species Not Identified, Acquired in Areas with Chloroquine-Resistant Malaria 1094
P. malariae and P. knowlesi 1096
P. vivax and P. ovale 1102
Pregnant Women 1102
Treatment of Severe Malaria 1102
Supportive Care for Severe Malaria 1102
Research and Vaccine Development 1102
Resources 1106
Centers for Disease Control and Prevention 1107
World Health Organization 1107
References 1107
References 1108
41 Arthropod Envenomation and Parasitism 1110
Hymenoptera (Bees, Wasps, and Ants) 1110
Bees 1110
Wasps 1111
Ants 1113
Hymenoptera Stinging Patterns 1115
Venom and Venom Apparatus 1115
Clinical Aspects 1116
Treatment and Prevention 1118
Immunotherapy 1118
Antivenom Therapy and Future Interventions 1119
Preparedness and Preventive Measures 1119
Lepidoptera 1119
Venomous Species and Venoms 1119
Stinging Patterns 1121
Clinical Aspects 1121
Treatment and Prevention 1122
Centipedes and Millipedes 1123
Millipedes 1124
Hemiptera (Sucking Bugs) 1124
Clinical Aspects 1125
Treatment and Prevention 1126
Beetles and Other Insects 1126
Diptera (Two-Winged Flies) 1127
Biting Midges (Culicoides) 1129
Blackflies (Simuliidae) 1129
Horseflies and Deerflies (Tabanidae) 1129
Other Biting Diptera 1129
Myiasis 1130
Furuncular Myiasis 1130
Hematophagous Myiasis 1132
Migratory Myiasis 1132
Wound Myiasis 1132
Lice (Order Anoplura) 1134
Species, Life Cycle, and Distribution 1134
Clinical Aspects 1134
Treatment and Prevention 1135
Louse-Borne Relapsing Fever 1136
Fleas (Order Siphonaptera) 1136
Species, Life Cycle, and Distribution 1136
Burrowing Flea 1136
Clinical Aspects 1136
Treatment and Prevention 1136
Mites (Class Arachnida, Order Acarina) 1137
Species, Life Cycle, and Distribution 1137
Scabies 1137
Life Cycle 1137
Clinical Aspects 1138
Treatment and Prevention 1139
Zoonotic Scabies 1139
Trombiculid Mites 1140
Miscellaneous Mites 1140
Parasitiformes. 1140
Acariniformes. 1140
General Treatment of Insect Bites 1141
Protection and Prevention 1141
Delusions of Parasitosis 1141
Conclusion 1141
References 1142
References 1143
42 Tick-Borne Diseases 1142
Ixodid Ticks 1150
Argasid Ticks 1151
Ticks as Poisonous Arthropods 1152
Tick Paralysis 1152
Tick Bite Red Meat Allergy 1153
Pajaroello Tick Bites 1153
Ticks as Vectors of Infectious Diseases 1153
Tick-Borne Borrelial Diseases 1154
Lyme Disease 1154
Epidemiology 1155
Clinical Manifestations 1155
Early Localized Disease (Stage I). 1156
Early Disseminated Disease (Stage II). 1157
Dermatologic Disease. 1157
Neurologic Disease. 1157
Gastrointestinal Disease. 1157
Cardiac Disease. 1157
Rheumatologic Disease. 1157
Late Disease (Stage III). 1158
Dermatologic Disease. 1158
Neurologic Disease. 1158
Rheumatologic Disease. 1158
Posttreatment Lyme Disease Syndrome. 1158
Lyme Disease in Pregnancy. 1158
Diagnosis 1158
Treatment 1160
Southern Tick-Associated Rash Illness 1161
Relapsing Fevers 1161
Tick-Borne Relapsing Fever 1161
Epidemiology 1162
Clinical Manifestations 1162
Antigenic Variation. 1162
Diagnosis 1163
Treatment 1163
Tick-Borne Viral Diseases 1163
Colorado Tick Fever 1163
Tick-Borne Encephalitis 1164
North American Tick-Borne Encephalitis Viral Diseases 1164
Crimean-Congo Hemorrhagic Fever 1164
Severe Fever and Thrombocytopenia Syndrome 1165
Heartland Viral Disease 1165
Tick-Borne Rickettsial Diseases 1165
Spotted Fever Group Rickettsial Diseases 1165
Rocky Mountain Spotted Fever 1166
Epidemiology. 1166
Pathophysiology. 1167
Clinical Manifestations and Diagnosis. 1167
Diagnosis. 1168
Treatment. 1168
Mediterranean Spotted Fever 1168
Siberian Tick Typhus 1169
African Tick Bite Fever 1169
Queensland Tick Typhus 1169
Q Fever 1169
Ehrlichiosis and Anaplasmosis 1169
Ehrlichiosis 1170
Anaplasmosis (Formerly Human Granulocytic Ehrlichiosis) 1170
Clinical Features of Ehrlichiosis and Anaplasmosis 1170
Diagnosis 1171
Treatment 1171
Babesiosis 1171
Epidemiology 1171
Pathogenesis 1172
Clinical Manifestations 1172
Diagnosis 1173
Treatment and Prevention 1173
Tularemia 1173
Tick-Borne Disease Prevention and Awareness 1173
References 1174
References 1175
43 Spider Bites 1174
Spiders and Their Venoms 1174
General Assessment and Treatment of Spider Bites 1183
Guide to Spider Diversity and Identification 1188
Suborder Mygalomorphae 1189
Family Theraphosidae: Tarantulas and Baboon Spiders 1189
Venom 1189
Urticating Hairs 1190
Clinical Presentation 1190
Treatment 1190
Family Hexathelidae: Funnel-Web Mygalomorphs 1191
Genus Atrax/Hadronyche 1191
Biology. 1191
Venom. 1191
Clinical Presentation. 1192
Treatment. 1192
Family Dipluridae: Funnel-Web Mygalomorphs 1192
Genus Trechona 1192
Biology. 1192
Venom. 1192
Clinical Presentation. 1192
Treatment. 1192
Family Actinopodidae 1192
Genus Missulena: Mouse Spiders 1192
Biology. 1192
Venom. 1193
Clinical Presentation. 1193
Treatment. 1193
Suborder Araneomorphae 1193
Family Sicariidae: Recluse Spiders 1193
Genus Loxosceles: Brown or Fiddle Spiders 1193
Biology. 1193
Venom. 1194
Clinical Presentation. 1194
Treatment. 1196
Genus Sicarius: Six-Eyed Crab Spiders 1197
Biology. 1197
Venom. 1197
Clinical Presentation. 1197
Treatment. 1197
Family Pholcidae: Cellar Spiders or Daddy Longlegs 1197
Family Desidae: Long-Jawed Intertidal Spiders 1197
Genus Badumna: Black House Spider 1197
Biology. 1197
Venom. 1197
Clinical Presentation. 1198
Treatment. 1198
Family Zodariidae: Hunting Spiders 1198
Family Gnaphosidae: Ground Spiders and Mouse Spiders 1198
Treatment. 1198
Family Lamponidae: White-Tailed Spiders 1198
Genus Lampona 1198
Biology. 1198
Venom. 1198
Clinical Presentation. 1198
Treatment. 1198
Family: Sparassidae: Crab Spiders and Hunting Spiders 1198
Biology 1198
Venom 1198
Clinical Presentation 1198
Treatment 1198
Family Oxyopidae: Lynx Spiders 1199
Genus Peucetia 1199
Biology. 1199
Venom. 1199
Clinical Presentation. 1199
Treatment. 1199
Family Salticidae: Jumping Spiders 1199
Family Ctenidae: Wandering Spiders 1199
Genus Phoneutria: Banana Spiders (Armed Spiders) 1199
Biology. 1199
Venom. 1199
Clinical Presentation. 1199
Treatment. 1200
Family Lycosidae: Wolf Spiders 1200
Genus Lycosa: Wolf Spiders 1200
Biology. 1200
Venom. 1200
Clinical Presentation. 1200
Treatment. 1200
Family Eutichuridae: Sac Spiders 1200
Genus Cheiracanthium: Running Spiders and Sac Spiders 1200
Biology. 1200
Venom. 1201
Clinical Presentation. 1201
Treatment. 1201
Family Corinnidae: Sac Spiders 1201
Family Agelenidae: Hobo, Grass, and Funnel-Web Spiders 1201
Genus Eratigena (Formerly Tegenaria): Hobo Spiders 1201
Biology. 1201
Venom. 1201
Clinical Presentation. 1201
Treatment. 1202
Genus Agelenopsis: Grass Spiders and Funnel-Web Spiders 1202
Biology. 1202
Venom. 1202
Clinical Presentation. 1202
Treatment. 1202
Family Theridiidae: Comb-Footed Spiders 1202
Genus Latrodectus: Widow Spiders 1202
Biology. 1202
Venom. 1203
Clinical Presentation. 1203
Treatment. 1204
Genus Steatoda: False Widow Spiders 1204
Biology. 1204
Venom. 1205
Clinical Presentation. 1205
Treatment. 1205
Genus Parasteatoda (Formerly Achaearanea): Grey House Spiders 1205
Biology. 1205
Venom. 1205
Clinical Presentation. 1205
Treatment. 1205
Family Araneidae: Orb-Weaving Spiders 1205
Genus Araneus 1205
Biology. 1205
Clinical Presentation. 1205
Treatment. 1205
Genus Argiope: Argiopes 1205
Biology. 1205
Venom. 1205
Clinical Presentation. 1205
Treatment. 1205
References 1205
References 1206
44 Scorpion Envenomation 1212
Scorpion Biology 1212
Venom 1212
Regional Considerations: Epidemiology, Risk Factors, and Treatment 1212
North Africa 1213
Morocco 1213
Algeria 1214
Tunisia 1214
Southern Africa 1215
Asia 1215
Turkey 1215
Israel 1216
Saudi Arabia 1216
Iran 1217
India 1217
Australia 1218
South America 1218
Colombia 1218
Venezuela 1218
Trinidad 1218
Brazil 1218
Argentina 1218
North America 1218
Mexico 1218
United States 1219
Centruroides sculpturatus Envenomation. 1220
Pathophysiology and Clinical Effects 1222
Cardiovascular Effects 1222
Respiratory Effects 1222
Neurologic Effects 1222
Gastrointestinal Effects 1223
Pancreatitis 1223
Other Gastrointestinal Effects 1223
Endocrine and Other Humoral Effects 1223
Genitourinary Effects 1223
Hematologic Effects 1223
Immunologic Effects 1223
Differential Diagnosis 1224
Treatment 1224
Pharmacologic Therapy 1224
Antivenom 1225
Treatment in Austere Environments 1226
Antivenom Administration Recommendations 1226
Prevention 1227
References 1227
References 1228
45 Protection from Blood-Feeding Arthropods 1227
Mosquitoes (Family Culicidae) 1227
Blackflies (Family Simuliidae) 1232
Biting Midges (Family Ceratopogonidae) 1234
Tabanids (Family Tabanidae) 1234
Sand Flies (Family Psychodidae) 1234
Tsetse Flies (Family Glossinidae) 1234
Stable Flies (Family Muscidae) 1234
Kissing Bugs (Family Reduviidae) 1234
Fleas (Family Pulicidae) 1234
Chigger Mites (Family Trombiculidae) 1234
Ticks (Families Ixodidae and Argasidae) 1235
Personal Protection 1235
Habitat Avoidance 1235
Physical Protection 1235
Repellents 1236
Chemical Repellents 1237
DEET. 1237
Picaridin. 1239
IR3535 (Ethyl-butylacetylaminopropionate). 1239
Botanical Repellents 1239
BiteBlocker. 1240
BioUD (2-Undecanone). 1240
Lemon Eucalyptus. 1240
Citronella. 1240
Efficacy of DEET Versus Botanical Repellents 1241
Alternative Repellents 1241
Permethrin 1241
Reducing Local Mosquito Populations 1241
Integrated Approach to Personal Protection 1242
References 1242
References 1243
7 Surgical and Medical Interventions 1248
46 Improvised Medicine in the Wilderness 1249
General Assessment and Vital Signs 1249
Height 1249
Weight 1249
Pulses in Adults and Children 1249
Radial Pulse and Trauma Prognosis 1249
Blood Pressure 1249
Blood Pressure without a Cuff 1249
Blood Pressure without a Stethoscope 1250
Wrist and Calf Blood Pressure Measurements 1250
Improvised Diagnostic Equipment and Supplies 1250
Stethoscopes 1250
Ear to Patient 1250
Improvised Standard Stethoscopes 1250
Precordial Stethoscope 1251
Stethoscope Earpiece 1251
Improvised Treatment Equipment and Supplies 1252
Gowns, Gloves, Masks, Booties, and Goggles 1252
Standard Precautions 1252
Gowns 1252
Caps and Masks 1252
Eye Protection 1252
Booties, Shoes, and Vapor Barrier Liners 1252
Syringes, Needles, and Intravenous Equipment 1252
Saline Locks 1252
Intravenous Tubing 1252
Pressure for Intravenous Fluids and Blood Bags 1252
Improvised Airway Management (See Chapter 19) 1252
Positioning for Safe Airway 1252
Opening the Airway 1252
Chin Lift–Jaw Thrust 1252
Head Turn 1252
Positioning the Tongue 1252
Nasal Airways 1253
Mouth-to-Mouth Rescue Breathing Barrier 1253
Surgical Airway (Cricothyrotomy) 1253
Other Alternatives to Secure an Airway 1255
Improvised Wound Management 1255
Wound Hemostasis 1255
Wound Anesthesia 1255
Wound Irrigation 1256
Wound Closure 1256
Wound Glues 1256
Cyanoacrylate. 1257
Availability. 1257
Contamination of Other Areas. 1257
Staples 1257
Binding and Taping 1257
Suture Needles 1257
Natural and Alternative Suture Materials 1258
Fishing Line. 1258
Horsehair Sutures. 1258
Silk and Yucca or Agave Fibers. 1258
Cotton Thread. 1258
Dental Floss. 1258
Other Nontraditional Wound Closure Methods 1258
Hair Tying (with Glue) for Scalp Wound Closure. 1258
Chicken Egg Membrane. 1259
Disinfecting Rather Than Sterilizing Alternative Suture Materials 1259
Scalpels 1259
Tweezers 1259
Cleaning and Reusing Medical Supplies and Equipment 1259
Cleaning 1259
Disinfection 1259
Boiling 1259
Alcohols 1260
Povidone-Iodine 1260
Disinfecting Specific Items 1260
“Sterile” Dressings 1260
Syringes and Needles 1260
Single-Use Needle on Same Patient 1260
Surgical Instruments 1260
Endoscopes 1260
Dressings and Bandages 1260
Dressings 1260
Dressing Material. 1260
Bandages 1260
Blister Management 1260
Removal of Objects 1260
Rings 1260
Embedded Foreign Bodies 1261
Cactus Spines 1261
Stingray Spines 1261
Trauma 1261
Tension Pneumothorax 1261
Improvised Pleural Decompression Technique 1261
Open (“Sucking”) Chest Wound 1262
Drainage System (Bottles/Bags) 1262
Improvised Treatment for Orthopedic Injuries 1263
General Guidelines 1263
Spinal Trauma 1263
Improvised Cervical Collars 1263
Closed-Cell Foam System. 1263
Padded Hip Belt. 1263
Clothing. 1263
Malleable Aluminum Splint. 1263
Improvised Spinal Protection Systems 1264
Short-Board “Immobilization” 1264
Internal-Frame Pack and Snow Shovel System. 1264
Inverted-Pack System. 1265
Snowshoe/Snowboard System. 1265
Long Spinal Protection Devices 1265
Continuous Loop System. 1265
Backpack Frame Litters. 1265
Kayak/Canoe System. 1266
Extremity Fractures and Dislocations 1266
Physical Examination and Diagnosis 1266
Fracture vs. Dislocation. 1266
Tuning Fork/Percussion Diagnoses. 1266
Shoulder Dislocation Diagnosis without Radiographs. 1266
Treatment 1267
Reduction Treatment without Radiographs. 1267
Remeasure. 1267
Shoulder Dislocation Reduction (see Chapter 22). 1267
Splinting and Traction Methods 1268
Nonrigid Splints 1268
Sling (Arm) 1268
Shoulder Immobilizer (Shoulder Spica Wrap) 1268
“Buddy” Taping 1268
“Pillow” Splints 1268
Sandbag Splints 1269
Rigid Splints 1269
Pelvic Fractures 1269
Applying an Improvised Pelvic Binder 1270
Femoral Fractures 1270
General Principles of Femoral Traction 1270
Femoral Traction System 1271
Ankle Hitch. 1272
Single-Runner System. 1272
Double-Runner System. 1273
Patient’s Boot System. 1273
Buck’s Traction. 1273
Rigid Support. 1274
Double–Ski Pole or Canoe Paddle System. 1274
Single Ski Pole or Canoe/Kayak Paddle. 1274
Tent Poles. 1274
Miscellaneous Objects. 1274
Traction Mechanism. 1274
Cam Lock or Fastex-Like Slider. 1275
Trucker’s Hitch. 1275
Prusik Knot. 1275
Spanish Windlass. 1275
Litter Traction. 1276
Proximal Anchor. 1276
Securing and Padding. 1276
Patellar Dislocation 1276
Ankle Injuries 1277
Trauma and Hypothermia 1277
Eye, Ear, Nose, Mouth, and Throat Improvisation 1277
Epistaxis 1277
Dental Trauma 1278
Esophageal Foreign Bodies 1279
Improvised Eyeglasses 1279
Useful Tools and Equipment to Carry 1279
Multitool 1279
Tape and Glue 1279
Specific Equipment 1280
Plastic Cable Ties 1280
Parachute Cord 1280
Safety Pins 1280
Wire 1280
Bolts and Wing Nuts 1280
Prefabricated Crossbar 1280
Closed-Cell Foam Pads 1280
Fluorescent Surveyor’s Tape 1280
Space Blanket or Lightweight Tarp 1280
Improvised Transport 1280
Carries 1280
Three-Person Wheelbarrow Carry 1280
Two-Hand Seat 1281
Four-Hand Seat 1281
Ski Pole or Ice Ax Carry 1281
Split-Coil Seat 1281
Two-Rescuer Split-Coil Seat 1281
Backpack Carry 1281
Nylon Webbing Carry 1281
Nonrigid Litters 1281
Blanket Litter 1281
Tree Pole Litter 1283
Parka Litter 1283
Internal-Frame Pack Litter 1283
Personal Floatation Device (Life Jacket) Litter 1284
Rope Litter 1284
Improvised Rescue Sled or Toboggan 1284
References 1284
References 1285
47 Principles of Pain Management 1284
First Contact 1288
Scene Stabilization 1288
Comfort Measures 1288
Tactical Breathing 1288
Pain Assessment 1288
PRICE: Protection, Rest, Ice, Compression, and Elevation 1289
Pharmacologic Treatment of Acute Pain in the Wilderness 1290
Summary of Integrated Multimodal Analgesia for an Injured Patient in the Wilderness 1290
Acetaminophen 1291
Nonsteroidal Antiinflammatory Drugs 1291
Opioids 1291
Opioids Require Close Titration To Be Effective 1292
Morphine 1293
Fentanyl 1293
Transmucosal and Intranasal Fentanyl 1293
Ketamine 1294
Unique Considerations 1294
Pharmacology 1294
Muscle Relaxants 1294
Pharmacologic Treatment of Specific Patient Populations in the Wilderness 1294
Stable Patients with Mild to Moderate Pain Able to Take Medicines by Mouth 1294
Stable Patient with Severe Pain 1294
Potentially Unstable Patient with Severe Pain 1295
Introduction to Regional Anesthesia for Wilderness Pain Management 1295
Auricular Acupuncture in Austere Environments 1295
Mechanism 1296
Battlefield Auricular Acupuncture 1296
Topical Therapies 1296
Analgesia for Corneal Abrasions 1297
Pretravel Preparation 1297
Practical Guide to Regional Anesthesia for Emergency and Wilderness Pain Management 1297
Benefits of Regional Anesthesia 1297
Pharmacology of Local Anesthetics 1298
Local Anesthetic Toxicity 1298
Prevention and Management 1298
Treatment 1299
Fracture Infiltration (“Hematoma Blocks”) 1299
Intraarticular Injections 1299
Peripheral Nerve Blocks 1299
Anatomy for Regional Anesthesia: Matching the Peripheral Block to the Injury 1300
Ultrasound Guidance 1300
Peripheral Nerve Injury 1300
Prevention of Nerve Injury 1301
Patient Selection. 1301
Needle Selection. 1301
Painless, Ultrasound-Guided “Stay-Away” Technique 1301
Pressure Monitoring 1301
Local Anesthetic Neurotoxicity 1301
Wilderness Regional Anesthesia by Area of Injury (Box 47-5) 1301
Regional Anesthesia for the Neck and Clavicle 1301
Regional Anesthesia for the Shoulder 1302
Emergency Regional Anesthesia for the Arm 1302
Emergency Regional Anesthesia for the Hand 1303
Emergency Regional Anesthesia for the Thorax 1303
Emergency Regional Anesthesia for the Lower Extremity 1303
Specific Block Techniques 1304
Superficial Cervical Plexus Block 1304
Anatomy 1304
Indications 1304
Landmark-Based Procedure 1304
Ultrasound-Guided Procedure 1305
Positioning. 1305
Needle Approach. 1305
Local Anesthetic 1305
Potential Complications 1305
The Arm: Blocks of Terminal Branches of Brachial Plexus 1305
Axillary Block 1306
Indications. 1306
Landmark-Based Procedure. 1306
Ultrasound-Guided Procedure 1307
Anatomy. 1307
Positioning. 1307
Needle Approach. 1307
Local Anesthetic. 1307
Potential Complications. 1307
The Hand 1307
Landmark-Based Blocks for the Hand and Fingers 1307
Wrist Block 1307
Positioning. 1307
Local Anesthetic. 1307
Digital Block. 1307
Ultrasound-Guided Forearm Blocks: Radial, Median, and Ulnar Nerves 1307
Positioning 1307
Radial Nerve 1309
Median Nerve 1309
Ulnar Nerve 1309
Needle Insertion and Injection 1309
Femoral and Fascia Iliaca Blocks 1309
Anatomy 1309
Indications 1310
Landmark-Based Procedure 1310
Ultrasound-Guided Procedure 1311
Anatomy and Indications. 1311
Positioning. 1311
Needle Approach. 1311
Local Anesthetic. 1311
Potential Complications. 1311
Popliteal Sciatic Block 1312
Anatomy and Indications 1312
Landmark-Based Procedure 1312
Common Peroneal Nerve Block 1312
Ultrasound-Guided Popliteal Sciatic Nerve Block 1312
Anatomy and Indications. 1312
Positioning. 1312
Needle Approach. 1312
Local Anesthetic. 1312
Potential Complications. 1312
Landmark-Based Ankle Block 1313
Ultrasound-Guided Posterior Tibial Nerve Block 1313
Anatomy and Indications. 1313
Positioning. 1314
Needle Approach. 1314
Local Anesthetic. 1314
Potential Complications. 1314
References 1314
References 1315
48 The Eye in the Wilderness 1317
Preliminary Planning 1317
The Wilderness Eye Emergency Kit 1317
Visual Acuity Measurement in the Wilderness 1317
General Therapeutic Approach 1318
Acute Periocular Inflammation 1318
Periocular Trauma 1319
Eyelid Laceration 1319
Corneal Frostbite 1319
Instillation of Adhesive Drops Into the Eye 1319
Retrobulbar Hemorrhage 1319
Chemical Injury of the Eye 1319
Cobra Venom 1319
Skunk Musk 1320
Acute Loss of Vision in a White, Quiet Eye 1320
Acute Red Eye 1321
Traumatic Ocular Disorders 1321
Obvious Open Globe 1321
Occult Ruptured Globe 1322
Corneal Abrasion 1322
Corneal Ulcer 1323
Traumatic Iritis 1323
Subconjunctival Hemorrhage 1323
Hyphema 1323
Nontraumatic Fluorescein-Positive Acute Red Eye 1324
Herpes Simplex Virus Keratitis 1324
Corneal Erosion 1324
Corneal Abrasion and Corneal Ulcer with Contact Lens Wear 1324
Nontraumatic Fluorescein-Negative Acute Red Eye with Pain That is Not Significantly Improved by Topical Anesthesia 1325
Acute Angle-Closure Glaucoma 1325
Nontraumatic Iritis 1325
Scleritis 1325
Nontraumatic Fluorescein-Negative Acute Red Eye with No Discomfort or with Discomfort That is Improved by Topical Anesthesia 1325
Conjunctivitis 1325
Blepharitis 1326
Ultraviolet Keratitis 1326
Conjunctival or Corneal Foreign Body 1327
Dry Eye 1327
Contact Lens Overwear Syndrome 1327
Episcleritis 1327
Solar Retinopathy 1328
Locating a Displaced Contact Lens 1328
Improvisation 1328
The Eye at Altitude 1328
Altitude Exposures and Ocular Physiology 1328
High-Altitude Retinal Hemorrhage 1328
Intraocular Gas Bubbles at Altitude 1329
Cortical Blindness at High Altitude 1330
Ocular Motility 1330
Contact Lenses in Mountaineering 1330
Refractive Changes at Altitude after Refractive Surgery 1330
Glaucoma at Altitude 1331
Ultraviolet Radiation Damage 1331
Sunglasses Selection in Mountaineering 1332
Photochromic Lenses 1332
The Eye and Diving 1332
The Hyperbaric Environment 1332
Ophthalmic Considerations in the Fitness-to-Dive Evaluation 1332
Underwater Refractive Correction 1333
Refractive Surgery and Diving 1333
Ocular and Periocular Barotrauma 1333
Decompression Sickness 1334
Ocular Tear Film as Indicator of Decompression Stress 1334
Ocular Fundus Lesions in Divers 1334
Arterial Gas Embolism 1335
Hyperoxic Myopia 1335
Ocular Jellyfish Stings 1335
Differential Diagnosis of Decreased Vision after Diving 1335
Acknowledgment 1335
References 1335
References 1336
49 Wilderness Dentistry 1339
Dental Anatomy 1339
History and Examination 1339
Dental Trauma 1339
Specific Dental Injuries 1342
Crown Infraction 1342
Uncomplicated Crown Fracture 1342
Complicated Crown Fracture 1342
Crown-Root Fracture 1343
Root Fracture 1343
Injuries to the Periodontium 1343
Concussion. 1343
Subluxation. 1343
Intrusion. 1343
Extrusion. 1343
Lateral Luxation. 1343
Avulsion. 1343
Comminution of Alveolar Socket or Fracture of Alveolar Socket Wall 1344
Dentoalveolar Fracture 1344
Soft Tissue Injuries 1344
Patient Instructions 1344
Proper Reduction 1345
Splinting 1345
Injuries to Primary Teeth 1345
Dislodged Fillings, Crowns, and Bridges 1345
Appliance Sores 1346
Orofacial Pain 1346
Pulpitis 1346
Mild Pulpitis (Characterized by Transient Thermal Sensitivity) 1346
Moderate Pulpitis (Longer Episodes of Pain) 1346
Severe Pulpitis (Intense, Continuous Pain) 1346
Periapical Osteitis/Acute Apical Periodontitis 1346
Cracked Tooth Syndrome 1347
Odontogenic Referred Pain 1347
Maxillary Sinusitis 1347
Temporomandibular Disorder 1348
Myofascial Pain and Dysfunction 1348
Maxillofacial Infections 1348
Viral Infections 1348
Yeast Infections 1349
Bacterial Infections 1349
Acute Apical Abscess/Cellulitis 1349
Incision and Drainage 1350
Deep Fascial Space Infections 1350
Chronic Apical Abscess 1351
Periodontal Abscess 1352
Pericoronitis 1352
Necrotizing Ulcerative Gingivitis 1352
Aphthous Ulcers 1352
Traumatic Ulcers 1353
Medication-Related Osteonecrosis of the Jaws 1353
Mucocele 1353
Exodontia (Tooth Extraction) 1354
Local Anesthesia 1355
Dental First-Aid Kit 1355
Prevention 1356
References 1356
References 1357
50 Wilderness Cardiology 1358
Cardiovascular System Response to Specific Wilderness Environments 1358
Hyperbaria (Underwater Diving) 1358
Hypoxia (High-Altitude Activity) 1359
Hyperthermia 1360
Hypothermia 1360
Screening and Preparation for Wilderness Travel 1360
Asymptomatic Wilderness Adventurers 1360
Established Coronary Artery Disease 1361
Cardiomyopathy and Congestive Heart Failure 1362
Congenital Heart Disease 1362
Arrhythmias 1363
Implanted Cardiac Defibrillators and Pacemakers 1363
Hypertension 1363
Basic Management of Cardiovascular Emergencies in the Wilderness Environment 1363
Chest Pain 1363
Arrhythmias 1364
Syncope 1364
Cardiac Arrest 1364
References 1366
References 1367
51 Wilderness Neurology 1366
History and Examination 1366
Acute Neurologic Conditions Secondary to Environmental Extremes 1366
High Altitude: Acute Mountain Sickness and High-Altitude Cerebral Edema 1366
Dive Medicine: Decompression Sickness 1366
Basic Management of Neurologic Emergencies 1369
Headache 1369
Guidelines for Diagnosis of Headache: Differentiating Benign From Ominous 1369
Migraine Headaches 1369
Acute Treatment of Migraine 1369
Preventive Treatment of Migraine 1370
Tension Headaches 1370
Localized and Cluster Headaches 1370
Headache with Other Neurologic Signs 1370
Sudden Headache with Acute Neurologic Signs 1371
Headache Caused by Increased Intracranial Pressure 1371
Sudden Headache 1371
Headache with Scalp Tenderness 1371
Headache after Head Injury 1371
Single Episode of Sudden Severe Headache 1371
Headache of Subacute Onset 1372
Transient Ischemic Attack and Stroke 1372
Diagnosis of Transient Ischemic Attack 1372
Managing Transient Ischemic Attack and Stroke 1372
Stroke 1372
Posterior Circulation Ischemia 1372
Transient Ischemic Attack 1372
Transient Ischemic Attack and Stroke IN Special Circ*mstances 1372
Transient Episodes of Impaired Consciousness 1372
Epilepsy 1373
Classification 1373
Diagnosing a Seizure 1373
Emergency Management of Seizures 1373
Status Epilepticus 1373
Managing a First-Time Seizure 1374
Syncope and Related Phenomena 1374
Simple Syncope, Cardiac Syncope, and Postural Hypotension 1374
Other Causes of Sudden Apparent Loss of Consciousness 1374
Hypoglycemia 1374
Panic and Hyperventilation 1374
Basilar Migraine 1374
Carcinoid Syndrome, Pheochromocytoma, and Scombroid Poisoning 1374
Drug Reactions 1374
Narcolepsy, Excessive Daytime Drowsiness, and Cataplexy 1374
Meningitis and Encephalitis 1374
Meningitis 1374
Meningitic Syndrome 1375
Clues to Specific Varieties of Bacterial Meningitis 1375
Emergency Wilderness Management of Meningitis 1375
Viral, Subacute, and Chronic Meningitis and Encephalitis 1376
Peripheral Nervous System Conditions 1376
Median Nerve Compression at the Wrist: Carpal Tunnel Syndrome 1376
Ulnar Nerve Compression at the Elbow 1376
Radial Nerve Palsy: Compression IN the Spiral Groove of the Humerus 1376
Backpacks: Numb Hands and Backpack Palsy 1376
Thigh Pain and Tingling: Meralgia Paresthetica 1376
Footdrop: Peroneal and Sciatic Nerve Lesions 1376
Lumbar Back Pain: Lateral and Central Disk Protrusion 1377
Cervical Disk Lesions 1377
Acute Lateral Cervical Disk Protrusion 1377
Neuralgic Amyotrophy (Acute Brachial Neuritis) 1377
Central Cervical Disk Protrusion (Cervical Myelopathy), Cord Compression, and Paraparesis 1377
Cranial Nerve Palsies and Vertigo 1377
Bell’s Palsy 1377
Acute Vertigo 1377
Sleep 1378
Sleep Management 1378
Management of Chronic Neurologic Conditions IN Austere Settings 1378
Epilepsy 1379
Cerebrovascular Disease 1379
Multiple Sclerosis 1379
Parkinson’s Disease and Other Neurodegenerative Conditions 1379
Suggested Readings 1379
Suggested Readings 1380
52 Mental Health in the Wilderness 1381
Mental Health Benefits: Ecotherapy and Wilderness Therapy 1381
Role of Wilderness Guide/Medical Provider in Emotional and Behavioral Health 1381
Prevention 1381
Prevention through Effective Orientation, Leadership, and Teamwork 1382
Group Dynamic Creation and Monitoring 1383
Identification 1383
Evaluation 1383
Triage 1384
Treatment Initiation 1384
Accessing Wholeness 1384
Evacuation 1385
Specific Disorders and Symptoms 1385
Anxiety Disorders 1385
Obsessive-Compulsive Disorders 1386
Mood Disorders 1386
Psychotic Disorders 1387
Organic Mental Disorders 1388
Personality Disorders 1388
Substance Abuse Disorders 1388
Suicide, Violence Potential, and Anger Management 1389
Somatic Complaints 1389
Insomnia 1390
Response to Crisis, Trauma, and Disasters 1390
Survival Psychology 1392
Children and Adolescents in the Wilderness 1392
Looking Toward the Future 1392
References 1392
References 1393
53 Chronic Diseases and Wilderness Activities 1392
Considerations for Wilderness Travel 1394
Increased Physical Activity 1394
Trip Preparation 1394
Environmental Extremes and Chronic Medical Conditions 1394
Cold 1395
Heat 1395
High Altitude 1395
Chronic Medical Conditions and Wilderness Travel 1396
Asthma 1396
Chronic Obstructive Pulmonary Disease 1397
Sleep Apnea 1399
Diabetes 1400
Peripheral Arterial Disease 1403
Raynaud’s Phenomenon 1404
Osteoarthritis 1405
Hematologic Conditions 1406
Anemia 1406
Thalassemia Trait. 1406
Iron Deficiency. 1406
Hemolytic Anemias. 1407
Glucose-6-Phosphate Dehydrogenase Deficiency. 1407
Sickle Cell Anemia and Trait. 1407
Hemophilia 1407
Von Willebrand Disease 1408
Thrombocytopenia 1408
Anticoagulation 1408
Travel Thrombosis 1409
The Asplenic Patient 1410
Oncology 1410
Chemotherapy 1410
Stem Cell (“Bone Marrow”) Transplantation 1411
Solid-Organ Transplant Recipients 1412
References 1413
References 1414
8 Rescue and Survival 1419
54 Wilderness Emergency Medical Services and Response Systems 1420
Defining Wilderness and Wilderness Medicine 1420
Relationship of Emergency Medical Services, Wilderness Medicine, Disaster Medicine, and Tactical Medicine 1421
History of Wilderness Emergency Medical Services 1421
Commercial WEMS Schools IN the United States 1422
In-House Training in the United States 1422
Growth of Wilderness Medicine 1423
Wilderness Emergency Medical Services Agencies 1423
Wilderness Emergency Medical Services Provider Types, Standardization, and Scope of Practice 1423
Levels of Wilderness Emergency Medical Services Providers 1424
Wilderness First Aid Provider 1424
Wilderness First Responder 1424
Wilderness Emergency Medical Technician 1425
Outdoor Emergency Care Provider 1425
Wilderness Paramedic 1425
Wilderness Physician and Advanced Practice Clinician 1425
Emergency Medical Dispatchers and Telemedicine Providers 1426
Medical Oversight 1426
Medical Advisors Versus Medical Directors 1426
Direct Medical Oversight 1426
Indirect Medical Oversight 1426
Operations 1426
Incident Command System 1426
Protocols 1427
Specific Protocols 1428
Anaphylaxis 1428
Termination of Resuscitation 1428
Wound Care 1428
Pain Management 1428
Joint Reduction 1429
Spinal Cord Protection 1429
Acute Coronary Syndrome 1429
Ectopic Pregnancy 1429
Hypoglycemia 1429
Common Ailments 1430
Medication Administration 1430
Equipment Specifically Needed IN Wilderness Emergency Medical Services 1430
The Future of Wilderness Emergency Medical Services 1430
Challenges to Wilderness Systems 1430
Provider Shortages 1430
Insufficient Funding 1431
Validity of and Reimbursem*nt for Services 1431
Defining No-Rescue Areas 1431
Future Areas of Growth IN Wilderness Emergency Medical Services 1432
Intersection of Rural Emergency Medical Services and Wilderness Emergency Medical Services 1432
Technology 1432
EMS as a Physician Subspecialty 1433
Summary 1433
Suggested Internet Resources for Wilderness Services 1433
References 1433
References 1434
55 Search and Rescue 1433
Search and Rescue: An Overview 1437
International Agreements 1437
International Stages of SAR Operations 1438
Awareness Stage 1438
Initial Action Stage 1438
Planning Stage 1438
Operations Stage 1438
Conclusion Stage 1438
COSPAS-SARSAT 1438
Distress Radio Beacons 1439
Emergency Position–Indicating Radio Beacons. 1439
Emergency Locator Transmitters. 1439
Personal Locator Beacons. 1439
Other International Search and Rescue Organizations 1440
Search and Rescue in the United States 1440
U.S. National Search and Rescue Plan 1440
National Response Framework 1441
The National SAR Supplement 1442
Catastrophic Incident SAR Addendum to the National SAR Supplement. 1442
Land SAR Addendum to the National SAR Supplement. 1442
U.S. Rescue Coordination Centers 1442
U.S. Air Force Rescue Coordination Center. 1442
Search Missions. 1443
Rescue Missions. 1443
MEDEVAC Missions. 1443
Mercy Missions. 1443
U.S. Coast Guard Rescue Coordination Centers. 1443
Federal Aviation Administration. 1444
Unmanned Aircraft Systems. 1444
Civil Air Patrol. 1444
U.S. Coast Guard Auxiliary. 1445
Other Federal SAR Resources 1445
The State’s Role in SAR: Coordination and Support 1446
Local SAR Response 1446
Standards and Regulations 1446
Organization of a Search and Rescue Event 1447
National Incident Management System 1447
Incident Command System 1447
Incident Management Teams 1448
Search and Rescue Operations 1449
Locate Phase 1449
First Notice 1449
Planning Data and Their Uses 1449
Search Tactics 1449
Clues and Their Value 1451
Search Resources 1451
Dogs. 1451
Human Trackers. 1451
Ground Search Teams 1452
Hasty Teams. 1452
Grid Teams. 1452
Aircraft. 1452
Search Planning Considerations 1452
Search Theory. 1453
Lost Subject Behavior. 1454
Access Phase 1455
Stabilization Phase 1456
Transport Phase 1457
Rescue Equipment 1457
Personal Protective Equipment. 1457
Special Gear. 1457
Software 1457
Rope. 1457
Webbing. 1458
Harnesses. 1458
Hardware 1459
Carabiners. 1459
Descent and Belay (Friction) Devices. 1459
Ascenders. 1460
Pulleys. 1461
Litters. 1462
Anatomy of a Search and Rescue Incident 1462
Search and Rescue Environments within the Wilderness Setting 1462
Special Environments in Search and Rescue 1463
Technical Rock 1463
Caves and Mines 1463
Whitewater (Swiftwater) River 1463
Ocean Surf 1464
Runout. 1464
Rip. 1464
Undertow. 1465
Cold, Snow, and Ice 1465
References 1465
References 1466
56 Technical Rescue, Self-Rescue, and Evacuation 1465
Warning 1468
Terms Used in Technical Rescue 1468
Epidemiology 1469
Risks of Wilderness Travel 1469
Injuries and Illnesses in Mountain Rescue Subjects 1469
Preventive Decision Making 1470
Risk Reduction 1470
Planning 1471
Leadership 1471
Communications 1471
Hazards in Wilderness Travel and Rescue 1472
Natural Hazards 1472
High Altitude 1472
Extremes of Temperature and Humidity 1472
Weather 1472
Lightning 1473
Rockfall 1473
Frozen Waterfalls (Ice) 1473
Avalanches 1473
Cornice Failures 1473
Terrain Features 1473
Glacier Hazards 1473
Hazards Caused by Equipment Failure 1474
Hazards Resulting from Human Factors of Rescuers 1475
Training 1475
Physical Conditioning and Skills 1475
Food, Water, and Sleep 1475
Experience in the Environment 1475
Mission Planning and Risk Assessment 1475
Team Safety. 1475
Aircraft Safety. 1475
External Influences on Rescue Attempts 1475
Hazards Resulting from Human Factors of Subjects 1476
Planning for Rescue 1476
Team Training 1476
Role of the Medical Director 1476
Patient Care in Wilderness and Technical Environments 1476
Priorities 1476
Limitations 1476
Initial Patient Assessment and Treatment 1477
Resuscitation 1477
Airway and Breathing 1477
Circulation and Control of Bleeding 1477
Treatment of Pain 1478
Prolonged Care and Transport 1478
Altitude Considerations during Rescue 1479
Suspension Trauma 1480
Use of Extrication Devices for Crevasse Rescue 1480
Companion Rescue 1480
Decision Making in Companion Rescue 1480
Improvised Searches 1480
Planning for Wilderness Medicine Technical Rescue 1481
Basic Concepts of Technical Rescue 1481
Anchors 1481
Descent 1483
Ascent 1484
Haul Systems 1485
Knot Pass 1486
Backup Systems with Belay 1486
Personal Escape 1487
One-on-One Pickoff 1487
Belays 1488
Highlines 1488
Establishing a Main Line 1488
Tensioning a Main Line 1489
The Load 1489
Tag Lines and Haul Lines 1489
Safety Factors 1489
General Principles of Rope Rescue 1490
Improvised Methods for Carrying an Ill or Injured Patient 1490
The Rucksack Stretcher 1490
Improvised Transport Over Snow 1490
Litters and Vacuum Mattresses for Organized Rescue 1490
Vacuum Mattresses 1490
Commercial Litters 1491
Patient Packaging 1492
Use of Aircraft in Mountain Rescue 1493
Fixed-Wing Aircraft in Mountain Rescue 1493
Helicopter Rescue in the Wilderness 1493
Helicopter Capabilities 1493
Safe Use of Helicopters 1493
Types of Helicopters 1494
Aeromedical Helicopters 1494
Law-Enforcement Helicopters 1494
Commercial Helicopters 1494
Media Helicopters 1494
Military Helicopters 1494
Limitations of Helicopters 1494
Visibility Minimums 1495
Weather Conditions 1495
Fuel 1495
Safety Precautions on the Ground 1495
Landing Zones (Helispots) 1495
Landing Zones in Confined Spaces 1495
Landings and Takeoffs 1495
Loading and Unloading 1496
Approaching the Helicopter 1496
Loading and Unloading Safety Procedures 1496
One-Skid Landings 1496
Loading and Unloading Without Moving Toward or Away from the Helicopter 1497
Hover Load and Hover Jump Operations 1497
External Loads 1497
Hoist Operations 1497
Short-Haul (or Long-Line) Operations 1497
Helirappel 1498
Patient Care in Helicopter Operations 1498
Unmanned Aerial Vehicles 1498
Canyon Rescue 1498
Canyon Hazards 1498
Canyon Anchors 1499
Canyon Descent 1499
Canyon Ascent 1500
Canyon Self-Rescue and Companion Rescue 1500
Canyon Litters 1501
Organized Canyon Rescue and Evacuation 1501
Helicopter Canyon Rescue 1502
Technical Rescue Resources for Mountain Rescue 1503
Technical Rescue Medical Kit 1503
Afterword 1503
References 1503
APPENDIX Technical Rescue Medical Kit* 1504
Medication Bag 1504
Intravenous Bag 1504
Miscellaneous Bag 1504
Front and Top Pockets 1504
Bandaging Side Pocket 1504
Miscellaneous Side Pocket 1504
Main Compartment 1504
Airway Bag 1505
Oxygen Kit† 1505
References 1506
Further Reading 1508
57 Litters and Carries 1505
Size-Up 1505
Drags and Carries 1509
Litter Improvisation 1510
Rescue Litters and Stretchers 1514
Desirable Characteristics of a Wilderness Stretcher 1514
Stretchers 1514
Basket-Style Stretchers 1514
Flat Stretchers 1516
Mountain Rescue Stretchers 1517
Flexible, Wrap-Around Stretchers 1518
Hybrid Devices 1520
Transportation Hardware Accessories 1521
Carrying a Loaded Litter 1521
Patient Packaging 1521
References 1522
References 1523
58 Helicopter Rescue and Air Medical Transport 1522
Evolution of Air Medical Transport 1524
Business and Organizational Models for Air Medical Transport Programs 1524
Hospital-Based Air Transport Services 1525
Community-Based Air Transport Services 1525
Government-Sponsored Air Transport Services 1525
Air Transport Organization: Lessons for Wilderness Medicine 1525
Crew Models in Air Medical Transport 1526
Air Transport Crew with a Physician 1526
Air Transport Crew Without a Physician 1526
Air Transport Crew Configuration: Lessons for Wilderness Medicine 1527
Physician Oversight in Air Medical Transport 1527
Direct and Indirect Medical Oversight 1527
Characteristics of the Medical Director 1527
The Medical Director: Lessons for Wilderness Medicine 1527
Types of Air Medical Transport Missions 1528
Scene Missions 1528
Interfacility Transports 1528
Types of Air Transport Missions: Lessons for Wilderness Medicine 1528
Air Transport Aircraft 1528
Airplanes for Long-Range Air Medical Transport 1528
Aircraft for Short- and Medium-Length Transports 1530
Helicopters for Wilderness Transport 1530
Categorizing and Comparing Helicopters Used in Air Medical Transport 1532
Single-Engine Helicopters 1534
Twin-Engine Helicopters 1536
Other Aircraft Factors 1538
Aviation Logistics and Selection of a Transport Vehicle 1539
Selection of an Airplane Versus a Helicopter for Transport 1539
Logistics and Triage in Helicopter Air Transport 1539
Aviation Safety 1540
Effects of Altitude on Air Medical Transport 1541
Boyle’s Law: Pressure, Volume, and Altitude 1541
Charles’s Law: Altitude and Temperature 1542
Henry’s Law: Altitude and Dissolved Gas Concentrations 1542
Medical Care in the in-Flight Setting 1542
Patient Loading and Cabin Considerations 1542
Motion and Vibrations 1543
Noise 1543
Cabin Layout and Space 1543
Communications and Coordination of Air and Ground Medical Resources 1544
Preflight Communications and Air-Ground Coordination 1544
Communications and Preparation AS the Aircraft Approaches the Patient’s Location 1544
Ground and Air Coordination during Patient Stabilization for Transport 1544
Preparation of the Landing Zone 1544
Helicopter Landing and on-Site Interactions between Air and Ground Personnel 1546
Communications after Transport to the Receiving Center 1548
Patient Populations That May be Suitable for Air Medical Transport 1548
Integration of Air Medical Transport Into Regional Systems Planning 1548
General Considerations for Triage in Air Medical Transport 1548
Air Medical Transport Outcomes Literature: State of the Evidence 1548
Patients with Traumatic Injury or Burns 1549
Patients with Cardiac Disease 1549
Stroke Patients 1549
Pediatric Patients and Neonates 1549
Obstetric Patients 1549
Other Disorders for Which Air Medical Transport May Be Useful 1550
Cost-Effectiveness of Air Medical Transport 1550
Air Medical Responses in Disaster and Mass Casualty Situations 1550
Air Medical Responses for Search and Rescue and Alpine Operations 1550
Airplanes in Search and Rescue Missions 1550
Helicopters in Search and Rescue Missions 1550
Helicopters and Avalanche Response 1551
Helicopters and Hoist Operations 1551
Helicopters and High-Altitude Search and Rescue in Lesser-Developed Countries 1552
Helicopter Flight at High Altitude 1554
Long-Line Operations at Extreme Altitude 1554
Medical Interventions during Helicopter Search and Rescue Missions 1554
Helicopter Program Safety and High-Altitude Operations 1554
Putting It All Together: Keys to Judicious Use of Air Medical Transport 1555
Air Medical Services Internet Resources 1555
Acknowledgments 1555
References 1555
References 1556
59 Essentials of Wilderness Survival 1560
General Considerations in Survival 1561
Oxygen 1561
Regulation of Body Temperature 1562
Cold Weather Survival 1563
Decreasing Body Heat Loss 1563
Dressing for Cold Weather 1564
First Layer 1564
Long Underwear. 1564
Socks. 1564
Thin Gloves (Glove Liners). 1564
Second Layer 1564
Shirt. 1564
Pants. 1564
Foot Gear. 1564
Hat. 1564
Third Layer 1564
Parka. 1564
Wind Pants. 1564
Hand Gear. 1564
Gaiters and Overboots. 1565
Fourth Layer 1565
Raingear. 1565
Vapor Barrier Systems. 1565
Shelter 1565
Summer Emergency Shelters 1565
Space Blankets and Bags 1565
Thermal Blankets 1565
Tube Tents 1566
Tarpaulins 1566
Plastic Bag Shelters 1566
Winter and Cold Weather Emergency Shelters 1566
Natural Shelters 1567
Constructed Shelters 1568
Snow Shelters 1568
Snow Trenches 1568
Snow Caves 1569
Snow Domes 1569
Igloos 1570
Tents 1571
Bivouac Sacks and Other Small and Portable Emergency Shelters 1571
Increasing Body Heat Production 1571
Adding Heat From the Outside 1571
Heat Sources 1571
Matches 1572
Safety Matches. 1572
Waterproof Matches. 1572
Windproof Matches. 1572
Strike-Anywhere Matches. 1573
Storm Matches. 1573
Match Containers 1573
Boy Scout–Style Match Containers. 1574
Olive Drab Military-Style Match Containers. 1574
Orange Military-Style Match Cases. 1574
Multipurpose Match Case. 1575
Other Methods of Igniting Tinder 1575
Building Fires 1577
Tools That Make Fire Building Easier 1579
Saws 1579
Wire Survival Saws. 1579
Linked-Style Survival Saws. 1579
Bow Saws. 1580
Pruning Saws. 1580
Fire-Starting Aids 1580
Commercial Fire-Starting Aids. 1580
Food 1583
Water 1584
Survival in Special Instances, Including Natural Catastrophes 1584
Stalled or Wrecked Automobiles 1584
Aircraft Accidents 1584
Floods 1585
Storms 1585
Thunderstorms 1585
Tornados 1585
Hurricanes 1585
Navigation in the Wilderness 1585
Backcountry Weather Forecasting 1585
Sanitation 1585
Psychological and Organizational Aspects of Survival 1586
Protection From Wild Animals 1587
Summary of Preparations for a Possible Survival Situation 1587
Appendix A Suggested Basic Contents of a Survival Kit for Temperate to Cold Weather 1588
Appendix B Suggested Additions for a Winter Survival Kit (When Cold Weather or Snow Is Present or Expected) 1590
Optional Items 1590
Mandatory for Avalanche Country 1590
Appendix C Vehicle Cold Weather Survival Kit 1590
Appendix D Minimal Equipment for a Survival First-Aid Kit 1591
Basic Items 1591
Small-Bag Items 1591
Other Items 1591
Additional Items for Consideration 1591
Suggested Readings 1591
Suggested Readings 1592
60 Jungle Travel and Survival 1591
Tropical Environment 1591
Trip Preparation 1593
Reading 1593
Attitude 1593
Relationship Considerations 1593
Conditioning 1593
Immunizations 1593
Medical Kit 1594
Gear 1595
Footwear 1595
Trail Shoes. 1596
Camp Boots. 1596
Other Options. 1596
Socks 1596
Clothing 1596
Hat 1596
Pullover 1596
Shirts 1596
Pants 1596
Undergarments 1597
Poncho 1597
Bedding 1597
Flannel Sheet 1597
Hammock 1597
Therm-a-Rest 1597
Mosquito Netting 1597
Backpacks 1597
Backpack for Porter 1597
Personal Pack 1597
Pack for River Trips 1597
Other Useful Items 1597
Antifogging Solution for Eyeglasses 1597
Batteries 1597
Binoculars 1597
Camera Equipment 1597
Camera Case or Bag 1598
Camp Soap 1598
Candles 1598
Cup and Plate 1598
Duct Tape 1598
Ear Plugs 1598
Fishing Supplies 1598
Garbage Bags 1598
Dry Bags 1598
Headlamp 1598
Inflatable Cushion or Pillow 1598
Insect Repellent 1598
Laminated Map 1598
Machete 1598
Matches or Cigarette Lighter 1599
Pen 1599
Pocket Tool 1599
Wide-Mouth Water Bottles 1599
Razor or Battery-Operated Shaver 1599
Spoon 1599
Sport Sponge 1599
Sunglasses 1599
Toilet Paper 1599
Umbrella 1599
Whistle 1599
Coping with the Jungle Environment 1599
Wetness 1599
Health Issues 1600
Health Risks 1600
Duration of Travel and Emotional Response 1600
Preventing Heat-Related Illness 1600
Unexpected Isolation 1600
Camp Life 1600
Shelter 1600
Food 1601
Potable Water 1603
Jungle Hazards 1603
Arthropods 1603
Ants. 1603
Chiggers. 1603
Jigger Flea. 1603
Myiasis. 1603
Scorpions and Spiders. 1603
Venomous Moths, Butterflies, and Caterpillars. 1603
Wasp and Bee Stings. 1604
Fish 1604
Stingray. 1604
Electric Eel. 1604
Candirú. 1604
Piranha. 1604
Mammals 1604
Bats. 1604
Dogs. 1604
Jaguars. 1604
Reptiles 1604
Snakes. 1604
Alligators and Crocodiles. 1604
Plants 1604
Armed or Spine-Bearing Plants. 1604
Chicha. 1604
Saw Grass. 1605
Hallucinogenic Plants 1605
Ayahuasca. 1605
Brugmansia. 1605
Virolas. 1605
Yopo. 1605
Miscellaneous Hazards 1606
Poison-Dart Frogs 1606
Falling Trees 1606
Fording Rivers 1606
Canoe Travel 1606
Log Bridges 1606
Mercury Contamination 1606
Riverain Hazards 1606
Rising Rivers. 1606
Safety of Swimming. 1606
Leptospirosis 1606
Schistosomiasis 1606
Quicksand 1606
Aquatic Plants 1606
Traveling with Children in the Tropics 1606
Survival 1607
Rescue Strategies 1607
Food 1608
Edibility Test 1609
Caveats 1609
Water 1609
Shelter 1610
Fire 1610
Tinder and Kindling 1610
Bamboo Fire Saw 1611
Bamboo Container 1611
Palm Spathe Container 1611
Psychology of Survival 1612
Cultural Factors 1612
Infanticide 1612
Intertribal and Intratribal Warfare, Revenge Killings, Homicide 1612
Enigmas 1612
Attribution of Causality 1613
Survival in Hostage Situations 1613
Prevention 1613
Categories of Hostage Takers 1613
Behavior at the Moment of Capture 1613
Hostage Rules of Behavior 1613
Stress Management in Captivity 1613
Adjusting to Captivity 1614
Stockholm Syndrome 1614
Escape 1614
Rescue 1614
Release 1614
References 1614
References 1615
61 Desert Travel and Survival 1614
The Desert Environment 1614
Preparation 1617
Clothing 1617
Survival Kit 1618
Priorities 1618
Water 1619
Shelter 1620
Food 1621
Hazards 1622
Travel 1622
Suggested Readings 1624
Suggested Readings 1625
62 Whitewater Medicine and Rescue 1624
Historical Perspective 1626
Injuries and Deaths From Whitewater Boating 1626
Whitewater Paddling Equipment 1627
River Hazards 1628
Hazards Created by the Flow of Water 1629
Eddies 1629
Hydraulics 1629
Undercuts 1629
Waterfalls 1629
Having to Swim in Whitewater 1629
Hazards Created by Obstacles in a River 1630
Drowning 1631
Trauma 1631
Proper Positioning for Prevention of Injuries 1631
Injuries Most Likely to Occur with Whitewater Sports 1632
Overuse Injuries 1632
Shoulder Dislocation 1632
Head, Facial, and Dental Injuries 1632
Spine Injuries 1634
Injuries Requiring Improvised Splinting 1634
Wounds and Infections 1634
Disorders Caused by Environmental Hazards 1634
Whitewater Rescue 1635
Rescue Equipment 1635
Throw Ropes 1635
Carabiners and Pulleys 1635
Prusik Loops 1635
Webbing 1635
Knives 1635
Whistles 1635
Rapidly Deployed Rescue Techniques 1635
Wading and Strong Swimmer Rescues 1636
Tagline Rescue 1636
Rescuing a Pinned Boat 1637
Appendix A Whitewater First-Aid Kit 1638
Appendix B Universal River Signals 1638
Appendix C Organizations 1639
References 1639
References 1640
63 Caving and Cave Rescue 1639
Environment 1641
Personal Safety 1643
Cave Navigation 1644
Cave Search 1644
Basic Evacuation 1644
Equipment for a Vertical Evacuation 1645
Logistics 1646
Cave Access 1646
Environmental Hazards 1646
Medical Hazards 1647
Patient Care 1648
The Caving Expedition 1649
Closing Comments 1649
References 1649
References 1650
9 Plants and Mushrooms 1651
64 Plant-Induced Dermatitis 1652
Irritant Contact Dermatitis 1652
Treatment 1657
Allergic Contact Dermatitis 1657
Toxicodendron (Poison Ivy/Oak/Sumac) 1658
Immunology of Poison Ivy and Poison Oak Dermatitis 1662
Treatment 1663
Prevention 1664
Compositae Family 1665
Contact Urticaria: Immunologic and Nonimmunologic Subtypes 1667
Phytophotodermatitis 1669
Phytophototoxic Contact Dermatitis 1670
Phytophotoallergic Contact Dermatitis 1671
References 1671
References 1672
65 Toxic Plant Ingestions 1674
General Considerations 1674
Plant Toxins 1674
Alkaloids 1674
Glycosides 1676
Resins 1676
Oxalates 1676
Phytotoxins 1676
Central Nervous System Toxins 1677
Anticholinergic Plants (Tropane Alkaloids) 1677
Anticholinergic Syndrome 1678
Jimsonweed 1678
Deadly Nightshade 1679
Mandrake 1679
Additional (Rare) Signs and Symptoms Seen with Anticholinergic Plants 1680
Treatment 1680
Nicotinic Plants (Pyridine and Piperidine Alkaloids) 1680
Nicotinic Syndrome 1680
Tobacco Plants 1680
Poison Hemlock 1681
Betel Nut 1681
Golden Chain Tree 1682
Blue Cohosh 1682
Treatment 1682
Other Neuromuscular Blocking Plants 1682
Yellow Jasmine 1682
Stinging Nettle 1682
Hallucinogenic Plants (Indoles, Phenylalkylamines) 1683
Morning Glory 1683
Nutmeg 1683
Cannabis 1683
Peyote 1684
San Pedro Cactus (Echinopsis or Trichocereus spp.) 1684
Dona Ana Cactus 1684
Mescal Bean Bush 1684
Iboga 1684
Gifbol 1684
Khat 1684
Anticholinergic Plants 1685
Treatment 1685
Sedating Plants 1685
Poppy 1685
Plants Producing Spastic Paraparesis/Quadriparesis (Neurotoxic Amino Acids) 1685
Grass Pea 1685
Convulsant Plants (Indoles, Resins) 1685
Strychnine 1685
Wild Wisteria 1686
Water Hemlock 1686
Myrtle-Leaved Coriaria 1686
Tutu 1687
Kratom 1687
Star Fruit 1687
Other Convulsants 1687
Cardiovascular Toxins 1687
Cardiotoxins That Inhibit Sodium/Potassium Adenosine Triphosphatase (Cardiac Glycosides) 1687
Foxglove 1688
Oleander 1688
Squill 1688
Suicide Tree 1689
Sea Mango 1689
Clinical Presentation 1689
Treatment 1690
Cardiotoxins That Open Sodium Channels (Steroid Alkaloids, Resins) 1690
Aconite 1690
Veratrum Alkaloids 1691
Grayanotoxins 1691
Treatment 1691
Other Cardiotoxins 1691
Taxine Alkaloids 1691
Oral and Gastrointestinal Toxins 1692
Oral Irritants (Glycosides, Oxalates) 1692
Daphne 1692
Insoluble Oxalates 1692
Gastrointestinal Irritants (Resins, Alkaloids) 1692
Chinaberry Trees 1692
Solanum 1693
Plants Containing Saponin Glycosides 1693
Pokeweed. 1693
Toxins That Inhibit Protein Synthesis (Phytotoxins) 1694
Toxalbumins (Ricin, Abrin, Curcin, Robin, Phasin) 1694
Treatment 1694
Hepatotoxic Agents 1695
Pyrrolizidine Alkaloids 1695
Kava Kava 1695
Greater Celandine 1695
Black Cohosh 1695
Coffee Senna 1695
Renal Toxins 1695
Soluble Oxalates 1695
Other Nephrotoxins 1696
Hematopoietic Toxins 1696
Plants with Anticoagulant Properties (Lactone Glycosides) 1696
Toxins That Inhibit Cell Division and Bone Marrow 1696
Colchicine 1696
Podophyllum 1696
Plants That Induce Hemolysis 1697
Fava Beans 1697
Endocrine and Metabolic Toxins 1697
Plants That Interfere with Steroid Metabolism 1697
Licorice 1697
Plants with Mitochondrial Toxins 1697
Ackee Fruit 1697
Wild Yams 1697
co*cklebur 1697
Bird-Lime/Blue Thistle 1698
Ox-Eye Daisy 1698
Karaka 1698
Gifblaar 1698
Cyanogenic Plants 1698
Treatment 1698
Reproductive Toxins 1699
Other Toxins 1699
Oils 1699
Acknowledgment 1699
Appendix A Common Toxic Plants 1700
Appendix B Nontoxic Plants 1703
References 1703
References 1704
66 Toxic Mushroom Ingestions 1710
Nontoxic Mushrooms 1713
Types of Mushroom Toxicity 1713
Gastrointestinal Toxins 1715
Causative Mushrooms 1715
Toxins 1720
Clinical Presentation 1722
Treatment 1722
Disulfiram-Like Toxins 1722
Causative Mushrooms 1722
Toxin 1723
Clinical Presentation 1723
Treatment 1723
Neurologic Toxins 1723
Muscarine 1723
Causative Mushrooms 1724
Toxin 1725
Clinical Presentation 1725
Treatment 1725
Isoxazole Reactions 1726
Causative Mushrooms 1726
Toxin 1726
Clinical Presentation 1726
Treatment 1727
Hallucinogenic Mushrooms 1727
Causative Mushrooms 1727
Toxin 1728
Clinical Presentation 1728
Treatment 1729
Protoplasmic Poisons 1729
Gyromitra Toxin 1729
Causative Mushrooms 1729
Toxin 1729
Clinical Presentation 1730
Treatment 1730
Renal Toxicity 1730
Causative Mushrooms 1730
Toxin 1730
Clinical Presentation 1731
Treatment 1731
Amatoxins 1731
Causative Mushrooms 1731
Toxins 1733
Clinical Presentation 1734
Treatment 1734
Miscellaneous Reports of Toxicity From Mushrooms 1735
Approach to the Patient with Mushroom Poisoning 1735
Recommended Field Guides 1736
References 1736
References 1737
67 Seasonal and Acute Allergic Reactions 1736
Allergic Rhinitis 1740
Epidemiology and Risk Factors 1740
Pathophysiology 1740
Allergens 1741
Pollens 1741
Fungi 1741
Dust Mites 1741
Animals 1741
Functions of the Nose 1742
Clinical Evaluation 1742
Differential Diagnosis 1743
Allergy Testing 1743
Treatment 1743
Avoidance 1743
Antihistamines and Decongestants 1743
Intranasal Corticosteroids 1744
Leukotriene Receptor Antagonists 1744
Other Medications 1745
Immunotherapy 1745
Approach to Treatment 1745
Prevention 1745
Urticaria and Angioedema 1745
Urticaria 1745
Treatment 1746
Angioedema 1746
Treatment 1747
Wilderness Considerations 1747
Anaphylaxis 1747
Etiology 1747
Epidemiology and Risk Factors 1748
Pathophysiology 1748
Clinical Presentation 1748
Diagnostic Tests 1749
Treatment 1749
Epinephrine 1749
Treatment of Hypotension 1750
β2-Adrenergic Agonists 1750
Glucocorticoids 1750
Antihistamines 1750
Biphasic Reactions 1750
Medical Evacuation 1750
Sequelae and Aftercare 1750
Prevention 1750
Acknowledgment 1750
References 1750
References 1751
68 Ethnobotany 1754
Evolution of Phytopharmaceuticals 1755
Herbal Preparations for Clinical and Wilderness Use 1756
Homeopathic Use of Botanicals 1756
Topical Application 1757
Use of Herbal Medicine in the Wilderness 1757
Availability and Application 1758
Side Effects and Toxicity 1758
Spectrum of Applicability 1758
Affordability 1758
North American Plant Medicines 1758
Ephedra (Ephedra species) 1758
Description and Habitat 1758
Pharmacology 1759
Native American and European Medicinal Uses 1759
Modern Clinical and Wilderness Applications 1759
Toxicity 1759
Goldenseal (Hydrastis canadensis) 1759
Description and Habitat 1759
Pharmacology 1759
Native American and European Medicinal Uses and Folklore 1760
Modern Clinical and Wilderness Applications 1760
Toxicity 1760
Arnica (Arnica montana) 1760
Description and Habitat 1760
Pharmacology 1760
Native American and European Medicinal Uses and Folklore 1761
Modern Clinical and Wilderness Applications 1761
Toxicity 1761
Garlic (Allium sativum) 1761
Description and Habitat 1761
Pharmacology 1761
Native American and European Medicinal Uses and Folklore 1762
Modern Clinical and Wilderness Applications 1762
Wilderness Medical Applications 1763
Toxicity 1763
Ginger (Zingiber officinale) 1763
Description and Habitat 1763
Pharmacology 1763
Native American and European Medicinal Use 1763
Modern Clinical and Wilderness Applications 1763
Toxicity 1764
Comfrey (Symphytum officinale) 1764
Description and Habitat 1764
Pharmacology 1764
Native American and European Medicinal Uses and Folklore 1764
Modern Clinical and Wilderness Applications 1764
Toxicity 1765
Aloe (Aloe vera) 1765
Description and Habitat 1765
Pharmacology 1765
Native American and European Medicinal Uses and Folklore 1765
Modern Clinical and Wilderness Applications 1765
Toxicity 1766
Plantain (Plantago major) 1766
Description and Habitat 1766
Native American and European Medicinal Uses and Folklore 1766
Modern Clinical and Wilderness Applications 1767
Toxicity 1767
Chamomile (Matricaria chamomilla) 1767
Description and Habitat 1767
Pharmacology 1767
Native American and European Medicinal Uses and Folklore 1767
Modern Clinical and Wilderness Applications 1767
Echinacea (Echinacea species) 1767
Description and Habitat 1767
Pharmacology 1768
Native American and European Medicinal Uses 1768
Modern Clinical and Wilderness Applications 1768
Calendula (Calendula officinalis) 1768
Description and Habitat 1768
Pharmacology 1768
Native American and European Medicinal Uses 1768
Modern Clinical and Wilderness Applications 1768
Gentian, Bitter Gentian, Yellow Gentian (Gentiana L. species) 1768
Description and Habitat 1768
Pharmacology 1768
Native American and European Medicinal Uses 1768
Modern Clinical and Wilderness Applications 1769
Desert Parsley, Fern-Leafed Lomatium (Lomatium dissectum, Nutt.) 1769
Description and Habitat 1769
Pharmacology 1769
Native American and European Medicinal Uses 1769
Modern Clinical and Wilderness Applications 1769
Devil’s Club (Oplopanax horridus) 1769
Description and Habitat 1769
Pharmacology 1769
Native American and European Medicinal Uses 1770
Modern Clinical and Wilderness Uses 1770
Old Man’s Beard (Usnea species) 1770
Description and Habitat 1770
Native American and European Medicinal Uses 1770
Modern Clinical and Wilderness Uses 1770
First-Aid Kit of Natural Products 1771
Homeopathic Medicines 1771
Single Preparations and Their Indications 1771
Aconite 1771
Apis 1771
Arnica 1771
Arsenicum 1771
Belladonna 1771
co*ckle 1773
Hypericum 1773
Ledum 1773
Poison Nut 1773
Rhus 1773
Combination Preparations for Acute Sprains and Strains 1773
Herbal Combination Formulas 1773
Nutritional Supplements 1773
Bromelain 1773
Papain 1773
Vitamin C 1774
Vitamin D3 1774
For Acute Gastroenteritis 1774
Diarrhea 1774
For Acute Hemorrhagic Conditions 1774
For Dermatologic Conditions 1774
SssstingStop Gel 1774
Ching Wang Hun (or Jing Wan Hong) Burn Ointment 1774
Other Skin Therapies 1774
For General Health and Wellness 1775
Jet Lag and Travel Fatigue 1775
Motion Sickness and Seasickness 1775
Cough, Cold, and Flu 1775
Pain and Trauma 1775
Frostbite, Heat Exhaustion, and Heatstroke 1776
Activated Charcoal for Travel* 1776
Plant and Other Poisons or Medications Neutralized by Activated Charcoal 1776
How to Make an Activated Charcoal Poultice 1776
Essential Oil Remedies for Travel 1777
Use of Essential Oils during Travel 1777
Aromatic Uses. 1777
Topical Uses. 1777
Internal Uses. 1778
Common Essential Oil Remedies during Travel 1778
Prevention. 1778
Motion Sickness and Seasickness. 1778
Cough, Cold, and Flu. 1778
Diarrhea, Dysentery, and Vomiting. 1778
Pain and Trauma. 1778
Frostbite. 1778
Heat Exhaustion and Heatstroke. 1778
Contraindications to Essential Oils on Travel 1778
Indications for Botanical and Essential Oil Remedies 1779
Appendix 1779
Companies 1779
Boiron 1779
Biological Homeopathic Industries (BHI) 1779
BioResource Inc. 1779
Institute for Traditional Medicine (ITM) 1779
Books 1780
Natural Health and Medicine 1780
Herbs and Herbalism 1780
Homeopathy Books 1780
Practitioners 1780
American Association of Naturopathic Physicians 1780
Herbal Medicines 1780
Herb Research Foundation 1780
Nutritional Products 1780
Crane Herb Company 1780
Thorne Research 1780
Metagenics 1780
Mountain Peak Nutritionals 1780
Vital Nutrients 1780
References 1780
References 1781
10 Marine Medicine 1784
69 Drowning and Submersion Injuries 1785
Classification and Types of Submersion Injuries and Drowning Scenarios 1785
Incidence and Epidemiology 1785
Risk Factors 1786
Age 1786
Gender 1787
Race 1787
Location 1787
Familiar or Unfamiliar Places 1787
Submerged Vehicle Incidents 1787
Scuba Diving Accidents 1787
Water Birthing Incidents 1788
Ability to Swim 1788
Alcohol and Drugs Contributing to Drowning Incidents 1788
Preexisting Disease 1788
Child Abuse, Homicide, and Suicide 1788
Boating-Related Drowning 1788
Pathophysiology 1789
The Human Body and Water 1789
The Initial Event 1789
Pulmonary System 1789
Swimming-Induced Pulmonary Edema 1790
Central Nervous System 1790
Cardiovascular System 1792
Hematologic and Electrolyte Disturbances 1792
Hypothermia 1792
Management: the Element of Time 1793
Clinical Presentation: a Case History 1793
On-Scene Management 1794
The Asymptomatic Patient: Grades 0 and 1 1794
The Symptomatic Patient: Grades 2, 3, and 4 1794
The Patient in Respiratory or Cardiopulmonary Arrest: Grades 5 and 6 1794
Cervical Spine Injury 1796
The Obviously Dead or Still-Submerged Patient 1796
Terminating Resuscitation Efforts 1796
En Route to Definitive Care 1796
Emergency Department Treatment of Drowning Patients 1797
In-Hospital Treatment of Drowning 1797
Pulmonary Management 1798
Cardiovascular System and Hemodynamics 1798
Central Nervous System 1799
Hypothermia 1799
Renal System 1799
Decompression Illness 1799
Infectious Diseases 1799
Prognosis and Termination of Resuscitation 1800
Drowning Prevention and Survival 1801
Preimmersion Interventions 1801
Preimmersion Interventions by Age 1801
Swimming Pool Safety 1802
Supervision and Lifeguards 1802
Training for Out-of-Hospital Personnel 1802
Swimming Lessons and Boating Instruction 1802
Personal Flotation Devices 1803
Preventive Equipment 1803
Education About Alcohol and Drugs 1803
Postimmersion Actions 1803
References 1804
References 1805
70 Safety and Survival at Sea 1810
How Do People Die in Recreational Boating Accidents? 1810
Personal Safety Gear 1811
Life Jackets 1811
The Inflatable Advantage 1812
Testing a Life Jacket 1813
Immersion (Survival) Suits 1813
Safety Harnesses 1813
Crew Overboard 1814
Remaining Aboard 1814
Recovery of Crew Overboard 1814
Crew Overboard Maneuvers 1816
Bringing the Victim Aboard 1816
Emergencies at Sea 1817
Fire at Sea 1817
Causes 1817
Fire from Fuels, Liquids, and Gases 1817
Fighting Fires 1818
Flooding 1819
Flood Mitigation 1820
Collisions with Other Vessels 1822
Automatic Identification System 1823
Using Radar to Avoid Collisions 1823
Visual Means of Avoiding Collisions 1823
Health Maintenance at Sea 1824
The Fearsome Five 1824
Food 1824
Fluid 1824
Fahrenheit 1825
Fatigue 1825
Fitness 1825
Seasickness 1825
Preventing and Treating Seasickness 1826
Marine Weather 1827
Thunderstorms and Squall Lines 1827
Sources of Marine Weather Information 1827
Traditional Weather Forecasting Methods 1828
Lightning 1828
Mitigating the Damage from Lightning 1829
Other Weather Phenomena at Sea 1829
Waterspouts 1829
Hurricanes and Cyclones 1829
Sea Conditions and Breaking Seas 1830
Emergency Communications and Distress Signals 1831
Visual and Sound Distress Signals 1831
Nonpyrotechnic Signals 1833
Cellular Telephones 1833
Satellite Phones 1834
Global Maritime Distress and Safety System and Digital Selective Calling 1834
VHF-FM Marine Radios 1834
SSB-HF Radios 1836
Emergency Beacons 1836
SEND Devices 1837
Abandon Ship and Life Rafts 1837
Decision to Abandon Ship 1837
Life Raft Classifications 1838
How to Abandon Ship 1838
Life Raft Storage 1839
Launching the Raft 1839
Life in the Raft: Extending Survival Time and Anticipating Rescue 1839
Signals and Watch Schedules 1840
Raft Maintenance 1840
Health Issues and Hypothermia 1840
Water 1840
Food 1841
Rescue and Evacuation of the Sick and Injured 1841
Automated Merchant Vessel Reporting Program 1841
Helicopter Evacuation 1842
References 1843
References 1844
71 Diving Medicine 1843
Historical Perspective 1846
Types of Diving and Diving Equipment 1847
Breath-Hold Diving 1847
Medical Problems of Breath-Hold Diving 1847
SCUBA Diving 1847
Rebreather Diving 1848
Rebreather Devices 1848
Oxygen Rebreather. 1848
Semiclosed-Circuit Rebreather. 1849
Manual Closed-Circuit Rebreather. 1849
Electronic Closed-Circuit Rebreather. 1849
Open-Circuit Scuba System versus Rebreather Approach 1849
Open-Circuit Air Approach. 1849
Rebreather Approach. 1849
Surface-Supplied (Tethered) Diving 1850
Mixed-Gas Diving 1850
Enriched Air Nitrox 1850
Heliox 1850
Trimix 1851
Technical Diving 1851
Saturation Diving 1851
Polar Diving 1852
Marine Life Hazards 1852
Polar Diving Emergencies 1852
Physiologic Considerations in Polar Diving 1852
Cold Water. 1852
Surface Cold Exposure. 1853
Hydration. 1853
Decompression. 1853
One-Atmosphere Diving 1853
Diving Physics 1853
Barotrauma 1854
Barotrauma of Descent 1855
Mask Barotrauma 1855
Sinus Barotrauma 1856
External Auditory Canal Barotrauma. 1856
Middle Ear Barotrauma. 1856
Inner Ear Barotrauma. 1858
Suit Barotrauma 1858
Dental Barotrauma 1858
Lung Barotrauma 1858
Underwater Blast Injury 1859
Barotrauma of Ascent 1859
Reverse Sinus or Ear Barotrauma (Reverse Squeeze) 1859
Alternobaric Vertigo 1859
Facial Baroparesis (Alternobaric Facial Palsy) 1859
Gastrointestinal Barotrauma 1859
Pulmonary Barotrauma 1859
Clinical Manifestations of Pulmonary Barotrauma. 1860
Local Pulmonary Injury. 1860
Arterial Gas Embolism 1861
Pathophysiology 1861
Arterial Gas Embolism and Sudden Death 1861
Clinical Manifestations 1862
Treatment 1863
Prehospital Care 1863
Hyperbaric Oxygen Therapy 1864
Adjunctive Treatment 1864
Prevention of Pulmonary Barotrauma and Arterial Gas Embolism 1864
Indirect Effects of Pressure 1864
Dalton’s Law of Partial Pressures 1864
Nitrogen Narcosis 1865
Oxygen Toxicity 1865
Pulmonary Oxygen Toxicity 1866
Central Nervous System Oxygen Toxicity 1866
Contaminated Breathing Gas (Carbon Monoxide Poisoning, Hypercarbia) 1866
Hyperventilation and Shallow Water Blackout 1866
Decompression Sickness 1867
Cause 1867
Pathophysiology 1867
Venous Gas Emboli 1867
Biochemical Effects of Bubbles 1868
Clinical Manifestations 1868
Musculoskeletal Decompression Sickness 1868
Fatigue 1869
Cutaneous Decompression Sickness (Skin Bends) 1869
Pulmonary Decompression Sickness (Chokes) 1869
Neurologic Decompression Sickness 1869
Inner Ear or Vestibular Decompression Sickness 1870
Vasomotor Decompression Sickness 1870
Long-Term Sequelae of Decompression Sickness 1870
Dysbaric Osteonecrosis 1870
Dysbaric Retinopathy 1870
Diagnosis 1870
Treatment 1870
Adjunctive Treatment 1872
Corticosteroids. 1872
Anticoagulants and Nonsteroidal Antiinflammatory Drugs. 1872
Prevention 1872
Decompression Sickness in Breath-Hold Divers 1872
Long-Term Health Effects of Diving 1872
Unusual Conditions of Uncertain Origin Following Dives 1873
Immersion Pulmonary Edema 1873
Internal Carotid Artery Dissection 1873
Medical Fitness for Diving 1873
General Considerations 1873
Medical Clearance for Diving 1874
Specific Conditions of Concern with Regard to Diving 1874
Neurologic Disorders 1874
Seizures. 1874
Head Injury. 1874
Unexplained Syncope. 1874
Migraine Headaches. 1874
Cardiovascular Disorders 1874
Atrial Septal Defect. 1874
Patent Foramen Ovale. 1874
Coronary Artery Disease. 1875
Dysrhythmias. 1875
Hypertension. 1875
Pulmonary Disorders 1876
Spontaneous Pneumothorax. 1876
Asthma. 1876
Bullous Lung Disease. 1876
Diabetes 1877
Pregnancy 1877
Ear, Nose, and Throat Disorders 1877
Sickle-Cell Disease or Trait 1877
Panic Disorders 1877
Abdominal Hernias 1877
Poor Physical Condition 1877
Medications and Diving 1877
Diving with Disabilities 1878
Flying after Diving 1878
Safe SCUBA Diving 1878
Dive Accident Investigation 1879
Investigation of Diving Fatalities 1879
References 1879
References 1880
72 Hyperbaric Medicine 1886
History of Hyperbaric Medicine 1886
Mechanisms of Hyperbaric Oxygen 1886
Effects of Hyperbaric Oxygen on Oxygen Content 1886
Effects of an Elevated Partial Pressure of Oxygen 1886
Vasoconstriction 1886
Bacteriostatic and Bactericidal Effects of Hyperbaric Oxygen 1887
Angiogenesis 1887
Wound Healing 1887
Ischemia-Reperfusion Injury 1887
Types of Hyperbaric Chambers 1889
Monoplace Hyperbaric Chambers 1889
Multiplace Hyperbaric Chambers 1889
Portable Recompression Chambers 1889
Hyperbaric Chambers for Altitude Illness 1889
Hyperbaric Chambers for Diving Injuries 1891
Contraindications to Hyperbaric Oxygen Therapy 1891
Absolute Contraindications 1891
Relative Contraindications 1891
Complications of Hyperbaric Oxygen Therapy 1891
Oxygen Toxicity 1891
Central Nervous System Oxygen Toxicity 1892
Pulmonary Oxygen Toxicity 1892
Barotrauma 1892
Claustrophobia 1892
Visual Refractive Changes 1892
Practical Aspects of Hyperbaric Treatment 1892
Evaluation of the Patient for Hyperbaric Oxygen Therapy 1892
Preparation for Hyperbaric Treatment 1892
Pediatric Considerations 1893
Approved Clinical Applications of Hyperbaric Oxygen Therapy 1893
Arterial Gas Embolism 1893
Decompression Sickness 1895
Arterial Insufficiencies 1895
Central Retinal Artery Occlusion 1895
Enhancement of Healing in Selected Problem Wounds 1895
Carbon Monoxide and Cyanide Poisoning 1896
Clostridial Myonecrosis (Gas Gangrene) 1897
Compromised Grafts and Flaps 1897
Crush Injuries and Skeletal Muscle Compartment Syndromes 1897
Delayed Radiation Injuries (Soft Tissue and Bony Necrosis) 1898
Idiopathic Sudden Sensorineural Hearing Loss 1899
Intracranial Abscess 1899
Necrotizing Soft Tissue Infections 1899
Refractory Osteomyelitis 1899
Severe Anemia 1900
Thermal Burns 1900
Trends in Hyperbaric Oxygen Therapy Research 1900
Acute Myocardial Ischemia 1900
Acute Cerebral Ischemia 1901
Traumatic Brain Injury 1901
Organ Transplantation 1901
Applications for Hyperbaric Oxygen Therapy in Wilderness Medicine 1901
Frostbite 1901
Brown Recluse Spider Bite 1902
Heatstroke 1902
Field Treatment of Combat Trauma 1902
References 1902
References 1903
73 Injuries From Nonvenomous Aquatic Animals 1908
Divisions and Definitions 1908
In Defense of the Fish 1908
General Principles of First Aid 1908
Wound Management 1908
Wound Irrigation 1909
Wound Debridement 1909
Wound Closure 1909
Prophylaxis Against Tetanus 1909
Bacteriology of the Aquatic Environment 1909
Marine Bacteriology 1909
Marine Environment 1909
Diversity of Organisms 1910
Wound Infections Caused by Vibrio Species 1910
Vibrio parahaemolyticus 1911
Vibrio vulnificus 1911
Vibrio mimicus 1912
Vibrio alginolyticus 1912
Photobacterium damsela 1912
Vibrio cholerae 1912
Growth in Culture 1912
Antibiotic Therapy 1913
Freshwater Bacteriology 1914
Diversity of Organisms 1914
Wound Infections Caused by Aeromonas Species 1914
Infections Caused by a Fish Pathogen, Streptococcus iniae 1914
Infection Caused by Desmodesmus armatus 1915
A General Approach to Antibiotic Therapy 1915
Sharks 1915
Life and Habits 1919
Shark Feeding and Attack 1924
Clinical Aspects 1928
Treatment 1931
Prevention 1934
Barracuda 1937
Life and Habits 1937
Clinical Aspects 1938
Treatment 1938
Prevention 1938
Moray Eels 1938
Life and Habits 1938
Clinical Aspects 1939
Treatment 1939
Prevention 1940
Giant Groupers 1940
Sea Lions and Seals 1941
Needlefish 1941
Large Leaping Fish 1942
Killer Whales 1943
Giant Clams 1943
Giant Squid 1944
Giant Octopus 1945
Giant Manta Ray 1945
Mantis Shrimp 1945
Piranha 1946
Snapping Turtle 1947
Triggerfish 1947
Sawfishes 1948
Stony Corals 1948
Life and Habits 1948
Clinical Aspects 1948
Treatment 1949
Prevention 1949
Electric Fish and Rays 1949
References 1950
References 1951
74 Envenomation by Aquatic Invertebrates 1955
Allergic Reactions 1955
Anaphylaxis 1955
Treatment 1955
Antivenom Administration 1955
Serum Sickness 1956
Phylum Porifera 1956
Sponges 1956
Life and Habits 1956
Clinical Aspects 1956
Treatment 1958
Prevention 1958
Phylum Cnidaria 1958
Morphology, Venom, and Venom Apparatus 1958
Cnidarian Syndrome 1961
Clinical Aspects 1961
Mild Envenomation. 1961
Moderate and Severe Envenomation. 1962
Treatment 1964
Systemic Envenomation. 1964
Pain Control. 1965
Treatment of Dermatitis. 1965
Delayed Reaction. 1966
Persistent Hyperpigmentation. 1966
Persistent Cutaneous Hypersensitivity. 1966
Prevention 1966
Class Hydrozoa 1966
Hydroids 1966
Clinical Aspects. 1967
Treatment. 1967
Fire Coral 1967
Clinical Aspects. 1968
Treatment. 1969
Physalia (Man-of-War) 1969
Clinical Aspects. 1970
Treatment. 1971
Seabather’s Eruption 1971
Clinical Aspects. 1971
Treatment. 1972
Gonionemus Species 1972
Classes Cubozoa and Scyphozoa 1972
Chironex (Box-Jellyfish) 1973
Clinical Aspects. 1974
Treatment. 1976
Irukandji Jellyfish 1978
Clinical Aspects. 1979
Treatment. 1979
Chrysaora (Sea Nettles) 1979
Clinical Aspects. 1979
Treatment. 1979
Class Anthozoa 1979
Actinaria (Anemones) 1979
Clinical Aspects. 1980
Treatment. 1981
Phylum Echinodermata 1981
Starfish 1981
Life and Habits 1981
Venom and Venom Apparatus 1981
Clinical Aspects 1982
Treatment 1982
Sea Urchins 1982
Life and Habits 1982
Venom and Venom Apparatus 1982
Clinical Aspects 1984
Treatment 1986
Sea Cucumbers 1988
Life and Habits 1988
Venom and Venom Apparatus 1988
Clinical Aspects 1988
Treatment 1989
Phylum Annelida 1989
Annelid Worms 1989
Life and Habits 1989
Clinical Aspects 1989
Treatment 1990
Phylum Mollusca 1990
Mollusks 1990
Cone Snails (Cone Shells) 1990
Life and Habits 1990
Venom and Venom Apparatus 1991
Clinical Aspects 1992
Treatment 1993
Octopuses 1993
Life and Habits 1993
Venom and Venom Apparatus 1993
Clinical Aspects 1996
Treatment 1996
Prevention 1996
Summary 1996
References 1996
References 1997
75 Envenomation by Aquatic Vertebrates 2001
Stingrays 2001
Life and Habits 2001
Venom and Venom Apparatus 2001
Clinical Aspects 2004
Treatment 2006
Prevention 2008
Scorpionfish and Similar Venomous Fish 2008
Life and Habits 2008
Venom and Venom Apparatus 2009
Clinical Aspects 2011
Treatment 2013
Prevention 2014
Catfish 2014
Life and Habits 2014
Venom and Venom Apparatus 2016
Clinical Aspects 2016
Treatment 2017
Prevention 2017
Weeverfish 2018
Life and Habits 2018
Venom and Venom Apparatus 2018
Clinical Aspects 2018
Treatment 2018
Prevention 2019
Venomous (Horned) Sharks 2019
Life and Habits 2019
Clinical Aspects 2019
Treatment 2019
Surgeonfish 2019
Life and Habits 2019
Clinical Aspects 2019
Treatment 2019
Platypus 2020
Venom and Venom Apparatus 2020
Clinical Aspects 2020
Treatment 2020
Sea Snakes 2020
Life and Habits 2020
Venom and Venom Apparatus 2021
Clinical Aspects 2022
Treatment 2022
Summary 2023
References 2023
References 2024
76 Aquatic Skin Disorders 2023
Phytoplankton Dermatoses 2023
Cyanobacteria 2023
Dinoflagellates 2026
Algae 2026
Sargassum algae Dermatitis 2026
Definition. 2026
Physiology. 2026
Clinical Presentation. 2026
Treatment. 2026
Prevention. 2026
Lyngbya Dermatitis 2026
Definition. 2026
Epidemiology and Risk Factors. 2027
Pathophysiology. 2027
Clinical Presentation. 2027
Differential Diagnosis. 2027
Treatment. 2027
Sequelae. 2028
Prevention. 2028
Ciguatera Dermatitis 2028
Definition. 2028
Epidemiology and Risk Factors. 2028
Pathophysiology. 2028
Clinical Presentation. 2028
Diagnostic Tests. 2028
Treatment. 2028
Sequelae. 2028
Prevention. 2028
Prototheca Dermatitis 2028
Definition. 2028
Epidemiology and Risk Factors. 2028
Pathophysiology. 2028
Clinical Presentation. 2028
1. Superficial Cutaneous Lesions. 2028
2. Olecranon Bursitis. 2028
3. Systemic Infection. 2028
Mucosal Protothecosis. 2029
Differential Diagnosis. 2029
Diagnostic Tests. 2029
Treatment. 2029
Human Pythiosis Dermatitis 2029
Definition. 2029
Epidemiology and Risk Factors. 2029
Pathophysiology. 2029
Clinical Presentation. 2029
Differential Diagnosis. 2029
Diagnostic Tests. 2030
Treatment. 2030
Prevention. 2030
Bacterial Infections 2030
Aeromonas Hydrophila Infections 2030
Definition 2031
Epidemiology and Risk Factors 2031
Pathophysiology 2031
Clinical Presentation 2031
Differential Diagnosis 2031
Diagnostic Tests 2031
Treatment 2031
Prevention 2031
Chromobacterium violaceum Infections 2031
Definition 2031
Epidemiology and Risk Factors 2031
Physiology 2031
Clinical Presentation 2031
Differential Diagnosis 2031
Treatment 2032
Prevention 2032
Pseudomonas aeruginosa Infections 2032
Definition 2032
Epidemiology 2032
Pathogenesis 2032
Hot Tub Folliculitis 2033
Definition. 2033
Epidemiology. 2033
Pathophysiology. 2033
Clinical Presentation. 2033
Diagnostic Tests. 2033
Treatment. 2033
Prevention. 2034
Green Nail Syndrome 2034
Definition. 2034
Pathophysiology. 2034
Risk Factors. 2034
Clinical Presentation. 2034
Differential Diagnosis. 2034
Diagnostic Tests. 2034
Treatment. 2034
Otitis Externa 2034
Definition. 2034
Epidemiology and Risk Factors. 2034
Pathophysiology. 2034
Clinical Presentation. 2034
Differential Diagnosis. 2035
Diagnostic Tests. 2035
Treatment. 2035
Sequelae. 2035
Prevention. 2035
Vibrio vulnificus Infections 2036
Definition 2036
Epidemiology and Risk Factors 2036
Clinical Presentation 2036
Pathophysiology and Histology 2036
Differential Diagnosis 2036
Diagnostic Tests 2036
Treatment 2036
Prevention 2036
Shewanella putrefaciens Infections 2036
Definition 2036
Pathophysiology 2036
Clinical Presentation 2037
Risk Factors 2037
Differential Diagnosis 2037
Diagnostic Tests 2037
Treatment 2037
Prevention 2037
Mycobacterium marinum Infections 2037
Definition 2037
Epidemiology and Risk Factors 2037
Pathophysiology 2037
Clinical Presentation 2037
Differential Diagnosis 2038
Diagnostic Tests 2038
Treatment 2038
Prevention 2038
Melioidosis 2038
Definition 2038
Epidemiology and Risk Factors 2039
Localized Form. 2039
Chronic Form. 2039
Differential Diagnosis 2039
Diagnostic Tests 2039
Treatment 2039
Prevention 2039
Erysipelothrix rhusiopathiae (Erysipeloid) 2039
Definition 2039
Epidemiology 2040
Pathophysiology 2040
Clinical Presentation 2040
Differential Diagnosis 2040
Diagnostic Tests 2040
Treatment 2040
Prevention 2040
Mycoplasma Infections 2040
Seal Finger 2040
Definition. 2040
Pathophysiology. 2041
Clinical Presentation. 2041
Differential Diagnosis. 2041
Risk Factors. 2041
Diagnostic Tests. 2041
Treatment. 2041
Prevention. 2041
Parasites 2041
Anisakidosis 2041
Definition 2041
Epidemiology and Risk Factors 2041
Pathophysiology and Clinical Presentation 2041
Differential Diagnosis 2042
Treatment 2042
Prevention 2042
Schistosome Cercarial Dermatitis 2042
Definition 2042
Epidemiology 2042
Pathophysiology 2043
Clinical Presentation 2043
Differential Diagnosis 2043
Diagnostic Tests 2043
Treatment 2043
Prevention 2044
Cutaneous Larva Migrans 2044
Definition 2044
Epidemiology and Risk Factors 2044
Pathophysiology 2044
Clinical Presentation 2044
Diagnostic Tests 2044
Differential Diagnosis 2044
Treatment 2044
Prevention 2044
Leeches 2044
Definition 2044
Epidemiology and Risk Factors 2044
Pathophysiology 2044
Clinical Presentation 2045
Treatment 2045
Prevention 2045
Sequelae 2045
Yeast 2045
Pityrosporum Folliculitis 2045
Definition 2045
Pathophysiology 2045
Epidemiology and Risk Factors 2045
Clinical Presentation 2045
Differential Diagnosis 2045
Diagnostic Tests 2045
Treatment 2045
Prevention 2045
Dermatoses Related to Diving 2046
Allergic Contact Dermatitis 2046
Definition 2046
Pathophysiology 2046
Clinical Presentation 2046
Differential Diagnosis 2046
Treatment 2046
Prevention 2046
Cutaneous Decompression Sickness: an Overview 2047
Definition 2047
Epidemiology and Risk Factors 2047
Pathophysiology 2047
Clinical Presentation 2047
Treatment 2048
References 2048
References 2049
77 Seafood Toxidromes 2048
Monitoring Marine Algae That Produce Phytotoxins and Seafood That May Cause Poisoning 2048
Sustainable and Safe Seafood Initiatives 2052
Ichthyosarcotoxism 2053
Ichthyocrinotoxication 2053
Ichthyohemotoxication 2053
Ichthyohepatotoxication 2053
Ichthyootoxication 2054
Ichthyoallyeinotoxication 2054
Gempylotoxication 2054
Specific Toxic Syndromes Related to Seafood Consumption 2054
Scombroid Poisoning 2054
Pathophysiology 2054
Clinical Presentation 2057
Treatment 2057
Prevention 2057
Tetrodotoxin Poisoning 2057
Pathophysiology 2057
Clinical Presentation 2058
Treatment 2058
Grass Carp Gallbladder Poisoning 2059
Poisonings Associated with Algal Blooms 2059
Ciguatera Poisoning 2059
Pathophysiology 2059
Clinical Presentation 2061
Diagnosis 2062
Treatment 2062
Prevention 2062
Clupeotoxic Fish Poisoning 2062
Pathophysiology 2063
Clinical Presentation 2063
Treatment 2063
Prevention 2063
Paralytic Shellfish Poisoning 2063
Pathophysiology 2064
Clinical Presentation 2064
Treatment 2065
Prevention 2065
Neurotoxic Shellfish Poisoning 2065
Pathophysiology 2065
Clinical Presentation 2065
Treatment 2065
Prevention 2065
Diarrhetic Shellfish Illness 2065
Amnestic Shellfish Poisoning 2066
Pathophysiology 2066
Clinical Presentation 2067
Treatment 2067
Prevention 2067
Possible Estuary-Associated Syndrome 2067
Haff Disease 2068
Blue-Green Algae Blooms 2068
Azaspiracid Shellfish Poisoning 2068
Pathophysiology 2068
Clinical Presentation 2068
Diagnosis 2069
Treatment 2069
Prevention 2069
Yessotoxin Poisoning 2069
Other Types of Shellfish and Invertebrate Poisoning 2069
Callistin Shellfish Poisoning 2069
Venerupin Shellfish Poisoning 2069
Tridacna Clam Poisoning 2069
Whelk Poisoning 2069
Ivory Shell Poisoning 2069
Abalone Poisoning 2069
Cephalopod Poisoning 2069
Sea Cucumber Poisoning 2070
Sea Hare Poisoning 2070
Anemone Poisoning 2070
Crab Poisoning 2070
Bacterial and Viral Pathogens in Seafood 2070
Bacteria Associated with Fecal Contamination 2070
Vibrio Poisoning and Septicemia 2071
Vibrio vulnificus Infection. 2071
Clinical Presentation. 2071
Treatment. 2072
Vibrio parahaemolyticus Infection. 2072
Vibrio mimicus Infection. 2072
Vibrio alginolyticus Infection. 2072
Vibrio cholerae Infection. 2072
Other Vibrios. 2072
Prevention of Vibrio Infection. 2072
Viruses Associated with Fecal Contamination 2072
Hepatitis Viruses 2073
Enteroviruses 2073
Small Round Viruses 2073
Botulism 2073
Clinical Presentation 2073
Treatment 2073
Prevention 2074
Parasites in Seafood 2074
Fish Tapeworm 2074
Trematodes 2074
Nematodes 2074
Anisakiasis 2074
Life and Habits. 2074
Clinical Presentation. 2075
Diagnosis and Treatment. 2075
Prevention. 2075
Eustrongylides 2075
Gnathostoma 2075
Life and Habits. 2075
Clinical Presentation. 2075
Diagnosis and Treatment. 2075
Prevention. 2075
Other Types of Poisoning Related to Seafood 2076
Poisoning by Environmental Contamination 2076
Red Seaweed Poisoning 2076
Sea Turtle Poisoning (Chelonintoxication) 2076
Liver Poisoning: Hypervitaminosis a 2077
Amebic Infections 2077
Primary Amebic Meningoencephalitis 2077
Granulomatous Amebic Encephalitis 2077
Acanthamoeba Keratitis 2078
Diseases Caused by Occupational Exposure to Seafood 2078
Pathophysiology 2078
Clinical Presentation 2078
Treatment 2078
Prevention 2078
References 2078
References 2079
78 Seafood Allergies 2088
Epidemiology 2088
Biologic Classification of Seafood 2088
Immunologic Mechanisms of Seafood Allergies 2088
Clinical Manifestations 2091
Occupational Seafood Allergies 2091
Differential Diagnosis 2092
Diagnosis 2092
Management 2093
Aftercare 2093
Molecular Biology of Seafood Allergies 2094
Fish Allergens 2094
Crustacean Allergens 2096
Mollusk Allergens 2096
Cross-Reactivity 2097
Fish Cross-Reactivity 2097
Shellfish Cross-Reactivity 2098
Shellfish Cross-Reactivity with Insects and Arachnids 2098
Future Directions 2098
References 2099
References 2100
11 Travel Medicine and Expeditions 2105
79 Travel Medicine 2106
Sources of Information 2106
Travel Health Risk Assessment 2106
Pretravel Preparations 2106
Hazards of Air Travel 2107
Jet Lag 2108
Before Travel 2108
In Flight 2108
On Arrival 2108
Deep Vein Thrombosis 2108
Immunizations for Travel 2108
Required Travel Vaccines 2111
Yellow Fever Vaccine 2111
Cholera Vaccine 2111
Smallpox Vaccine 2112
Recommended Travel Vaccines 2112
Hepatitis A Vaccine 2112
Hepatitis B Vaccine 2113
Typhoid Fever Vaccine 2114
Meningococcal Vaccine 2114
Japanese Encephalitis Virus Vaccine 2115
Rabies Vaccine 2115
Tick-Borne Encephalitis Vaccine 2115
Bacille Calmette-Guérin Vaccine 2115
Varicella-Zoster Virus (Chickenpox) Vaccine 2115
Influenza Vaccine 2115
Other Vaccines 2116
Routine Vaccines 2116
Diphtheria, Tetanus, and Pertussis Vaccine 2116
Poliomyelitis Vaccine 2116
Measles, Mumps, and Rubella Vaccine 2116
Haemophilus Influenzae Type B (Hib) Vaccine 2116
Pneumococcal Vaccine 2116
Malaria 2116
Malaria Risk Assessment 2116
Precautions Against Insects (see Chapter 45) 2117
Malaria Chemoprophylaxis (see Chapter 40) 2117
Standby Self-Diagnosis AND Drug Treatment 2119
Traveler’s Diarrhea (see Chapter 82) 2119
Chemoprophylaxis 2120
Symptomatic Treatment 2121
High-Altitude Illness (see Chapter 2) 2121
Radiation From the Sun (see Chapter 16) 2123
Motion Sickness 2123
Travel Medical Kit 2123
Post-Travel Medical Care AND Screening 2123
Resources for Travel Medicine Information 2124
Acknowledgment 2124
References 2124
References 2125
80 Expedition Medicine 2124
Historical Background 2124
Expedition Demographics 2124
Preexisting Medical Conditions 2129
The Expedition Medical Officer 2129
Clinical Skills 2129
Preexpedition Phase 2129
Expedition Phase 2129
Location. 2129
Environment. 2129
Goals. 2129
Preexisting Medical Conditions. 2130
Postexpedition Phase 2130
Expedition Skills 2130
Personal Skills 2130
Self-Awareness 2130
Communication Skills 2130
Empathy and Compassion 2130
Adaptability 2130
Sense of Humor 2130
Skills of Conflict Resolution 2130
Decision Making and Hierarchy. 2130
Expectations. 2131
Conflict Stemming From Expedition Purpose, Ethics, and Morals. 2131
Who is Qualified to be the Expedition Medical Officer? 2131
Expedition Medical Planning 2133
Medical Screening 2133
Generic PreExpedition Advice for Persons with Preexisting Medical Conditions 2133
Vaccinations, Malaria Chemoprophylaxis, and Personal Medication 2134
Vaccinations 2134
Malaria Chemoprophylaxis 2134
Personal Medication 2134
Risk Management 2134
Country-Specific Risks 2135
Expedition Medical Training 2136
Expedition Medical Kit Preparation 2136
Diagnostic Equipment 2136
Medical Kit Packaging 2136
Problems of Transporting Controlled Drugs 2137
Treating Infections 2137
Analgesia 2137
Other Essential Drugs 2137
Creams and Ointments 2137
Emergency Equipment 2137
Obtaining Medical Supplies 2137
Base Camp and Satellite Medical Kits 2137
Medical Kits for Special Environments 2137
Communications Technology 2137
Legal and Ethical Considerations of Expedition Medicine 2138
Duty of Care 2138
Level of Control and Age/Experience of the Ill or Injured Person 2139
Comparison with Peers 2139
Likelihood of an Incident Occurring 2139
Maintenance of Equipment and Cost of Precautions 2139
Emergency Situations 2139
Standard of Care 2139
Confidentiality 2139
Consent 2139
Competence and Capacity 2140
Negligence 2140
How Much Should Laypersons be Taught About Medicine? 2140
Legal Position of a Physician Advising Care to be Administered by a Layperson 2140
Liability on Commercial Expeditions 2140
Expeditions Departing Without an EMO 2140
Medical Records 2140
Professional Indemnity Insurance 2140
Ethical Considerations of Interacting with Local Populations 2141
Preexpedition Planning 2141
During the Expedition 2141
Treating Local Staff 2142
Biomedical Research 2142
Dealing with the Media 2142
Resources 2143
Appendix Recommended Medical Kit 2143
References 2144
References 2145
81 Non–North American Travel and Exotic Diseases 2146
Major Viral Infections 2146
Major Viral Hemorrhagic Fevers 2146
Yellow Fever 2146
Virology and Pathophysiology 2146
Ecology and Epidemiology 2146
Clinical Presentation and Diagnosis 2146
Management 2147
Prevention 2147
Dengue 2147
Virology and Pathophysiology 2147
Ecology and Epidemiology 2147
Clinical Presentation 2147
Prevention and Management 2148
Lassa Fever 2148
Epidemiology 2148
Virology and Pathophysiology 2148
Clinical Presentation 2148
Diagnosis 2148
Management 2148
Ebola and Marburg Viruses 2149
Pathophysiology and Clinical Presentation 2149
Diagnosis and Treatment 2149
Crimean-Congo Hemorrhagic Fever 2149
Virology and Epidemiology 2149
Pathophysiology and Clinical Presentation 2149
Diagnosis 2149
Management 2149
Hemorrhagic Fever with Renal Syndrome and Hantavirus Cardiopulmonary Syndrome 2149
Epidemiology 2150
Virology and Pathophysiology 2150
Clinical Presentation 2150
Diagnosis 2150
Management 2150
Japanese B Encephalitis 2150
Epidemiology 2150
Virology and Pathophysiology 2150
Clinical Presentation 2150
Diagnosis 2150
Management 2151
Named Hepatitis Viruses 2151
Hepatitis A 2151
Epidemiology. 2151
Virology and Pathophysiology. 2151
Clinical Manifestations. 2151
Diagnosis. 2151
Management. 2151
Prevention. 2151
Hepatitis B 2151
Epidemiology. 2151
Virology and Pathophysiology. 2151
Clinical Presentation. 2151
Diagnosis. 2152
Management. 2152
Prevention. 2152
Delta Hepatitis (Hepatitis D) 2152
Epidemiology. 2152
Virology and Pathophysiology. 2152
Management and Prevention. 2152
Hepatitis C 2152
Epidemiology. 2152
Virology and Clinical Manifestations. 2152
Diagnosis. 2152
Management and Prevention. 2152
Hepatitis E 2153
Hepatitis F and Hepatitis G 2153
Major Bacterial Infections 2153
Typhoid and Paratyphoid Fever 2153
Epidemiology 2153
Bacteriology and Pathophysiology 2153
Clinical Presentation 2153
Diagnosis 2153
Management 2154
Prevention 2154
Meningococcal Disease 2154
Epidemiology 2154
Bacteriology and Pathogenesis 2154
Clinical Presentation 2154
Diagnosis 2154
Management 2155
Prevention 2155
Pertussis 2155
Epidemiology 2155
Bacteriology and Pathophysiology 2155
Clinical Presentation 2155
Diagnosis 2155
Management 2155
Prevention 2155
Diphtheria 2156
Epidemiology 2156
Bacteriology and Pathogenesis 2156
Clinical Presentation 2156
Diagnosis 2156
Management 2156
Prevention 2156
Tetanus 2156
Epidemiology 2156
Bacteriology and Pathophysiology 2156
Clinical Presentation 2157
Management 2157
Prevention 2157
Major Protozoan Infections Other Than Malaria 2157
African Trypanosomiasis 2157
Clinical Manifestations 2158
Diagnosis 2158
Management 2158
South American Trypanosomiasis (Chagas’ Disease) 2158
Clinical Manifestations 2158
Diagnosis 2158
Management 2158
Leishmaniasis 2158
Major Helminthic Infections 2159
Schistosomiasis 2159
Clinical Manifestations 2159
Treatment and Prevention 2159
Filariases 2159
Onchocerciasis 2159
Lymphatic Filariasis 2159
Loiasis (Loaiasis) 2160
Intestinal Helminth Infections 2160
Ascariasis 2160
Hookworm 2160
Strongyloidiasis 2160
Enterobiasis 2161
References 2161
References 2162
82 Infectious Diarrhea from Wilderness and Foreign Travel 2161
General Principles of Enteric Disease 2161
Epidemiology 2161
Pathophysiology 2164
Traveler’s Diarrhea 2165
Definition 2165
Etiology 2165
Clinical Syndromes 2165
Persistent and Chronic Diarrhea 2166
Laboratory Tests and Procedures 2167
Treatment 2168
Symptomatic Therapy 2168
Antimicrobial Therapy 2168
Prevention and Prophylaxis 2169
Food, Beverage, and Personal Hygiene 2169
Chemoprophylaxis 2170
Immunoprophylaxis 2170
Bacterial Enteropathogens 2170
Escherichia Coli 2170
Enterotoxigenic E. coli 2170
Enteroinvasive E. coli 2171
Enteroaggregative E. coli 2171
Diffusely Adherent E. coli 2171
Salmonella 2171
Shigella 2171
Campylobacter 2171
Vibrios 2172
Aeromonas Species and Plesiomonas Shigelloides 2172
Viral Enteric Pathogens 2172
Intestinal Protozoa 2172
Giardia Lamblia 2173
Natural Reservoirs 2173
Transmission and Infectious Dose 2173
Pathophysiology and Clinical Presentation 2173
Diagnosis 2174
Treatment 2174
Entamoeba 2174
Epidemiology and Risk 2174
Pathophysiology and Clinical Course 2175
Diagnosis 2175
Treatment 2175
Cryptosporidium 2176
Epidemiology and Risk for Wilderness and International Travelers 2176
Pathophysiology and Clinical Course 2177
Diagnosis 2177
Treatment 2177
Cystoisospora Belli 2177
Epidemiology and the Risk for Wilderness and International Travelers 2177
Pathophysiology and Clinical Course 2177
Diagnosis 2177
Treatment 2177
Cyclospora Cayetanensis 2177
Epidemiology and the Risk for Wilderness and International Travelers 2177
Pathophysiology and Clinical Course 2177
Diagnosis 2178
Treatment 2178
Miscellaneous Parasitic Agents 2178
Microsporidia 2178
Sarcocystis 2178
Balantidium 2178
Blastocystis 2178
Dientamoeba 2178
References 2178
References 2179
12 Disaster Medicine and Global Humanitarian Relief 2183
83 Natural Disaster Management 2184
Scope of the Problem 2184
Health Consequences of Disasters 2184
Health and the Medical Response to Natural Disasters 2185
Scene Safety 2186
Provision of Acute Care 2186
Provision of Mental Health Care 2186
Support for Primary Care and Long-Term Care 2186
Care of the Deceased 2187
Care for Vulnerable Populations 2187
Organizational Systems for Disaster Response 2187
The Incident Command System and the National Incident Management System 2187
The United Nations Cluster Approach for Global Humanitarian Response 2188
Core Activities of the Disaster Response and Recovery Phases 2189
Professionalization of the Disaster Response 2191
Social Media and Mobile Technology in Disasters 2191
Responder Self-Care 2192
References 2192
References 2193
84 Global Humanitarian Medicine and Disaster Relief 2195
Survey of Key Events and Medical Problems 2195
Armed Conflict 2195
Population Displacement 2196
Natural Disasters 2197
Disease Epidemics 2197
Sexual Violence and Mental Illness 2198
Famine and Malnutrition 2198
Neglected Diseases 2198
Emerging Urban Contexts 2198
Actors during Events: Their Capabilities, Limitations, and Usual Roles 2199
Motivating Factors for Organizational Involvement 2201
Needs in Humanitarian Crises 2202
Initial Assessment 2202
Water and Sanitation 2202
Water. 2202
Sanitation. 2202
Food and Nutrition 2202
Shelter, Security, and Site Planning 2203
Health Care in the Emergency Phase 2203
Control of Communicable Diseases and Epidemics 2203
Public Health Surveillance 2204
Human Resources and Training 2204
Coordination and Logistic Support 2204
Identifying Health Care Needs Following a Disaster and Setting Up a Humanitarian Intervention 2204
Background 2204
Principles for Health Assessment in Disasters and Crises 2205
The Assessment Process 2205
Planning. 2205
Team. 2206
Tools. 2206
Methods 2206
Initial Assessment. 2206
Surveys and Sampling Methods. 2206
Data Analysis. 2206
Reporting 2207
Program Development: the Logical Framework 2207
Surveillance, Monitoring, and Evaluation 2208
Putting Services in Place and Mobilizing Resources 2208
The Aid Worker in the Humanitarian Crisis 2209
Motivating Factors for Personal Involvement in Humanitarian Events and Disasters 2209
Professional Characteristics of the Aid Worker 2210
Typical Daily Field Responsibilities of Health Care Workers 2212
How to Become Involved and Stay Involved 2214
How to Prepare for a Mission 2215
Preparing to Deliver Medical Care in a Crisis 2215
Working Outside One’s Skill Set 2216
Dealing With Death 2216
Behavior and Expectations 2217
Practical Considerations 2217
Getting Oriented 2217
How to Pack 2217
Additional Training 2217
Practical Tips on How to Have a Good Mission 2217
Personal Matters. 2217
Professional Matters. 2223
Considerations When Returning Home 2223
Activities After Returning From a Mission 2224
Evolution of the Humanitarian System 2224
Efforts Toward Improving Responses to Needs in the Field 2225
The Sphere Project 2225
United Nations Reform: The Cluster Approach 2225
Humanitarian NGO Professionalization 2225
Training and Certification 2225
Current Challenges, Controversies and Key Future Issues 2226
Growth and Its Effects 2226
Local People and Local Capacity 2226
Medical Quality and Access to Care 2227
Security, Insecurity, and Power in the Field 2228
Humanitarianism and Environmentalism 2228
Humanitarian Ethics and Morals 2228
Appendix A Suggested Packing List 2229
Documents 2229
Gifts to Bring Your Team 2229
Address or Contact List* 2229
Gear 2229
Electronics 2229
First-Aid Kit 2229
Toiletries 2230
Extras 2230
References 2230
References 2231
85 Natural and Human-Made Hazards 2230
Disaster Risk Reduction and Management 2230
Slow-Onset Versus Rapid-Onset Hazards 2232
Assessing Vulnerability and Risk 2233
Disaster Mitigation Strategies 2233
Engineering and Construction 2233
Physical Planning Measures 2233
Economic Measures 2233
Legislation, Management, and Institutional Measures 2233
Societal Measures 2234
The Nature of Hazards 2234
Geologic Hazards 2234
Earthquakes 2234
Causal Phenomena 2234
Characteristics 2234
Earthquake Scales 2234
Location and Predictability 2235
Earthquake Hazards 2237
Fault Displacement and Ground Shaking. 2237
Ground Failure and Soil Liquefaction. 2237
Lateral Spreads and Flow Failure. 2237
Landslides and Avalanches. 2237
Tsunamis. 2237
Fires. 2237
Typical Adverse Effects 2237
Earthquake Risk Reduction Measures 2238
Risk Reduction in China. 2238
Tsunamis 2239
Causal Phenomena and Characteristics 2239
Predictability 2239
Vulnerability 2240
Typical Adverse Effects 2240
Casualties and Public Health. 2240
Crops and Food Supplies. 2240
Tsunami Risk Reduction Measures 2241
Warning Systems. 2241
Structural Design. 2241
Mapping and Land Use. 2241
Education. 2241
Volcanic Eruptions 2241
Causal Phenomena 2241
Pelean Eruptions. 2242
Plinian Eruptions. 2242
Vesuvian Eruptions. 2242
Vulcanian Eruptions. 2242
Strombolian Eruptions. 2242
Hawaiian Eruptions. 2242
Icelandic Eruptions. 2242
Characteristics 2242
Pyroclastic Flows. 2242
Air-Fall Tephra. 2242
Lava Flows. 2243
Volcanic Gases. 2243
Lahars and Landslides. 2243
Tsunamis. 2243
Location 2243
Predictability 2243
Problems in Eruption Forecast and Prediction. 2243
Vulnerability 2243
Typical Adverse Effects 2243
Casualties and Health. 2243
Settlements, Infrastructure, and Agriculture. 2244
Volcanic Eruption Risk Reduction Measures 2244
Despite Precautions, People Took High Risks in the Mt Merapi Eruption. 2244
Landslides 2244
Causal Phenomena 2244
Characteristics 2244
Falls. 2244
Slides. 2244
Topples. 2244
Lateral Spreads. 2245
Flows. 2245
Casualties. 2245
Predictability 2245
Vulnerability 2246
Typical Adverse Effects 2246
Landslide Risk Reduction Measures 2246
Climatic Hazards 2246
Tropical Cyclones 2246
Causal Phenomena 2246
Formation and Initial Development Stage. 2246
Maturity Stage. 2247
Decay Stage. 2247
Characteristics 2247
Destructive Winds. 2247
Storm Surges. 2248
Rainfall Events. 2248
Deadly Hurricanes 2249
Predictability 2249
Vulnerability 2250
Typical Adverse Effects 2250
Casualties and Public Health. 2250
Water Supplies. 2250
Crops and Food Supplies. 2250
Communications and Logistics. 2250
Preparedness Measures Take Root After Cyclone Nargis in Burma (Myanmar) 2250
Cyclone Risk Reduction Measures 2251
Tornadoes 2251
Causal Phenomena 2251
Predictability 2252
Vulnerability 2252
Examples of Tornado Outbreaks 2252
Tornado Risk Reduction Measures 2252
Floods 2252
Pakistan Flood Disaster of 2010 2253
Causal Phenomena 2253
Types of Floods 2253
Flash Floods. 2253
River Floods. 2253
Coastal Floods. 2253
Contribution by Humans 2254
Predictability 2254
Vulnerability 2254
Typical Adverse Effects 2254
Casualties and Public Health. 2254
Water, Crops, and Food Supplies. 2254
Flood Risk Reduction Measures 2255
Drought 2255
Types of Droughts 2255
Meteorologic Drought. 2255
Hydrologic Drought. 2255
Agricultural Drought. 2255
Socioeconomic Drought. 2255
Causal Phenomena 2255
Predictability 2256
Vulnerability 2256
Typical Adverse Effects 2256
Drought Risk Reduction Measures 2256
Winter Storms 2257
Causal Phenomena 2257
Strong Winds. 2257
Extreme Cold. 2257
Ice Storms. 2257
Snowstorms. 2257
Predictability 2257
Vulnerability 2257
The 1998 Ice Storm 2257
Environmental Hazards 2258
Environmental Pollution 2258
Causal Phenomena 2258
Air Pollution. 2258
Marine Pollution. 2258
Freshwater Pollution. 2258
Ozone Depletion. 2258
Climate Change and Global Warming. 2258
Characteristics and Typical Adverse Effects 2259
Air Pollution. 2259
Marine Pollution. 2259
Freshwater Pollution. 2259
Global Warming. 2259
Rise in Sea Levels. 2259
Climate Change. 2259
Changes in Ecosystems. 2260
Public Health Impact. 2260
Measurement of Pollutants 2260
Air and Water Pollutants. 2260
Ozone Depletion. 2260
Greenhouse Effect. 2260
Environmental Pollution Risk Reduction Measures 2260
Air and Water Pollution. 2260
Ozone Depletion. 2260
Climate Change and Global Warming. 2260
Saving the Arctic 2260
Deforestation 2261
Causal Phenomena 2261
Conversion of Forests to Agricultural Land. 2261
Overexploitation of Forest Products. 2261
Fuel Wood Crisis. 2261
Characteristics 2261
Predictability 2262
Typical Adverse Effects 2262
Economic Impact. 2262
Deforestation Risk Reduction Measures 2262
Desertification 2262
Causal Phenomena 2262
Climate Conditions. 2262
Poor Land Use Management. 2263
Overcultivation. 2263
Cash Cropping. 2264
Overgrazing. 2264
Deforestation. 2264
Poor Irrigation Management. 2264
Role of Government Policy. 2264
Characteristics 2264
Degradation of Vegetation. 2264
Degradation of Soil. 2264
Water Erosion. 2264
Wind Erosion. 2264
Soil Compaction. 2264
Waterlogging (Salinization and Alkalinization). 2264
Predictability 2264
Rate and Scope 2264
Desertification Risk Reduction 2264
Acknowledgments and Resources 2265
Suggested Readings 2265
Suggested Readings 2266
86 Global Crimes, Incarceration, and Quarantine 2265
Hostile Geopolitical Environments and Political Insecurity 2265
Increasing Numbers of Violent Regional Ethnic Conflicts 2267
Civilian Casualties 2267
Human Rights Abuses 2267
Danger by Geography: the World’s Most Dangerous Places 2267
Reasons for Enhanced Personal Risk in Politically Unstable Regions 2267
Increasing Civilian Nongovernmental Organization Involvement in Unstable Regions 2267
Targeting of Civilians on the Basis of Nationality 2268
Targeting Aid Workers 2268
Restricted Access in Politically Unstable Regions 2268
Weapons 2268
Risk Reduction Strategies for Situations in Which There Are Armed Combatants. 2268
Do Not Carry a Gun. 2268
Avoid Places Where There Is a Danger of Being Injured. 2269
Avoid Confrontations With Local Militias or Thugs. 2269
Avoid Celebrations Where Guns Are Being Fired. 2269
Stay Low to the Ground. 2269
Land Mines and Unexploded Ordnance 2269
Mine Types. 2269
Effects of Land Mines on Populations and Health. 2269
Risk-Reduction Strategies When Traveling in Regions That Are Mined. 2269
Banning Land Mines. 2269
High-Risk Situations for International Travelers 2269
Checkpoints 2270
Informal Roadblocks 2270
Demonstrations 2270
Risk-Reduction Strategies for Travel Between Borders and Military Checkpoints 2270
Global Crimes: Patterns and Implications for Travelers 2270
The Scope and Array of Global Crime 2270
Human Trafficking and Sex Slavery 2270
Terrorism 2270
Risk-Reduction Strategies for Terrorist Attacks. 2271
Kidnapping and Hostage Situations 2271
Risk-Reduction Strategies in Kidnapping or Hostage Situations. 2271
Piracy and Threats While Traveling at Sea 2271
Incarceration and Quarantine 2272
Incarceration and Detention: a Global Perspective 2272
Drug Offenses Abroad 2272
Quarantine 2272
Quarantine Within the United States 2272
Quarantine Abroad 2273
Safety and Security Strategies for Travelers 2273
Approaches That May Be Counterproductive 2273
Being Overconfident 2273
Escalating Activities 2273
Relying on Limited Information 2273
Becoming Desensitized to Risks 2273
Traveling and Working in a Conflict Zone: Individual Considerations 2273
Contacts and Resources 2273
Assistance for Victims of Crime Overseas 2274
Summary: Traveling and Working in Politically Insecure Regions 2274
References 2274
References 2275
13 Food and Water 2276
87 Nutrition, Malnutrition, and Starvation 2277
Importance of Nutrition in Stressful Environments 2277
Environmental Stress and Nutrient Requirements 2277
Nutritional Considerations in Planning for Wilderness Activities 2278
Food and Adaptive Thermogenesis. 2279
Potential Thermogenic Nutrients. 2280
Tailoring Fat, Carbohydrate, and Protein to Different Environments. 2281
The “Right” Macronutrient Mix for Work at Altitude. 2281
Energy: How Critical Is It? 2282
Carbohydrates: Critical for Performance of High Work Output 2282
Fat: A Special Place in Wilderness Exploration? 2283
Protein and Maintenance of Lean Body Mass and Performance 2284
Protein and Maintenance of Muscle Mass When Energy Intake Is Inadequate. 2285
Vitamins and Their Relationship to Health and Physical Performance 2286
Antioxidant Nutrients 2287
Mineral Supplements: Electrolytes, Hematopoiesis, and Bone Health 2288
Special Nutritional Requirements for Female Wilderness Travelers 2288
Nutritional Deprivation: Malnutrition and Starvation 2290
Definitions 2290
Malnutrition in a Wilderness Setting 2290
Starvation 2290
Acute Energy Restriction 2290
Long-Term Energy Restriction 2291
Hierarchy of Tissue Utilization during Starvation 2292
Sequence of Events During Starvation 2293
The Limits of Human Starvation and Factors Influencing Survival 2293
Loss of Fat and Lean Body Mass 2293
Age and Gender Differences in Survival From Starvation 2294
Feeding Victims of Starvation 2294
Nutrition Planning for Wilderness Activities 2296
Practical Considerations 2296
Food Bars 2297
Selecting Food Bars 2297
Emergency Food Supplies 2298
References 2298
References 2299
88 Field Water Disinfection 2298
Benefits of Water Treatment 2298
Risk of Waterborne Disease Transmission 2302
Developing Countries 2303
United States and Developed Countries 2303
Recreational Contact 2304
Specific Etiologic Agents 2304
Viruses 2304
Protozoa 2304
Giardia and Cryptosporidium. 2304
Parasitic Organisms 2305
Bacterial Spores 2305
Algae 2305
Chemical Hazards 2305
Persistence of Enteric Pathogens in the Environment 2305
Natural Purification Mechanisms 2305
Standards for Water Disinfection 2306
Standards for Portable Disinfection Products 2307
EPA Registration 2307
Mechanical Filters. 2307
Filter Testing. 2307
Chemical Methods 2307
Disinfection Methods: Definitions 2307
Heat 2308
Boiling Time 2308
Improvisation 2309
Hot Tap Water 2309
Solar Heat 2309
Physical Removal 2310
Turbidity and Clarification 2310
Sedimentation 2310
Coagulation-Flocculation 2310
Toxicity 2311
Alternative Agents 2311
Adsorption 2311
Granular Activated Carbon 2311
Filtration 2311
Reverse Osmosis 2313
Forward Osmosis 2313
Choice of Filter (See Preferred Technique and Appendix A) 2313
Improvised Filters 2313
Biosand Filters 2314
Chemical Disinfectants 2314
Halogens (Chlorine and Iodine) 2314
Variables With Chemical Agents 2314
Concentration and Contact Time. 2314
Contaminants. 2315
Halogen Demand and Residual Concentration. 2315
Temperature. 2316
pH. 2316
Susceptibility of Microorganisms. 2316
Bacteria. 2316
Viruses. 2316
Cysts and Parasites. 2316
Disinfection Constant. 2318
Chlorine 2318
Chemistry 2318
Toxicity 2319
Products and Techniques for Chlorination 2319
Superchlorination-Dechlorination. 2319
Iodine 2319
Chemistry 2319
Toxicity 2320
Thyroid Effects of Iodine Ingestion. 2320
Dose-Response or Threshold Level. 2320
Recommendations. 2320
Products and Techniques for Iodination 2320
Resins. 2320
Iodine Resin Filters. 2321
Chlorine Versus Iodine 2321
Taste 2322
Minimizing Dose. 2322
Dehalogenation. 2322
Alteration of Chemical Species (Reduction). 2322
Miscellaneous Disinfectants 2322
Peroxygens 2322
Ozone 2323
Chlorine Dioxide 2323
Mixed-Species Disinfection (Electrolysis) 2323
Hydrogen Peroxide 2323
Potassium Permanganate 2323
Citrus 2324
Metals 2324
Silver 2324
Copper and Zinc 2324
Nanoparticles: Solar Photocatalytic Disinfection 2324
Ultraviolet Light 2325
Solar Disinfection 2325
Comparative Studies and Preferred Techniques 2325
Preferred Technique 2326
Prevention and Sanitation 2327
Handwashing 2328
Kitchen and Food Sanitation 2328
Human Waste Disposal 2328
References 2328
Appendix A Water Disinfection Devices and Products for Field Use 2329
Appendix B Chemical Disinfection Products 2342
Iodination 2342
Iodine Solutions 2342
Iodophors (Povidone-Iodine) 2342
Crystals (Saturated Solution) 2342
Product 2342
Comments 2343
Iodine Tablets 2343
Products 2343
Comments 2343
Chlorination 2343
Sodium Hypochlorite 2343
Household Bleach 2343
Calcium Hypochlorite (Dry Chlorine) 2343
Comments 2344
Halazone Tablets 2344
Comments 2344
Sodium Dichloroisocyanurate 2344
Manufacturers and Product Formulations 2344
Formulation and Instructions 2344
Comments 2344
Chlorination-Flocculation 2344
Comments 2344
Chlorine Dioxide 2345
Tablets 2345
Formulation and Instructions 2345
Comments 2345
Liquid Chlorine Dioxide Products 2345
Formulation and Instructions 2345
Comments and Claims 2345
Mixed-Species Disinfection 2345
Comments 2345
Silver 2346
Comments 2346
Comments 2346
Miscellaneous Products 2346
Comments 2346
Comments and Claims 2346
References 2347
89 Dehydration and Rehydration 2353
Body Water, Fluid Turnover, and Fluid Requirements 2353
Hydration Assessment 2353
Urine Concentration 2355
Body Mass 2355
Thirst 2356
Sweat and Sweat Prediction 2356
Physiologic Consequences of Dehydration 2357
Environmental Heat Stress, Dehydration, and Performance 2358
Dehydration and Work Productivity 2360
Dehydration and Cognitive Performance 2361
Dehydration and Heat-Related Illness 2361
Hyponatremia 2361
Dehydration and Limits of Survival 2362
Dehydration and Susceptibility to Cold Injury 2363
Fluid Replacement (Before, During, After) 2363
American College of Sports Medicine Fluid Replacement Recommendations 2364
Before Exercise 2364
During Exercise 2364
After Exercise 2364
Education 2365
Modifying Factors 2365
Diet 2365
Caffeine and Alcohol 2365
Facilities and Clothing 2365
Gender 2365
Age 2365
Acknowledgment and Disclaimer 2366
References 2366
References 2367
90 Living Off the Land 2366
Achieving a Balanced Diet 2366
Essence of Survival 2366
Water Procurement and Preparation 2371
Finding and Collecting Water 2371
Green Vegetation 2371
Animal Trails 2372
Bird Movement 2372
Open Water Sources 2372
Seeps and Springs 2372
Tanks 2372
Wells 2373
Windmills 2374
Guzzlers 2374
Dew 2374
Rain 2375
Snow 2375
Water Machine. 2375
Using Body Heat to Melt Snow. 2377
Using the Sun to Melt Snow. 2377
Digging Holes to Collect Subsurface Water 2377
Beach Wells 2377
Solar Stills 2377
Water from Vegetation 2377
Water Vines 2377
Transpiration Bags 2378
How Long a Person Can Live Without Food 2379
Success Stories 2381
Wild Animal Foods 2382
Mammals 2382
Rabbits and Hares 2382
Rodents 2383
Larger Mammals 2383
Birds 2383
Insects 2384
Reptiles 2386
Amphibians 2386
Fish 2387
Crustaceans 2387
Mollusks 2387
Methods of Procuring Animals for Food 2388
Simple Noose Snares 2388
Baited Snare 2390
Noose Stick 2390
Squirrel Pole 2390
Catapult (Slingshot or Flip) Hunting 2391
Freshwater Fishing 2392
Survival Firearms 2397
Hunting Guidelines 2397
Wild Plant Foods 2397
Procurement of Wild Plant Foods 2398
Preparation of Wild Plant Foods 2411
Cooking Methods 2411
Basic Food Preservation 2411
References 2412
References 2413
14 Unique Populations and Considerations 2414
91 Children in the Wilderness 2415
What Makes Children Different? 2415
Size and Shape 2415
Musculoskeletal System 2415
Cardiovascular and Respiratory Systems 2415
Thermoregulation 2416
Immunologic System and Infections 2417
Types of Traumatic Injuries 2417
General Considerations and Expectations for Children in Wilderness Travel 2417
Children in the First 2 Years of Life 2417
Travel Expectations 2417
Safety 2418
Food and Drink 2418
Diapers 2418
Equipment 2418
Children 2 to 4 Years of Age 2418
Travel Expectations 2418
Safety 2419
Food 2420
Toileting 2420
Children of School Age (5 Years and Up) 2420
Travel Expectations 2420
Safety 2421
Equipment 2421
Environmental Illnesses 2421
Dehydration 2421
Symptoms 2421
Treatment 2422
Hypothermia 2422
Prevention 2422
Treatment 2422
Frostbite 2423
Treatment 2423
Hyperthermia 2423
Prevention 2423
Symptoms and Treatment 2423
Sun Damage 2423
Prevention 2424
Sunscreens 2425
Treatment 2425
Drowning 2425
Prevention 2425
High-Altitude Illness 2426
Symptoms 2426
Prevention 2426
Treatment 2426
Bites and Stings 2426
Snakebites 2426
Hymenoptera Stings 2427
Mosquito Bites 2427
Tick Bites 2428
Lost Children and Survival 2428
Homesickness 2428
Foreign Travel with Children 2429
General Recommendations for Travel With Children 2429
Immunizations 2430
Prophylaxis: Malaria 2432
Travel-Related Problems 2434
Motion Sickness 2434
Eustachian Tube Dysfunction 2434
Traveler’s Diarrhea 2434
Prevention 2434
Treatment 2435
Constipation 2436
Abdominal Pain 2436
Respiratory Infections and Otitis Media 2436
Fever of Unclear Etiology 2437
Headache 2438
Conjunctivitis 2438
Rashes 2438
Lacerations 2438
Animal Bites 2438
Poisoning 2439
Foreign Bodies 2439
Special Considerations for Children With Chronic Medical Problems 2439
Asthma 2439
Diabetes 2439
Sickle Cell Disease 2440
Congenital Heart Disease and Pulmonary Hypertension 2440
Epilepsy 2440
Traveling With Infants and Neonates 2440
Pediatric Wilderness Medical Kits 2441
Environmental Concerns and Child Health 2443
References 2443
References 2444
92 Women in the Wilderness 2446
Gender-Based Research 2446
Pre–Wilderness Travel Women’s Health Assessment 2446
What Makes Women Different? 2446
Gender-Related Performance 2446
Gender-Related Issues Concerning Environmental Exposure 2448
Women and Altitude 2448
Women and Hot and Cold Environments 2449
Gender-Related Issues Concerning Infectious Diseases 2449
Practical Issues for Women During Wilderness Travel 2449
Dysmenorrhea 2450
Controlling the Menstrual Cycle 2450
Menstrual Cycle Disturbance 2450
Causes of Abnormal Uterine Bleeding 2453
Ovulatory Women 2453
Anovulatory Women 2453
Pregnancy Tests 2455
Contraceptive Options During Wilderness Travel 2455
Barrier Contraceptives 2455
Hormonal Contraceptives 2455
Transdermal Hormonal Contraception 2455
vagin*l Ring 2455
Intrauterine Devices 2456
Emergency Contraception 2456
Special Issues Related to Hormonal Contraceptives and Wilderness Travel 2457
Changes in Time Zone 2457
Absorption of Oral Contraceptives 2457
Drug Interactions That May Affect Oral Contraceptive Efficacy 2457
Gender and Risk for Venous Thromboembolism: Contraception, Pregnancy, and Beyond 2457
Breast Health 2458
Urinary Tract Issues 2458
vagin*l Discharge or Itching 2458
Vulvovagin*l Candidiasis 2458
Bacterial Vaginosis 2459
Trichom*onas Vaginitis 2459
Atrophic Vaginitis 2459
Noninfectious Vulvovaginitis 2460
Sexually Transmitted Infections 2460
Nonoccupational Postexposure HIV Prophylaxis 2460
Personal Safety 2460
Sexual Assault 2460
Wilderness Travel During Pregnancy 2460
Pre–Wilderness Travel Evaluation During Pregnancy 2460
Physiologic Changes Accompanying Pregnancy 2462
Cardiovascular Adaptation 2462
Changes in Blood Volume 2462
Respiratory Status 2462
Urinary System 2462
Integumentary and Musculoskeletal Status 2462
Changes in Immune Status: Response to Infection and Vaccines 2463
Immunizations During Pregnancy and Lactation. 2463
Medications During Pregnancy 2463
Food and Drug Administration Guidelines 2463
Other Resources for Information on Medications During Pregnancy 2463
Infectious Disease Risk 2465
Food-Borne and Waterborne Disease 2465
Vector-Borne Disease: Malaria 2467
Personal Protective Measures. 2467
Chemoprophylaxis. 2467
Hepatitis E 2468
Zika Virus 2468
Sports and Wilderness Adventure Risks During Pregnancy 2468
Exercise During Pregnancy 2468
Altitude and Pregnancy 2468
Recommendations for Pregnant Women Traveling to a High Altitude 2469
Acute Mountain Sickness 2469
Water Sports During Pregnancy 2469
Heat and Pregnancy 2470
Exposure to Venomous Animal Bites and Stings 2470
Remote Wilderness Travel During Pregnancy 2470
Prenatal Care in the Wilderness 2470
Complications During Pregnancy 2470
Miscarriage 2470
Ectopic Pregnancy 2471
Later Pregnancy Complications 2471
Placenta Previa. 2472
Placental Abruption. 2472
Premature Labor. 2472
Preeclampsia. 2472
Emergency Delivery 2472
Complicated Deliveries 2474
Vertex Delivery 2474
Shoulder Dystocia 2474
Breech Delivery 2475
Neonatal Resuscitation 2476
Delivery of Placenta 2476
Resources for Obstetrics in Remote Settings 2476
Breastfeeding 2477
Breastfeeding Practicalities 2477
Medications During Breastfeeding 2477
Useful References on Medication During Breastfeeding 2477
Wilderness Health Issues for Women Over 50 Years of Age 2477
Acknowledgments 2478
References 2478
References 2479
93 Older Adults in the Wilderness 2478
Definition of Older Adult 2478
Why and How Some Older Adults Venture Into the Wilderness 2483
Classifying “Fitness for Adventure” by Age, Health, and Functional Status 2484
Environmental Stresses and Older Adults 2484
Altitude 2485
Cold 2486
Heat 2487
Travel Medicine and Older Adults 2488
Medical Examination for Older Adults Planning Wilderness Travel 2488
Cardiovascular Disease 2489
Coronary Artery Disease 2490
Hypertension 2490
Dermatologic Disorders 2490
Thin Skin 2490
Onychomycosis 2490
Dental Issues 2491
Gastrointestinal Disorders 2491
Genitourinary Disorders 2491
Menopause 2491
Musculoskeletal Disorders 2492
Arthroplasty 2492
Spinal Stenosis 2492
Foot Problems 2493
Falls and Resulting Injuries 2493
Sensory Senescence 2493
Vision Issues 2493
Taste Issues 2493
Touch Issues 2493
Hearing Issues 2493
Tremors 2494
Neuropsychiatric and Substance Abuse Disorders 2494
Pharmacology, Pharmaco*kinetics, and Polypharmacy 2495
Conclusion 2497
Acknowledgments 2497
References 2497
References 2498
94 Persons With Disabilities in the Wilderness 2497
People With Disabilities in the Wilderness 2501
Preparation for a Wilderness Adventure 2501
Worldwide Wilderness Programs for Persons With Disabilities 2501
Prevalence of Disability in the United States 2502
A Brief History of Disabilities, Disability Terminology, and Disability Etiquette 2502
Disability Etiquette 2502
Barriers That Restrict People With Disabilities 2503
Wilderness Legal and Legislative Issues 2503
Preparing People With Disabilities for Wilderness Adventures 2503
Checklist for Preparation for a Trip 2504
Selected Disabilities With Wilderness Considerations 2505
Persons With Challenges to Mobility 2505
Persons With Amputations 2505
Prosthetics 2505
Preparation of Prosthetics Before a Trip. 2506
Discomfort Caused by Prosthetics. 2506
Persons With Cerebral Palsy 2506
Trip Preparation 2506
Challenges During the Trip 2506
Persons With Multiple Sclerosis 2507
Preparation for and Challenges During the Trip 2507
Persons With Spinal Cord Injuries 2507
Trip Preparation 2507
Challenges During the Trip 2507
Persons With Sensory Challenges 2509
Persons With Vision Loss 2509
Trip Preparation. 2509
Challenges During the Trip. 2509
Persons With Hearing Loss 2509
Trip Preparation. 2510
Challenges During the Trip. 2510
Persons With Cognitive Challenges 2510
Persons With Intellectual Disabilities 2510
Persons With Autism 2510
Trip Preparation. 2510
Persons With Traumatic Brain Injuries 2510
Trip Preparation. 2511
Persons With Psychological or Mental Health Challenges 2511
Trip Preparation 2511
A Selected Emergent Medical Disability 2512
Hereditary Angioedema Occurring in the Wilderness 2512
Clinical Presentation 2512
Trip Preparation 2512
Challenges During the Trip 2513
Adaptive Sports 2513
River Sports: Canoeing, Kayaking, and Rafting 2513
Climbing 2513
Hand Cycling and Tandem Reclining Cycles 2514
Hiking 2514
Horseback Riding 2515
Hunting 2515
Scuba Diving 2515
Scuba Diving for Persons With Spinal Cord Injuries and Amputations 2515
Balance Challenges. 2515
Thermal Issues. 2515
Anxiety. 2516
Other Equipment and Considerations. 2516
Scuba Diving for a Visually Impaired Person 2516
Scuba Diving for a Person With Hearing Impairment 2516
Skiing 2516
Assistance Dogs 2516
Opportunities for Wilderness Adventures 2517
Resources for Wilderness Sports 2517
Archery 2517
Canoeing 2517
Cycling and Racing 2517
Horseback Riding 2517
Hunting, Shooting, and Fishing 2518
Rock Climbing 2518
Rowing and Sailing 2518
Running 2518
Scuba Diving 2518
Snowboarding and Skiing 2518
Swimming 2518
Water Skiing 2518
References 2518
References 2519
95 Physiology of Exercise, Conditioning, and Performance Training for Wilderness Adventure 2520
Mental Awareness 2520
Physical Conditioning 2520
Aerobic Fitness 2520
Maximum Oxygen Consumption 2520
Threshold of Sustainability 2521
Improving Human Performance 2522
Malleability of the Lactate Threshold 2522
Training Effect on the Lactate Threshold 2522
Efficiency of Movement 2524
Aging and Training 2525
High Altitude and Exercise 2526
Effect of High Altitude on Exercise 2526
Hypoxic Training 2527
Artificial Training Methods: Blood Transfusion 2528
References 2528
References 2529
96 Exercise, Conditioning, and Performance Training 2531
Fitness as a Lifestyle 2531
Specificity 2531
Strength, Muscular Endurance, and Power 2531
Abdominal Muscles and the Core 2531
Flexibility 2533
Conditioning 2533
Functional Conditioning 2533
Strength, Endurance, and Power for Wilderness Preparedness 2534
Upper Body 2534
Push-Ups. 2534
Pull-Ups. 2534
Lower Body 2534
Squats. 2534
Lunges. 2535
Abdominal and Core Muscle Conditioning 2535
Isometric Abdominal Muscles Retraining Drill 2535
Using Neutral Spine Posture and Preventing Hyperlordosis for Push-Ups, Planks, and Pull-Ups. 2536
Using Bands and Cables While Standing With Neutral Spine Posture. 2536
Hands and Wrists 2536
Feet and Ankles 2536
Power and Plyometrics 2537
Stretching for Wilderness Preparedness 2537
Anterior Shoulder and Chest 2537
Hip and Thigh 2538
Hamstrings 2538
Achilles Tendon and Foot 2538
Flexibility-Enhancing Techniques 2538
Balance Skills for the Trail 2539
Developing Speed for Wilderness Situations 2539
Conditioning for Special Environments 2540
Heat 2540
Cold 2540
Altitude 2540
Scuba Diving 2540
Performance and Injury 2541
Avoiding Exercise Injuries 2541
Healthier Spine Positioning 2541
Standing, Walking, and Running. 2541
Lifting Loads. 2541
Carrying Loads. 2541
Stretch and Exercise 2541
Healthier Knee Positioning 2541
Healthier Neck Positioning 2542
Avoiding Injuries From Stretching 2542
Back Pain Prevention During Long Travel to the Wilderness 2542
Use of Lumbar Roll 2542
Long Sitting in an Automobile 2543
Buses and Flights 2543
Soreness After Exertion 2543
Fitness Myths 2543
Performance Enhancement 2544
Performance-Enhancing Drugs and Nutrients for Exercise and Expeditions 2544
Methylxanthines 2544
Caffeine 2544
Theophylline 2545
Theobromine 2545
Guarana 2545
Yerba Mate 2545
Cholinergic Stimulants (Tobacco, Areca, and Lobelia) 2545
Nicotine 2545
Betel Nut 2545
Lobelia 2545
Sympathomimetic Stimulants: Monoaminergic Substances (Amphetamines, Coca, Khat, and Ephedra) 2545
Amphetamines 2545
Coca 2546
Khat 2546
Ephedra (Ma Huang) 2546
Other Stimulants 2546
Ginseng 2546
Anabolic Steroids 2546
Anabolic (Growth-Promoting) Nonsteroids 2546
DHEA 2546
Androstenedione 2546
Creatine 2547
Foods 2547
Carbohydrates 2547
Vitamins and Minerals 2547
Bee Pollen 2547
Water 2547
Fitness Water, Fitness Carbo, and/or Protein Drinks With “Buzz” 2547
Alerting and Wakefulness Adjuncts 2547
References 2547
References 2548
97 Wilderness and Endurance Events 2552
Types of Events 2552
Adventure Races 2552
Cycling Events 2553
Marathons and Ultramarathons 2553
Triathlons 2553
Medical Support for Wilderness and Endurance Events 2553
Mass Gatherings 2553
Wilderness and Endurance Events 2554
Development of a Medical Support Plan 2554
Personnel, Equipment, Supplies, and Logistics 2556
Personnel 2556
Equipment and Supplies 2556
Logistics 2556
Communication 2557
Emergency Response 2557
Acceptance of Medical Care 2557
Medical Disqualification 2558
Emergency Medical Services and Search and Rescue Teams 2558
Legal Considerations 2558
Injuries and Illnesses by Event Type 2558
Cycling Events 2558
Triathlons 2558
Marathons and Ultramarathons 2558
Adventure Races 2559
Specific Injuries and Illnesses: Endemic Disease 2560
Major Trauma 2560
Foot Care 2560
Dehydration and Hyponatremia 2561
References 2561
References 2562
98 Canyoneering and Canyon Medicine 2563
Canyoneering 2563
Historical Perspective 2563
Demographics 2563
Canyon Environment 2563
Canyoneering Hazards 2564
Equipment 2566
Progression Techniques 2568
Progression Without a Rope 2568
Progression With a Rope 2568
Canyon Classification and Mapping 2569
Canyon Medicine 2570
Epidemiology of Injuries and Illnesses 2570
Mechanism of Injuries and Illnesses 2571
Falls, Jumps, and Other Traumatic Mechanisms 2572
Environmental Exposure 2572
Medical Management 2573
Risk Assessment and Safety 2573
Drowning Management 2574
Patient Assessment 2574
Hypothermia Prevention 2575
Pain Management 2575
Alternative Routes for Fluid Administration 2576
Hemorrhage and Wound Care 2576
Splinting and Reduction 2576
Patient Packaging 2576
Medical Equipment 2577
First-Aid Materials for Canyoneers 2577
Medical Equipment for Search and Rescue Teams 2577
Organization of Equipment Packs 2577
Canyon Stretcher 2579
Evacuation 2579
Evacuation Planning 2579
Medical Considerations in Evacuation 2579
Technical Materials for Evacuation by Search and Rescue Teams 2580
Communication Equipment During Evacuation 2580
Rescue 2580
Companion Rescue 2580
Search and Rescue Operations 2581
Demographics of Search and Rescue Operations. 2581
Duration of Search and Rescue Operations. 2581
Financial Costs of Canyon Rescue. 2582
Education of Search and Rescue Teams for Canyon Rescue. 2582
Acknowledgments 2582
References 2582
References 2583
99 Cycles, Snowmobiles, and Other Wilderness Conveyances 2582
Mountain Bikes 2582
Equipment 2582
Protective Gear 2584
Mechanism of Injury 2584
Falling Over the Handlebars 2584
Falling Sideways 2584
Pedal-Related Injuries 2585
Epidemiology of Mountain Biking Injuries 2585
Injury Rates 2585
Age and Gender 2585
Types of Injuries 2585
Injury Rates for Different Types of Riding 2586
Causes of Mountain Biking Injuries 2586
Acute Mountain Biking Injuries 2586
Craniofacial, Brain, and Cervical Spine Injuries 2586
Thoracoabdominal Injuries 2587
Genitourinary Injuries 2587
Appendicular Skeleton Injuries 2587
Upper Extremity Injuries. 2587
Lower Extremity Injuries. 2587
Electrolyte Disorders 2588
Severe and Fatal Injuries 2588
Chronic Mountain Biking Injuries (Overuse Syndromes) 2588
Injury Prevention 2589
Medical Coverage at Mountain Biking Events 2589
Snowmobiles 2589
Equipment 2590
Protective Gear 2590
Mechanism of Injury 2591
Epidemiology of Snowmobiling Injuries 2591
Alcohol and Snowmobiling Injuries 2592
Types of Snowmobiling Injuries 2592
Fatal Snowmobiling Injuries 2592
Pediatric Snowmobiling Injuries 2592
Falls Through the Ice When Snowmobiling 2592
Safety and Risk Reduction in Snowmobiling 2594
All-Terrain Vehicles 2594
Equipment 2594
Protective Gear and Helmets 2594
Mechanism of Injury 2595
Epidemiology of ATV Injuries 2596
Nonfatal Injuries 2596
Fatal Injuries 2596
Pediatric Injuries and Fatalities 2596
Alcohol and ATVs 2596
Types of ATV Injuries 2596
Safety and Risk Reduction 2597
References 2598
References 2599
100 Medical Liability and Wilderness Emergencies 2598
Tort Law and the Doctrine of Negligence 2598
Case Study: Snakebite and Medical Malpractice 2598
Liability Concerns in Wilderness Medicine 2602
Duty to Warn and Educate Trip Participants 2602
Case Study: Duty to Warn 2602
Medical Clearance of Trip Participants 2603
The Americans With Disabilities Act 2603
Medical Screening 2604
Professional Liability, Medical Malpractice, and Good Samaritan Laws 2604
Waiver of Liability 2605
No Waiver for Gross Negligence 2606
Other Bars to Waiver 2606
Effective Waiver 2606
Duty to Rescue and Abandonment Doctrine 2606
Harm to the Rescuer 2607
Abandonment Doctrine 2607
Standing Orders and Medical Kits 2607
Medical Record Keeping in Wilderness Medicine 2608
Medical Liability in Foreign Countries 2609
Good Samaritan Laws Abroad 2609
Transporting Medical Supplies Overseas 2609
Retaining a Foreign Attorney 2609
Medical Care Provided In-Flight 2609
Conclusion 2610
References 2610
References 2611
101 Ethics of Wilderness Medicine 2610
Application of Values and Principles to Guide Human Activities 2610
Sources of Values 2612
Values in Modern Biomedical Ethics 2612
Values Applicable to Wilderness Medicine 2612
Safety or Security 2612
Utility 2613
Decision-Making Capacity and Consent 2613
Bioethical Decision-Making Process* 2614
Choosing an Action in the Standard Setting 2614
Choosing an Action in the Wilderness 2615
Using an Algorithm as a Guide for a Decision 2615
Ethical Dilemmas in Wilderness Medicine 2616
Standard-of-Care Dilemmas 2616
Limited Resources 2616
Cultural Differences 2616
Giving Authority to Untrained Personnel 2617
Priority-in-Care Dilemmas 2617
Triage Choices: Whom to Rescue First and How to Distribute Resources 2617
Issues of Survival 2618
Issues of Direct Life-Threatening Situations for the Health Care Provider 2618
Decision-Making Dilemmas 2618
Advance Directives 2618
Euthanasia 2618
Dilemmas in Wilderness Policies 2619
When to Stop Searches 2619
Motorized Vehicle Restrictions and Environmental Protection in Wilderness Areas 2619
No-Rescue Areas 2619
Summary 2619
References 2619
References 2620
15 Wilderness Equipment and Special Knowledge 2621
102 Wilderness Preparation, Equipment, and Medical Supplies 2622
Epidemiology Review 2622
General Preparation 2622
Pretrip Evaluation for Healthy Participants 2624
Evaluation of Participants With Preexisting Medical Conditions 2624
Training in First Aid and Wilderness Safety 2625
Trip Duration and Access to Medical Support 2626
Environmental Risks: Weather and Terrain 2626
Supplies, Kit Assembly Strategies, and Specialized Equipment 2626
Strategies for Packaging Medical Kits 2627
How Much to Bring 2627
Personal Medical Kit 2628
Comprehensive Community Medical Kit 2637
Medical Supplies for the Medically Trained Traveler 2638
Specialized Equipment for Environmental and Recreational Hazards 2640
High-Altitude Exposure 2641
Cold Exposure 2641
A Note on “Space Blankets” 2642
Water Disinfection 2642
Bicycling 2642
Mountain Climbing and Hiking 2642
Protection Against Mosquito-Borne Illness 2642
Items Stored in the Vehicle 2643
Medical Reference Material 2643
Mobile Health (mHealth) and Emerging Technologies 2644
Medications Useful in the Wilderness Setting 2644
Priority Prescription and Over-the-Counter Medications 2644
Passing Through Customs With Medications 2645
Preparing for Common Medical Problems in the Wilderness 2646
Gastrointestinal, Genitourinary, and Reproductive Care 2646
Diarrhea and Abdominal Pain 2646
Sexually Transmitted Infections 2646
Oral Hygiene and Health 2646
Fractures and Dislocations 2647
Sleeping and Staying Awake 2647
Blisters and Foot Care 2647
Wounds 2648
Bites and Stings 2649
Sunburn, Snowblindness, and Sunglasses 2649
Pain 2650
Special Considerations 2650
A Sample Journey 2650
Appendix A Information Sources on Wilderness Emergencies and Suggested Reading 2651
Appendix B Pretrip Medical Evaluation Form for Wilderness Travel 2652
Appendix C Suppliers Listed in Chapter 2655
References 2655
References 2656
103 Emergency Oxygen Administration 2657
Indications 2657
Contraindications 2657
Pulmonary Oxygen Toxicity 2657
Central Nervous System Oxygen Toxicity 2657
Equipment 2657
Cylinders 2657
Valves 2658
Regulators 2658
Devices for Assisted Ventilation 2658
Bag-Valve-Mask Device 2658
Resuscitation Mask 2659
FROPV/Positive-Pressure Demand Valve 2660
Demand-Only, or FROPVs in Demand Mode 2661
Constant Flow Devices for Adequately Breathing Patients 2661
Nonrebreather Mask 2661
Nasal Cannula 2662
Oxygen Rebreathers 2662
Emergency Oxygen Administration at High Altitude 2662
Oxygen Generator Systems 2663
How to Administer Oxygen From a Tank (Cylinder) 2663
Precautions 2663
Special Considerations in Nonbreathing or Inadequately Breathing Patients 2663
Hazards 2663
Legal Issues 2664
References 2664
References 2665
104 Telemedicine in the Wilderness 2664
Evolution of Telemedicine 2664
Telemedicine Systems Engineering 2667
Modern Telemedicine 2672
Telemedicine in the Wild 2673
References 2674
References 2675
105 Wilderness and Global Communications and Techniques 2676
Two-Way Local Communication 2676
Family Radio Service 2676
General Mobile Radio Service 2676
900-MHz Band 2677
2-Meter and 70-Centimeter Amateur Radio Service 2677
Two-Way Long-Distance Voice Communication 2678
Iridium 2679
Globalstar 2679
Inmarsat 2679
Thuraya 2679
Satellite Messaging Devices 2680
Satellite Internet 2681
Satellite Wi-Fi 2681
Emergency Beacons 2682
References 2682
References 2683
106 Wilderness Navigation Techniques 2682
Navigation With the Global Navigation Satellite Systems 2684
Geodetic Coordinate System 2686
Universal Transverse Mercator Coordinate System 2687
Compass Navigation 2689
Magnetic Dip, Deviation, and Declination 2689
Compass Types 2690
Compass Use 2691
Makeshift Compasses 2692
Celestial Navigation 2692
Celestial Coordinates 2694
Horizon Coordinate System 2694
Celestial Lines of Position 2695
Methods for Latitude 2695
Methods for Longitude 2696
Celestial Methods for Direction Finding 2696
Shadow Methods 2696
Direction by Amplitudes 2698
Direction by Observation of Circumpolar Stars 2698
Direction by Observation of Other Stars 2699
Practical Field-Expedient Celestial Navigation 2700
Navigation With a Pocket Radio 2700
Orienteering and Geocaching 2701
The Orienteering Meet 2701
Orienteering for Children 2703
Geocaching 2703
Conclusion 2703
References 2703
References 2704
107 Principles of Meteorology and Weather Prediction 2705
General Circulation and Atmospheric Profile 2705
Climate Controls and Radiation Balance 2705
Atmospheric Profile 2705
Lapse Rate 2705
Moisture 2705
Climatic Regions Controlled by Latitude: Tropics, Midlatitudes, and Poles 2705
Midlatitude and Polar Climates 2705
Subtropical and Tropical Climates 2706
Monsoons 2706
Tropical Cyclones 2707
Thunderstorms 2707
Types of Thunderstorms 2708
Arid Climates 2708
Mountain Climates 2708
Marine/Coastal Climates 2708
Human Comfort 2709
Weather Forecasting 2710
Obtaining Data and Forecasts and Predicting Weather in the Near Term 2710
Portable Weather Instruments of Use in the Wilderness 2710
Barometer 2710
Thermometer 2710
Lightning Detector 2710
Types of Forecasts 2711
Skill 2711
How to Interpret Forecasts 2711
Accessing Forecasts 2711
North America 2711
International Forecasts 2711
Forecast Variables 2711
Seasonal Precipitation Forecasts 2711
Temperature Forecasts 2711
Humidity 2711
Wind Direction and Speed 2711
Precipitation 2711
Forecast Products 2711
United States 2711
International 2711
How to Obtain Surface Observations 2712
United States 2712
Global Data 2712
How to Access and Interpret Weather Satellite and Radar Data 2713
Weather Prediction in the Wilderness 2713
Clouds 2713
Clouds and Weather 2715
Boundary Layer Stability 2716
Backing and Veering 2716
References 2716
References 2717
108 Ropes and Knot Tying 2716
Ropes, Webbing, and Cordage Terminology 2716
Rope Selection Considerations 2718
Fall Factors 2718
Rope Diameter 2718
Rope Strength 2718
Safety Factors 2719
Service Life 2719
Webbing 2719
Accessory Cord 2719
Rope for Life Safety 2720
Strength 2720
Impact Force 2720
Number of Falls Held 2720
Elongation 2721
Diameter 2721
Abrasion Resistance 2721
Compatibility With Other Equipment 2721
Hand 2721
Quality 2721
Weight 2721
Water Resistance/Flotation 2721
Life Safety Rope Construction 2721
Materials 2721
Nylon 2721
Polyester 2722
Ultra-High-Molecular-Weight Polyethylene 2722
Aramids 2722
Polyolefin 2722
Rope Type 2722
Dynamic Kernmantle Rope 2722
Static Kernmantle Rope 2722
Low-Stretch Kernmantle Rope 2722
Knots in Software 2722
Uses 2723
How Knots Work 2723
Knot Terminology 2723
Categories of Knots 2724
Stopper Knots 2724
End-of-Line Knots 2724
Midline Knots 2725
Knots That Join Two Ropes (Bends) 2726
Hitches 2728
Lashing 2729
Emergency Harnesses 2729
Knot Safety 2729
Knots and Software Strength 2730
Learning More About Software and Knots 2731
109 Ultrasound in the Wilderness 2732
Introduction to Ultrasound 2732
Probe Construction and Frequency 2732
Overview of Clinical Imaging 2732
Common Clinical Imaging Applications 2733
Focused Assessment With Sonography for Trauma 2733
Right Upper Quadrant 2733
Left Upper Quadrant 2733
Pelvis 2734
Cardiac View 2734
Thoracic Ultrasound for Pneumothorax and Pulmonary Edema 2737
Pneumothorax 2737
Pulmonary Edema 2737
Musculoskeletal Assessment 2738
Fractures 2738
Dislocation 2739
Optic Nerve Sheath Ultrasonography 2740
Doppler and Blood Flow Studies 2741
Inferior Vena Cava and Volume Assessment 2741
Echocardiography for Patent Foramen Ovale 2741
Pregnancy 2743
First-Trimester Ultrasound 2743
Second- and Third-Trimester Ultrasound 2744
Fetal Positioning and Number of Pregnancies. 2744
Amniotic Fluid Volume Assessment. 2745
Placental Positioning. 2745
Gestational Age/Dating. 2745
Right Upper Quadrant Ultrasonography 2746
Right Lower Quadrant Ultrasonography 2747
Technique 2747
Peripheral Veins 2747
Special Considerations for Ultrasound in Remote Locations 2747
Tele-Ultrasound 2747
Power Supply Considerations 2749
Advantages of Ultrasound in the Wilderness 2750
Portability 2750
Safety and Noninvasiveness 2750
Versatility 2751
Cost 2751
Limitations of Wilderness Ultrasound 2751
References 2751
References 2752
110 Outdoor Clothing for the Wilderness Professional 2754
Fiber and Fabric 2754
Natural Fibers 2754
Wool and Merino Wool 2754
Down 2754
Fur, Leather, and Hides 2755
Synthetic Fibers 2756
Blends 2756
Waterproof/Breathable Fabrics 2756
Laminates. 2756
Coated Fabrics. 2757
Soft-Shell Fabrics. 2757
Durable Water-Repellent Finish. 2757
Layering 2757
Base Layer 2758
Middle Layer 2758
Outer Layer 2759
Multilayered Garments 2759
Accessories 2759
Headgear 2759
Neckwear 2759
Eyewear 2760
Handwear 2760
Footwear 2761
Care and Storage of Clothing 2762
Laundering 2762
Drying 2763
Durable Water-Repellent Finish 2763
Footwear 2763
Storage 2764
Repair 2764
Special-Use Clothing 2764
Sun Protection Clothing 2764
Insect-Repellent Clothing 2764
Fire-Resistant Clothing 2764
Vapor-Barrier Clothing 2764
Sport-Specific Clothing 2764
Climate-Specific Clothing 2764
Heat 2765
Temperate 2765
Cold 2765
Extreme Cold 2766
Water (Ocean and River) 2766
Selected Resources 2766
Selected Resources 2767
111 Nonmedical Backcountry Equipment for Wilderness Professionals 2768
General Concepts for Choosing Equipment 2768
Choosing Gear 2768
Essential Emergency Equipment 2768
Who? 2768
What and Where? 2768
When? 2769
How Far? How Long? 2769
Navigation 2770
Sun Protection 2771
Sunglasses and Goggles 2771
Lights 2771
Headlamps 2771
Flashlights 2771
Lanterns 2771
Lantern Safety 2772
Tools 2772
Multifunction Tools 2772
Knives 2773
Blade Shapes 2773
Construction 2773
Handles 2774
Care 2774
Shovels and Trowels 2774
Saws and Axes 2774
Gear Repair 2774
First-Aid Kit 2774
Fire-Starting Materials 2774
Food 2774
Water 2774
Heat Packs and Heaters 2775
Optics 2776
Packs 2776
Lumbar Packs 2776
Day Packs 2776
Backpacks 2776
Duffels, Stuff Sacks, and Dry Bags 2777
Electronics 2778
Power 2779
Overnight Gear 2779
Stoves 2779
Accessories 2781
Cook Sets 2781
Personal Toiletries 2781
Sleeping Bags 2781
Insulation 2782
Down. 2782
Synthetics. 2782
Temperature 2782
Sleeping Pads 2783
Shelters 2784
Construction and Design 2784
Shape and Size 2785
Bivouac Sack 2785
Tarps 2785
Tents 2786
Accessories 2786
Care of Outdoor Equipment 2787
Selected Resources 2787
Selected Resources 2788
112 Native American Healing 2787
Definitions 2789
Native American 2789
Health 2789
Traditional Healers 2789
Elder 2790
Etiology in a World of “All My Relations” 2790
Biomedical 2790
Environmental 2791
Psychological/Psychosocial 2791
Spiritual 2792
Assessment and Diagnosis 2792
Treatment 2793
Contraindications 2793
Aftercare 2795
Prevention 2795
Clinical Example: Back Pain 2795
The Challenges of Research 2797
References 2798
References 2799
16 Wilderness Medicine Education and Research 2801
113 Wilderness Medicine Education 2802
Principles of Adult Learning 2803
Basic Principles 2804
Concepts, Theories, and Models 2804
The Education Cycle 2804
Experience-Based Learning 2804
Education and the Human Organism 2804
Learner Sophistication 2805
Principles of Andragogy 2805
Learner-Centered Education 2805
Learning-Oriented Teaching Model 2805
Decision Making and Error 2805
Putting It All Together 2806
Educational Techniques 2806
Learning Strategies 2807
Lecture 2807
Demonstration 2808
Skills Development Sessions 2809
Problem-Based Learning 2809
Case-Based Learning 2809
Scenarios and Role-Play 2810
Subject-Based Learning 2811
Discussion 2811
Small-Group Learning 2812
Distance Learning 2812
Field Experiences 2813
Outcomes and Competency-Based Education 2813
Assessing Learners’ Needs 2814
Learning Objectives 2814
Assessing Learning 2815
Timing of Evaluation 2815
Feedback 2816
The 360-Degree Evaluation 2816
Assessment Design 2817
Evaluating the Assessment Tool 2817
Limitations of Training 2818
Contrived Situations 2818
Teaching in Wilderness Medicine 2819
Good Teachers 2819
The Educational Environment 2820
The Classroom 2820
The Indoor Classroom 2820
The Outdoor Classroom 2821
Training Aids 2821
Equipment Considerations 2821
Audio and Visual Aids 2821
Textbooks 2822
Syllabus Material and Handouts 2822
Simulations 2822
Evaluation of Teaching 2824
Method of Evaluation 2824
Fairness and Confidentiality 2825
Usefulness of the Results 2825
What to Evaluate 2825
Format of the Evaluation Instrument 2825
Providing the Results 2825
Program and Curriculum Development 2825
Retention of Learning 2826
Wilderness Medicine Injury and Illness Data 2826
Concepts and Models 2827
Steps in Designing a Curriculum 2827
Desired Outcomes 2828
Determine the Content 2828
Select Teaching Methods 2828
Select Learning Assessment Instruments 2828
Developing the Course Evaluation 2828
Planning for Continuing Medical Education 2828
Professional Organizations and Training Programs in Wilderness Medicine 2829
Professional Societies 2829
Certification Programs for Outdoor Recreation and Education 2829
Training for Health Care Professionals 2831
Medical School, Residency, and Fellowship Offerings 2831
Continuing Medical Education Conferences and Travel 2832
References 2833
References 2834
114 MedWAR 2833
MedWAR Mission Statement 2836
The History of MedWAR 2836
The MedWAR Model: How It Works 2837
MedWAR Research 2839
Simulations, Scenarios, and Education in MedWAR 2841
Conclusion 2842
References 2842
References 2843
115 Evidence-Based Wilderness Medicine 2842
What EBM Is and Is Not 2842
The Evidence-Based Clinical Practitioner 2844
Evidence-Based Medicine: Experts Versus Practitioners 2845
Evidence-Based Medicine Resources for Wilderness Medicine Providers 2846
Moving Beyond Evidence- Based Medicine: What Is Implementation Science? 2850
The Future of Evidence-Based Medicine and Dissemination and Implementation in Wilderness Medicine 2851
Conclusion 2852
References 2852
References 2853
116 National Park Service Medicine 2852
Mission of the National Park Service 2852
History of the National Park Service 2852
Organization of the National Park Service 2855
Director’s Order #51 2856
Developing Advanced Medical Training for National Park Service Rangers 2857
Parkmedic Program 2857
Certification and Authorization of Providers 2857
Parkmedic (Level V) Scope of Practice 2858
Parkmedic Training 2858
Protocols for Parkmedics 2858
Local Control of Extended Scope of Practice 2859
Needs Assessment 2860
Level of EMS Training of National Park Service Providers 2860
Park EMS Medical Advisor Role 2860
Medical Oversight 2860
Medical Control 2860
Quality Assurance and Continuing Quality Improvement 2860
Continuing Education 2861
Refresher Courses for NREMT Recertification 2861
Continuing Education Sessions 2861
Multicasualty Incident Drills 2861
Specialized Support Assets 2861
Personnel and National Response 2861
Volunteers-in-Parks Program 2862
Technical Rescues 2862
Air Operations 2862
Search and Rescue Teams 2863
Future Directions 2863
References 2864
References 2865
117 Genomics in Wilderness Medicine 2864
Genetic and Environmental Influences on the Phenotype 2864
Establishing the Genetic Basis of A Trait 2866
The Era of Genomics 2868
Human Genetic Variation 2869
Genome-Wide Association Studies 2869
Omics Revolution 2870
Functional Genomic Elements 2870
Technologies for Identifying Genetic Variants and Their Associations With Disease 2872
Genetic Responses to Extreme Environments 2872
Genetics and Altitude 2872
Hypoxia and Acclimatization 2872
Altitude Illness 2873
Acute Altitude Illnesses 2873
Acute Mountain Sickness. 2873
Genetics of Acute Mountain Sickness. 2873
High-Altitude Cerebral Edema. 2874
Genetics of High-Altitude Cerebral Edema. 2874
High-Altitude Pulmonary Edema. 2874
Genetics of High-Altitude Pulmonary Edema. 2874
Chronic Altitude Illnesses 2874
Chronic Mountain Sickness. 2874
Genetics of Chronic Mountain Sickness. 2876
High-Altitude Pulmonary Hypertension. 2876
Genetics of High-Altitude Pulmonary Hypertension. 2876
High-Altitude Adaptation 2877
Genetics of Altitude Adaptation. 2879
Genetic Influences on Adaptation to Temperature and Ultraviolet Radiation 2881
Genetic Influences on Exertion in the Wilderness 2881
Physiology of Exercise 2881
Exercise Genomics 2881
Human Variation and Studies Relating Genes to Performance 2881
Baseline Fitness 2881
Family and Twin Studies. 2881
Genetics of Exercise Capacity. 2882
Training Responsiveness 2882
Family and Twin Studies 2882
Genetics of Training Responsiveness 2882
Athletic Performance 2882
Family and Twin Studies 2882
Genetics of Athletic Performance 2883
Susceptibility to Injuries and Illnesses Related to Exercise 2883
Genetics of Achilles Tendon Injuries 2883
Genetics in Diagnostic Tests, Treatments, and Preventive Measures 2883
Personalized Medicine 2883
Predictive Medicine 2883
Pharmacogenomics 2883
Personalized Genomic Wilderness Medicine 2884
Which Genes Should We Test? 2884
Is the Test Worth It? 2884
Who Is Going to Interpret the Genomics Data? 2884
What Are the Ethical Concerns Surrounding Genomic Medicine? 2884
Moving Forward 2884
References 2884
References 2885
17 The Wilderness 2890
118 Wilderness Management and Preservation 2891
Historical Development of the Wilderness Concept 2891
Wilderness Legislation and Policy in the United States 2891
Wilderness Stewardship Philosophy 2893
Potential Threats to Wilderness 2893
Wilderness Management Agencies in the United States 2894
Distribution of Wilderness in the United States 2894
Wilderness Values and Public Perceptions 2894
Wilderness Visitors 2895
Distribution of Wilderness Visitor Use 2895
Wilderness Management Principles 2896
Wilderness Preservation as a National and International Movement 2896
References 2896
References 2897
119 The Changing Environment 2898
Issues of Environmental Change 2898
Climate Change 2898
Stratospheric Ozone Depletion 2900
Erosion of Biodiversity (See Chapter 120) 2901
Population Growth 2902
Pollution 2903
Impacts of Environmental Change on Wilderness Areas 2903
Conversion of Wilderness 2904
Human Penetration of Wilderness Areas 2904
Direct Impacts 2905
Indirect Impacts 2905
High-Risk Technologies 2905
Consequences of Environmental Change 2905
Environmental Change and Medical Emergencies 2906
Complexity and Uncertainty 2907
What Might Be Done About Limiting Environmental Change? 2907
Changes in Environmental Science and Policy Making 2907
References 2909
References 2910
120 Biodiversity and Human Health 2909
Understanding the Etiology of the Biodiversity Crisis 2909
Threatened Ecosystems 2912
Species Decline 2914
Loss of Genetic Diversity 2914
Invasive Species 2915
Public Health Concerns 2915
Altered Epidemiology of Diseases 2916
Loss of Biologic Raw Materials 2916
Loss of Models for Medical Research 2916
Threatened Food Production 2917
Threatened Water Resources 2917
Case Study 2917
Conclusion 2919
References 2919
References 2920
121 Health Implications of Environmental Change 2919
Climate Change 2921
Vulnerable Populations 2921
Direct Impacts of Climate Change on Human Health 2921
Heat-Related Health Impacts 2921
Floods and Storms 2921
Health Effects Mediated Through Natural Systems 2922
Vector-Borne Diseases 2922
Malaria (see Chapter 40) 2922
Other Viral Diseases (see Chapter 39) 2922
Other Vector-Borne Diseases 2922
Waterborne Disease 2923
Climate Change as A Threat Multiplier 2923
Mental Health 2923
Nutrition 2923
Violence and Conflict 2923
Biodiversity Loss 2923
Threats to Ecosystem Services 2924
Deforestation 2924
Nutrient Cycles 2924
Ocean Acidification 2925
Freshwater Use 2925
Atmospheric Aerosol Loading 2925
Chemical Pollution 2926
References 2926
References 2927
122 Sustainability 2926
Sustainability in the Wilderness 2926
Seven Principles of Stewardship 2926
Plan Ahead and Prepare 2929
Travel and Camp on Durable Surfaces 2929
Dispose of Waste Properly 2929
Leave What You Find 2929
Minimize Campfire Impacts 2929
Respect Wildlife 2929
Be Considerate of Other Visitors 2929
Sustainability in Special Environs 2929
The Mountains 2929
Snow 2929
Water 2929
Tundra 2929
The Desert 2930
Sustainability and the Human Footprint 2930
Energy 2930
Renewable Energy 2931
Biomass 2931
Wind Power 2931
Solar Power 2931
Geothermal Energy 2931
Nuclear Energy 2932
Sustainable Living 2932
Sustainable Hospitals 2932
Sustainable Travel 2933
Hydraulic Fracturing 2933
Water Pollution 2933
Air Quality 2935
Seismic Activity 2935
Sand Mining 2935
Global Warming 2935
National Parks in the United States 2935
Conclusion 2935
The Challenge 2936
References and Selected Resources 2936
Selected Resources 2937
Carbon Offsets 2937
Nuclear 2937
Green Hospitals 2937
References 2937
123 Brief Introduction to Oceanography 2938
Ocean Statistics 2938
Brief Appreciation of the Ocean’s History and Modern Ocean Tools 2938
Water Characteristics 2939
Ocean Structure 2941
Ocean Circulation 2942
Ocean Movement: Waves, Tides, and Tsunamis 2943
Conditions for Oceanic Life 2946
Marine Primary Productivity 2947
Important Planktonic Autotrophs 2949
Harmful Algal Blooms 2950
Biogeochemical Cycles 2950
Marine Environmental Issues 2951
Oil Pollution 2951
Plastic Waste 2952
124 Brief Introduction to Forestry 2952
Definitions 2953
Forestry 2953
Forest 2953
Wilderness 2954
Trees and Rainfall 2954
Types of Forests 2954
Importance of Forests to People 2956
Human Interaction With Forests 2957
Hazards to People in Forests 2958
References 2958
References 2959
125 Brief Introduction to Earth Sciences 2958
Earth’s Origin 2958
Earth’s Interior Structure 2960
Earth’s Composition 2961
The Brittle, Restless Crust: Plate Tectonics 2962
Divergent Plate Margins 2963
Convergent Plate Margins 2963
Strike-Slip or Transform Plate Margins 2964
Tectonic Origin of Rocks 2964
Igneous Rocks 2966
Metamorphic Rocks 2967
Dynamics of Sedimentation and Sedimentary Rocks 2967
Present-Day Geology as a Key to Understanding the Past 2969
How Rocks Are Dated 2969
Geologic Time 2969
The Grand Canyon: an Example of Earth Science at Work 2970
Introduction and Physical Setting 2970
Creating the Rocks: 2 Billion Years of Earth History 2970
Basem*nt Rocks 2970
Grand Canyon Supergroup 2970
Paleozoic Rocks 2970
Mesozoic Rocks 2974
Cenozoic Rocks 2974
Carving Grand Canyon 2975
Summary of Grand Canyon Geology 2977
Selected Resources 2977
Selected Resources 2978
126 Space Medicine 2977
The Spaceflight Environment 2979
Pressure 2979
Spaceflight Decompression Risks 2979
Decompression-Related Injuries 2979
In-Flight Decompression Events 2980
Oxygen 2980
Carbon Dioxide 2981
Temperature 2981
Carbon Monoxide 2982
Propellants and Coolants 2982
Fire 2983
Water 2983
Dust, Particulates, and Other Contaminants 2983
The Radiation Environment 2984
Radiation Health Effects 2984
Monitoring and Risk Reduction 2985
Mission Considerations 2985
Preflight 2985
Launch 2985
Effects of Microgravity 2986
Space Adaptation Syndrome 2986
Postflight 2987
Physiologic Concerns of Spaceflight 2987
Cardiovascular Issues 2987
Dysrhythmias 2988
Cardiovascular Fitness 2989
Monitoring and Treatment 2989
Future Research 2989
Visual Impairment/Intracranial Pressure Syndrome 2989
Musculoskeletal Issues 2990
Psychiatric and Behavioral Health 2991
Dermatology and Hygiene 2993
Trauma 2993
Immunology 2994
Urology 2995
Gynecology and Reproductive Issues 2996
Ophthalmology 2996
Otolaryngology 2998
Dental Concerns 2998
Gastrointestinal Issues 2998
Neurology 2999
Onboard Medical Capability 2999
Medical Kits 2999
Diagnostic Imaging 3000
Future Capabilities 3001
Summary and Future Considerations 3001
Acknowledgments 3002
References 3002
References 3003
Appendix Drug Stability in the Wilderness 3008
Environmental Factors Influencing Drug Stability 3008
Expiration Dates and Shelf Life 3009
Packaging 3009
Sterility 3010
Storage 3010
Drugs for A Basic Field Kit 3010
How to Read the Drug List 3010
Drug List 3011
Acetaminophen Capsules, Tablets, Oral Solution, and Suppositories (OTC) 3011
Acetaminophen With Codeine Tablets and Oral Solution (S III) 3011
Acetaminophen With Hydrocodone Tablets and Oral Solution (S II) 3011
Acetazolamide Tablets, Extended-Release Capsules, Oral Solution, and Injection (RX) 3011
Acetic Acid Otic Solution (OTC) 3011
Albuterol Tablets, Syrup, and Inhaled Formulation (RX) 3011
Aloe Vera Gel, Ointment, and Laxatives (OTC) 3011
Amiodarone Tablets, Oral Solution, Inhalants, and Injections (RX) 3011
Antacids (OTC) 3011
Aspirin Tablets, Oral Solution, and Suppositories (OTC) 3011
Atenolol Tablets (RX) 3012
Atropine Injection and Ophthalmic Solution (RX) 3012
Azithromycin Tablets, Oral Solution, Injection, and Ophthalmic Solutions (RX) 3012
Bacitracin Topical Formulation (OTC) 3012
Bismuth Subsalicylate Tablets and Oral Solution (OTC) 3012
Bretylium Tosylate (RX) 3012
Bupivacaine Injection (RX) 3012
Butorphanol Tartrate Nasal Spray and IM and IV Injections (S IV) 3012
Calcium Chloride, Calcium Gluceptate, and Calcium Gluconate Injection (RX) 3012
Calendula Topical Formulation (OTC) 3012
Ceftriaxone Injection (RX) 3012
Cephalexin Capsules, Tablets, and Oral Solution (RX) 3012
Charcoal, Activated (OTC) 3012
Ciprofloxacin Tablets, Capsules, Oral Solution, Injection, Ophthalmic Solution, and Otic Solutions (RX) 3012
Crotalidae Antivenom (RX) 3012
Cyclopentolate Hydrochloride Ophthalmic Solution (RX) 3012
Dabigatran Tablets (RX) 3012
Deet (N,N-Diethyl-Meta-Toluamide, Diethyltoluamide)–Containing Insect Repellent (OTC) 3012
Dermabond (2-Octyl Cyanoacrylate) Topical Skin Adhesive (RX) 3013
Dexamethasone Tablets and Oral, Injection, Implantation, Intravitreal, and Ophthalmic Solutions (RX) 3013
Dextroamphetamine Tablets, Capsules, and Oral Solution (S II) 3013
Dextrose Oral Solution (OTC) and Injection (RX) 3013
Diazepam Tablets, Oral Solution, Suppositories, and Injection (S IV) 3013
Digoxin Tablets and Injection (RX) 3013
Diltiazem Tablets, Oral Solution, and Injection (RX) 3013
Diphenhydramine Tablets, Oral Solution (OTC), and Injection (RX) 3013
Domeboro (Acetic Acid and Aluminum Acetate) Otic Solutions (OTC) 3013
Dopamine Hydrochloride Injection (RX) 3013
Doxycycline Capsules, Tablets, Oral Solution, and Injection (RX) 3013
Edoxaban Tablets (RX) 3013
EMLA (Lidocaine/Prilocaine) Topical Formulation (RX) 3013
Epinephrine Injection and Topical, Inhaled, and Intranasal Formulations (RX) 3013
Erythromycin Tablets, Oral Solution, and Topical Ointment (RX) 3013
Famotidine Tablets (OTC) and Injection (RX) 3014
Fentanyl Oral Lozenges, Sublingual Tablets, Sublingual Spray, Buccal Film, Injection, and Intranasal Formulation (RX) 3014
Fluocinolone Acetonide Topical Ointment, Otic Solution, and Shampoo (RX) 3014
Furazolidone Tablets and Solution (NA) 3014
Furosemide Tablets, Solution, and Injection (RX) 3014
Glucagon Injection (RX) 3014
Haloperidol Tablets and Injection (RX) 3014
Hydrocortisone Tablets, Solution, Injection, and Topical Cream (RX) 3014
Hydromorphone Tablets, Solution, Suppositories, and Injection (S II) 3014
Ibuprofen Tablets and Solution (OTC) 3014
Insulin (Regular) Injection and Inhaled Formulation (RX) 3014
Intravenous Solutions (D5W, Ns, Lr, D5ns, and Other Admixtures) 3014
Isoproterenol Hydrochloride Inhalant and Injection (RX) 3014
Ivermectin Tablets (RX) 3014
Kaletra (Lopinavir/Ritonavir) Tablets (RX) 3014
Ketoconazole Tablets, Shampoo, Foam, and Gel (RX) 3014
Lacosamide Tablets, Oral Solution, and Injection (RX) 3014
Lacrisert (Hydroxypropyl Methylcellulose) Ophthalmic Solution (RX) 3014
Lemon Grass (Cymbogogon) Citronella Oil Topical Formulation (OTC) 3014
Levetiracetam Tablets, Oral Solution, and Injection (RX) 3015
Levofloxacin Tablets, Solution, Injection, and Ophthalmic Formulation (RX) 3015
Lidocaine Injection and Topical, Intradermal, and Ophthalmic Solutions (RX) 3015
Lidocaine/Epinephrine/Tetracaine (LET) Topical Solution (RX) 3015
Lindane (Gamma-Hexachlorocyclohexane) Lotion and Shampoo (RX) 3015
Loperamide Hydrochloride Capsules (OTC) 3015
Lorazepam Tablets, Oral Solution, and Injection (S IV) 3015
Malarone (Atovaquone/Proguanil) Tablets (RX) 3015
Mannitol Injection (RX) 3015
Mebendazole Tablets (RX) 3015
Meperidine Hydrochloride Tablets, Oral Solution, and Injection (S II) 3015
Metoprolol Tablets, Oral Solution, and Injection (RX) 3015
Metronidazole Capsules, Tablets, and Injection (RX) 3015
Midazolam Oral Solution and Injection (S IV) 3015
Modafinil Tablets (S IV) 3015
Morphine Sulfate Tablets, Epidural Suspension, and Injection (S II) 3015
Moxifloxacin Tablets, Oral Solution, Injection, and Ophthalmic Route (RX) 3016
Mupirocin Topical Formulation (RX) 3016
Nalbuphine Hydrochloride Injection (RX) 3016
Naloxone Hydrochloride Injection (RX) 3016
Neosporin Ointment (OTC) 3016
Nifedipine Capsules, Tablets, Oral Solution, and Injection (RX) 3016
Nitroglycerin Capsules, Sublingual Tablets and Sprays, Injection, Patches, and Topical Formulation (RX) 3016
Norfloxacin Tablets, Oral Solution, and Ophthalmic Solution (RX) 3016
Ofloxacin Tablets, Injection, Ophthalmic Solution, and Otic Solution (RX) 3016
Penicillin G Procaine Injection (RX) 3016
Penicillin GK and G Sodium Injection (RX) 3016
Phenobarbital Tablets, Solution, and IM and IV Injections (S IV) 3016
Phenylephrine Injection and Ophthalmic Solution (RX) and Nasal Spray (OTC) 3016
Phenytoin Capsules, Tablets, Oral Solution, and Injection (RX) 3016
Polysporin Ointment (RX) 3017
Potassium Permanganate Astringent Solution (OTC) 3017
Povidone-Iodine Solution (OTC) 3017
Prednisone Tablets and Oral Solution (RX) 3017
Prochlorperazine Capsules, Tablets, Oral Solution, and Injection (RX) 3017
Promethazine Capsules, Tablets, Solution, Injection, and Suppositories (RX) 3017
Pseudoephedrine and Pseudoephedrine/Triprolidine Capsules and Tablets (OTC) 3017
Rivaroxaban Tablet (RX) 3017
Rocuronium Injection (RX) 3017
Sildenafil Tablets (RX) 3017
Simethicone Capsules, Tablets, Drops, and Ultrasound Suspension (OTC) 3017
Sodium Bicarbonate Tablets, Injection, and Suppositories (RX) 3017
Sodium Sulfacetamide Tablets, Cream, Lotion, Ointment, and Ophthalmic Route (RX) 3017
Succinylcholine Injection (RX) 3017
Temazepam Capsules (S IV) 3017
Tetanus Toxoid, Tetanus Toxoid/Diphtheria/Acellular Pertussis, and Hyperimmune Tetanus Globulin Vaccine Solutions (RX) 3017
Tetracaine Hydrochloride Ophthalmic Solution (RX) 3017
Tetracycline Capsules, Tablets, Oral Solution, Injection, and Topical Ointment (RX) 3017
Tolnaftate Topical Antifungal Solution (OTC) 3017
Triazolam Tablets (S IV) 3018
Trimethoprim/Sulfamethoxazole (80 Mg/400 Mg) Tablets, Oral Solution, and Injection (RX) 3018
Truvada (Emtricitabine/Tenofovir) Tablets (RX) 3018
Verapamil Hydrochloride Capsules, Tablets, and Injection Solution (RX) 3018
Warfarin Tablets (RX) 3018
Zinc Salts (OTC) 3018
Zolpidem Tablets, Sublingual Tablets, and Spray (S IV) 3018
References 3018
References 3019
Index 3021
A 3021
B 3026
C 3030
D 3037
E 3040
F 3045
G 3048
H 3050
I 3054
J 3057
K 3058
L 3058
M 3061
N 3065
O 3067
P 3068
Q 3074
R 3075
S 3078
T 3085
U 3090
V 3091
W 3092
X 3095
Y 3095
Z 3096
IBC_Clinical Key ad 3097

commenti sui metadati

producers:
GPL Ghostscript 9.15

Titolo alternativo

[9780323396097] Auerbach`s Wilderness Medicine E-Book

Titolo alternativo

Auerbach's Wilderness Medicine E-Book

Autore alternativo

Auerbach MD MS FACEP MFAWM FAAEM, Paul S., Cushing MD MPH, Tracy A, Harris MD MFA FRCP Edin., N. Stuart

Autore alternativo

Paul S. Auerbach MD MS FACEP MFAWM FAAEM

Editore alternativo

Saunders

Edizione alternativa

7th edition, 2017

Edizione alternativa

7, 2016

Descrizione alternativa

Now In Its 7th Edition, Auerbach's Wilderness Medicine Continues To Help You Quickly And Decisively Manage Medical Emergencies Encountered In Any Wilderness Or Other Austere Setting! World-renowned Authority Dr. Paul Auerbach And 2 New Associate Editors Have Assembled A Team Of Experts To Offer Proven, Practical, Visual Guidance For Effectively Diagnosing And Treating The Full Range Of Issues That Can Occur In Situations Where Time And Resources Are Scarce...this Indispensable Resource Equips Physicians, Nurses, Advanced Practice Providers, First Responders, And Rescuers With The Essential Knowledge And Skills To Effectively Address And Prevent Injuries And Illnesses - No Matter Where They Happen!--publisher's Description. High-altitude Physiology -- High-altitude Medicine And Pathophysiology -- High Altitude And Preexisting Medical Conditions -- Avalanches -- Lightning-related Injuries And Safety -- Thermoregulation -- Accidental Hypothermia -- Immersion Into Cold Water -- Frostbite -- Nonfreezing Cold-induced Injuries -- Polar Medicine -- Pathophysiology Of Heat-related Illnesses -- Clinical Management Of Heat-related Illnesses -- Wildland Fires : Dangers And Survival -- Emergency Care Of The Burned Patient -- Exposure To Radiation From The Sun -- Volcanic Eruptions, Hazards, And Mitigation -- Wilderness Trauma And Surgical Emergencies -- Emergency Airway Management -- Management Of Facial Injuries -- Wound Management -- Wilderness Orthopedics -- Splints And Slings -- Taping And Bandaging -- Foot Problems And Care -- Hunting And Fishing Injuries -- Tactical Medicine -- Combat And Casualty Care -- Injury Prevention : Decision Making, Safety, And Accident Avoidance --^ Bites And Injuries Inflicted By Wild And Domestic Animals -- Rabies -- Bear Behavior And Attacks -- Alligator And Crocodile Attacks -- Wilderness-acquired Zoonoses -- Bites By Venomous Reptiles In Canada, The United States, And Mexico -- Bites By Venomous And Nonvenomous Reptiles Worldwide -- Ranch And Rodeo Medicine -- Emergency Veterinary Medicine -- Mosquitoes And Mosquito-borne Diseases -- Malaria -- Arthropod Envenomation And Parasitism -- Tick-borne Diseases -- Spider Bites -- Scorpion Envenomation -- Protection From Blood-feeding Arthropods -- Improvised Medicine In The Wilderness -- Principles Of Pain Management -- The Eye In The Wilderness -- Wilderness Dentistry -- Wilderness Cardiology -- Wilderness Neurology -- Mental Health In The Wilderness -- Chronic Diseases And Wilderness Activities -- Wilderness Emergency Medical Services And Response Systems -- Search And Rescue -- Technical Rescue, Self-rescue, And Evacuation -- Litters And Carries --^ Helicopter Rescue And Air Medical Transport -- Essentials Of Wilderness Survival -- Jungle Travel And Survival -- Desert Travel And Survival -- Whitewater Medicine And Rescue -- Caving And Cave Rescue -- Plant-induced Dermatitis -- Toxic Plant Ingestions -- Toxic Mushroom Ingestions -- Seasonal And Acute Allergic Reactions -- Ethnobotany : Plant-derived Medical Therapy -- Drowning And Submersion Injuries -- Safety And Survival At Sea -- Diving Medicine -- Hyperbaric Medicine -- Injuries From Nonvenomous Aquatic Animals -- Envenomation By Aquatic Invertebrates -- Envenomation By Aquatic Vertebrates -- Aquatic Skin Disorders -- Seafood Toxidromes -- Seafood Allergies -- Travel Medicine -- Expedition Medicine -- Non–north American Travel And Exotic Diseases -- Infectious Diarrhea From Wilderness And Foreign Travel -- Natural Disaster Management -- Global Humanitarian Medicine And Disaster Relief -- Natural And Human-made Hazards : Disaster Risk Management Issues -- Global Crimes, Incarceration, And Quarantine -- Nutrition, Malnutrition, And Starvation -- Field Water Disinfection -- Dehydration And Rehydration -- Living Off The Land -- Children In The Wilderness -- Women In The Wilderness -- Older Adults In The Wilderness -- Persons With Disabilities In The Wilderness -- Physiology Of Exercise, Conditioning, And Performance Training For Wilderness Adventure -- Exercise, Conditioning, And Performance Training -- Wilderness And Endurance Events -- Canyoneering And Canyon Medicine -- Cycles, Snowmobiles, And Other Wilderness Conveyances -- Medical Liability And Wilderness Emergencies -- Ethics Of Wilderness Medicine -- Wilderness Preparation, Equipment, And Medical Supplies -- Emergency Oxygen Administration -- Telemedicine In The Wilderness -- Wilderness And Global Communications And Techniques -- Wilderness Navigation Techniques -- Principles Of Meteorology And Weather Prediction -- Ropes And Knot Tying -- Ultrasound In The Wilderness -- Outdoor Clothing For The Wilderness Professional -- Nonmedical Backcountry Equipment For Wilderness Professionals -- Native American Healing -- Wilderness Medicine Education -- Medwar : Medical Wilderness Adventure Race -- Evidence-based Wilderness Medicine -- National Park Service Medicine -- Genomics In Wilderness Medicine -- Wilderness Management And Preservat

Descrizione alternativa

Now In Its 7th Edition, Auerbach’s Wilderness Medicine Continues To Help You Quickly And Decisively Manage Medical Emergencies Encountered In Any Wilderness Or Other Austere Setting! World-renowned Authority Dr. Paul Auerbach And 2 New Associate Editors Have Assembled A Team Of Experts To Offer Proven, Practical, Visual Guidance For Effectively Diagnosing And Treating The Full Range Of Issues That Can Occur In Situations Where Time And Resources Are Scarce. This Indispensable Resource Equips Physicians, Nurses, Advanced Practice Providers, First Responders, And Rescuers With The Essential Knowledge And Skills To Effectively Address And Prevent Injuries And Illnesses – No Matter Where They Happen! Face Any Medical Challenge In The Wilderness With Expert Guidance From Hundreds Of Outstanding World Experts Edited By Dr. Auerbach And 2 New Associate Editors, Drs.tracy Cushing And N. Stuart Harris. New And Expanded Chapters With Hundreds Of New Photos And Illustrative Drawings Help Increase Your Visual Understanding Of The Material. Acquire The Knowledge And Skills You Need With Revised Chapters Providing Expanded Discussions Of High-altitude Medicine, Improvisation, Technical Rescue, Telemedicine, Ultrasound, And Wilderness Medicine Education. Ten New Chapters Cover Acute High-altitude Medicine And Pathophysiology; High Altitude And Pre-existing Medical Conditions; Cycles, Snowmobiles, And Other Wilderness Conveyances; Medical Wilderness Adventure Races (medwar); Canyoneering And Canyon Medicine; Evidence-based Wilderness Medicine; National Park Service Medicine; Genomics And Personalized Wilderness Medicine; Forestry; And Earth Sciences.

data de apertura del código

2022-03-08