Sunday 28 April 2013
Awesome field guide for any Wilderness Emergency Medical practitioner
Snakes & snake bite in Southern Africa by Johan Marais
Saturday 27 April 2013
Preparing for REMOTE wilderness expeditions
- Region specific considerations
- climatological
- meteorological
- geographical
- topographical
- geological
- hydrological
- Environmental resources
- Mental preparation
- Organisational including group psychology and sociological considerations
- Time (the resource you cannot negotiate)
- Equipment / expertise / exercise tolerance and physical abilities of team / evacuation plan
Snow blindness
Also known as ultra-violet eye injury. It is a severely painful condition primarily caused by ultra-violet B radiation reflected by snow, and sometimes even water and sand. This is usually a self-limiting problem and can be mitigated by wearing appropriate eye protection.
Liebermeister's Rule and Faget's Sign: Useful clinical guides in the wilderness environment
For every 1 degree Celcius increase in body temperature, the heart rate increases by approximately 10 beats per minute (Liebermeister's Rule), except in situations where there is a relative bradycardia in a patient with a fever (Faget's Sign). This occurs in:
- Yellow fever
- Typhoid
- Tularaemia
- Brucellosis
- Colorado tick fever
- Legionella pneumonia
- Mycoplasma pneumonia
- Drug fever (Beta blockers)(Beta-Faget Sign)
Blood pressure estimates
With lack of appropriate equipment in the field, simple vital sign assessments might become challenging tasks. Estimation of blood pressure in a patient in the wilderness environment is one example. Without sphygomomanometers, the closest clinical assessment one can do is to determine the presence of various pulses. The presence of a radial pulse denotes a systolic BP of at least 80 mmHg. The presence of a femoral pulse implies a systolic BP of at least 70 mmHg. A palpable carotid pulse implies a perfusing systolic BP of at least 60 mmHg. There have been arguments against these estimates as they can be sometimes unreliable. However, in the field without appropriate equipment, these are acceptable.
Continuous management of the wilderness emergency medicine patient whilst awaiting evacuation
The best way to probably monitor and record the care of the wilderness emergency medicine patient whilst awaiting evacuation is to use a SOAP NOTE. The SOAP note is a detailed periodic documentation of the continued care of the patient. It comprises the following elements:
- Subjective data: further new complaints and a subjective assessment of the change in the severity and conditions of existing complaints such as pain score
- Objective data: continued vital signs and clinical monitoring for deterioration
- Assessment: a periodic appraisal of the status of the patient
- Plan: a detailed periodic management plan for ongoing and additional care requirements
Wilderness emergency assessment of the patient: Initial assessment
The primary survey of the wilderness emergency medicine patient needs to include an initial survey of the environment. The aspects to consider here are:
- Immediate hazards in the environment and what needs to be done to protect the rescuers and the victim
- Environmental support and mitigation: what can the environment offer by way of assistance in the care of the patient's primary survey needs and how can you use the environment to mitigate the risk against worsening of the patient's vital signs (eg thermoregulatory control)
- Long-term hazards that will create obstacles to the on-going care of the patient whilst awaiting evacuation
- Environmental management to support the patient during the waiting period whilst awaiting evacuation (shelter, warmth, food etc) (Consider the survival Maslow's hierarchy of needs)
Welcome to the Wilderness Emergency Medicine Course
I am an Emergency Medicine doctor with a special interest in austere environment's emergency medicine. I have worked in remote environments in the wilderness and mountains and on expeditions and love the outdoors. My desire to contribute to the development of emergency medicine in SA met with an obstacle when I saw the focus was on the more traditional aspects and curriculum of emergency medicine. This is understandably so as the specialty cannot develop without core content being developed. However, with my own passion for the esoteric parts of emergency medicine I decided to see what was out there for us in SA with regard to austere environment's emergency medicine. Unfortunately, wilderness emergency medicine is a very young branch of emergency medicine and great efforts were made by some of the great outdoor doctors from Wild Medix and Destination Medicine to offer courses in this regard. These courses were offered as first aid courses and the uptake has not been very promising. My goal then was to develop an intense and comprehensive Wilderness Emergency Medicine course that was accessible and affordable to most practitioners in the field of pre-hospital emergency medicine. Research into international course offerings showed that importing a course was a possibility, except for the costs involved that was mostly due to rand-dollar exchange rates. So, after chatting to several colleagues, I decided to develop my own course from scratch. The first step was to choose course content and develop a synopsis, which is now well developed. The next step is CPD / CEU accreditation including points for ethics to make it fairly meaningful, which is currently in process. I have also secured the services of an internationally experienced mountain climbing and rescue expert to deliver the mountaineering basics, an experienced paramedic with rescue and survival skills to assist with the wilderness component and a trauma surgeon with the same outdoor passion as me to assist with the medical component. The end result is a fantastic opportunity for anyone with a love for the outdoors and a passion for emergency medicine...the Wilderness Emergency Medicine course.
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