Return-Path: Received: from mb1i0.ns.pitt.edu (mb1i1.ns.pitt.edu [136.142.185.161]) by imap.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisimap-7.2.2.4) ID ; Thu, 27 Jul 2000 00:24:44 -0400 (EDT) Received: from list.srv.cis.pitt.edu (majordom@[136.142.185.20]) by pitt.edu (PMDF V5.2-32 #41462) with ESMTP id <01JS8QDJLLWM003HBP@mb1i0.ns.pitt.edu>; Thu, 27 Jul 2000 00:24:44 EST Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.2) ID ; Thu, 27 Jul 2000 00:24:10 -0400 (EDT) Received: from mail1.hushmail.com (mail1.hushmail.com [216.18.8.67]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.2) ID for ; Thu, 27 Jul 2000 00:24:04 -0400 (EDT) Received: (from root@localhost) by mail1.hushmail.com (8.8.7/8.8.7) id VAA30463; Wed, 26 Jul 2000 21:23:33 -0700 Date: Wed, 26 Jul 2000 21:20:46 -0600 (PDT) From: melriser@hushmail.com Subject: Re: W-EMED Test message Sender: owner-wilderness-emergency-medicine@list.pitt.edu To: wilderness-emergency-medicine@list.pitt.edu Reply-to: wilderness-emergency-medicine@list.pitt.edu Message-id: <200007270423.VAA30463@mail1.hushmail.com> MIME-version: 1.0 Content-type: multipart/mixed; boundary="Hushpart_boundary_lgAxnlgktOseoAqHIFKnGplvDqiXuWsG" Precedence: bulk --Hushpart_boundary_lgAxnlgktOseoAqHIFKnGplvDqiXuWsG Content-type: text/plain Well I just joined and could start some traffic... I used to be an EMT years ago with some SAR experience... However I have a technolgy job now and want to get back in as a volunteer or VFD type... We have a VFD close by and I have contacted them about training and such... i though a list would be good for refreshing skills and gaining contacts... Mel Riser Volente, Texas At Wed, 26 Jul 2000 19:15:23 -0700, "Liz Marr" wrote: > >There are slow days, and then there are SLOW months. > > >-- >^v^v^v^v^v^v^v^v^v^v^v^v^v^v^v^v^v^v^v^v^v^v^v^v^v^v^v^v^v^v^v^v^ >Visit the SAR-Dogs website: http://www.sar-dogs.com >Do not reproduce without author's express permission. >To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" >as the body of a message (no subject) To: Majordomo@list.pitt.edu >Submissions To: wilderness-emergency-medicine@list.pitt.edu > --Hushpart_boundary_lgAxnlgktOseoAqHIFKnGplvDqiXuWsG-- IMPORTANT NOTICE: If you are not using HushMail, this message could have been read easily by the many people who have access to your open personal email messages. Get your FREE, totally secure email address at http://www.hushmail.com. Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- Return-Path: Received: from mb2i0.ns.pitt.edu (mb2i1.ns.pitt.edu [136.142.185.162]) by imap.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisimap-7.2.2.3) ID ; Mon, 17 Jul 2000 16:50:11 -0400 (EDT) Received: from list.srv.cis.pitt.edu (majordom@[136.142.185.20]) by pitt.edu (PMDF V5.2-32 #41462) with ESMTP id <01JRVPUWWADE00435O@mb2i0.ns.pitt.edu>; Mon, 17 Jul 2000 16:50:12 EST Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.2) ID ; Mon, 17 Jul 2000 16:49:58 -0400 (EDT) Received: from gate1.health.state.ny.us (gate.health.state.ny.us [192.135.176.62]) by list.srv.cis.pitt.edu with SMTP (8.8.8/8.8.8/cisls-7.2.2.2) ID for ; Mon, 17 Jul 2000 16:49:56 -0400 (EDT) Received: by gate1.health.state.ny.us id QAA18751 (InterLock SMTP Gateway 4.2 for wilderness-emergency-medicine@list.pitt.edu) ; Mon, 17 Jul 2000 16:49:24 -0400 Received: by gate1.health.state.ny.us (Internal Mail Agent-1); Mon, 17 Jul 2000 16:49:24 -0400 Date: Mon, 17 Jul 2000 16:49:09 -0400 From: rrt01@health.state.ny.us Subject: Re: W-EMED use of tourniquets! Sender: owner-wilderness-emergency-medicine@list.pitt.edu To: wilderness-emergency-medicine@list.pitt.edu Reply-to: wilderness-emergency-medicine@list.pitt.edu Message-id: <200007172049.QAA18751@gate1.health.state.ny.us> MIME-version: 1.0 Content-type: text/plain; charset=us-ascii Content-disposition: inline Precedence: bulk X-Lotus-FromDomain: NYSDOH I agree with Jay's ( and earlier posters') comments. BTW, I've got >24 years EMS experience (including 9yrs in NYC) and have never needed a tourniquet. An additional point to consider is the amount of time that has elapsed between the injury and when you first encounter the patient. If it has been <10 minutes since the injury, I see where you could "conceiveably" (although highly unlikely) need a tourniquet. If it has been hours since the injury occurred (as in most wilderness rescue situations that I've experienced,) any wound requiring a tourniquet will be found on a patient who is already dead... Just my $.02... Raymond R. Thielke, EMT/P, MA(c) JadedMedic@aol.com on 07/17/2000 03:06:02 PM Please respond to wilderness-emergency-medicine@list.pitt.edu To: wilderness-emergency-medicine@list.pitt.edu cc: (bcc: Raymond R. Thielke/Syracuse/DOH) Subject: Re: W-EMED use of tourniquets! Hi folks, In all my years of careening about the landscape on ambulances or on first responder units, I have never once been in a situation where I felt that I needed to apply a tourniquet. In my experience (and I'm sure that many of you have had similar experiences), most bleeding will stop by itself, and do so long before it become life-threatening, if simply left alone. In more serious cases, direct pressure alone will do just fine. (I have learned to hold pressure for ten minutes while resisting the temptation to occasionally peek at the wound.) Note: This means pressure applied with a _dry_ dressing. I have seen too many responders apply a saline-soaked dressing to a wound and then fail to understand why it kept bleeding. I tell my students that you can stop the bleeding (with a dry dressing) or you can try to clean out the wound (with a wet dressing) but you have to make up your mind regarding which of the two you're trying to do. You can't do both at the same time. Pursuant to the above, if I as a member of an ambulance crew or first responder unit arrived at a scene and saw "wet" blood on a victim, I knew that I had better get busy because two things were probably true: 1. This person had a "leak" somewhere that was big enough that it wasn't going to stop by itself. 2. If they were still "leaking" by the time I got there (typically anywhere from ten to twenty minutes after the injury occurred) they had likely already lost a significant amount of blood. Still, I found that direct pressure or maybe a dressing with mild pressure would almost always correct the problem. If that didn't work (which happened maybe once a year) the hitting a pressure point -- assuming the wound is on an extremity, of course -- for a few minutes while a pressure dressing was applied. Still, I carried a 2" Ace bandage and at least one 8"x10" dressing in my jump kit for those very rare occasions when I needed to apply a "heavy pressure" pressure dressing. What I have seen, time and time and time again, is "civilians" applying what amounted to a venous tourniquet above the wound. This, of course, tends to _increase_ the amount of blood that the victim uses. I've seen some really _scary_ cases of this. In other words, in all my years in EMS (eight years of street duty) I have never once been in a position where I felt that I needed to apply a tourniquet and I have never once seen a tourniquet applied by a civilian "for the right reasons and in the right way." In other words, I have seen an appropriate usage rate by civilians of zero. I tell my students that tourniquets may make the most sense as a means of applying pressure to a pressure point when for some reason the rescuer can't stay with the victim. Thus, I can see a role for them in a battlefield scenario or some other sort of mass casualty situation in which the number of victims is greater than the number of rescuers, but in everyday use when EMS can get there quickly and the rescuer can stay with the victim and apply direct pressure and hit the pressure point, I don't see any compelling reason for their use. One reference that I haven't seen cited so far is Eric Weiss's book "A Comprehensive Guide to Wilderness and Travel Medicine." Weiss recommends releasing the tourniquet after one hour to see if the bleeding has been brought under control by then and, if it has been controlled, to leave the tourniquet in place but untightened. Regards to all Jay Wiseman FA/CPR Instructor at large Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- Return-Path: Received: from mb2i0.ns.pitt.edu (mb2i1.ns.pitt.edu [136.142.185.162]) by imap.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisimap-7.2.2.3) ID ; Mon, 17 Jul 2000 15:08:04 -0400 (EDT) Received: from list.srv.cis.pitt.edu (majordom@[136.142.185.20]) by pitt.edu (PMDF V5.2-32 #41462) with ESMTP id <01JRVMB806GI00435F@mb2i0.ns.pitt.edu>; Mon, 17 Jul 2000 15:08:02 EST Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.2) ID ; Mon, 17 Jul 2000 15:06:45 -0400 (EDT) Received: from imo-r18.mx.aol.com (imo-r18.mx.aol.com [152.163.225.72]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.2) ID for ; Mon, 17 Jul 2000 15:06:42 -0400 (EDT) Received: from JadedMedic@aol.com by imo-r18.mx.aol.com (mail_out_v27.12.) id h.d0.8a074ea (9665) for ; Mon, 17 Jul 2000 15:06:03 -0400 (EDT) Date: Mon, 17 Jul 2000 15:06:02 -0400 (EDT) From: JadedMedic@aol.com Subject: Re: W-EMED use of tourniquets! Sender: owner-wilderness-emergency-medicine@list.pitt.edu To: wilderness-emergency-medicine@list.pitt.edu Reply-to: wilderness-emergency-medicine@list.pitt.edu Message-id: MIME-version: 1.0 X-Mailer: AOL 5.0 for Windows sub 118 Content-type: text/plain; charset="US-ASCII" Content-transfer-encoding: 7bit Precedence: bulk Hi folks, In all my years of careening about the landscape on ambulances or on first responder units, I have never once been in a situation where I felt that I needed to apply a tourniquet. In my experience (and I'm sure that many of you have had similar experiences), most bleeding will stop by itself, and do so long before it become life-threatening, if simply left alone. In more serious cases, direct pressure alone will do just fine. (I have learned to hold pressure for ten minutes while resisting the temptation to occasionally peek at the wound.) Note: This means pressure applied with a _dry_ dressing. I have seen too many responders apply a saline-soaked dressing to a wound and then fail to understand why it kept bleeding. I tell my students that you can stop the bleeding (with a dry dressing) or you can try to clean out the wound (with a wet dressing) but you have to make up your mind regarding which of the two you're trying to do. You can't do both at the same time. Pursuant to the above, if I as a member of an ambulance crew or first responder unit arrived at a scene and saw "wet" blood on a victim, I knew that I had better get busy because two things were probably true: 1. This person had a "leak" somewhere that was big enough that it wasn't going to stop by itself. 2. If they were still "leaking" by the time I got there (typically anywhere from ten to twenty minutes after the injury occurred) they had likely already lost a significant amount of blood. Still, I found that direct pressure or maybe a dressing with mild pressure would almost always correct the problem. If that didn't work (which happened maybe once a year) the hitting a pressure point -- assuming the wound is on an extremity, of course -- for a few minutes while a pressure dressing was applied. Still, I carried a 2" Ace bandage and at least one 8"x10" dressing in my jump kit for those very rare occasions when I needed to apply a "heavy pressure" pressure dressing. What I have seen, time and time and time again, is "civilians" applying what amounted to a venous tourniquet above the wound. This, of course, tends to _increase_ the amount of blood that the victim uses. I've seen some really _scary_ cases of this. In other words, in all my years in EMS (eight years of street duty) I have never once been in a position where I felt that I needed to apply a tourniquet and I have never once seen a tourniquet applied by a civilian "for the right reasons and in the right way." In other words, I have seen an appropriate usage rate by civilians of zero. I tell my students that tourniquets may make the most sense as a means of applying pressure to a pressure point when for some reason the rescuer can't stay with the victim. Thus, I can see a role for them in a battlefield scenario or some other sort of mass casualty situation in which the number of victims is greater than the number of rescuers, but in everyday use when EMS can get there quickly and the rescuer can stay with the victim and apply direct pressure and hit the pressure point, I don't see any compelling reason for their use. One reference that I haven't seen cited so far is Eric Weiss's book "A Comprehensive Guide to Wilderness and Travel Medicine." Weiss recommends releasing the tourniquet after one hour to see if the bleeding has been brought under control by then and, if it has been controlled, to leave the tourniquet in place but untightened. Regards to all Jay Wiseman FA/CPR Instructor at large Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- Return-Path: Received: from mb1i0.ns.pitt.edu (mb1i1.ns.pitt.edu [136.142.185.161]) by imap.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisimap-7.2.2.3) ID ; Sun, 16 Jul 2000 19:07:35 -0400 (EDT) Received: from list.srv.cis.pitt.edu (majordom@[136.142.185.20]) by pitt.edu (PMDF V5.2-32 #41462) with ESMTP id <01JRUGDVJ5DI002KEE@mb1i0.ns.pitt.edu>; Sun, 16 Jul 2000 19:07:35 EST Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.2) ID ; Sun, 16 Jul 2000 19:07:15 -0400 (EDT) Received: from mail01.iprimus.com.au (mail01.iprimus.com.au [203.134.64.91]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.2) ID for ; Sun, 16 Jul 2000 19:07:11 -0400 (EDT) Received: (apparently) from gosta ([203.134.36.94]) by mail01.iprimus.com.au with Microsoft SMTPSVC(5.5.1877.467.46); Mon, 17 Jul 2000 09:07:15 +1000 Date: Mon, 17 Jul 2000 09:06:44 +1000 From: Gosta Subject: Re: W-EMED use of tourniquets! Sender: owner-wilderness-emergency-medicine@list.pitt.edu To: wilderness-emergency-medicine@list.pitt.edu Reply-to: wilderness-emergency-medicine@list.pitt.edu Message-id: <000e01bfef7a$84c1b880$5e2486cb@gosta> MIME-version: 1.0 X-MIMEOLE: Produced By Microsoft MimeOLE V5.00.2919.6600 X-Mailer: Microsoft Outlook Express 5.00.2919.6600 Content-type: multipart/alternative; boundary="----=_NextPart_000_000B_01BFEFCE.54563320" X-Priority: 3 X-MSMail-priority: Normal Precedence: bulk This is a multi-part message in MIME format. ------=_NextPart_000_000B_01BFEFCE.54563320 Content-Type: text/plain; charset="iso-8859-1" Content-Transfer-Encoding: quoted-printable Gurkan, Generally, as you point out, tourniquets aren't needed in the = pre-hospital field. Most haemorrhages can be stopped by direct pressure = or even occasionally by clamping off an exposed torn artery. The times = when they are indicated tend to be serious trauma, often involving crush = injuries. There can also be occasions when you can't reach a seriously = haemorrhaging wound due to entrapment. When a tourniquet is released, it = is important to monitor EKG (as well as vitals) for hyperkalaemia and/or = rapid bleed out. Immediately reapply and treat hyperkalaemia and = hypovolaemia if protocols permit. G=F6sta Liljeqvist (Intensive Care Paramedic) Sydney/Australia.=20 B. Health Sc.(Pre-Hospital Care) Ad. Dip. Paramedical Sc. M.A.C.A.P. ------=_NextPart_000_000B_01BFEFCE.54563320 Content-Type: text/html; charset="iso-8859-1" Content-Transfer-Encoding: quoted-printable
Gurkan,
Generally, as you point out, = tourniquets aren't=20 needed in the pre-hospital field. Most haemorrhages can be stopped by = direct=20 pressure or even occasionally by clamping off an exposed torn = artery. The=20 times when they are indicated tend to be serious trauma, often involving = crush=20 injuries. There can also be occasions when you can't reach a = seriously=20 haemorrhaging wound due to entrapment. When a tourniquet is released, it = is=20 important to monitor EKG (as well as vitals) for hyperkalaemia and/or = rapid=20 bleed out. Immediately reapply and treat hyperkalaemia and hypovolaemia = if=20 protocols permit.
 
G=F6sta Liljeqvist (Intensive Care = Paramedic)=20 Sydney/Australia.
B. Health Sc.(Pre-Hospital Care) Ad. = Dip.=20 Paramedical Sc. M.A.C.A.P.
 
 
------=_NextPart_000_000B_01BFEFCE.54563320-- Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- Return-Path: Received: from mb2i0.ns.pitt.edu (mb2i1.ns.pitt.edu [136.142.185.162]) by imap.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisimap-7.2.2.3) ID ; Sun, 16 Jul 2000 14:04:30 -0400 (EDT) Received: from list.srv.cis.pitt.edu (majordom@[136.142.185.20]) by pitt.edu (PMDF V5.2-32 #41462) with ESMTP id <01JRU5S4EMF0003XDW@mb2i0.ns.pitt.edu>; Sun, 16 Jul 2000 14:04:29 EST Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.2) ID ; Sun, 16 Jul 2000 14:02:50 -0400 (EDT) Received: from imo-d08.mx.aol.com (imo-d08.mx.aol.com [205.188.157.40]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.2) ID for ; Sun, 16 Jul 2000 14:02:47 -0400 (EDT) Received: from Yankeemedc@aol.com by imo-d08.mx.aol.com (mail_out_v27.12.) id h.c5.767e856 (3878) for ; Sun, 16 Jul 2000 14:02:14 -0400 (EDT) Date: Sun, 16 Jul 2000 14:02:13 -0400 (EDT) From: Yankeemedc@aol.com Subject: Re: W-EMED use of tourniquets! Sender: owner-wilderness-emergency-medicine@list.pitt.edu To: wilderness-emergency-medicine@list.pitt.edu Reply-to: wilderness-emergency-medicine@list.pitt.edu Message-id: MIME-version: 1.0 X-Mailer: AOL 5.0 for Windows sub 108 Content-type: text/plain; charset="US-ASCII" Content-transfer-encoding: 7bit Precedence: bulk Gurkan, Orthopedic surgeons, and vascular surgeons routinely stop blood flow in extremities, in the case of orthopods, sometimes for long periods of time. The biggest hazards noted with tourniquets has to do with improper application - this is in two distinct areas, both dealing with tissue damage to viable tissue. The first has to do with placement. You are absolutely right in stating that the anatomy of the forearm (and of the lower leg, also) preclude effective application of a tourniquet. Oh, yes, you can get it to stop, if you apply enough pressure, but by that time you have caused significant tissue damage with the pressure of the tourniquet. So PLACE the tourniquet at a point where minimal pressure will occlude blood flow, basically the same place we would use a pressure point, mid humerus or upper femur compressing the arteries between the tourniquet and the bone, not trying to pinch it between bones. The second has to do with the tourniquet itself. When you tighten the tourniquet, you are pulling it down into the tissue, causing a shearing effect. If you spread this effect over a large area, you minimize the damage to underlying tissues. If you use something narrow, like a shoelace (heavens forbid), you actually can tear the underlying tissues with the tourniquet, causing more damage. One of the best touniquets is a BP cuff, just above arterial pressure. It is plenty wide enough not to cause damage, and the pressure is well regulated to prevent over tightening. Remember, you just have to go high enough to stop bleeding. The tissues of the extremities will last for a long time without significant damage in an ischemic state. Perhaps Keith Conover will comment further on this. But even though a tourniquet has long been chided as an extreme measure, it is a very useful tool which can be utilized with great effectiveness when used properly. Charles Dusha Asst Chief/ Paramedic Logan-Rogersville Fire District Springfield, MO Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- Return-Path: Received: from mb1i0.ns.pitt.edu (mb1i1.ns.pitt.edu [136.142.185.161]) by imap.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisimap-7.2.2.3) ID ; Sun, 16 Jul 2000 12:47:03 -0400 (EDT) Received: from list.srv.cis.pitt.edu (majordom@[136.142.185.20]) by pitt.edu (PMDF V5.2-32 #41462) with ESMTP id <01JRU333CV3Q0029PF@mb1i0.ns.pitt.edu>; Sun, 16 Jul 2000 12:47:03 EST Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.2) ID ; Sun, 16 Jul 2000 12:44:46 -0400 (EDT) Received: from hotmail.com (f256.law9.hotmail.com [64.4.8.131]) by list.srv.cis.pitt.edu with SMTP (8.8.8/8.8.8/cisls-7.2.2.2) ID for ; Sun, 16 Jul 2000 12:44:43 -0400 (EDT) Received: (qmail 82703 invoked by uid 0); Sun, 16 Jul 2000 16:44:12 +0000 Received: from 213.243.28.76 by www.hotmail.com with HTTP; Sun, 16 Jul 2000 09:44:12 -0700 (PDT) Date: Sun, 16 Jul 2000 10:44:12 -0600 (MDT) From: Gurkan Ozel Subject: W-EMED use of tourniquets! Sender: owner-wilderness-emergency-medicine@list.pitt.edu To: wilderness-emergency-medicine@list.pitt.edu Reply-to: wilderness-emergency-medicine@list.pitt.edu Message-id: <20000716164412.82702.qmail@hotmail.com> MIME-version: 1.0 Content-type: text/plain; format=flowed Content-transfer-encoding: 8BIT Precedence: bulk X-Originating-IP: [213.243.28.76] Hi all, Was wondering what you guys think of use of tourniquets. Two main questions (maybe everything can be asked about TNTs), where to be applied and how long should be left in place once applied…Although this is a wilderness medicine list I want to find out about its use at urban situations as well. Almost all of my sources regarding urban patient care, suggest not to release the tourniquet until the patient arrives ER or a physician is consulted. This may be true when, the majority of time, the arrival time from the scene (scene to ER) is somewhere between 30-45 minutes or shorter. What if your ETA (to ER) is longer than 45 minutes? (this runs around 50 minutes in Turkey – excluding the major cities where there is a good response system had been set up-, and even more especially for the highway accidents where there is a limited aeromedical services available and you are, say, 60-70 miles away from the nearest medical facility) What would your suggestion be during a long urban transports and the patient needs a tourniquet to be applied since everything else failed? What is the safe time limit before the tissue necrosis occurs as a result of ischemia? As long as the wilderness recovery is indicated, the sources I have suggests several different applications. Regarding the time limits: No time limit is indicated (Isaac, J., Outward Bound WFA Handbook), totally discouraged (Wilkerson, J.A.; Medicine for Mountaineering), advised not to be released until a physician consulted (NSC and WMS – WFA Emergency Care for Remote Locations, Schimelphenig, T. and Lindsey, L..; NOLS WFA), advised to be released briefly every 10-15 mins (Auerbach, P.S.; Medicine for the Outdoors, Tilton, B. ; Medicine for the Backcountry) and released every 5 minutes according to the WMS Practice Guidelines (Forgey, W. – editor). Another point is where to be applied, and the options are: “Just above the wound (2-4 inches above)” or “as close to the wound as possible and above elbow or knee”. Imagine a casualty with a hand torn apart 4 inches above his wrist, and no other option left to try but a tourniquet to stop bleeding. If you consider losing a limb, ain’t that better to apply just above the wound and loose as little part of the limb as possible? Then the effectiveness is of question, the anatomy of the forearm will not allow a complete shut off of a blood supply... Would like to hear what the list members think! Many thanks for the invaluable input in advance. Gurkan Ozel, EMT-B Ankara, Turkey ________________________________________________________________________ Get Your Private, Free E-mail from MSN Hotmail at http://www.hotmail.com Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- Return-Path: Received: from post-ofc09.srv.cis.pitt.edu (root@post-ofc09.srv.cis.pitt.edu [136.142.185.57]) by imap.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisimap-7.2.2.4) ID ; Fri, 30 Jun 2000 11:11:21 -0400 (EDT) Received: from localhost (root@localhost) by post-ofc09.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Fri, 30 Jun 2000 11:10:49 -0400 (EDT) Received: via switchmail; Fri, 30 Jun 2000 11:10:49 -0400 (EDT) Received: from post-ofc09.srv.cis.pitt.edu via qmail ID ; Fri, 30 Jun 2000 11:10:48 -0400 (EDT) Received: from mb2i0.ns.pitt.edu (mb2i1.ns.pitt.edu [136.142.185.162]) by post-ofc09.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Fri, 30 Jun 2000 11:10:45 -0400 (EDT) Received: from list.srv.cis.pitt.edu (majordom@[136.142.185.20]) by mb2i0.ns.pitt.edu (PMDF V5.2-32 #41462) with ESMTP id <01JR7N26C4KO000CPW@mb2i0.ns.pitt.edu>; Fri, 30 Jun 2000 11:10:45 EST Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.2) ID ; Fri, 30 Jun 2000 11:08:13 -0400 (EDT) Received: from zonetail.med.unc.edu (zonetail.med.unc.edu [152.19.4.12]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.2) ID for ; Fri, 30 Jun 2000 11:08:10 -0400 (EDT) Received: from med.unc.edu (apex.med.unc.edu [152.19.4.80]) by zonetail.med.unc.edu (8.9.3/8.9.3) with ESMTP id LAA00385 for ; Fri, 30 Jun 2000 11:08:09 -0400 (EDT) Date: Fri, 30 Jun 2000 11:08:09 -0400 (EDT) From: Tom Bush Subject: Re: W-EMED Interesting article on rattlesnakes Sender: owner-wilderness-emergency-medicine@list.pitt.edu To: wilderness-emergency-medicine@list.pitt.edu Reply-to: wilderness-emergency-medicine@list.pitt.edu Message-id: <19df61c92b.1c92b19df6@med.unc.edu> MIME-version: 1.0 X-Mailer: Netscape Webmail Content-type: multipart/mixed; boundary="--452629f57e35de2" Content-language: en Precedence: bulk X-Accept-Language: en This is a multi-part message in MIME format. ----452629f57e35de2 Content-Type: text/plain; charset=us-ascii Content-Disposition: inline Content-Transfer-Encoding: 7bit Interesting artcile and sound advice. We should also keep in mind the significant morbidity related to the treatment and over treatment of snake bite. While 20 or so people die each year from snake bite in the US over 200 suffer from effects of treatment. Only about 1/2 of all snake bites result in significant envenomation. Here in NC (and most of the southeast) 80% of snake bites are from the Copperhead. Their venom is less toxic and infrequently requires antivenin. The article makes many excellent points and we should keep in mind that the best first aid for snake bite is a set of car keys. We should also realize that not all bites require anitvenin and close observation with supportive care is frequently the best course of action. Tom Bush, NP Clinical Assistant Professor Department of Orthopaedics University of NC at Chapel Hill ----- Original Message ----- From: "Kevin Mar" Date: Friday, June 30, 2000 0:27 am Subject: W-EMED Interesting article on rattlesnakes > Hi all, > > A friend came across this article and I thought I'd pass it on. > Especiallyintriguing is the section that discusses the evolution > of rattlesnake venom. > > http://www.amnh.org/naturalhistory/features/0700_feature.html > > Hope you all find it useful. > > Kevin Mar > Durham Search & Rescue > North Carolina Search & Rescue, Central Unit > > > > Do not reproduce without author's express permission. > To unsubscribe, send the text "unsubscribe wilderness-emergency- > medicine"as the body of a message (no subject) To: > Majordomo@list.pitt.eduSubmissions To: wilderness-emergency- > medicine@list.pitt.edu ----452629f57e35de2 Content-Type: text/x-vcard; name="explore.vcf"; charset=us-ascii Content-Disposition: attachment; filename="explore.vcf Content-Description: Card for Tom Bush Content-Transfer-Encoding: 7bit begin:vcard n:Bush;Tom fn:Tom Bush NP tel;work:919.962.2600 org:University of North Carolina at Chapel Hill;Orthopaedics adr:;;CB #7055;Chapel Hill;NC;27599-7055; version:2.1 email;internet:Tom_Bush@med.unc.edu title:Clinical Assistant Professor end:vcard ----452629f57e35de2-- Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- Return-Path: Received: from post-ofc06.srv.cis.pitt.edu (root@post-ofc06.srv.cis.pitt.edu [136.142.185.43]) by imap.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisimap-7.2.2.4) ID ; Fri, 30 Jun 2000 00:31:41 -0400 (EDT) Received: from localhost (root@localhost) by post-ofc06.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Fri, 30 Jun 2000 00:31:07 -0400 (EDT) Received: via switchmail; Fri, 30 Jun 2000 00:31:07 -0400 (EDT) Received: from post-ofc01.srv.cis.pitt.edu via qmail ID ; Fri, 30 Jun 2000 00:29:33 -0400 (EDT) Received: from mb1i0.ns.pitt.edu (mb1i1.ns.pitt.edu [136.142.185.161]) by post-ofc01.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Fri, 30 Jun 2000 00:29:31 -0400 (EDT) Received: from list.srv.cis.pitt.edu (majordom@[136.142.185.20]) by mb1i0.ns.pitt.edu (PMDF V5.2-32 #41462) with ESMTP id <01JR70O39BGC001B50@mb1i0.ns.pitt.edu>; Fri, 30 Jun 2000 00:29:28 EST Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.2) ID ; Fri, 30 Jun 2000 00:27:00 -0400 (EDT) Received: from smtp10.atl.mindspring.net (smtp10.atl.mindspring.net [207.69.200.246]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.2) ID for ; Fri, 30 Jun 2000 00:26:52 -0400 (EDT) Received: from kdmar (user-2ivf51u.dialup.mindspring.com [165.247.148.62]) by smtp10.atl.mindspring.net (8.9.3/8.8.5) with SMTP id AAA23977 for ; Fri, 30 Jun 2000 00:26:51 -0400 (EDT) Date: Fri, 30 Jun 2000 00:27:41 -0400 From: Kevin Mar Subject: W-EMED Interesting article on rattlesnakes Sender: owner-wilderness-emergency-medicine@list.pitt.edu To: wilderness-emergency-medicine@list.pitt.edu Reply-to: wilderness-emergency-medicine@list.pitt.edu Message-id: MIME-version: 1.0 X-MIMEOLE: Produced By Microsoft MimeOLE V5.00.2919.6600 X-Mailer: Microsoft Outlook IMO, Build 9.0.2416 (9.0.2911.0) Content-type: text/plain; charset="iso-8859-1" Content-transfer-encoding: 7bit Importance: Normal X-Priority: 3 (Normal) X-MSMail-priority: Normal Precedence: bulk Hi all, A friend came across this article and I thought I'd pass it on. Especially intriguing is the section that discusses the evolution of rattlesnake venom. http://www.amnh.org/naturalhistory/features/0700_feature.html Hope you all find it useful. Kevin Mar Durham Search & Rescue North Carolina Search & Rescue, Central Unit Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- Return-Path: Received: from post-ofc04.srv.cis.pitt.edu (root@post-ofc04.srv.cis.pitt.edu [136.142.185.11]) by imap.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisimap-7.2.2.4) ID ; Thu, 29 Jun 2000 09:56:41 -0400 (EDT) Received: from localhost (root@localhost) by post-ofc04.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Thu, 29 Jun 2000 09:56:09 -0400 (EDT) Received: via switchmail; Thu, 29 Jun 2000 09:56:09 -0400 (EDT) Received: from post-ofc01.srv.cis.pitt.edu via qmail ID ; Thu, 29 Jun 2000 09:54:40 -0400 (EDT) Received: from mb2i0.ns.pitt.edu (mb2i1.ns.pitt.edu [136.142.185.162]) by post-ofc01.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Thu, 29 Jun 2000 09:54:24 -0400 (EDT) Received: from list.srv.cis.pitt.edu (majordom@[136.142.185.20]) by mb2i0.ns.pitt.edu (PMDF V5.2-32 #41462) with ESMTP id <01JR664535LW000B5S@mb2i0.ns.pitt.edu>; Thu, 29 Jun 2000 09:54:23 EST Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.2) ID ; Thu, 29 Jun 2000 09:51:50 -0400 (EDT) Received: from macs.mxim.com (macs.mxim.com [204.17.143.130]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.2) ID for ; Thu, 29 Jun 2000 09:51:47 -0400 (EDT) Received: from localhost (localhost [127.0.0.1]) by macs.mxim.com (8.7/8.6.9) with SMTP id GAA26934 for ; Thu, 29 Jun 2000 06:51:02 -0700 (PDT) Date: Thu, 29 Jun 2000 06:51:01 -0700 (PDT) From: Hal Lillywhite Subject: Re: W-EMED African Travel and Malaria In-reply-to: "Your message of Mon, 26 Jun 2000 17:03:30 CDT." Sender: owner-wilderness-emergency-medicine@list.pitt.edu To: wilderness-emergency-medicine@list.pitt.edu Reply-to: wilderness-emergency-medicine@list.pitt.edu Message-id: <200006291351.GAA26934@macs.mxim.com> MIME-version: 1.0 X-Mailer: exmh version 2.0.1 12/23/97 Content-type: text/plain; charset=us-ascii Precedence: bulk OK, this one is just for fun. My grandfather told about having malaria or yellow fever (don't remember which) when he was a little boy. Quinine was new at the time but the nice capsules now availible hadn't been invented. They wrapped the stuff in tissue paper and he was expected to swallow the tissue paper pills. Sure enough, he recovered fairly rapidly and everybody was talking about what wonderful stuff this new drug was. Once he was recovered enough to leave the couch where he had been during his illness his mother set out to clean it. That's when she found the nest where he had hidden the pills so he wouldn't have to try to swallow them. Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- Return-Path: Received: from post-ofc02.srv.cis.pitt.edu (root@post-ofc02.srv.cis.pitt.edu [136.142.185.24]) by imap.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisimap-7.2.2.4) ID ; Thu, 29 Jun 2000 07:45:36 -0400 (EDT) Received: from localhost (root@localhost) by post-ofc02.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Thu, 29 Jun 2000 07:45:04 -0400 (EDT) Received: via switchmail; Thu, 29 Jun 2000 07:45:04 -0400 (EDT) Received: from post-ofc09.srv.cis.pitt.edu via qmail ID ; Thu, 29 Jun 2000 07:44:35 -0400 (EDT) Received: from mb2i0.ns.pitt.edu (mb2i1.ns.pitt.edu [136.142.185.162]) by post-ofc09.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Thu, 29 Jun 2000 07:44:32 -0400 (EDT) Received: from list.srv.cis.pitt.edu (majordom@[136.142.185.20]) by mb2i0.ns.pitt.edu (PMDF V5.2-32 #41462) with ESMTP id <01JR61K4U30S000B5T@mb2i0.ns.pitt.edu>; Thu, 29 Jun 2000 07:44:30 EST Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.2) ID ; Thu, 29 Jun 2000 07:43:14 -0400 (EDT) Received: from imo-r18.mx.aol.com (imo-r18.mx.aol.com [152.163.225.72]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.2) ID for ; Thu, 29 Jun 2000 07:43:12 -0400 (EDT) Received: from Caverbru@aol.com by imo-r18.mx.aol.com (mail_out_v27.10.) id h.e8.66aed14 (4323) for ; Thu, 29 Jun 2000 07:42:34 -0400 (EDT) Date: Thu, 29 Jun 2000 07:42:33 -0400 (EDT) From: Caverbru@aol.com Subject: Re: W-EMED African Travel and Malaria Sender: owner-wilderness-emergency-medicine@list.pitt.edu To: wilderness-emergency-medicine@list.pitt.edu Reply-to: wilderness-emergency-medicine@list.pitt.edu Message-id: MIME-version: 1.0 X-Mailer: AOL 5.0 for Windows sub 114 Content-type: text/plain; charset="US-ASCII" Content-transfer-encoding: 7bit Precedence: bulk To go with what Steve said, In 1990 Peace Corps Kenya was giving Volunteers a kit to do a self blood test as well as Fansidar to take if high fever symptoms appeared. At that time a PCV in our village was taking Chloroquine and Paludrin faithfully as well as following all other precautions. He still contracted the disease without the normal symptoms, was misdiagnosed by a Kenyan doctor with US training, perhaps because of a lab error, and subsequently died. We were also a full days travel to the nearest doctor. So self treatment and diagnoses is iffy, When you go to these places you take your chances. Be careful. Bru Randall RPCV Kenya 1989-1991 Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- Return-Path: Received: from post-ofc09.srv.cis.pitt.edu (root@post-ofc09.srv.cis.pitt.edu [136.142.185.57]) by imap.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisimap-7.2.2.4) ID ; Tue, 27 Jun 2000 12:15:59 -0400 (EDT) Received: from localhost (root@localhost) by post-ofc09.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Tue, 27 Jun 2000 12:15:27 -0400 (EDT) Received: via switchmail; Tue, 27 Jun 2000 12:15:27 -0400 (EDT) Received: from post-ofc01.srv.cis.pitt.edu via qmail ID ; Tue, 27 Jun 2000 12:13:27 -0400 (EDT) Received: from mb1i0.ns.pitt.edu (mb1i1.ns.pitt.edu [136.142.185.161]) by post-ofc01.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Tue, 27 Jun 2000 12:13:25 -0400 (EDT) Received: from list.srv.cis.pitt.edu (majordom@[136.142.185.20]) by mb1i0.ns.pitt.edu (PMDF V5.2-32 #41462) with ESMTP id <01JR3IDTOB8Q001BB6@mb1i0.ns.pitt.edu>; Tue, 27 Jun 2000 12:13:25 EST Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.2) ID ; Tue, 27 Jun 2000 12:12:48 -0400 (EDT) Received: from cgi.icon.co.za (cgi.icon.co.za [196.35.95.41]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.2) ID for ; Tue, 27 Jun 2000 12:12:43 -0400 (EDT) Received: from mail450.icon.co.za (ismtp.icon.co.za [196.35.95.40]) by cgi.icon.co.za (Postfix) with ESMTP id B19D64C532 for ; Tue, 27 Jun 2000 18:19:03 +0200 (SAST) Received: from icon.co.za (c2-ndf-11.dial-up.net [196.34.156.139]) by mail450.icon.co.za (8.9.3/8.9.3) with ESMTP id SAA21911 for ; Tue, 27 Jun 2000 18:13:37 +0200 (GMT) Date: Tue, 27 Jun 2000 18:04:27 +0200 From: Arthur Morgan Subject: Re: W-EMED African Travel and Malaria Sender: owner-wilderness-emergency-medicine@list.pitt.edu To: wilderness-emergency-medicine@list.pitt.edu Reply-to: wilderness-emergency-medicine@list.pitt.edu Message-id: <3958D08A.3C2F7041@icon.co.za> MIME-version: 1.0 X-Mailer: Mozilla 4.7 [en] (Win98; I) Content-type: text/plain; charset=us-ascii Content-transfer-encoding: 7bit Precedence: bulk X-Accept-Language: en-GB,en,af,pl References: Steven, I agree completely with what you said in your letter, as far as it goes. Most of Africa has malaria strains that have high grade resistance to chloroquine. Few people realize how FAST malaria can progress. I have had the disease a few times. The last time I went to bed healthy, woke up with mild symptoms and took the treatment. I walked over the road to the hospital where I worked and just had the strength to 'phone my wife to come by car to collect me - perhaps an hour or less from mild disease to incapacitation. If I had to wait a few hours for treatment I doubt if I would have survived. Arthur "Steven D. Pirie" wrote: > > > The current thought up here in Canada is that the non medical traveller > should not begin a self treatment for malaria unless they are unable to > seek medical care within 24 hours from the time of onset (fever). Due to > the fact that malaria symptoms are so non-specific there is a real risk of > treating another disease, and or running into problems with the toxicity of > malaria therapy. Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- Return-Path: Received: from post-ofc06.srv.cis.pitt.edu (root@post-ofc06.srv.cis.pitt.edu [136.142.185.43]) by imap.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisimap-7.2.2.4) ID ; Mon, 26 Jun 2000 17:04:31 -0400 (EDT) Received: from localhost (root@localhost) by post-ofc06.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Mon, 26 Jun 2000 17:03:59 -0400 (EDT) Received: via switchmail; Mon, 26 Jun 2000 17:03:58 -0400 (EDT) Received: from post-ofc01.srv.cis.pitt.edu via qmail ID ; Mon, 26 Jun 2000 17:03:02 -0400 (EDT) Received: from mb2i0.ns.pitt.edu (mb2i1.ns.pitt.edu [136.142.185.162]) by post-ofc01.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Mon, 26 Jun 2000 17:02:57 -0400 (EDT) Received: from list.srv.cis.pitt.edu (majordom@[136.142.185.20]) by mb2i0.ns.pitt.edu (PMDF V5.2-32 #41462) with ESMTP id <01JR2E7DZ0HY0001LX@mb2i0.ns.pitt.edu>; Mon, 26 Jun 2000 17:02:54 EST Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.2) ID ; Mon, 26 Jun 2000 17:00:38 -0400 (EDT) Received: from mail1.toronto.istar.net (mail1.toronto.istar.net [209.89.75.17]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.2) ID for ; Mon, 26 Jun 2000 17:00:35 -0400 (EDT) Received: from ip37.ottawa8.dialup.canada.psi.net ([154.5.70.37]) by mail1.toronto.istar.net with smtp (Exim 2.02 #1) id 136g0M-0005wm-00 for wilderness-emergency-medicine@list.pitt.edu; Mon, 26 Jun 2000 17:01:20 -0400 Date: Mon, 26 Jun 2000 17:03:30 -0500 From: pirie@istar.ca (Steven D. Pirie) Subject: W-EMED African Travel and Malaria Sender: owner-wilderness-emergency-medicine@list.pitt.edu X-Sender: pirie@istar.ca (Unverified) To: wilderness-emergency-medicine@list.pitt.edu Reply-to: wilderness-emergency-medicine@list.pitt.edu Message-id: MIME-version: 1.0 Content-type: text/plain; charset="us-ascii" Precedence: bulk Arthur and others, >Quinine must be carried with you for at least this time. Treatment must be >>started as soon as you become ill and a formal diagnosis can wait. A >delay of >just a few hours to get back to your supply of quinine can allow >the disease to >become really nasty, and a day to make a proper diagnosis >can be fatal. The current thought up here in Canada is that the non medical traveller should not begin a self treatment for malaria unless they are unable to seek medical care within 24 hours from the time of onset (fever). Due to the fact that malaria symptoms are so non-specific there is a real risk of treating another disease, and or running into problems with the toxicity of malaria therapy. I have heard that there is a rapid detection (of malaria) product sold outside of Canada that uses a simple dipstick test. The sensitivity and specificity of these tests in research laboratories is > 90%. There is however limited (if any) data about their accuracy in the hands of non-experienced operators and under non-refrigerated (read: real world) conditions. I am not sure if they are ready to be used yet by the wilderness traveller for the self diagnosis of malaria. Before recommending that a traveller undertakes self diagnosis and treatment I think it is important for us (the medical worker) to sit down and educate them on the signs and symptoms of malaria, other diseases that it can mimic and the risk / benefits of starting treatment on their own. It is also as important for the person to realize that they must get to a physician as soon as possible and that self treatment does not negate this obligation. I tell them that it is a "life saving measure like a AnaKit" and that self treatment is only temporary. Quinine alone to carry for self treatment is not good enough. For self treatment (prior to getting to a medical clinic): If in a chloroquine sensitive regions and not receiving chloroquine prophylaxis, self-treatment with chloroquine should be taken. Chloroquine is supplied in a 150 mg base (Aralen or in some parts of the world Nivaquine) and the self treatment is 1.5 gm (base) over 3 days. It is recommended that: Day 1 - 2 tabs BID Day 2 - 2 tabs BID Day 3 - 2 tabs for a total of 10 tabs. Chloroquine prophylaxis should then be started. If in a chloroquine sensitive regions and already receiving chloroquine prophylaxis, self treatment with atovaquone 250 mg / proguanil 100 mg (Marlarone) should be taken. Take 4 tabs once a day for 3 days. Once again chloroquine prophylaxis should be resumed. If in a chloroquine or chloroquine and mefloquine resistant P. falciparum regions, treatment recommendations for un-complicated P. falciparum involve taken oral Marlarone (as above) and resuming Mefloquine or other another appropriate prophylaxis. OR Oral Quinine 250 mg, two tabs TID for 3 to 7 days (7 in SE Asia) and doxycycline 100 mg, one tab BID for 7 days. You need both the Doxy and the Quinine to be effective. Once again Mefloquine or other appropriate prophylaxis should be resumed. OR If in Sub-Saharan Africa or the Indian Subcontinent you can begin oral Quinine (as above) plus three tabs of Pyrimethamine 25 mg with Sulfadoxine 500 mg (Fansidar). Once again Mefloquine or other appropriate prophylaxis should be resumed. It is worth noting that Fansidar is not the same drug as Fansimef (which is marketed in some areas. Fansimef is a combination of Mefloquine and Fansidar as is NOT recommended for the prevention or treatment of malaria. There is a risk of additive toxicity and reduced efficacy if used. Oral Quinine is not enough. Hope that helps, don't prescribe off this email (look it up incase I made a typo). Steven ---------------------------------------------------------- Lt. Steven D. Pirie, RN, BScN, UE General Duty Ward Officer - Military In-Patient Unit Canadian Forces Support Unit Ottawa - Civic Hospital Site 2 Health Support Operational Training Unit ---------------------------------------------------------- Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- Return-Path: Received: from post-ofc05.srv.cis.pitt.edu (root@post-ofc05.srv.cis.pitt.edu [136.142.185.10]) by imap.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisimap-7.2.2.4) ID ; Sun, 25 Jun 2000 21:00:13 -0400 (EDT) Received: from localhost (root@localhost) by post-ofc05.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Sun, 25 Jun 2000 20:59:40 -0400 (EDT) Received: via switchmail; Sun, 25 Jun 2000 20:59:40 -0400 (EDT) Received: from post-ofc09.srv.cis.pitt.edu via qmail ID ; Sun, 25 Jun 2000 20:59:22 -0400 (EDT) Received: from mb2i0.ns.pitt.edu (mb2i1.ns.pitt.edu [136.142.185.162]) by post-ofc09.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Sun, 25 Jun 2000 20:59:14 -0400 (EDT) Received: from list.srv.cis.pitt.edu (majordom@[136.142.185.20]) by mb2i0.ns.pitt.edu (PMDF V5.2-32 #41462) with ESMTP id <01JR185ZE3FW00153D@mb2i0.ns.pitt.edu>; Sun, 25 Jun 2000 20:59:10 EST Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.2) ID ; Sun, 25 Jun 2000 20:58:53 -0400 (EDT) Received: from picusnet.com (mail.picusnet.com [207.7.90.2]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.2) ID for ; Sun, 25 Jun 2000 20:58:50 -0400 (EDT) Received: from default [207.7.95.127] by picusnet.com (SMTPD32-5.05) id AAC336E000B8; Sun, 25 Jun 2000 20:58:43 -0400 Date: Sun, 25 Jun 2000 20:55:23 -0500 From: GATORDOC Subject: Re: W-EMED Water purification for adventure race Sender: owner-wilderness-emergency-medicine@list.pitt.edu To: wilderness-emergency-medicine@list.pitt.edu Reply-to: wilderness-emergency-medicine@list.pitt.edu Message-id: <000d01bfdf11$9837e020$7f5f07cf@default> MIME-version: 1.0 X-MIMEOLE: Produced By Microsoft MimeOLE V5.00.2919.6600 X-Mailer: Microsoft Outlook Express 5.00.2919.6600 Content-type: text/plain; charset="iso-8859-1" Content-transfer-encoding: 7bit X-Priority: 3 X-MSMail-priority: Normal Precedence: bulk References: <395622DC.18897.5A0B0F7@localhost> Geez Keith, are you going to put one of those things in the back of your truck also? By the way, The US Navy SEALs use the PUR Explorer. It is field cleanable, and high output. I think it would be ideal for the race. Rob ----- Original Message ----- From: "Keith Conover, M.D., FACEP" To: "Daryl" Cc: Sent: Sunday, June 25, 2000 2:18 PM Subject: Re: W-EMED Water purification for adventure race > On 24 Jun 2000, at 22:50, Daryl wrote: > > > My recommendation is for a combination of Iodine, either in liquid or > > tablet form, and the trusty "Milbank's Bag". For those who don't know, > > the Milbank's Bag has been in use by various sections of the British > > Forces for many years and, is still favoured by many including myself, > > as the ultimate crud remover. Manufacturers of modern devices will > > disagree, quite naturally as they want to sell their products! > > Hmmm. Sounds interesting, could you describe it in a bit more > detail? Haven't seen one avaialable in the U.S. > > BTW, for something like the EcoChallenge, something that works by > gravity may be a bit slow for the contestants. Most of the iodine- > resin filters have a prefilter that keeps out crud and is easily > cleaned. The advantage of the iodine-resin filters is that they can > be used rapidly to provide small amounts of drinkable water _now_ -- > just pump a liter into a one-liter Nalgene laboratory grade water > bottle (the standard kind used by outdoor people in the US > overwhelmingly -- and the filters have screwon caps so the output > can go directly into the bottle) and throw in your pack. In 15 > minutes the iodine has done its work and the water is ready to drink. > > Good if you're constantly on the go. > > Looking forward to hearing more about the Milbank bag. > > Thanks. > > --Keith Conover, M.D., FACEP > http://www.pitt.edu/~kconover > sent with Pegasus high-security email > download free from www.pmail.com > Do not reproduce without author's express permission. > To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" > as the body of a message (no subject) To: Majordomo@list.pitt.edu > Submissions To: wilderness-emergency-medicine@list.pitt.edu > Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- Return-Path: Received: from post-ofc01.srv.cis.pitt.edu (root@post-ofc01.srv.cis.pitt.edu [136.142.185.25]) by imap.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisimap-7.2.2.4) ID for ; Sun, 25 Jun 2000 21:27:55 -0400 (EDT) Received: from localhost (root@localhost) by post-ofc01.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.2) ID for kconover@imap.pitt.edu; Sun, 25 Jun 2000 21:27:53 -0400 (EDT) Received: via switchmail for kconover+@pitt.edu; Sun, 25 Jun 2000 21:27:53 -0400 (EDT) Received: from mail.webpostal.com.ar (mail.webpostal.com.ar [200.16.190.25]) by post-ofc01.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cispo-7.2.2.2) ID for ; Sun, 25 Jun 2000 21:27:46 -0400 (EDT) Received: from marcelo ([200.51.54.86]) by mail.webpostal.com.ar (Netscape Messaging Server 4.15) with SMTP id FWQ61S00.X2Q for ; Sun, 25 Jun 2000 22:27:28 +0300 Message-ID: <023c01bfdef8$3cc71940$563633c8@marcelo> From: "jym@smandes.neuquen.com.ar" To: References: <39531D02.6896.29D280@localhost> Subject: Re: W-EMED Fw: Water purification for adventure race Date: Sun, 25 Jun 2000 19:40:42 -0300 MIME-Version: 1.0 Content-Type: text/plain; charset="iso-8859-1" Content-Transfer-Encoding: 8bit X-Priority: 3 X-MSMail-Priority: Normal X-Mailer: Microsoft Outlook Express 5.00.2919.6600 X-MimeOLE: Produced By Microsoft MimeOLE V5.00.2919.6600 Dear Keith So glad to hear from you again. It's been a long time since our last contact. Thanks for the info. By the way we are interested in getting training specifically in Search and I thought about you and mentioned your name over here. It would be great to have you teach us all you know and visit my place. I would like to know if you would be interested in this and what the costs would be. We still do not have any schedule because just started talking about it. Eric and me would do all the translation. We would also love to get some training in rope rescue. The ecochallenge was held just 100 miles from home and what you saw is what our region looks like. So we will take you on a nice climb or hike. Very kind regards to you and Betty and daughter? Say hi to Jorge Marcelo Parada MD Hospital Ramón Carrillo (8370) San Martín de los Andes Neuquén- ARGENTINA email jym@smandes.neuquen.com.ar ----- Original Message ----- From: "Keith Conover, M.D., FACEP" To: ; Sent: Friday, June 23, 2000 9:17 AM Subject: Re: W-EMED Fw: Water purification for adventure race I'm a fan of the iodine-resin filters. They serve as a filter to eliminate large parasites like giardia, as with all filters. Like the filters with smaler pore size, they filter out almost all bacteria. Th iodine resin, however, allows the filter to also kill off harmful bacteria (hepatitis, viral gastroenteritis). They also have an optional charcoal filter, that eliminates residual iodine in the output (the viruses are still coated with iodine and will diein about 15 minutes). The charcoal filter will also help get rid of pesticides and heavy metals. There are several manfufacturers in the U.S. I have had several of the devices made by PUR and have been quite happy. The larger models, e.g., the Scout, have an included cleaning mechanism which is not present in the lighter models, which may be appropriate. I've been able to clean off the lighter model's filter elements by opening and cleaning off with some paper or leaves or an old toothbrush, but the quicker cleaning of the Scout and similar models, without having to take them apart, may be worth the extra weight. On the other hand, the smaller and newer filters have filter elements that, instead of being like a round cylinder, have "pleats" much like the air or oil filters on a car, and will go much longer without cleaning. Don't know about jungle water, but when I was hiking in an area where most water was from pumps with iron pipes, the rust clogged the filter after only 3-4 days and I had to clean it off with some leaves (old cylinder type filter). Hope this helps some. Hope all is well with you and your family and the skiing's good in San Martin de Los Andes this season! It's 85 degrees F (30 degrees C) here in Pittsburgh today. P.S. we saw your picture on the film of the EcoChallenge last -- and Jorge Varcellotti says hi. Take care. On 22 Jun 2000, at 22:58, jym@smandes.neuquen.com.ar wrote: > I would appreciate the list members opinion on what would be the best > water purification system for Ecochallenge competitors (team of 4) in > the next race to be held in Borneo (Kinabalu). Ecochallenge is an > adventure race. Iodine in tablets or liquid is mandatory for the > organization, and this alone is quite a good option but I do not have > extensive experience with water filters with "jungle type water". If a > water filter was an option, how many would a 4 member team need for > 6-10 days? and what brand would be a good choice.These questions are > to address the clogging problem. Thanks > > Marcelo Parada MD > Hospital Ramón Carrillo > (8370) San Martín de los Andes > Neuquén- ARGENTINA > > email jym@smandes.neuquen.com.ar > --Keith Conover, M.D., FACEP http://www.pitt.edu/~kconover sent with Pegasus high-security email download free from www.pmail.com -- End -- Return-Path: Received: from post-ofc04.srv.cis.pitt.edu (root@post-ofc04.srv.cis.pitt.edu [136.142.185.11]) by imap.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisimap-7.2.2.4) ID ; Sun, 25 Jun 2000 15:21:13 -0400 (EDT) Received: from localhost (root@localhost) by post-ofc04.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Sun, 25 Jun 2000 15:20:41 -0400 (EDT) Received: via switchmail; Sun, 25 Jun 2000 15:20:41 -0400 (EDT) Received: from post-ofc01.srv.cis.pitt.edu via qmail ID ; Sun, 25 Jun 2000 15:20:04 -0400 (EDT) Received: from mb1i0.ns.pitt.edu (mb1i1.ns.pitt.edu [136.142.185.161]) by post-ofc01.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Sun, 25 Jun 2000 15:19:59 -0400 (EDT) Received: from list.srv.cis.pitt.edu (majordom@[136.142.185.20]) by mb1i0.ns.pitt.edu (PMDF V5.2-32 #41462) with ESMTP id <01JR0WBGEEUC00167E@mb1i0.ns.pitt.edu>; Sun, 25 Jun 2000 15:19:59 EST Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.2) ID ; Sun, 25 Jun 2000 15:18:59 -0400 (EDT) Received: from mb1i0.ns.pitt.edu (mb1i1.ns.pitt.edu [136.142.185.161]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.2) ID for ; Sun, 25 Jun 2000 15:18:56 -0400 (EDT) Received: from micron ("port 1046"@[136.142.20.141]) by mb1i0.ns.pitt.edu (PMDF V5.2-32 #41462) with ESMTP id <01JR0WA372GK0014F7@mb1i0.ns.pitt.edu> for wilderness-emergency-medicine@list.pitt.edu; Sun, 25 Jun 2000 15:18:55 -0500 (EST) Date: Sun, 25 Jun 2000 15:18:52 -0400 From: "Keith Conover, M.D., FACEP" Subject: Re: W-EMED Water purification for adventure race In-reply-to: <004d01bfde26$fa6352c0$e02a8cd4@default> Sender: owner-wilderness-emergency-medicine@list.pitt.edu To: Daryl Cc: wilderness-emergency-medicine@list.pitt.edu Reply-to: wilderness-emergency-medicine@list.pitt.edu Message-id: <395622DC.18897.5A0B0F7@localhost> MIME-version: 1.0 X-Mailer: Pegasus Mail for Win32 (v3.12c) Content-type: text/plain; charset=US-ASCII Content-transfer-encoding: 7BIT Precedence: bulk On 24 Jun 2000, at 22:50, Daryl wrote: > My recommendation is for a combination of Iodine, either in liquid or > tablet form, and the trusty "Milbank's Bag". For those who don't know, > the Milbank's Bag has been in use by various sections of the British > Forces for many years and, is still favoured by many including myself, > as the ultimate crud remover. Manufacturers of modern devices will > disagree, quite naturally as they want to sell their products! Hmmm. Sounds interesting, could you describe it in a bit more detail? Haven't seen one avaialable in the U.S. BTW, for something like the EcoChallenge, something that works by gravity may be a bit slow for the contestants. Most of the iodine- resin filters have a prefilter that keeps out crud and is easily cleaned. The advantage of the iodine-resin filters is that they can be used rapidly to provide small amounts of drinkable water _now_ -- just pump a liter into a one-liter Nalgene laboratory grade water bottle (the standard kind used by outdoor people in the US overwhelmingly -- and the filters have screwon caps so the output can go directly into the bottle) and throw in your pack. In 15 minutes the iodine has done its work and the water is ready to drink. Good if you're constantly on the go. Looking forward to hearing more about the Milbank bag. Thanks. --Keith Conover, M.D., FACEP http://www.pitt.edu/~kconover sent with Pegasus high-security email download free from www.pmail.com Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- Return-Path: Received: from post-ofc04.srv.cis.pitt.edu (root@post-ofc04.srv.cis.pitt.edu [136.142.185.11]) by imap.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisimap-7.2.2.4) ID ; Mon, 26 Jun 2000 13:44:43 -0400 (EDT) Received: from localhost (root@localhost) by post-ofc04.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Mon, 26 Jun 2000 13:44:12 -0400 (EDT) Received: via switchmail; Mon, 26 Jun 2000 13:44:12 -0400 (EDT) Received: from post-ofc09.srv.cis.pitt.edu via qmail ID ; Mon, 26 Jun 2000 13:43:17 -0400 (EDT) Received: from mb1i0.ns.pitt.edu (mb1i1.ns.pitt.edu [136.142.185.161]) by post-ofc09.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Mon, 26 Jun 2000 13:43:13 -0400 (EDT) Received: from list.srv.cis.pitt.edu (majordom@[136.142.185.20]) by mb1i0.ns.pitt.edu (PMDF V5.2-32 #41462) with ESMTP id <01JR277RZBRS001C5A@mb1i0.ns.pitt.edu>; Mon, 26 Jun 2000 13:43:10 EST Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.2) ID ; Mon, 26 Jun 2000 13:42:25 -0400 (EDT) Received: from cgi.icon.co.za (cgi.icon.co.za [196.35.95.41]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.2) ID for ; Mon, 26 Jun 2000 13:42:20 -0400 (EDT) Received: from mail450.icon.co.za (ismtp.icon.co.za [196.35.95.40]) by cgi.icon.co.za (Postfix) with ESMTP id AD2F24C5A5 for ; Mon, 26 Jun 2000 19:48:32 +0200 (SAST) Received: from icon.co.za (a5-jhb-59.dial-up.net [196.26.214.59]) by mail450.icon.co.za (8.9.3/8.9.3) with ESMTP id TAA06923 for ; Mon, 26 Jun 2000 19:43:11 +0200 (GMT) Date: Sun, 25 Jun 2000 15:19:04 +0200 From: Arthur Morgan Subject: Re: W-EMED African Travel Sender: owner-wilderness-emergency-medicine@list.pitt.edu To: wilderness-emergency-medicine@list.pitt.edu Reply-to: wilderness-emergency-medicine@list.pitt.edu Message-id: <395606C8.BE719132@icon.co.za> MIME-version: 1.0 X-Mailer: Mozilla 4.7 [en] (Win98; I) Content-type: text/plain; charset=us-ascii Content-transfer-encoding: 7bit Precedence: bulk X-Accept-Language: en-GB,en,af,pl References: Hello all, Sorry about the delay in answering. There has been no mention of AIDS/HIV in the posts. This is the most common viral disease that anyone in Africa is likely to encounter unless good hygiene is practised. The incidence is **much** higher than any government will admit. The spread is by sex, blood products and dirty needles. Avoid each and every one of these. No matter how you try to avoid malaria there will be some infections. For at least 6 months after leaving the area ANY illness **IS** malaria unless it is otherwise diagnosed. Quinine must be carried with you for at least this time. Treatment must be started as soon as you become ill and a formal diagnosis can wait. A delay of just a few hours to get back to your supply of quinine can allow the disease to become really nasty, and a day to make a proper diagnosis can be fatal. Arthur Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- Return-Path: Received: from post-ofc05.srv.cis.pitt.edu (root@post-ofc05.srv.cis.pitt.edu [136.142.185.10]) by imap.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisimap-7.2.2.4) ID ; Sat, 24 Jun 2000 18:02:22 -0400 (EDT) Received: from localhost (root@localhost) by post-ofc05.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Sat, 24 Jun 2000 18:01:50 -0400 (EDT) Received: via switchmail; Sat, 24 Jun 2000 18:01:50 -0400 (EDT) Received: from post-ofc01.srv.cis.pitt.edu via qmail ID ; Sat, 24 Jun 2000 18:00:22 -0400 (EDT) Received: from mb2i0.ns.pitt.edu (mb2i1.ns.pitt.edu [136.142.185.162]) by post-ofc01.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Sat, 24 Jun 2000 18:00:18 -0400 (EDT) Received: from list.srv.cis.pitt.edu (majordom@[136.142.185.20]) by mb2i0.ns.pitt.edu (PMDF V5.2-32 #41462) with ESMTP id <01JQZNLVC2BW0010T3@mb2i0.ns.pitt.edu>; Sat, 24 Jun 2000 18:00:17 EST Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.2) ID ; Sat, 24 Jun 2000 17:59:44 -0400 (EDT) Received: from scooby.lineone.net (doggy.lineone.net [194.75.152.224]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.2) ID for ; Sat, 24 Jun 2000 17:59:35 -0400 (EDT) Received: from default (host212-140-42-224.btinternet.com [212.140.42.224]) by scooby.lineone.net (8.9.3/8.9.3) with SMTP id WAA23221 for ; Sat, 24 Jun 2000 22:58:50 +0100 (BST) Date: Sat, 24 Jun 2000 22:50:20 +0100 From: Daryl Subject: Re: W-EMED Water purification for adventure race Sender: owner-wilderness-emergency-medicine@list.pitt.edu To: wilderness-emergency-medicine@list.pitt.edu Reply-to: wilderness-emergency-medicine@list.pitt.edu Message-id: <004d01bfde26$fa6352c0$e02a8cd4@default> MIME-version: 1.0 X-MIMEOLE: Produced By Microsoft MimeOLE V5.00.2919.6600 X-Mailer: Microsoft Outlook Express 5.00.2919.6600 Content-type: multipart/alternative; boundary="----=_NextPart_000_003B_01BFDE2E.92E1D9C0" X-Priority: 3 X-MSMail-priority: Normal Precedence: bulk References: <001001bfdcb6$213d7e60$593633c8@marcelo> This is a multi-part message in MIME format. ------=_NextPart_000_003B_01BFDE2E.92E1D9C0 Content-Type: text/plain; charset="iso-8859-1" Content-Transfer-Encoding: quoted-printable Greetings from across the pond. My recommendation is for a combination of Iodine, either in liquid or = tablet form, and the trusty "Milbank's Bag". For those who don't know, the Milbank's Bag has been in use by various = sections of the British Forces for many years and, is still favoured by = many including myself, as the ultimate crud remover. Manufacturers of modern devices will disagree, quite naturally as they = want to sell their products! Basically the bag works by allowing water to filter through into a = container where the water may be finally treated with iodine or other = favoured treatment. 1. There is nothing to go wrong 2. There is no filter element to clean (other than to wash the bag out) 3. There is no fragile filter to crack or break (The only way you will = "break" a Milbank's Bag is by setting fire to it!) 4. It works on gravity - no pumping required 5. If it clogs with crud, simply wash it out and start again, time 20 - = 30 seconds. Not very likely with a pump device! 6. No parts to go astray 7. No expensive parts to replace after ox uses 8. A fraction of the cost of all singing - all dancing devices My business colleague, in a previous life, was a survival instructor at = the British Forces Jungle Survival School in Brunei. The Milbank's Bag = never failed to shine when it came down to the initial cleansing of = water with a high vegetation content. The mechanical devices failed = simply because they became crudded up with vegetation, silt etc, = necessitating regular, i.e. every 10 - 15 pumps, stripping and thorough = cleaning of the device and filter. Not to mention crud that got stuck in = the inlet pipe on some models! We still use the bag as our No.1 choice in all environments, from the UK = to Middle East to Belize and, after 30 years the only belly gripes I = have had is from drinking "safe" tap water and, during this time have = only used 2 bags (the first was "borrowed"). Contact me off list if you require any further info on use or supply of = the bag. Best of luck with your venture - Kinabalu is a great spot! Daryl J Wight ----- Original Message -----=20 From: jym@smandes.neuquen.com.ar=20 To: wilderness-emergency-medicine@list.pitt.edu=20 Sent: 23 June 2000 02:55 Subject: W-EMED Water purification for adventure race I would appreciate the list members opinion on what would be the best = water purification system for Ecochallenge competitors (team of 4) in = the next race to be held in Borneo (Kinabalu). Ecochallenge is an = adventure race. Iodine in tablets or liquid is mandatory for the organization, and = this alone is quite a good option but I do not have extensive experience = with water filters with "jungle type water". If a water filter was an = option, how many would a 4 member team need for 6-10 days? and what = brand would be a good choice.These questions are to address the clogging = problem. Thanks Marcelo Parada MD Hospital Ram=F3n Carrillo (8370) San Mart=EDn de los Andes Neuqu=E9n- ARGENTINA email jym@smandes.neuquen.com.ar =20 ------=_NextPart_000_003B_01BFDE2E.92E1D9C0 Content-Type: text/html; charset="iso-8859-1" Content-Transfer-Encoding: quoted-printable
Greetings from across the = pond.
 
My recommendation is for a = combination of=20 Iodine, either in liquid or tablet form, and the trusty "Milbank's=20 Bag".
For those who don't know, the = Milbank's Bag has=20 been in use by various sections of the British Forces for many years = and, is=20 still favoured by many including myself, as the ultimate crud=20 remover.
Manufacturers of modern devices will = disagree,=20 quite naturally as they want to sell their products!
 
Basically the bag works by allowing = water to=20 filter through into a container where the water may be finally treated = with=20 iodine or other favoured treatment.
1. There is nothing to go = wrong
2. There is no filter element to = clean (other=20 than to wash the bag out)
3. There is no fragile filter to = crack or break=20 (The only way you will "break" a Milbank's Bag is by setting fire to=20 it!)
4. It works on gravity - no pumping=20 required
5. If it clogs with crud, simply = wash it out and=20 start again, time 20 - 30 seconds. Not very likely with a pump=20 device!
6. No parts to go = astray
7. No expensive parts to replace = after ox=20 uses
8. A fraction of the cost of all = singing - all=20 dancing devices
 
My business colleague, in a previous = life, was a=20 survival instructor at the British Forces Jungle Survival School in = Brunei. The=20 Milbank's Bag never failed to shine when it came down to the initial = cleansing=20 of water with a high vegetation content. The mechanical devices failed = simply=20 because they became crudded up with vegetation, silt etc, necessitating = regular,=20 i.e. every 10 - 15 pumps, stripping and thorough cleaning of the device = and=20 filter. Not to mention crud that got stuck in the inlet pipe on some=20 models!
 
We still use the bag as our No.1 = choice in all=20 environments, from the UK to Middle East to Belize and, after 30 years = the only=20 belly gripes I have had is from drinking "safe" tap water and, during = this time=20 have only used 2 bags (the first was "borrowed").
 
Contact me off list if you require = any further=20 info on use or supply of the bag.
 
Best of luck with your venture - = Kinabalu is a=20 great spot!
 
Daryl J Wight
----- Original Message -----
From:=20 jym@smandes.neuquen.com.ar =
To: wilderness-emergency-= medicine@list.pitt.edu=20
Sent: 23 June 2000 02:55
Subject: W-EMED Water = purification for=20 adventure race

I would appreciate the list = members opinion=20 on what would be the best water purification system for Ecochallenge=20 competitors (team of 4) in the next race to be held in Borneo = (Kinabalu).=20 Ecochallenge is an adventure race.
Iodine in tablets or liquid is = mandatory for the=20 organization, and this alone is quite a good option but I do not have=20 extensive experience with water filters with "jungle type water". If a = water=20 filter was an option, how many would a 4 member team need for = 6-10 days?=20 and what brand would be a good choice.These questions are to address = the=20 clogging problem.
Thanks
 
Marcelo Parada MD
Hospital Ram=F3n = Carrillo
(8370) San Mart=EDn de los Andes
Neuqu=E9n- = ARGENTINA
 
email  jym@smandes.neuquen.com.ar= =20  
------=_NextPart_000_003B_01BFDE2E.92E1D9C0-- Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- Return-Path: Received: from post-ofc03.srv.cis.pitt.edu (root@post-ofc03.srv.cis.pitt.edu [136.142.185.39]) by imap.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisimap-7.2.2.4) ID ; Sat, 24 Jun 2000 14:58:16 -0400 (EDT) Received: from localhost (root@localhost) by post-ofc03.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Sat, 24 Jun 2000 14:57:42 -0400 (EDT) Received: via switchmail; Sat, 24 Jun 2000 14:57:42 -0400 (EDT) Received: from post-ofc09.srv.cis.pitt.edu via qmail ID ; Sat, 24 Jun 2000 14:57:14 -0400 (EDT) Received: from mb1i0.ns.pitt.edu (mb1i1.ns.pitt.edu [136.142.185.161]) by post-ofc09.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Sat, 24 Jun 2000 14:57:12 -0400 (EDT) Received: from list.srv.cis.pitt.edu (majordom@[136.142.185.20]) by mb1i0.ns.pitt.edu (PMDF V5.2-32 #41462) with ESMTP id <01JQZH7TW8TC0013TE@mb1i0.ns.pitt.edu>; Sat, 24 Jun 2000 14:57:10 EST Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.2) ID ; Sat, 24 Jun 2000 14:55:10 -0400 (EDT) Received: from mail1.uts.ohio-state.edu (mail1.uts.ohio-state.edu [128.146.214.30]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.2) ID for ; Sat, 24 Jun 2000 14:55:08 -0400 (EDT) Received: from page (ts5-4.homenet.ohio-state.edu [140.254.112.91]) by mail1.uts.ohio-state.edu (8.9.3/8.9.3) with SMTP id OAA17166 for ; Sat, 24 Jun 2000 14:55:06 -0400 (EDT) Date: Sat, 24 Jun 2000 14:55:06 -0400 (EDT) From: John Page Subject: W-EMED Re: Water Purification option Sender: owner-wilderness-emergency-medicine@list.pitt.edu X-Sender: page.95@pop.service.ohio-state.edu To: Wilderness-emergency-medicine@list.pitt.edu Reply-to: wilderness-emergency-medicine@list.pitt.edu Message-id: <200006241855.OAA17166@mail1.uts.ohio-state.edu> MIME-version: 1.0 X-Mailer: Windows Eudora Pro Version 2.1.2 Content-type: text/plain; charset="us-ascii" Precedence: bulk Marcelo - Regarding your water purification needs I suggest that you look into follwing - First off you must evaluate your likely hood of having a water source available and where each such source is to be found... Assuming you have access to water - Swimming pool treatment 50 grains @ quart of water oxidizer 2cc All of which can be carried in two water proof plastic containers no bigger than 1/2 cup containers. Details: Swimming pool treatment MUST include a min of: Dry contents Active ingredient = 65% Calcium Hypochlorite W/ 65% min cholorine Inert ingredients = 35% I use "Super Shock It" (HTM) A 1 pound container will last you all multiple life times 78% Calcium Hypochlorite W/75% min chlorine 22% inert Oxidizer Hydrogen peroxide 3% most any from a phrarmacy will suffice Directions: 1. Contact your local science dept. or lab to get ahold of a .050 grain heavy duty little scoop 2. Ask same for a small/modest sized sterile transfer pipette Add one scoop (50 grains) into each quart of water mix & shake WELL - loosen cap threads to ensure that some of the mix trickels out and along all thread areas. Then verify a good/strong chlorine smell exists If not ADD a second scoop of 50 grains This may well be neccessary should water source be poor quality or very cold. WAIT 30 minutes Add 2cc oxidizer & shake well Yes loosen threads a bit again - simply to rid chlorine taste and smell on mouth area. This is all you need to do - Suggest: You contact your local university medical center - or military base medical dept. to confirm details of disease likelyhood for the areas you will be going into. Then match up my above suggestions to them to verify which (IF any) diseases are not purified... WARNING: CHOLRINE is dangerous - DO NOT swallow by itself!!!! May be fatal if swallowed alone. IF SWALLOWED ALONE (by itself without being mixed as stated above per quart) - DO NOT INDUCE VOMITTING. Feed patient milk soaked bread followed by cooking oil. Call physician immediately!! ONLY mix cholorine with water! Contamination of chlorine with other substances MAY cause generation of heat, fire, or explosion. Caution is required - yet I find it very minor when treated with a bit of respect and mixed as above. We are useing the above mix within Ohio State University within the Outdoor Pursuits programs which include backpacking, hiking, rock climbing, sea kayaking, caving, etc. I might also hint that you set up two complete sets of purification packets and have two individuals carry them - so as not to loose one... Recomend: a high quality miniature water proof container for your calcium/chlorine - it sucks up moisture and can be a mucky mess if gotten the least bit wet. A complete packet of which can fit within a shirt pocket and weigh only a couple oz. Hope this helps - John Page Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- Return-Path: Received: from post-ofc05.srv.cis.pitt.edu (root@post-ofc05.srv.cis.pitt.edu [136.142.185.10]) by imap.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisimap-7.2.2.4) ID ; Fri, 23 Jun 2000 15:28:15 -0400 (EDT) Received: from localhost (root@localhost) by post-ofc05.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Fri, 23 Jun 2000 15:27:42 -0400 (EDT) Received: via switchmail; Fri, 23 Jun 2000 15:27:41 -0400 (EDT) Received: from post-ofc09.srv.cis.pitt.edu via qmail ID ; Fri, 23 Jun 2000 14:53:08 -0400 (EDT) Received: from mb1i0.ns.pitt.edu (mb1i1.ns.pitt.edu [136.142.185.161]) by post-ofc09.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Fri, 23 Jun 2000 14:53:06 -0400 (EDT) Received: from list.srv.cis.pitt.edu (majordom@[136.142.185.20]) by mb1i0.ns.pitt.edu (PMDF V5.2-32 #41462) with ESMTP id <01JQY2SFRKCI001759@mb1i0.ns.pitt.edu>; Fri, 23 Jun 2000 14:53:06 EST Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.2) ID ; Fri, 23 Jun 2000 14:52:10 -0400 (EDT) Received: from pol.net (sigma.po.com [204.178.220.39]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.2) ID for ; Fri, 23 Jun 2000 14:52:08 -0400 (EDT) Received: from web3.po.com (web3.po.com [204.178.220.30]) by pol.net (8.9.3/8.8.8) with ESMTP id OAA08497 for ; Fri, 23 Jun 2000 14:50:50 -0400 (EDT) Received: (from www@localhost) by web3.po.com (8.9.3+Sun/8.9.1) id OAA02472; Fri, 23 Jun 2000 14:50:48 -0400 (EDT) Date: Fri, 23 Jun 2000 14:50:48 -0400 (EDT) From: Charles Werntz Subject: Re: Re: W-EMED African Travel Sender: owner-wilderness-emergency-medicine@list.pitt.edu To: wilderness-emergency-medicine@list.pitt.edu Reply-to: wilderness-emergency-medicine@list.pitt.edu Message-id: <200006231850.OAA02472@web3.po.com> MIME-version: 1.0 Content-type: TEXT/PLAIN Content-transfer-encoding: 7bit Precedence: bulk X-Authentication-warning: web3.po.com: www set sender to cwerntz@pol.net using -f Tobias, if you haven't had any luck yet, we have a rather nice travel medicine clinic out here in Morgantown, WV. They have all of vacinations, and they provide good handouts about the health and cultural concerns about where you'll be traveling. (304) 293-2311, then ask for the "traveller's clinic". Hope this helps > On 19 Jun 2000, at 14:59, Tobias Joy wrote: > > > Also, what should I get insofaras immunizations above the required > > ones (yellow fever, malaria, and cholera, although cholera isn't > > officially required). Any leads on a "one-stop" immunization place? > > I can get to Pittsburgh and down to DC and Baltimore with no problems > > (the closer to Cumberland, MD, the better). > Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- Return-Path: Received: from post-ofc06.srv.cis.pitt.edu (root@post-ofc06.srv.cis.pitt.edu [136.142.185.43]) by imap.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisimap-7.2.2.4) ID ; Fri, 23 Jun 2000 11:18:39 -0400 (EDT) Received: from localhost (root@localhost) by post-ofc06.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Fri, 23 Jun 2000 11:18:07 -0400 (EDT) Received: via switchmail; Fri, 23 Jun 2000 11:18:06 -0400 (EDT) Received: from post-ofc09.srv.cis.pitt.edu via qmail ID ; Fri, 23 Jun 2000 11:16:21 -0400 (EDT) Received: from mb1i0.ns.pitt.edu (mb1i1.ns.pitt.edu [136.142.185.161]) by post-ofc09.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Fri, 23 Jun 2000 11:16:19 -0400 (EDT) Received: from list.srv.cis.pitt.edu (majordom@[136.142.185.20]) by mb1i0.ns.pitt.edu (PMDF V5.2-32 #41462) with ESMTP id <01JQXV7NRW8C0015DB@mb1i0.ns.pitt.edu>; Fri, 23 Jun 2000 11:16:19 EST Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.2) ID ; Fri, 23 Jun 2000 11:15:48 -0400 (EDT) Received: from mb1i0.ns.pitt.edu (mb1i1.ns.pitt.edu [136.142.185.161]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.2) ID for ; Fri, 23 Jun 2000 11:15:41 -0400 (EDT) Received: from snickers ("port 1033"@[136.142.23.63]) by mb1i0.ns.pitt.edu (PMDF V5.2-32 #41462) with SMTP id <01JQXTE9982O0016JV@mb1i0.ns.pitt.edu> for wilderness-emergency-medicine@list.pitt.edu; Fri, 23 Jun 2000 10:24:23 -0500 (EST) Date: Fri, 23 Jun 2000 10:26:42 -0400 From: Suzanne Atkinson Subject: Re: W-EMED Fw: Water purification for adventure race Sender: owner-wilderness-emergency-medicine@list.pitt.edu To: wilderness-emergency-medicine@list.pitt.edu Reply-to: wilderness-emergency-medicine@list.pitt.edu Message-id: <001401bfdd1f$0deb1ca0$0200a8c0@snickers> MIME-version: 1.0 X-MIMEOLE: Produced By Microsoft MimeOLE V5.00.2615.200 X-Mailer: Microsoft Outlook Express 5.00.2615.200 Content-type: text/plain; charset="iso-8859-1" Content-transfer-encoding: 7bit X-Priority: 3 X-MSMail-priority: Normal Precedence: bulk References: <39531D02.6896.29D280@localhost> My two cents about cleaning filters, and charcoal filter add ons. The newer 'pleated' filters that Kieth mentions are usually cleaned on the inside of the cylinder...that is, the pumped water flows from the inside of the hollow cylynder to the outside. This means that cleaning must be done with a certain sized brush. I lost the brush on a rockies trip, and after that the filter was useless...it was next to impossible to reach inside and effectively clean it with a bandana, pine cone wrapped in a bandana, etc. However the design of the model I used, the SweetWater, was enormously easier to pump than some of the PURs I've tried. It has a levereaged handle that flips into place to aid pumping, a pressure relief valve so that you don't blow out the filter trying to force bad water through, and at one time, the filters were absolutely guaranteed not to clog before 200 gallons, or else you got a new filter. The best part of the SweetWater was that you could add or remove the iodine portion of the filter depending on whether or not you wanted to use it. I solved the lost brush problem on my next trip by tying it to the filter's storage sack! Secondly, PUR, Sweet Water and others all sell 'add-on' pre-and post filters that should fit onto any input or output hose on your existing filter. That means you can almost mix and match elements that you want. These include "silt-stoppers" (a prefilter) and iodine and charcoal filters (postfilter). Suzanne Atkinson Pgh, PA ----- Original Message ----- From: Keith Conover, M.D., FACEP To: ; Sent: Friday, June 23, 2000 8:17 AM Subject: Re: W-EMED Fw: Water purification for adventure race > There are several manfufacturers in the U.S. I have had several of > the devices made by PUR and have been quite happy. The larger > models, e.g., the Scout, have an included cleaning mechanism > which is not present in the lighter models, which may be > appropriate. I've been able to clean off the lighter model's filter > elements by opening and cleaning off with some paper or leaves or > an old toothbrush, but the quicker cleaning of the Scout and similar > models, without having to take them apart, may be worth the extra > weight. On the other hand, the smaller and newer filters have filter > elements that, instead of being like a round cylinder, have "pleats" > much like the air or oil filters on a car, and will go much longer > without cleaning. Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- Return-Path: Received: from post-ofc02.srv.cis.pitt.edu (root@post-ofc02.srv.cis.pitt.edu [136.142.185.24]) by imap.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisimap-7.2.2.4) ID ; Fri, 23 Jun 2000 08:19:35 -0400 (EDT) Received: from localhost (root@localhost) by post-ofc02.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Fri, 23 Jun 2000 08:19:02 -0400 (EDT) Received: via switchmail; Fri, 23 Jun 2000 08:19:01 -0400 (EDT) Received: from post-ofc09.srv.cis.pitt.edu via qmail ID ; Fri, 23 Jun 2000 08:18:01 -0400 (EDT) Received: from mb1i0.ns.pitt.edu (mb1i1.ns.pitt.edu [136.142.185.161]) by post-ofc09.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Fri, 23 Jun 2000 08:18:00 -0400 (EDT) Received: from list.srv.cis.pitt.edu (majordom@[136.142.185.20]) by mb1i0.ns.pitt.edu (PMDF V5.2-32 #41462) with ESMTP id <01JQXOZI5W2M0016JV@mb1i0.ns.pitt.edu>; Fri, 23 Jun 2000 08:17:56 EST Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.2) ID ; Fri, 23 Jun 2000 08:17:11 -0400 (EDT) Received: from mb1i0.ns.pitt.edu (mb1i1.ns.pitt.edu [136.142.185.161]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.2) ID for ; Fri, 23 Jun 2000 08:17:09 -0400 (EDT) Received: from micron ("port 1024"@[136.142.20.78]) by mb1i0.ns.pitt.edu (PMDF V5.2-32 #41462) with ESMTP id <01JQXOYHOTAK0015DB@mb1i0.ns.pitt.edu> for wilderness-emergency-medicine@list.pitt.edu; Fri, 23 Jun 2000 08:17:08 -0500 (EST) Date: Fri, 23 Jun 2000 08:17:06 -0400 From: "Keith Conover, M.D., FACEP" Subject: Re: W-EMED Fw: Water purification for adventure race In-reply-to: <002401bfdcb6$781899e0$593633c8@marcelo> Sender: owner-wilderness-emergency-medicine@list.pitt.edu To: "jym@smandes.neuquen.com.ar" , wilderness-emergency-medicine@list.pitt.edu Reply-to: wilderness-emergency-medicine@list.pitt.edu Message-id: <39531D02.6896.29D280@localhost> MIME-version: 1.0 X-MIME-Autoconverted: from Quoted-printable to 8bit by list.srv.cis.pitt.edu id IAA14003 X-Mailer: Pegasus Mail for Win32 (v3.12c) Content-type: text/plain; charset=ISO-8859-1 Content-transfer-encoding: 8BIT Precedence: bulk I'm a fan of the iodine-resin filters. They serve as a filter to eliminate large parasites like giardia, as with all filters. Like the filters with smaler pore size, they filter out almost all bacteria. Th iodine resin, however, allows the filter to also kill off harmful bacteria (hepatitis, viral gastroenteritis). They also have an optional charcoal filter, that eliminates residual iodine in the output (the viruses are still coated with iodine and will diein about 15 minutes). The charcoal filter will also help get rid of pesticides and heavy metals. There are several manfufacturers in the U.S. I have had several of the devices made by PUR and have been quite happy. The larger models, e.g., the Scout, have an included cleaning mechanism which is not present in the lighter models, which may be appropriate. I've been able to clean off the lighter model's filter elements by opening and cleaning off with some paper or leaves or an old toothbrush, but the quicker cleaning of the Scout and similar models, without having to take them apart, may be worth the extra weight. On the other hand, the smaller and newer filters have filter elements that, instead of being like a round cylinder, have "pleats" much like the air or oil filters on a car, and will go much longer without cleaning. Don't know about jungle water, but when I was hiking in an area where most water was from pumps with iron pipes, the rust clogged the filter after only 3-4 days and I had to clean it off with some leaves (old cylinder type filter). Hope this helps some. Hope all is well with you and your family and the skiing's good in San Martin de Los Andes this season! It's 85 degrees F (30 degrees C) here in Pittsburgh today. P.S. we saw your picture on the film of the EcoChallenge last -- and Jorge Varcellotti says hi. Take care. On 22 Jun 2000, at 22:58, jym@smandes.neuquen.com.ar wrote: > I would appreciate the list members opinion on what would be the best > water purification system for Ecochallenge competitors (team of 4) in > the next race to be held in Borneo (Kinabalu). Ecochallenge is an > adventure race. Iodine in tablets or liquid is mandatory for the > organization, and this alone is quite a good option but I do not have > extensive experience with water filters with "jungle type water". If a > water filter was an option, how many would a 4 member team need for > 6-10 days? and what brand would be a good choice.These questions are > to address the clogging problem. Thanks > > Marcelo Parada MD > Hospital Ramón Carrillo > (8370) San Martín de los Andes > Neuquén- ARGENTINA > > email jym@smandes.neuquen.com.ar > --Keith Conover, M.D., FACEP http://www.pitt.edu/~kconover sent with Pegasus high-security email download free from www.pmail.com Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- Return-Path: Received: from post-ofc03.srv.cis.pitt.edu (root@post-ofc03.srv.cis.pitt.edu [136.142.185.39]) by imap.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisimap-7.2.2.4) ID ; Fri, 23 Jun 2000 01:13:33 -0400 (EDT) Received: from localhost (root@localhost) by post-ofc03.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Fri, 23 Jun 2000 01:13:00 -0400 (EDT) Received: via switchmail; Fri, 23 Jun 2000 01:13:00 -0400 (EDT) Received: from post-ofc09.srv.cis.pitt.edu via qmail ID ; Fri, 23 Jun 2000 01:12:10 -0400 (EDT) Received: from mb2i0.ns.pitt.edu (mb2i1.ns.pitt.edu [136.142.185.162]) by post-ofc09.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Fri, 23 Jun 2000 01:12:08 -0400 (EDT) Received: from list.srv.cis.pitt.edu (majordom@[136.142.185.20]) by mb2i0.ns.pitt.edu (PMDF V5.2-32 #41462) with ESMTP id <01JQXA4K8IFO000R4M@mb2i0.ns.pitt.edu>; Fri, 23 Jun 2000 01:12:08 EST Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.2) ID ; Fri, 23 Jun 2000 01:11:41 -0400 (EDT) Received: from tenforward.com (tenforward.com [206.213.105.2]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.2) ID for ; Fri, 23 Jun 2000 01:11:35 -0400 (EDT) Received: from default [209.168.55.38] by tenforward.com (SMTPD32-6.00) id A18066D8029A; Thu, 22 Jun 2000 22:11:28 -0700 Date: Thu, 22 Jun 2000 22:08:36 -0700 From: "The Tate's" Subject: RE: W-EMED Fw: Water purification for adventure race In-reply-to: <002401bfdcb6$781899e0$593633c8@marcelo> Sender: owner-wilderness-emergency-medicine@list.pitt.edu To: wilderness-emergency-medicine@list.pitt.edu Reply-to: wilderness-emergency-medicine@list.pitt.edu Message-id: MIME-version: 1.0 X-MIMEOLE: Produced By Microsoft MimeOLE V5.00.2615.200 X-Mailer: Microsoft Outlook IMO, Build 9.0.2416 (9.0.2910.0) Content-type: multipart/alternative; boundary="----=_NextPart_000_0038_01BFDC96.69C9C820" Importance: Normal X-Priority: 3 (Normal) X-MSMail-priority: Normal Precedence: bulk This is a multi-part message in MIME format. ------=_NextPart_000_0038_01BFDC96.69C9C820 Content-Type: text/plain; charset="iso-8859-1" Content-Transfer-Encoding: 7bit I think that you should look at the Silver loaded ceramic ones they can be cleaned when they get muddy. You might also contact REI at http://www.rei.com they specialize in this kind of equipment. Most of the good ones include pre-filters that take care of the mud. Good luck on the Challenge! David Tate -----Original Message----- From: owner-wilderness-emergency-medicine@list.pitt.edu [mailto:owner-wilderness-emergency-medicine@list.pitt.edu]On Behalf Of jym@smandes.neuquen.com.ar Sent: Thursday, June 22, 2000 6:58 PM To: wilderness-emergency-medicine@list.pitt.edu Subject: W-EMED Fw: Water purification for adventure race ------=_NextPart_000_0038_01BFDC96.69C9C820 Content-Type: text/html; charset="iso-8859-1" Content-Transfer-Encoding: quoted-printable
I=20 think that you should look at the Silver loaded ceramic ones they can be = cleaned=20 when they get muddy. You might also contact REI at http://www.rei.com they specialize = in this=20 kind of equipment. Most of the good ones include pre-filters that take = care of=20 the mud.
 
Good=20 luck on the Challenge!
 
David=20 Tate
 
 
 
-----Original Message-----
From:=20 owner-wilderness-emergency-medicine@list.pitt.edu=20 [mailto:owner-wilderness-emergency-medicine@list.pitt.edu]On Behalf = Of=20 jym@smandes.neuquen.com.ar
Sent: Thursday, June 22, 2000 = 6:58=20 PM
To:=20 wilderness-emergency-medicine@list.pitt.edu
Subject: W-EMED = Fw:=20 Water purification for adventure=20 race

------=_NextPart_000_0038_01BFDC96.69C9C820-- Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- Return-Path: Received: from post-ofc02.srv.cis.pitt.edu (root@post-ofc02.srv.cis.pitt.edu [136.142.185.24]) by imap.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisimap-7.2.2.4) ID ; Thu, 22 Jun 2000 23:20:55 -0400 (EDT) Received: from localhost (root@localhost) by post-ofc02.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Thu, 22 Jun 2000 23:20:23 -0400 (EDT) Received: via switchmail; Thu, 22 Jun 2000 23:20:23 -0400 (EDT) Received: from post-ofc01.srv.cis.pitt.edu via qmail ID ; Thu, 22 Jun 2000 23:20:01 -0400 (EDT) Received: from mb2i0.ns.pitt.edu (mb2i1.ns.pitt.edu [136.142.185.162]) by post-ofc01.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Thu, 22 Jun 2000 23:19:58 -0400 (EDT) Received: from list.srv.cis.pitt.edu (majordom@[136.142.185.20]) by mb2i0.ns.pitt.edu (PMDF V5.2-32 #41462) with ESMTP id <01JQX67ILMD0000285@mb2i0.ns.pitt.edu>; Thu, 22 Jun 2000 23:19:58 EST Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.2) ID ; Thu, 22 Jun 2000 23:18:19 -0400 (EDT) Received: from mail.webpostal.com.ar (mail.webpostal.com.ar [200.16.190.25]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.2) ID for ; Thu, 22 Jun 2000 23:18:11 -0400 (EDT) Received: from marcelo ([200.51.54.89]) by mail.webpostal.com.ar (Netscape Messaging Server 4.15) with SMTP id FWKR5R00.08U for ; Fri, 23 Jun 2000 00:17:51 +0300 Date: Thu, 22 Jun 2000 22:58:01 -0300 From: "jym@smandes.neuquen.com.ar" Subject: W-EMED Fw: Water purification for adventure race Sender: owner-wilderness-emergency-medicine@list.pitt.edu To: wilderness-emergency-medicine@list.pitt.edu Reply-to: wilderness-emergency-medicine@list.pitt.edu Message-id: <002401bfdcb6$781899e0$593633c8@marcelo> MIME-version: 1.0 X-MIMEOLE: Produced By Microsoft MimeOLE V5.00.2919.6600 X-Mailer: Microsoft Outlook Express 5.00.2919.6600 Content-type: multipart/alternative; boundary="----=_NextPart_000_0021_01BFDC9D.50F56960" X-Priority: 3 X-MSMail-priority: Normal Precedence: bulk This is a multi-part message in MIME format. ------=_NextPart_000_0021_01BFDC9D.50F56960 Content-Type: text/plain; charset="iso-8859-1" Content-Transfer-Encoding: quoted-printable I would appreciate the list members opinion on what would be the best = water purification system for Ecochallenge competitors (team of 4) in = the next race to be held in Borneo (Kinabalu). Ecochallenge is an = adventure race. Iodine in tablets or liquid is mandatory for the organization, and this = alone is quite a good option but I do not have extensive experience with = water filters with "jungle type water". If a water filter was an option, = how many would a 4 member team need for 6-10 days? and what brand would = be a good choice.These questions are to address the clogging problem. Thanks Marcelo Parada MD Hospital Ram=F3n Carrillo (8370) San Mart=EDn de los Andes Neuqu=E9n- ARGENTINA email jym@smandes.neuquen.com.ar =20 ------=_NextPart_000_0021_01BFDC9D.50F56960 Content-Type: text/html; charset="iso-8859-1" Content-Transfer-Encoding: quoted-printable
I would appreciate the list = members opinion on=20 what would be the best water purification system for Ecochallenge = competitors=20 (team of 4) in the next race to be held in Borneo (Kinabalu). = Ecochallenge is an=20 adventure race.
Iodine in tablets or liquid is = mandatory for the=20 organization, and this alone is quite a good option but I do not have = extensive=20 experience with water filters with "jungle type water". If a water = filter was an=20 option, how many would a 4 member team need for 6-10 days? and what = brand=20 would be a good choice.These questions are to address the clogging=20 problem.
Thanks
 
Marcelo Parada MD
Hospital Ram=F3n=20 Carrillo
(8370) San Mart=EDn de los Andes
Neuqu=E9n- = ARGENTINA
 
email  jym@smandes.neuquen.com.ar= =20  
------=_NextPart_000_0021_01BFDC9D.50F56960-- Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- Return-Path: Received: from post-ofc07.srv.cis.pitt.edu (root@post-ofc07.srv.cis.pitt.edu [136.142.185.73]) by imap.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisimap-7.2.2.4) ID ; Thu, 22 Jun 2000 23:21:17 -0400 (EDT) Received: from localhost (root@localhost) by post-ofc07.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.3) ID ; Thu, 22 Jun 2000 23:20:46 -0400 (EDT) Received: via switchmail; Thu, 22 Jun 2000 23:20:45 -0400 (EDT) Received: from post-ofc09.srv.cis.pitt.edu via qmail ID ; Thu, 22 Jun 2000 23:18:46 -0400 (EDT) Received: from mb1i0.ns.pitt.edu (mb1i1.ns.pitt.edu [136.142.185.161]) by post-ofc09.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Thu, 22 Jun 2000 23:18:44 -0400 (EDT) Received: from list.srv.cis.pitt.edu (majordom@[136.142.185.20]) by mb1i0.ns.pitt.edu (PMDF V5.2-32 #41462) with ESMTP id <01JQX65WTIOM0013S2@mb1i0.ns.pitt.edu>; Thu, 22 Jun 2000 23:18:41 EST Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.2) ID ; Thu, 22 Jun 2000 23:15:58 -0400 (EDT) Received: from mail.webpostal.com.ar (mail.webpostal.com.ar [200.16.190.25]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.2) ID for ; Thu, 22 Jun 2000 23:15:42 -0400 (EDT) Received: from marcelo ([200.51.54.89]) by mail.webpostal.com.ar (Netscape Messaging Server 4.15) with SMTP id FWKR1P00.W99 for ; Fri, 23 Jun 2000 00:15:25 +0300 Date: Thu, 22 Jun 2000 22:55:36 -0300 From: "jym@smandes.neuquen.com.ar" Subject: W-EMED Water purification for adventure race Sender: owner-wilderness-emergency-medicine@list.pitt.edu To: wilderness-emergency-medicine@list.pitt.edu Reply-to: wilderness-emergency-medicine@list.pitt.edu Message-id: <001001bfdcb6$213d7e60$593633c8@marcelo> MIME-version: 1.0 X-MIMEOLE: Produced By Microsoft MimeOLE V5.00.2919.6600 X-Mailer: Microsoft Outlook Express 5.00.2919.6600 Content-type: multipart/alternative; boundary="----=_NextPart_000_000D_01BFDC9C.FA450760" X-Priority: 3 X-MSMail-priority: Normal Precedence: bulk This is a multi-part message in MIME format. ------=_NextPart_000_000D_01BFDC9C.FA450760 Content-Type: text/plain; charset="iso-8859-1" Content-Transfer-Encoding: quoted-printable I would appreciate the list members opinion on what would be the best = water purification system for Ecochallenge competitors (team of 4) in = the next race to be held in Borneo (Kinabalu). Ecochallenge is an = adventure race. Iodine in tablets or liquid is mandatory for the organization, and this = alone is quite a good option but I do not have extensive experience with = water filters with "jungle type water". If a water filter was an option, = how many would a 4 member team need for 6-10 days? and what brand would = be a good choice.These questions are to address the clogging problem. Thanks Marcelo Parada MD Hospital Ram=F3n Carrillo (8370) San Mart=EDn de los Andes Neuqu=E9n- ARGENTINA email jym@smandes.neuquen.com.ar =20 ------=_NextPart_000_000D_01BFDC9C.FA450760 Content-Type: text/html; charset="iso-8859-1" Content-Transfer-Encoding: quoted-printable
I would appreciate the list = members opinion on=20 what would be the best water purification system for Ecochallenge = competitors=20 (team of 4) in the next race to be held in Borneo (Kinabalu). = Ecochallenge is an=20 adventure race.
Iodine in tablets or liquid is = mandatory for the=20 organization, and this alone is quite a good option but I do not have = extensive=20 experience with water filters with "jungle type water". If a water = filter was an=20 option, how many would a 4 member team need for 6-10 days? and what = brand=20 would be a good choice.These questions are to address the clogging=20 problem.
Thanks
 
Marcelo Parada MD
Hospital Ram=F3n=20 Carrillo
(8370) San Mart=EDn de los Andes
Neuqu=E9n- = ARGENTINA
 
email  jym@smandes.neuquen.com.ar= =20  
------=_NextPart_000_000D_01BFDC9C.FA450760-- Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- Return-Path: Received: from post-ofc05.srv.cis.pitt.edu (root@post-ofc05.srv.cis.pitt.edu [136.142.185.10]) by imap.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisimap-7.2.2.4) ID ; Tue, 20 Jun 2000 22:43:12 -0400 (EDT) Received: from localhost (root@localhost) by post-ofc05.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Tue, 20 Jun 2000 22:42:39 -0400 (EDT) Received: via switchmail; Tue, 20 Jun 2000 22:42:39 -0400 (EDT) Received: from post-ofc01.srv.cis.pitt.edu via qmail ID ; Tue, 20 Jun 2000 22:41:16 -0400 (EDT) Received: from mb2i0.ns.pitt.edu (mb2i1.ns.pitt.edu [136.142.185.162]) by post-ofc01.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Tue, 20 Jun 2000 22:41:06 -0400 (EDT) Received: from list.srv.cis.pitt.edu (majordom@[136.142.185.20]) by mb2i0.ns.pitt.edu (PMDF V5.2-32 #41462) with ESMTP id <01JQUC9LDWP4000FKB@mb2i0.ns.pitt.edu>; Tue, 20 Jun 2000 22:41:04 EST Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.2) ID ; Tue, 20 Jun 2000 22:40:36 -0400 (EDT) Received: from jason04.u.washington.edu (root@jason04.u.washington.edu [140.142.78.5]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.2) ID for ; Tue, 20 Jun 2000 22:40:33 -0400 (EDT) Received: from aagaard04.u.washington.edu (mcmullen@aagaard04.u.washington.edu [140.142.13.103]) by jason04.u.washington.edu (8.9.3+UW00.05/8.9.3+UW00.01) with ESMTP id TAA43318 for ; Tue, 20 Jun 2000 19:40:32 -0700 Received: from localhost (mcmullen@localhost) by aagaard04.u.washington.edu (8.9.3+UW00.05/8.9.3+UW99.09) with ESMTP id TAA281146 for ; Tue, 20 Jun 2000 19:40:31 -0700 Date: Tue, 20 Jun 2000 19:40:31 -0700 (PDT) From: Russell McMullen Subject: Re: W-EMED African Travel In-reply-to: <394FE7A0.30215.A450CFB@localhost> Sender: owner-wilderness-emergency-medicine@list.pitt.edu To: wilderness-emergency-medicine@list.pitt.edu Reply-to: wilderness-emergency-medicine@list.pitt.edu Message-id: MIME-version: 1.0 Content-type: TEXT/PLAIN; charset=US-ASCII Precedence: bulk If the primary physicians in Cumberland are not members of a certified yellow fever vaccination center they won't be able to provide this vaccine. Russell McMullen, M.D. University of Washington Medical Center On Tue, 20 Jun 2000, Keith Conover, M.D., FACEP wrote: > On 19 Jun 2000, at 14:59, Tobias Joy wrote: > > > Also, what should I get insofaras immunizations above the required > > ones (yellow fever, malaria, and cholera, although cholera isn't > > officially required). Any leads on a "one-stop" immunization place? > > I can get to Pittsburgh and down to DC and Baltimore with no problems > > (the closer to Cumberland, MD, the better). > > I'm sure that any of the family medicine or internal medicine > physicians in Cumberland would be happy to do this for you. Might > have to order some of the stuff for you but other than that, shouldn't > be a problem. > > --Keith Conover, M.D., FACEP > http://www.pitt.edu/~kconover > sent with Pegasus high-security email > download free from www.pmail.com > Do not reproduce without author's express permission. > To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" > as the body of a message (no subject) To: Majordomo@list.pitt.edu > Submissions To: wilderness-emergency-medicine@list.pitt.edu > Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- Return-Path: Received: from post-ofc09.srv.cis.pitt.edu (root@post-ofc09.srv.cis.pitt.edu [136.142.185.57]) by imap.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisimap-7.2.2.4) ID ; Tue, 20 Jun 2000 21:54:29 -0400 (EDT) Received: from localhost (root@localhost) by post-ofc09.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Tue, 20 Jun 2000 21:53:58 -0400 (EDT) Received: via switchmail; Tue, 20 Jun 2000 21:53:58 -0400 (EDT) Received: from post-ofc01.srv.cis.pitt.edu via qmail ID ; Tue, 20 Jun 2000 21:53:11 -0400 (EDT) Received: from mb1i0.ns.pitt.edu (mb1i1.ns.pitt.edu [136.142.185.161]) by post-ofc01.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Tue, 20 Jun 2000 21:53:09 -0400 (EDT) Received: from list.srv.cis.pitt.edu (majordom@[136.142.185.20]) by mb1i0.ns.pitt.edu (PMDF V5.2-32 #41462) with ESMTP id <01JQUAL3TD2O0012Q9@mb1i0.ns.pitt.edu>; Tue, 20 Jun 2000 21:53:05 EST Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.2) ID ; Tue, 20 Jun 2000 21:52:39 -0400 (EDT) Received: from mb1i0.ns.pitt.edu (mb1i1.ns.pitt.edu [136.142.185.161]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.2) ID for ; Tue, 20 Jun 2000 21:52:37 -0400 (EDT) Received: from micron ("port 1475"@[136.142.21.185]) by mb1i0.ns.pitt.edu (PMDF V5.2-32 #41462) with ESMTP id <01JQUAKGARO40012J6@mb1i0.ns.pitt.edu> for wilderness-emergency-medicine@list.pitt.edu; Tue, 20 Jun 2000 21:52:37 -0500 (EST) Date: Tue, 20 Jun 2000 21:52:32 -0400 From: "Keith Conover, M.D., FACEP" Subject: Re: W-EMED African Travel In-reply-to: <001601bfda20$75ccfc00$026fa8c0@allconet.org> Sender: owner-wilderness-emergency-medicine@list.pitt.edu To: Tobias Joy , wilderness-emergency-medicine@list.pitt.edu Reply-to: wilderness-emergency-medicine@list.pitt.edu Message-id: <394FE7A0.30215.A450CFB@localhost> MIME-version: 1.0 X-Mailer: Pegasus Mail for Win32 (v3.12c) Content-type: text/plain; charset=US-ASCII Content-transfer-encoding: 7BIT Precedence: bulk References: On 19 Jun 2000, at 14:59, Tobias Joy wrote: > Also, what should I get insofaras immunizations above the required > ones (yellow fever, malaria, and cholera, although cholera isn't > officially required). Any leads on a "one-stop" immunization place? > I can get to Pittsburgh and down to DC and Baltimore with no problems > (the closer to Cumberland, MD, the better). I'm sure that any of the family medicine or internal medicine physicians in Cumberland would be happy to do this for you. Might have to order some of the stuff for you but other than that, shouldn't be a problem. --Keith Conover, M.D., FACEP http://www.pitt.edu/~kconover sent with Pegasus high-security email download free from www.pmail.com Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- Return-Path: Received: from post-ofc02.srv.cis.pitt.edu (root@post-ofc02.srv.cis.pitt.edu [136.142.185.24]) by imap.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisimap-7.2.2.4) ID ; Tue, 20 Jun 2000 16:52:14 -0400 (EDT) Received: from localhost (root@localhost) by post-ofc02.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Tue, 20 Jun 2000 16:51:40 -0400 (EDT) Received: via switchmail; Tue, 20 Jun 2000 16:51:39 -0400 (EDT) Received: from post-ofc09.srv.cis.pitt.edu via qmail ID ; Tue, 20 Jun 2000 16:49:45 -0400 (EDT) Received: from mb2i0.ns.pitt.edu (mb2i1.ns.pitt.edu [136.142.185.162]) by post-ofc09.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Tue, 20 Jun 2000 16:49:42 -0400 (EDT) Received: from list.srv.cis.pitt.edu (majordom@[136.142.185.20]) by mb2i0.ns.pitt.edu (PMDF V5.2-32 #41462) with ESMTP id <01JQTZYWB1W0000GJP@mb2i0.ns.pitt.edu>; Tue, 20 Jun 2000 16:49:38 EST Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.2) ID ; Tue, 20 Jun 2000 16:46:57 -0400 (EDT) Received: from cmailg3.svr.pol.co.uk (cmailg3.svr.pol.co.uk [195.92.195.173]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.2) ID for ; Tue, 20 Jun 2000 16:46:47 -0400 (EDT) Received: from modem-57.technetium.dialup.pol.co.uk ([62.136.37.57] helo=default) by cmailg3.svr.pol.co.uk with smtp (Exim 3.13 #0) id 134Uuz-0005ro-00 for wilderness-emergency-medicine@list.pitt.edu; Tue, 20 Jun 2000 21:46:45 +0100 Date: Tue, 20 Jun 2000 21:42:53 +0100 From: Mandy MacIver Subject: Re: W-EMED African Travel and HIB Sender: owner-wilderness-emergency-medicine@list.pitt.edu To: wilderness-emergency-medicine@list.pitt.edu Reply-to: wilderness-emergency-medicine@list.pitt.edu Message-id: <018701bfdaf8$352624a0$a321883e@default> MIME-version: 1.0 X-MIMEOLE: Produced By Microsoft MimeOLE V5.00.2314.1300 X-Mailer: Microsoft Outlook Express 5.00.2314.1300 Content-type: text/plain; charset="iso-8859-1" Content-transfer-encoding: 7bit X-Priority: 3 X-MSMail-priority: Normal Precedence: bulk References: Steven Pirie, Hi. Thought you might be interested to know the recommendations for Hib vaccination in UK. Other than being part of the primary course of childhood immunisation (since 1992) it is recommended for everyone with a splenectomy (1 dose for over one year olds and 3 for under ones). Routine immunisation of children over 4 years and adults including travellers is not included in the UK recommendations as the chance of invasive disease falls sharply after this age. Cheers Mandy MacIver, Inverness, UK. Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- Return-Path: Received: from post-ofc07.srv.cis.pitt.edu (root@post-ofc07.srv.cis.pitt.edu [136.142.185.73]) by imap.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisimap-7.2.2.4) ID ; Tue, 20 Jun 2000 09:12:05 -0400 (EDT) Received: from localhost (root@localhost) by post-ofc07.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.3) ID ; Tue, 20 Jun 2000 09:11:32 -0400 (EDT) Received: via switchmail; Tue, 20 Jun 2000 09:11:32 -0400 (EDT) Received: from post-ofc01.srv.cis.pitt.edu via qmail ID ; Tue, 20 Jun 2000 09:04:25 -0400 (EDT) Received: from mb1i0.ns.pitt.edu (mb1i1.ns.pitt.edu [136.142.185.161]) by post-ofc01.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Tue, 20 Jun 2000 09:04:20 -0400 (EDT) Received: from list.srv.cis.pitt.edu (majordom@[136.142.185.20]) by mb1i0.ns.pitt.edu (PMDF V5.2-32 #41462) with ESMTP id <01JQTJPZY34A000ZYH@mb1i0.ns.pitt.edu>; Tue, 20 Jun 2000 09:04:20 EST Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.2) ID ; Tue, 20 Jun 2000 09:02:15 -0400 (EDT) Received: from jason02.u.washington.edu (root@jason02.u.washington.edu [140.142.76.8]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.2) ID for ; Tue, 20 Jun 2000 09:02:13 -0400 (EDT) Received: from aagaard04.u.washington.edu (mcmullen@aagaard04.u.washington.edu [140.142.13.103]) by jason02.u.washington.edu (8.9.3+UW00.05/8.9.3+UW00.01) with ESMTP id GAA25530 for ; Tue, 20 Jun 2000 06:02:11 -0700 Received: from localhost (mcmullen@localhost) by aagaard04.u.washington.edu (8.9.3+UW00.05/8.9.3+UW99.09) with ESMTP id GAA213526 for ; Tue, 20 Jun 2000 06:02:11 -0700 Date: Tue, 20 Jun 2000 06:02:07 -0700 (PDT) From: Russell McMullen Subject: Re: W-EMED African Travel In-reply-to: <001601bfda20$75ccfc00$026fa8c0@allconet.org> Sender: owner-wilderness-emergency-medicine@list.pitt.edu To: wilderness-emergency-medicine@list.pitt.edu Reply-to: wilderness-emergency-medicine@list.pitt.edu Message-id: MIME-version: 1.0 Content-type: TEXT/PLAIN; charset=US-ASCII Precedence: bulk You can access listings of travel clinics through the web sites of two organizations The American Society of Tropical Medicine and Hygiene [www.astmh.org] which has a somewhat more academic and research-oriented membership, but has a clinician's group, most of whom have a longstanding interest in travel medicine and maintain clinics. and the International Society of Travel Medicine [www.istm.org] which has a more world-wide membership, albeit primarily North American and European; a higher proportion of this organizations members are involved in clinical practice, but there are many members from academic and research-oriented institutions as well. There is likely to be quite a bit of overlap on the two lists. While membership in either organization cannot guarantee quality, it demonstrates that providers are interested in the development of travel medicine and have some interest in keeping up with advances in this field. At many clinics, especially ones for which travel medicine is a small part of the practice, you MAY get a somewhat cookbook approach, being recommended what can be found on various websites or official recommendations without taking into account the parts of a country you might be visiting, particular diseases that might be present in those regions, etc. Also without taking into account side effects of certain medications or interactions of medications with those you are already on, and in general without paying attention to your proposed trip and to your overall health issues. While your trip seems pretty straightforward, if you have any medical issues, these should be included in your planning. As examples: mefloquine, commonly recommened for malaria prophylaxis, should not be taken by someone with a history of seizures, significant history of depression, anxiety, or other psychiatric issues, and with certain cardiac conduction disorders. One alternative, daily doxycycline, can trigger photosensitivity, cause esophagitis [especially if taken improperly], and predispose to candida vaginitis. Chloroquine is generally ineffective at preventing falciparum [the most severe type] in this part of the world, but might be recommended by someone who is used to dealing with semi-immune natives of these countries, or an older physician who remembers what they used in Vietnam for malaria prevention, but hasn't kept up with developments in malaria resistance to medications. Daily primaquine is a new recommendation that few other than people following travel medicine closely would know about [and which requires a blood test for glucose-6-phosphate dehydrogenase activity before starting it]. I use these not as hard and fast recommendations, but just as examples of issues that might need to be considered. I hope the lists above are helpful; best of luck and have a great experience. Russell McMullen, M.D. Travel and Tropical Medicine Service Box 356123 University of Washington Medical Center Seattle, WA 98195 USA 206-598-6205 P.S.: Re vaccines and one you didn't mention: Hepatitis A is the most common vaccine-preventable illness contracted by travelers [with the possible exception of influenza], and unless immune through previous infection you should certainly have this before travel to any place in the developing world. On Mon, 19 Jun 2000, Tobias Joy wrote: > Greetings everyone, > > I'm going to Kenya and Tanzania on a 2 week safari trip, starting July > 9th... I was wondering what everyone would suggest as to meds I should > take, what should I have in my first aid kit, and where I should try to > visit if you've been there. > > Also, what should I get insofaras immunizations above the required ones > (yellow fever, malaria, and cholera, although cholera isn't officially > required). Any leads on a "one-stop" immunization place? I can get to > Pittsburgh and down to DC and Baltimore with no problems (the closer to > Cumberland, MD, the better). > > Any help would be greatly appreciated. > > Toby > > Do not reproduce without author's express permission. > To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" > as the body of a message (no subject) To: Majordomo@list.pitt.edu > Submissions To: wilderness-emergency-medicine@list.pitt.edu > Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- Return-Path: Received: from post-ofc07.srv.cis.pitt.edu (root@post-ofc07.srv.cis.pitt.edu [136.142.185.73]) by imap.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisimap-7.2.2.4) ID ; Tue, 20 Jun 2000 00:06:47 -0400 (EDT) Received: from localhost (root@localhost) by post-ofc07.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.3) ID ; Tue, 20 Jun 2000 00:06:14 -0400 (EDT) Received: via switchmail; Tue, 20 Jun 2000 00:06:14 -0400 (EDT) Received: from post-ofc01.srv.cis.pitt.edu via qmail ID ; Tue, 20 Jun 2000 00:05:10 -0400 (EDT) Received: from mb1i0.ns.pitt.edu (mb1i1.ns.pitt.edu [136.142.185.161]) by post-ofc01.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Tue, 20 Jun 2000 00:05:08 -0400 (EDT) Received: from list.srv.cis.pitt.edu (majordom@[136.142.185.20]) by mb1i0.ns.pitt.edu (PMDF V5.2-32 #41462) with ESMTP id <01JQT0WF5UOE000T37@mb1i0.ns.pitt.edu>; Tue, 20 Jun 2000 00:05:05 EST Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.2) ID ; Tue, 20 Jun 2000 00:03:05 -0400 (EDT) Received: from mail1.toronto.istar.net (mail1.toronto.istar.net [209.89.75.17]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.2) ID for ; Tue, 20 Jun 2000 00:03:00 -0400 (EDT) Received: from ip28.ottawa8.dialup.canada.psi.net ([154.5.70.28]) by mail1.toronto.istar.net with smtp (Exim 2.02 #1) id 134FGK-0001tg-00 for wilderness-emergency-medicine@list.pitt.edu; Tue, 20 Jun 2000 00:03:46 -0400 Date: Tue, 20 Jun 2000 00:05:47 -0500 From: pirie@istar.ca (Steven D. Pirie) Subject: W-EMED African Travel and HIB Sender: owner-wilderness-emergency-medicine@list.pitt.edu X-Sender: pirie@istar.ca (Unverified) To: wilderness-emergency-medicine@list.pitt.edu Reply-to: wilderness-emergency-medicine@list.pitt.edu Message-id: MIME-version: 1.0 Content-type: text/plain; charset="us-ascii" Precedence: bulk Ms. Maggiani (and others), > I would also make sure that the "routine" immunizations are up to date... > Diphtheria, Pertussis, Tetanus, Measles, Mumps, Rubella, Polio and HIB. >Do you recommend HIB for adults? In the US I believe we only give it to >>infants. No, I just listed off the routine ones without even thinking. Interesting point though, the HIB vaccine was recommended by Travel Medical Advisor: the physicians update on international health, Immunizations for the International Traveller 2.2 (4/96) by E.C. Jong and B. Sharp for "routine" immunizations for the traveller, maybe they made the same mistake I did . Now that I think about it I have never had a patient that is going overseas come in without it. Here in Canada it is also only given as a childhood immunization. If a patient came in without it, I cannot imagine that they would need it, unless maybe they were splenectomized as HIB is an encapsulated bacteria and they would be more susceptible to it. Any thoughts? Steven ---------------------------------------------------------- Lt. Steven D. Pirie, RN, BScN, UE General Duty Ward Officer - Military In-Patient Unit Canadian Forces Support Unit Ottawa - Civic Hospital Site 2 Health Support Operational Training Unit ---------------------------------------------------------- Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- Return-Path: Received: from post-ofc09.srv.cis.pitt.edu (root@post-ofc09.srv.cis.pitt.edu [136.142.185.57]) by imap.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisimap-7.2.2.4) ID ; Mon, 19 Jun 2000 22:47:44 -0400 (EDT) Received: from localhost (root@localhost) by post-ofc09.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Mon, 19 Jun 2000 22:47:12 -0400 (EDT) Received: via switchmail; Mon, 19 Jun 2000 22:47:12 -0400 (EDT) Received: from post-ofc09.srv.cis.pitt.edu via qmail ID ; Mon, 19 Jun 2000 22:45:11 -0400 (EDT) Received: from mb2i0.ns.pitt.edu (mb2i1.ns.pitt.edu [136.142.185.162]) by post-ofc09.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Mon, 19 Jun 2000 22:45:09 -0400 (EDT) Received: from list.srv.cis.pitt.edu (majordom@[136.142.185.20]) by mb2i0.ns.pitt.edu (PMDF V5.2-32 #41462) with ESMTP id <01JQSY4APD5E0009X6@mb2i0.ns.pitt.edu>; Mon, 19 Jun 2000 22:45:09 EST Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.2) ID ; Mon, 19 Jun 2000 22:43:15 -0400 (EDT) Received: from tisch.mail.mindspring.net (tisch.mail.mindspring.net [207.69.200.157]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.2) ID for ; Mon, 19 Jun 2000 22:43:12 -0400 (EDT) Received: from kdmar.pobox.com (user-2ivf1p9.dialup.mindspring.com [165.247.135.41]) by tisch.mail.mindspring.net (8.9.3/8.8.5) with ESMTP id WAA15074 for ; Mon, 19 Jun 2000 22:43:11 -0400 (EDT) Date: Mon, 19 Jun 2000 22:43:43 -0400 From: Kevin Mar Subject: Re: W-EMED African Travel In-reply-to: <001601bfda20$75ccfc00$026fa8c0@allconet.org> Sender: owner-wilderness-emergency-medicine@list.pitt.edu X-Sender: kdmar@pop.mindspring.com To: wilderness-emergency-medicine@list.pitt.edu Reply-to: wilderness-emergency-medicine@list.pitt.edu Message-id: <4.3.1.2.20000619223529.00ab0220@pop.mindspring.com> MIME-version: 1.0 X-Mailer: QUALCOMM Windows Eudora Version 4.3.1 Content-type: text/plain; charset="us-ascii"; format=flowed Precedence: bulk References: Hi Toby, An *extremely* useful link that I used when I prepared for a trip to West Africa is: http://www.tripprep.com It has a list of general requirements for immunizations as well as travel advisories for many different countries. There is also a list of Travel Medicine clinics. I think that the travel clinics subscribe to be listed, though, so don't take it to be a complete list. The travel clinic I went to is not in their list, yet was very knowledgeable. Of course, there is also the CDC Travel Health site: http://www.cdc.gov/travel/ Hope these are helpful. Have a great trip. Kevin ----------------------------------------------------------------------- Kevin Mar Durham Search & Rescue Central Unit, North Carolina Search and Rescue ----------------------------------------------------------------------- Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- Return-Path: Received: from post-ofc01.srv.cis.pitt.edu (root@post-ofc01.srv.cis.pitt.edu [136.142.185.25]) by imap.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisimap-7.2.2.4) ID ; Mon, 19 Jun 2000 20:15:23 -0400 (EDT) Received: from localhost (root@localhost) by post-ofc01.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Mon, 19 Jun 2000 20:14:50 -0400 (EDT) Received: via switchmail; Mon, 19 Jun 2000 20:14:49 -0400 (EDT) Received: from post-ofc09.srv.cis.pitt.edu via qmail ID ; Mon, 19 Jun 2000 20:14:25 -0400 (EDT) Received: from mb1i0.ns.pitt.edu (mb1i1.ns.pitt.edu [136.142.185.161]) by post-ofc09.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Mon, 19 Jun 2000 20:14:22 -0400 (EDT) Received: from list.srv.cis.pitt.edu (majordom@[136.142.185.20]) by mb1i0.ns.pitt.edu (PMDF V5.2-32 #41462) with ESMTP id <01JQSSUD8BYM000U9N@mb1i0.ns.pitt.edu>; Mon, 19 Jun 2000 20:14:22 EST Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.2) ID ; Mon, 19 Jun 2000 20:12:02 -0400 (EDT) Received: from imo-d09.mx.aol.com (imo-d09.mx.aol.com [205.188.157.41]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.2) ID for ; Mon, 19 Jun 2000 20:11:56 -0400 (EDT) Received: from BjmPAc@aol.com by imo-d09.mx.aol.com (mail_out_v27.10.) id h.c0.53b6538 (4328) for ; Mon, 19 Jun 2000 20:11:13 -0400 (EDT) Date: Mon, 19 Jun 2000 20:11:13 -0400 (EDT) From: BjmPAc@aol.com Subject: Re: W-EMED African Travel Sender: owner-wilderness-emergency-medicine@list.pitt.edu To: wilderness-emergency-medicine@list.pitt.edu Reply-to: wilderness-emergency-medicine@list.pitt.edu Message-id: MIME-version: 1.0 X-Mailer: AOL 5.0 for Windows sub 109 Content-type: text/plain; charset="US-ASCII" Content-transfer-encoding: 7bit Precedence: bulk In a message dated 6/19/00 6:22:08 PM Eastern Daylight Time, pirie@istar.ca writes: << I would also make sure that the "routine" immunizations are up to date... Diphtheria, Pertussis, Tetanus, Measles, Mumps, Rubella, Polio and HIB. >> Steven: Do you recommend HIB for adults? In the US I believe we only give it to infants. Barbara J. Maggiani, PA-C Cape Fear, North Carolina Physician Assistant Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- Return-Path: Received: from post-ofc01.srv.cis.pitt.edu (root@post-ofc01.srv.cis.pitt.edu [136.142.185.25]) by imap.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisimap-7.2.2.4) ID ; Mon, 19 Jun 2000 18:22:20 -0400 (EDT) Received: from localhost (root@localhost) by post-ofc01.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Mon, 19 Jun 2000 18:21:49 -0400 (EDT) Received: via switchmail; Mon, 19 Jun 2000 18:21:48 -0400 (EDT) Received: from post-ofc01.srv.cis.pitt.edu via qmail ID ; Mon, 19 Jun 2000 18:20:09 -0400 (EDT) Received: from mb1i0.ns.pitt.edu (mb1i1.ns.pitt.edu [136.142.185.161]) by post-ofc01.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Mon, 19 Jun 2000 18:20:06 -0400 (EDT) Received: from list.srv.cis.pitt.edu (majordom@[136.142.185.20]) by mb1i0.ns.pitt.edu (PMDF V5.2-32 #41462) with ESMTP id <01JQSOUOUNTS000X8Q@mb1i0.ns.pitt.edu>; Mon, 19 Jun 2000 18:20:06 EST Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.2) ID ; Mon, 19 Jun 2000 18:18:04 -0400 (EDT) Received: from mail1.toronto.istar.net (mail1.toronto.istar.net [209.89.75.17]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.2) ID for ; Mon, 19 Jun 2000 18:18:01 -0400 (EDT) Received: from ip176.ottawa8.dialup.canada.psi.net ([154.5.70.176]) by mail1.toronto.istar.net with smtp (Exim 2.02 #1) id 1349sT-0000p9-00 for wilderness-emergency-medicine@list.pitt.edu; Mon, 19 Jun 2000 18:18:46 -0400 Date: Mon, 19 Jun 2000 18:20:47 -0500 From: pirie@istar.ca (Steven D. Pirie) Subject: W-EMED African Travel Sender: owner-wilderness-emergency-medicine@list.pitt.edu X-Sender: pirie@istar.ca (Unverified) To: wilderness-emergency-medicine@list.pitt.edu Reply-to: wilderness-emergency-medicine@list.pitt.edu Message-id: MIME-version: 1.0 Content-type: text/plain; charset="us-ascii" Precedence: bulk Toby and others, >I'm going to Kenya and Tanzania on a 2 week safari trip That should be quite the trip! Wish I was going with you. >Also, what should I get insofaras immunizations above the required ones >(yellow fever, malaria, and cholera, although cholera isn't officially >required). There is no doubt that Kenya and Tanzania both have real problems with Malaria. There is no IMMUNIZATION for malaria, but there is prophylactic medication that you can take. For both Kenya and Tanzania the currently recommended medication is Mefloquine. Kenya has malaria in all areas (including the game parks). There is little malaria in Nairobi and at areas above 2500 metres. Recently there has been an increase in the incidence of malaria in the costal regions and in other flooded areas. Mefloquine needs to be taken one week before entering a malaria infected area and four weeks after you leave the area. Also worth noting is that there have been case reports of Rift Valley Fever, most of the cases were in remote areas however there were some cases in Nairobi too. Since one way of getting the Fever (as well as malaria) is from Mosquito's you should have some anti-mosquito precautions (e.g. DEET) in place. As you mentioned Cholera is a problem. If you take the immunization it needs to be done 3 weeks apart from Yellow Fever. Yellow fever in Kenya is pretty regional (minimal, if any cases in Nairobi). I still think it is required however to get into Kenya. I would get the Typhoid Fever vaccine if I was going. If you go with the oral vaccine it needs to be taken before you go on the Mefloquine. Hepatitis A is a problem, (needless to say don't drink unpurified water) I would get the immunization for both Hepatitis A and B. Tuberculosis and Schistosomiasis are problems in Kenya. No vaccine, you can't win them all eh? I would also make sure that the "routine" immunizations are up to date... Diphtheria, Pertussis, Tetanus, Measles, Mumps, Rubella, Polio and HIB. Hope that helps, make sure that you visit a traval clinic soon, to get the wheels rolling. Take care and have a safe trip, Steven ----------------------------------------------------------------- Lt. Steven D. Pirie, RN, BScN, UE General Duty Ward Officer - Military In-Patient Unit Canadian Forces Support Unit Ottawa - Civic Hospital Site 2 Health Support Operational Training Unit ----------------------------------------------------------------- Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- Return-Path: Received: from post-ofc01.srv.cis.pitt.edu (root@post-ofc01.srv.cis.pitt.edu [136.142.185.25]) by imap.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisimap-7.2.2.4) ID ; Mon, 19 Jun 2000 15:26:16 -0400 (EDT) Received: from localhost (root@localhost) by post-ofc01.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Mon, 19 Jun 2000 15:25:43 -0400 (EDT) Received: via switchmail; Mon, 19 Jun 2000 15:25:43 -0400 (EDT) Received: from post-ofc01.srv.cis.pitt.edu via qmail ID ; Mon, 19 Jun 2000 15:24:48 -0400 (EDT) Received: from mb2i0.ns.pitt.edu (mb2i1.ns.pitt.edu [136.142.185.162]) by post-ofc01.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Mon, 19 Jun 2000 15:24:45 -0400 (EDT) Received: from list.srv.cis.pitt.edu (majordom@[136.142.185.20]) by mb2i0.ns.pitt.edu (PMDF V5.2-32 #41462) with ESMTP id <01JQSIQ9T8EU000D9U@mb2i0.ns.pitt.edu>; Mon, 19 Jun 2000 15:24:44 EST Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.2) ID ; Mon, 19 Jun 2000 15:23:01 -0400 (EDT) Received: from hotmail.com (oe51.law7.hotmail.com [216.33.236.87]) by list.srv.cis.pitt.edu with SMTP (8.8.8/8.8.8/cisls-7.2.2.2) ID for ; Mon, 19 Jun 2000 15:22:58 -0400 (EDT) Received: (qmail 17107 invoked by uid 65534); Mon, 19 Jun 2000 19:22:27 +0000 Date: Mon, 19 Jun 2000 15:17:42 -0700 From: Craig Button Subject: Re: W-EMED African Travel Sender: owner-wilderness-emergency-medicine@list.pitt.edu To: wilderness-emergency-medicine@list.pitt.edu Reply-to: wilderness-emergency-medicine@list.pitt.edu Message-id: <20000619192227.17106.qmail@hotmail.com> MIME-version: 1.0 X-MIMEOLE: Produced By Microsoft MimeOLE V5.00.2919.6600 X-Mailer: Microsoft Outlook Express 5.00.2919.6600 Content-type: text/plain; charset="iso-8859-1" Content-transfer-encoding: 7bit X-Priority: 3 X-MSMail-priority: Normal Precedence: bulk X-Originating-IP: [12.79.213.138] References: <001601bfda20$75ccfc00$026fa8c0@allconet.org> Try Johns Hopkins. ----- Original Message ----- From: "Tobias Joy" To: Sent: Monday, June 19, 2000 11:59 AM Subject: W-EMED African Travel > Greetings everyone, > > I'm going to Kenya and Tanzania on a 2 week safari trip, starting July > 9th... I was wondering what everyone would suggest as to meds I should > take, what should I have in my first aid kit, and where I should try to > visit if you've been there. > > Also, what should I get insofaras immunizations above the required ones > (yellow fever, malaria, and cholera, although cholera isn't officially > required). Any leads on a "one-stop" immunization place? I can get to > Pittsburgh and down to DC and Baltimore with no problems (the closer to > Cumberland, MD, the better). > > Any help would be greatly appreciated. > > Toby > > Do not reproduce without author's express permission. > To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" > as the body of a message (no subject) To: Majordomo@list.pitt.edu > Submissions To: wilderness-emergency-medicine@list.pitt.edu > Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- Return-Path: Received: from post-ofc04.srv.cis.pitt.edu (root@post-ofc04.srv.cis.pitt.edu [136.142.185.11]) by imap.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisimap-7.2.2.4) ID ; Mon, 19 Jun 2000 17:05:18 -0400 (EDT) Received: from localhost (root@localhost) by post-ofc04.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Mon, 19 Jun 2000 17:04:46 -0400 (EDT) Received: via switchmail; Mon, 19 Jun 2000 17:04:46 -0400 (EDT) Received: from post-ofc01.srv.cis.pitt.edu via qmail ID ; Mon, 19 Jun 2000 17:02:44 -0400 (EDT) Received: from mb1i0.ns.pitt.edu (mb1i1.ns.pitt.edu [136.142.185.161]) by post-ofc01.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Mon, 19 Jun 2000 17:02:41 -0400 (EDT) Received: from list.srv.cis.pitt.edu (majordom@[136.142.185.20]) by mb1i0.ns.pitt.edu (PMDF V5.2-32 #41462) with ESMTP id <01JQSM5MH5E2000ABI@mb1i0.ns.pitt.edu>; Mon, 19 Jun 2000 17:02:37 EST Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.2) ID ; Mon, 19 Jun 2000 16:58:46 -0400 (EDT) Received: from gate1.health.state.ny.us (gate.health.state.ny.us [192.135.176.62]) by list.srv.cis.pitt.edu with SMTP (8.8.8/8.8.8/cisls-7.2.2.2) ID for ; Mon, 19 Jun 2000 16:58:28 -0400 (EDT) Received: by gate1.health.state.ny.us id QAA23925 (InterLock SMTP Gateway 4.2 for wilderness-emergency-medicine@list.pitt.edu) ; Mon, 19 Jun 2000 16:57:57 -0400 Received: by gate1.health.state.ny.us (Internal Mail Agent-1); Mon, 19 Jun 2000 16:57:57 -0400 Date: Mon, 19 Jun 2000 16:57:47 -0400 From: rrt01@health.state.ny.us Subject: Re: W-EMED African Travel Sender: owner-wilderness-emergency-medicine@list.pitt.edu To: wilderness-emergency-medicine@list.pitt.edu Reply-to: wilderness-emergency-medicine@list.pitt.edu Message-id: <200006192057.QAA23925@gate1.health.state.ny.us> MIME-version: 1.0 Content-type: text/plain; charset=us-ascii Content-disposition: inline Precedence: bulk X-Lotus-FromDomain: NYSDOH Check with a travel agent and/or your yellow pages. In Syracuse, NY, we have Travel Health Services. They were a great "one-stop" shop for immunizations and health-related advice when my wife and I went to Ghana for 6 weeks in 1997. It is run by an MD and an NP. I'm sure a similar office must exist in your local area. Good Luck, Raymond R. Thielke, EMT/P "Tobias Joy" on 06/19/2000 02:59:12 PM Please respond to wilderness-emergency-medicine@list.pitt.edu To: wilderness-emergency-medicine@list.pitt.edu cc: (bcc: Raymond R. Thielke/Syracuse/DOH) Subject: W-EMED African Travel Greetings everyone, I'm going to Kenya and Tanzania on a 2 week safari trip, starting July 9th... I was wondering what everyone would suggest as to meds I should take, what should I have in my first aid kit, and where I should try to visit if you've been there. Also, what should I get insofaras immunizations above the required ones (yellow fever, malaria, and cholera, although cholera isn't officially required). Any leads on a "one-stop" immunization place? I can get to Pittsburgh and down to DC and Baltimore with no problems (the closer to Cumberland, MD, the better). Any help would be greatly appreciated. Toby Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- Return-Path: Received: from post-ofc06.srv.cis.pitt.edu (root@post-ofc06.srv.cis.pitt.edu [136.142.185.43]) by imap.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisimap-7.2.2.4) ID ; Mon, 19 Jun 2000 15:05:41 -0400 (EDT) Received: from localhost (root@localhost) by post-ofc06.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Mon, 19 Jun 2000 15:05:07 -0400 (EDT) Received: via switchmail; Mon, 19 Jun 2000 15:05:07 -0400 (EDT) Received: from post-ofc09.srv.cis.pitt.edu via qmail ID ; Mon, 19 Jun 2000 15:04:37 -0400 (EDT) Received: from mb2i0.ns.pitt.edu (mb2i1.ns.pitt.edu [136.142.185.162]) by post-ofc09.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Mon, 19 Jun 2000 15:04:35 -0400 (EDT) Received: from list.srv.cis.pitt.edu (majordom@[136.142.185.20]) by mb2i0.ns.pitt.edu (PMDF V5.2-32 #41462) with ESMTP id <01JQSI17WHW8000B3P@mb2i0.ns.pitt.edu>; Mon, 19 Jun 2000 15:04:32 EST Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.2) ID ; Mon, 19 Jun 2000 15:01:38 -0400 (EDT) Received: from mail.allconet.org ([64.26.80.189]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.2) ID for ; Mon, 19 Jun 2000 15:01:34 -0400 (EDT) Received: from mines1 ([64.26.80.178]) by mail.allconet.org (Netscape Messaging Server 3.62) with SMTP id 178 for ; Mon, 19 Jun 2000 15:04:38 -0400 Date: Mon, 19 Jun 2000 14:59:12 -0400 From: Tobias Joy Subject: W-EMED African Travel In-reply-to: Sender: owner-wilderness-emergency-medicine@list.pitt.edu To: wilderness-emergency-medicine@list.pitt.edu Reply-to: wilderness-emergency-medicine@list.pitt.edu Message-id: <001601bfda20$75ccfc00$026fa8c0@allconet.org> MIME-version: 1.0 X-MIMEOLE: Produced By Microsoft MimeOLE V5.00.2314.1300 X-Mailer: Microsoft Outlook CWS, Build 9.0.2416 (9.0.2911.0) Content-type: text/plain; charset="iso-8859-1" Content-transfer-encoding: 7bit Importance: Normal X-Priority: 3 (Normal) X-MSMail-priority: Normal Precedence: bulk Greetings everyone, I'm going to Kenya and Tanzania on a 2 week safari trip, starting July 9th... I was wondering what everyone would suggest as to meds I should take, what should I have in my first aid kit, and where I should try to visit if you've been there. Also, what should I get insofaras immunizations above the required ones (yellow fever, malaria, and cholera, although cholera isn't officially required). Any leads on a "one-stop" immunization place? I can get to Pittsburgh and down to DC and Baltimore with no problems (the closer to Cumberland, MD, the better). Any help would be greatly appreciated. Toby Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- Return-Path: Received: from post-ofc01.srv.cis.pitt.edu (root@post-ofc01.srv.cis.pitt.edu [136.142.185.25]) by imap.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisimap-7.2.2.3) ID ; Fri, 2 Jun 2000 10:28:19 -0400 (EDT) Received: from localhost (root@localhost) by post-ofc01.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Fri, 2 Jun 2000 10:27:34 -0400 (EDT) Received: via switchmail; Fri, 2 Jun 2000 10:27:33 -0400 (EDT) Received: from list.srv.cis.pitt.edu via qmail ID ; Fri, 2 Jun 2000 10:26:39 -0400 (EDT) Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.1) ID ; Fri, 2 Jun 2000 10:23:14 -0400 (EDT) Received: from imo-r14.mx.aol.com (imo-r14.mx.aol.com [152.163.225.68]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.1) ID for ; Fri, 2 Jun 2000 10:23:11 -0400 (EDT) From: Bushfyre@aol.com Received: from Bushfyre@aol.com by imo-r14.mx.aol.com (mail_out_v27.9.) id h.d.58fb998 (3996) for ; Fri, 2 Jun 2000 10:22:11 -0400 (EDT) Message-ID: Date: Fri, 2 Jun 2000 10:22:10 EDT Subject: W-EMED travel plans To: wilderness-emergency-medicine@list.pitt.edu MIME-Version: 1.0 Content-Type: text/plain; charset="US-ASCII" Content-Transfer-Encoding: 7bit X-Mailer: AOL 5.0 for Windows sub 105 Sender: owner-wilderness-emergency-medicine@list.pitt.edu Precedence: bulk Reply-To: wilderness-emergency-medicine@list.pitt.edu Hello A group of us are going to Colo for a two week backpacking trip Can anyone tell me what over the counter drugs we should be carrying for this extended time and altitude Thanks Stephanie Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- Return-Path: Received: from post-ofc01.srv.cis.pitt.edu (root@post-ofc01.srv.cis.pitt.edu [136.142.185.25]) by imap.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisimap-7.2.2.3) ID ; Thu, 1 Jun 2000 17:56:03 -0400 (EDT) Received: from localhost (root@localhost) by post-ofc01.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Thu, 1 Jun 2000 17:55:28 -0400 (EDT) Received: via switchmail; Thu, 1 Jun 2000 17:55:28 -0400 (EDT) Received: from list.srv.cis.pitt.edu via qmail ID ; Thu, 1 Jun 2000 17:54:32 -0400 (EDT) Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.1) ID ; Thu, 1 Jun 2000 17:51:12 -0400 (EDT) Received: from imo11.mx.aol.com (imo11.mx.aol.com [152.163.225.1]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.1) ID for ; Thu, 1 Jun 2000 17:51:10 -0400 (EDT) From: Mobile9@aol.com Received: from Mobile9@aol.com by imo11.mx.aol.com (mail_out_v27.9.) id h.a9.6569b99 (4187) for ; Thu, 1 Jun 2000 17:50:09 -0400 (EDT) Message-ID: Date: Thu, 1 Jun 2000 17:50:09 EDT Subject: Re: W-EMED Severe Weather Preparedness To: wilderness-emergency-medicine@list.pitt.edu MIME-Version: 1.0 Content-Type: text/plain; charset="US-ASCII" Content-Transfer-Encoding: 7bit X-Mailer: AOL 5.0 for Windows sub 105 Sender: owner-wilderness-emergency-medicine@list.pitt.edu Precedence: bulk Reply-To: wilderness-emergency-medicine@list.pitt.edu In California, at least, the state Office of Emergency Services has model plans and offers on-site advice for schools and such. I understand they have some particularly good information not only about the school setting itself, but about the communications with the emergency service folks who are in that general area. I know our plans call for getting to the schools quickly and then setting up a pretty standard multi-casualty response. The schools have some checklists for the immediate post-event periods. Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- Return-Path: Received: from post-ofc06.srv.cis.pitt.edu (root@post-ofc06.srv.cis.pitt.edu [136.142.185.43]) by imap.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisimap-7.2.2.3) ID ; Thu, 1 Jun 2000 16:46:10 -0400 (EDT) Received: from localhost (root@localhost) by post-ofc06.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Thu, 1 Jun 2000 16:45:34 -0400 (EDT) Received: via switchmail; Thu, 1 Jun 2000 16:45:34 -0400 (EDT) Received: from list.srv.cis.pitt.edu via qmail ID ; Thu, 1 Jun 2000 16:44:46 -0400 (EDT) Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.1) ID ; Thu, 1 Jun 2000 16:41:33 -0400 (EDT) Received: from mb1i0.ns.pitt.edu (mb1i1.ns.pitt.edu [136.142.185.161]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.1) ID for ; Thu, 1 Jun 2000 16:41:30 -0400 (EDT) Received: from micron ("port 1978"@[136.142.21.24]) by mb1i0.ns.pitt.edu (PMDF V5.2-32 #41462) with ESMTP id <01JQ3G65VAB6000C0N@mb1i0.ns.pitt.edu> for wilderness-emergency-medicine@list.pitt.edu; Thu, 1 Jun 2000 16:41:29 EST Date: Thu, 01 Jun 2000 16:41:26 -0400 From: "Keith Conover, M.D., FACEP" Subject: Re: W-EMED Severe Weather Preparedness In-reply-to: <4c.631dc57.26678b58@aol.com> To: Caverbru@aol.com, wilderness-emergency-medicine@list.pitt.edu Message-id: <39369236.29002.6D83FA0@localhost> MIME-version: 1.0 X-Mailer: Pegasus Mail for Win32 (v3.12c) Content-type: text/plain; charset=US-ASCII Content-transfer-encoding: 7BIT Sender: owner-wilderness-emergency-medicine@list.pitt.edu Precedence: bulk Reply-To: wilderness-emergency-medicine@list.pitt.edu On 1 Jun 2000, at 5:48, Caverbru@aol.com wrote: > Second, my school recently had its annual severe weather drill. I > have some question about where some of the students were sent to > stand. Does anyone know which agency should be able to visit my > school and make appropriate recommendations not just guesses, I can > make those. When dealing with similar questions for hospital disaster plans, I've found the National Weather Service people to be quite helpful as well as possessed of expert knowledge. --Keith Conover, M.D., FACEP http://www.pitt.edu/~kconover sent with Pegasus high-security email download free from www.pmail.com Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- Return-Path: Received: from post-ofc07.srv.cis.pitt.edu (root@post-ofc07.srv.cis.pitt.edu [136.142.185.73]) by imap.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisimap-7.2.2.3) ID ; Thu, 1 Jun 2000 05:55:08 -0400 (EDT) Received: from localhost (root@localhost) by post-ofc07.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.3) ID ; Thu, 1 Jun 2000 05:54:32 -0400 (EDT) Received: via switchmail; Thu, 1 Jun 2000 05:54:32 -0400 (EDT) Received: from list.srv.cis.pitt.edu via qmail ID ; Thu, 1 Jun 2000 05:53:03 -0400 (EDT) Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.1) ID ; Thu, 1 Jun 2000 05:48:50 -0400 (EDT) Received: from imo-r19.mx.aol.com (imo-r19.mx.aol.com [152.163.225.73]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.1) ID for ; Thu, 1 Jun 2000 05:48:47 -0400 (EDT) From: Caverbru@aol.com Received: from Caverbru@aol.com by imo-r19.mx.aol.com (mail_out_v27.9.) id h.4c.631dc57 (4537) for ; Thu, 1 Jun 2000 05:48:09 -0400 (EDT) Message-ID: <4c.631dc57.26678b58@aol.com> Date: Thu, 1 Jun 2000 05:48:08 EDT Subject: W-EMED Severe Weather Preparedness To: wilderness-emergency-medicine@list.pitt.edu MIME-Version: 1.0 Content-Type: text/plain; charset="US-ASCII" Content-Transfer-Encoding: 7bit X-Mailer: AOL 5.0 for Windows sub 70 Sender: owner-wilderness-emergency-medicine@list.pitt.edu Precedence: bulk Reply-To: wilderness-emergency-medicine@list.pitt.edu First, I'd like to thank all of you who helped with my question about spider bites. The new Caladryl did the trick. Second, my school recently had its annual severe weather drill. I have some question about where some of the students were sent to stand. Does anyone know which agency should be able to visit my school and make appropriate recommendations not just guesses, I can make those. Thanks, Bru Randall Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- Return-Path: Received: from post-ofc01.srv.cis.pitt.edu (root@post-ofc01.srv.cis.pitt.edu [136.142.185.25]) by imap.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisimap-7.2.2.3) ID ; Mon, 29 May 2000 21:18:47 -0400 (EDT) Received: from localhost (root@localhost) by post-ofc01.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Mon, 29 May 2000 21:18:14 -0400 (EDT) Received: via switchmail; Mon, 29 May 2000 21:18:14 -0400 (EDT) Received: from list.srv.cis.pitt.edu via qmail ID ; Mon, 29 May 2000 21:17:05 -0400 (EDT) Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.1) ID ; Mon, 29 May 2000 21:15:52 -0400 (EDT) Received: from smtp1.vnet.net (smtp1.vnet.net [166.82.1.31]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.1) ID for ; Mon, 29 May 2000 21:15:49 -0400 (EDT) Received: from vnet.net (pool-209-138-138-026-atln.grid.net [209.138.138.26]) by smtp1.vnet.net (8.9.1a/8.9.1) with ESMTP id VAA23935; Mon, 29 May 2000 21:15:42 -0400 (EDT) Message-ID: <3933152B.D1841F97@vnet.net> Date: Mon, 29 May 2000 21:11:08 -0400 From: Sam Chewning X-Mailer: Mozilla 4.03 [en]C-DIAL (Win95; U) MIME-Version: 1.0 To: wilderness-emergency-medicine@list.pitt.edu CC: "Jack T. Grandey" Subject: Re: W-EMED Intraarticular local anaesthetics for shoulder reduction References: <3921B71E.7106.4C93C80@localhost> Content-Type: text/plain; charset=us-ascii Content-Transfer-Encoding: 7bit Sender: owner-wilderness-emergency-medicine@list.pitt.edu Precedence: bulk Reply-To: wilderness-emergency-medicine@list.pitt.edu Keith Conover, M.D., FACEP wrote: > The following article was discussed at the Center for Emergency > Medicine's residency journal club tonight: > > Matthews DE, Roberts T > Intraarticular Lidocaine Versus Intravenous Analgesic for Reduction > of Acute Anterior Shoulder Dislocations: A Prospective > Randomized Study > Am J Sports Med 1995; 23 54-58 > > The technique sounds relatively easy for those with EMT- > P/RN/CRNP/PA/MD/DO training. We also discussed the ideas of: > > - using bupivicaine (Marcaine), particularly in wilderness situations, > > - possibly injecting a small amount (2-4 mg) of morphine to saturate > the endorphin receptors in the joint capsule (has been shown to be > quite effective analgesia by itself), and > > - about the idea of aspirating and discarding blood from the > hemarthrosis to decrease swelling, pain, and later scarring and > limitation of motion. > > >From this small but reasonably good study, it looks as though local > anaesthesia works as well as systemic analgesia. I haven't tried it in > the ED yet, but I certainly will -- and will plan to use it in the > wilderness. If interested, read a copy of the article in your nearby > medical library (it's hard to decipher the photos in a photocopy) to > learn how to do the technique. > > --Keith Conover, M.D., FACEP > http://www.pitt.edu/~kconover > sent with freeware Pegasus high-security email > www.pegasususa.com > Do not reproduce without author's express permission. > To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" > as the body of a message (no subject) To: Majordomo@list.pitt.edu > Submissions To: wilderness-emergency-medicine@list.pitt.edu Intraarticualr injections are doable. Risks: #1 and this is a biggy, INFECTION. The blood in the joint makes a wonderful culture media. Very strict sterile technique should be maintained. #2 the anatomy has been distorted, and the "normal" landmarks are hard to find. This makes these injections somewhat harder for those not used to injecting broken people. #3 Damage to the articular cartilage. Even a 22 gauge needle can do a sig. amount to digging as it is jammed into the hum. head. Bottom line: This is reasonable to do in the ED. , but we have such great and "safe" conc. sedation meds that not only give good pain relief, but wonderful relaxation (a real plus for joint reduction). I am not wild about intraarticular injections becoming a wide spread field practice Sam Chewning, MD Fellow AAOS Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- Return-Path: Received: from post-ofc05.srv.cis.pitt.edu (root@post-ofc05.srv.cis.pitt.edu [136.142.185.10]) by imap.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisimap-7.2.2.3) ID ; Sat, 27 May 2000 14:59:53 -0400 (EDT) Received: from localhost (root@localhost) by post-ofc05.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Sat, 27 May 2000 14:59:05 -0400 (EDT) Received: via switchmail; Sat, 27 May 2000 14:59:05 -0400 (EDT) Received: from list.srv.cis.pitt.edu via qmail ID ; Sat, 27 May 2000 14:57:18 -0400 (EDT) Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.1) ID ; Sat, 27 May 2000 14:54:04 -0400 (EDT) Received: from imo-r19.mx.aol.com (imo-r19.mx.aol.com [152.163.225.73]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.1) ID for ; Sat, 27 May 2000 14:54:02 -0400 (EDT) From: JadedMedic@aol.com Received: from JadedMedic@aol.com by imo-r19.mx.aol.com (mail_out_v27.9.) id h.bc.5ae3052 (4069) for ; Sat, 27 May 2000 14:53:16 -0400 (EDT) Message-ID: Date: Sat, 27 May 2000 14:53:15 EDT Subject: W-EMED Why do we need oxygen at all....really? To: wilderness-emergency-medicine@list.pitt.edu MIME-Version: 1.0 Content-Type: text/plain; charset="US-ASCII" Content-Transfer-Encoding: 7bit X-Mailer: AOL 5.0 for Windows sub 104 Sender: owner-wilderness-emergency-medicine@list.pitt.edu Precedence: bulk Reply-To: wilderness-emergency-medicine@list.pitt.edu Hi WMED, I wrote this for the CPR/AED list (see www.merginet.com for more info on that if you like) and it occurred to me that it might be useful to post it here as well. I hope you like it. Regards, Jay xxxxxxxxxxxxxxxxxxxxxxx Hi folks, I've been mulling things over and doing a bit of reading, and I've found that a few items useful to me keep coming up. Question: Why do we need oxygen at all...really? Answer: We breathe in oxygen so that we can turn it into water. No lie. That is a biochemically correct answer. Actually, what it's really all about is ATP. ATP is the "gasoline" of the cell -- the energy source. If a cell runs out of ATP, several biochemical mechanisms essential to the life of the cell that require this energy cease and the cell begins to suffer damage to its membranes and other structures. If this damage reaches a certain point it become irreversible, even if ATP becomes available again, and now that particular cell is basically doomed. So where does the cell get this ATP? Basically, from glucose. To simplify a bit, if necessary the body can convert fats or proteins either into glucose or into substances that the cells can substitute for glucose -- somewhat -- but it's basically useful to simply assume that the cell gets all of its ATP from glucose. Again, to simplify a bit, all carbohydrates and sugars are ultimately metabolized into glucose if they're going to be used for ATP production. Glucose -- six carbon atoms, twelve hydrogen atoms, six oxygen atoms -- enters a cell by means of a specific process called facilitated diffusion. (This diffusion process is facilitated by insulin. No insulin = greatly reduced entrance of glucose into the cell. This is almost always a Bad Thing.) OK, so insulin got the glucose molecule into the cell. At this point the glucose molecule is split by an enzyme into two molecules of what's called pyruvic acid and two units of ATP. Because oxygen is not necessary for this process -- a process which is actually nearly a dozen steps long -- it's sometimes called "anaerobic glycolysis." ("Glycolysis" is a fancy word that simply means "dissolving sugar.") These two units of ATP are available for immediate use if necessary and are what allow us short "bursts" of high energy such as when we must suddenly sprint for a bus. However, we're gonna need to get a _lot_ more ATP from these two molecules of pyruvic acid if we're gonna get the business of living done, so they are immediately hauled over to the mitochondria and rudely shoved inside -- where the mitochondria promptly proceed to eat them alive. (No screaming has been heard coming from inside the mitochondria, so far, but we're developing better listening devices all the time.) As the mitochondria eat the molecules of pyruvic acid, they spit out their body parts -- molecules of carbon dioxide and the occasional hydrogen atom. They also begin to toss out molecules of ATP, _lots_ of molecules of ATP. In the end, after much biochemical screaming and thrashing, the mitochondria have spit out the pathetic remains of the two molecules of pyruvic acid -- six molecules of carbon dioxide, plus the unharmed but somewhat freaked out twelve hydrogen atoms that were attached to them. (Be nice to them. They're really been through a lot.) The carbon dioxide molecules usually remove themselves fairly easily by simply diffusing out of the cell and then back to the lungs for exhalation. Those hydrogen atoms, however, are another matter. The still-somewhat-shaken-up hydrogen atoms, left to themselves, get lonely and want to go out on dates. When they get lonely and have no dates, they turn into acid. Acid damages the cell. Houston, we have a problem. We gotta get some dates for these hydrogen atoms. Fortunately, we have some volunteers. Oxygen atoms are willing to go out on dates with the hydrogen atoms. Actually, they are so willing to give their all for the cause that they're willing to go out on a date with two hydrogen atoms at once. This give us water. We like water. We like water inside our cell a _whole_ lot more than we like acid inside our cell. Yessir, indeed we do. As so, as long as there are enough amiable oxygen atoms to date the hydrogen atoms, the system works. Actually, the overall equation is: One molecule of glucose (C6, H12, O6) -- I apologize for not being able to do subscripts in this program -- plus six molecules of molecules of oxygen (6 O2) yields six molecules of carbon dioxide (6 CO2) plus six molecules of water (6 H2O). Oh yeah, it also yields a grand total of 38 new molecules of ATP. That should keep us fueled for a while. (Oh, hey, by the way, about 60% of the total energy generated by this whole process is given off as heat. This heat helps keep us warm. We like being warm.) The water molecules leave the cell on their date, and all is well. (Psssst! These are actually one-way dates. The hydrogen atoms are in fact "being take for a ride" and won't be coming back. Don't warn the hydrogen atoms about that, OK?) Now all we need are some more oxygen atom volunteers to date the freshly arrived hydrogen atoms. Sigh, a cellular social director's work is just never done. So, in terms of oxygen therapy, what we _really_ need down here in the cell is to have enough new oxygen atoms on hand to date the new hydrogen atoms as they arrive. You try to can send more if you want, but we may not be able to use them, and if you try to send us a "hurricane" of them, then I'm afraid that most of the poor dears won't even make it into the cell (or even make it from the alveoli into the blood that eventually comes to the cell), let alone make it into the mitochondria for a date, and we do so hate to send such willing volunteers away dateless. But please do make sure that you keep us supplied with that basic minimum. Most of the time, that's the _really_ important part. Just FYI, due to the shape of the oxyhemoglobin dissociation curve, that essential minimum tends to correspond with an arterial pO2 of 60 mmHg, and that tends to correspond with a pulseox of 90%. That's all for now. Regards, Jay Wiseman FA/CPR Instructor at large Owner of "Jay's Molecular Dating Service" -- now offering membership to oxygen atoms [Duck! Here it comes!] at special reduced rates. Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- Return-Path: Received: from post-ofc09.srv.cis.pitt.edu (root@post-ofc09.srv.cis.pitt.edu [136.142.185.57]) by imap.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisimap-7.2.2.3) ID for ; Fri, 26 May 2000 11:23:39 -0400 (EDT) Received: from localhost (root@localhost) by post-ofc09.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.2) ID for kconover@imap.pitt.edu; Fri, 26 May 2000 11:23:38 -0400 (EDT) Received: via switchmail for kconover+@pitt.edu; Fri, 26 May 2000 11:23:38 -0400 (EDT) Received: from buzz.slic.com (qmailr@eagle.slic.com [216.73.13.5]) by post-ofc09.srv.cis.pitt.edu with SMTP (8.8.8/8.8.8/cispo-7.2.2.2) ID for ; Fri, 26 May 2000 11:23:37 -0400 (EDT) Received: (qmail 1276 invoked from network); 26 May 2000 15:36:18 -0000 Received: from saratoga-async46.slic.com (HELO oemcomputer) (216.207.140.46) by eagle.slic.com with SMTP; 26 May 2000 15:36:18 -0000 Message-ID: <000b01bfc727$e1805840$2e8ccfd8@oemcomputer> From: "Michelle Schonzeit" To: References: <392D37F4.3820.10D34F51@localhost> Subject: Re: SAR Ready Packs Date: Fri, 26 May 2000 11:34:25 -0400 MIME-Version: 1.0 Content-Type: text/plain; charset="iso-8859-1" Content-Transfer-Encoding: 7bit X-Priority: 3 X-MSMail-Priority: Normal X-Mailer: Microsoft Outlook Express 5.00.2014.211 X-MimeOLE: Produced By Microsoft MimeOLE V5.00.2014.211 > On 3 May 2000, at 9:19, Michelle Schonzeit wrote: > > > As far as the turkey baster, while I've never had to use it in the > > field, I have tested with just suctioning water out of a glass, and > > that doesn't *seem* to work bad. > > In all seriousness I suggest you try it on partially-digested > spaghetti and meatballs with teeth and blood clots. > > --Keith Conover, M.D., FACEP > http://www.pitt.edu/~kconover > sent with Pegasus high-security email > download free from www.pmail.com Thanks. Point very well taken! Michelle Schonzeit Whiteface Mt. Ski Patrol - Search and Rescue of the Northern Adirondacks http://www.angelfire.com/mt/schonzeit -- End -- Return-Path: Received: from post-ofc02.srv.cis.pitt.edu (root@post-ofc02.srv.cis.pitt.edu [136.142.185.24]) by imap.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisimap-7.2.2.3) ID ; Sun, 21 May 2000 16:17:07 -0400 (EDT) Received: from localhost (root@localhost) by post-ofc02.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Sun, 21 May 2000 16:16:30 -0400 (EDT) Received: via switchmail; Sun, 21 May 2000 16:16:29 -0400 (EDT) Received: from list.srv.cis.pitt.edu via qmail ID ; Sun, 21 May 2000 16:15:46 -0400 (EDT) Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.1) ID ; Sun, 21 May 2000 16:12:06 -0400 (EDT) Received: from mb2i0.ns.pitt.edu (mb2i1.ns.pitt.edu [136.142.185.162]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.1) ID for ; Sun, 21 May 2000 16:12:03 -0400 (EDT) Received: from micron ("port 1056"@[136.142.23.193]) by mb2i0.ns.pitt.edu (PMDF V5.2-32 #41462) with ESMTP id <01JPO1WW5NYQ001EQ2@mb2i0.ns.pitt.edu> for wilderness-emergency-medicine@list.pitt.edu; Sun, 21 May 2000 16:12:03 EST Date: Sun, 21 May 2000 16:12:01 -0400 From: "Keith Conover, M.D., FACEP" Subject: W-EMED (Fwd) Re: Inhalational rewarming devices To: wilderness-emergency-medicine@list.pitt.edu Message-id: <39280AD1.6863.4B85A7@localhost> MIME-version: 1.0 X-Mailer: Pegasus Mail for Win32 (v3.12c) Content-type: text/plain; charset=US-ASCII Content-transfer-encoding: 7BIT Sender: owner-wilderness-emergency-medicine@list.pitt.edu Precedence: bulk Reply-To: wilderness-emergency-medicine@list.pitt.edu Forwarded with permission. ------- Forwarded message follows ------- From: Keith Conover, M.D., FACEP To: Jel Coward Subject: Re: Inhalational rewarming devices Copies to: Jack Grandey Send reply to: kconover+@pitt.edu Date sent: Sun, 21 May 2000 11:41:36 -0400 On 21 May 2000, at 16:00, Jel Coward wrote: > Our MR teams here have just been issued with Little Dragon > inhalational re-warming devices > > They work via CO2 being added to soda lime and produce warm/hot > humified air (and can have O2 added as well) > > They can get quite hot (up to about 55 degC) > > I have looked around but am struggling to find much background on > them. My gut feeling is that they are quite heavy and probably offer > little to the hypothermic casualty > > Do you guys have any information on inhalational rewarming in the > field and/or these type of devices that you could point me towards Inhalational rewarming with warm, humidified air has been shown to be safe but only mildly effective in hypothermia rewarming. However, the "only mildly effective" has been in room-temperature settings, and I am sure that it works much better in cold ambient temperatures, as it prevents a major source of heat loss in a well- packaged litter patient, i.e., respiratory heat loss. However, I've tried some of these systems and they are clumsy and not well-tolerated by patients who don't want anything over their face -- although I've had some success with putting a thin wool scarf across the patient's nose and mouth which serves as a "rebreathe flap" -- the moisture or ice that forms on the scarf humidifies the incoming air and thus decreases heat loss. Remember, most of the heat lost in respiration is from evaporation, not from the heat content of dry or even moist air. But in terms of amount of heat added to a cold mountain/cave rescue patient per unit weight that you have to carry, the HeatPac charcoal vest, despite Sterba's complaints (see reference below), still is the best in my opinion. Details about the HeatPac are available on my web site, URL below. I will also paste in at the bottom a bibliography of some of the literature that leads me to these conclusions. So, the little dragon is probably OK but may not be significantly better than an equivalent weight of hot packs. But if you have lots of people to hump gear, use it! And, with your kind permission, I'd like to send your question and my reply to the wilderness-emergency-medicine list. Take care. White JD, Butterfield AB, Nucci RC, Johnson C. Rewarming in accidental hypothermia: radio-wave versus inhalation therapy. Ann Emerg Med 1986; 16:50- 54. White JD, Butterfield AB, Nucci RC, Johnson C. Rewarming in immersion hypothermia: radio-wave and inhalation therapy. Resuscitation 1986; 14:141-148. Sterba JA. Efficacy and safety of prehospital techniques to treat accidental hypothermia. J Emerg Med 1991; 20:896-901. Lloyd EL. Airway rewarming in the treatment of accidental hypothermia: a review. J Wild Med 1990; 1:65-78. Lloyd EL. Hypothermia and cold. Sci Prog 1989; 73:101- 116. Lloyd EL. Hypothermia and cold stress. Rockville, MD: Aspen Systems Corporation, 1986. Lloyd EL. Treatment of accidental hypothermia [letter]. BMJ 1979; 1:413-414. Lloyd EL. Accidental hypothermia: central rewarming in the field [letter]. BMJ 1974; 4:83-91. Kaufman JW, Hamilton R, Dejneka KY, Askew GK. Comparative effectiveness of hypothermia rewarming techniques: radio frequency energy vs. warm water. Resuscitation 1995; 29:203-14. Hayward JS, Eckerson JD, Kemna D. Thermal and cardiovascular changes during three methods of resuscitation from mild hypothermia. Resuscitation 1984; 11:21-33. ------- End of forwarded message ------- --Keith Conover, M.D., FACEP http://www.pitt.edu/~kconover sent with Pegasus high-security email download free from www.pmail.com Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- Return-Path: Received: from post-ofc06.srv.cis.pitt.edu (root@post-ofc06.srv.cis.pitt.edu [136.142.185.43]) by imap.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisimap-7.2.2.3) ID ; Tue, 16 May 2000 21:07:15 -0400 (EDT) Received: from localhost (root@localhost) by post-ofc06.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Tue, 16 May 2000 21:06:41 -0400 (EDT) Received: via switchmail; Tue, 16 May 2000 21:06:41 -0400 (EDT) Received: from list.srv.cis.pitt.edu via qmail ID ; Tue, 16 May 2000 21:05:58 -0400 (EDT) Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.1) ID ; Tue, 16 May 2000 21:04:52 -0400 (EDT) Received: from mb1i0.ns.pitt.edu (mb1i1.ns.pitt.edu [136.142.185.161]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.1) ID for ; Tue, 16 May 2000 21:04:45 -0400 (EDT) Received: from micron ("port 1262"@[136.142.20.180]) by mb1i0.ns.pitt.edu (PMDF V5.2-32 #41462) with ESMTP id <01JPHCKTRVQI000PP0@mb1i0.ns.pitt.edu> for wilderness-emergency-medicine@list.pitt.edu; Tue, 16 May 2000 21:01:22 EST Date: Tue, 16 May 2000 21:01:18 -0400 From: "Keith Conover, M.D., FACEP" Subject: W-EMED Intraarticular local anaesthetics for shoulder reduction To: wilderness-emergency-medicine@list.pitt.edu Message-id: <3921B71E.7106.4C93C80@localhost> MIME-version: 1.0 X-Mailer: Pegasus Mail for Win32 (v3.12c) Content-type: text/plain; charset=US-ASCII Content-transfer-encoding: 7BIT Sender: owner-wilderness-emergency-medicine@list.pitt.edu Precedence: bulk Reply-To: wilderness-emergency-medicine@list.pitt.edu The following article was discussed at the Center for Emergency Medicine's residency journal club tonight: Matthews DE, Roberts T Intraarticular Lidocaine Versus Intravenous Analgesic for Reduction of Acute Anterior Shoulder Dislocations: A Prospective Randomized Study Am J Sports Med 1995; 23 54-58 The technique sounds relatively easy for those with EMT- P/RN/CRNP/PA/MD/DO training. We also discussed the ideas of: - using bupivicaine (Marcaine), particularly in wilderness situations, - possibly injecting a small amount (2-4 mg) of morphine to saturate the endorphin receptors in the joint capsule (has been shown to be quite effective analgesia by itself), and - about the idea of aspirating and discarding blood from the hemarthrosis to decrease swelling, pain, and later scarring and limitation of motion. From this small but reasonably good study, it looks as though local anaesthesia works as well as systemic analgesia. I haven't tried it in the ED yet, but I certainly will -- and will plan to use it in the wilderness. If interested, read a copy of the article in your nearby medical library (it's hard to decipher the photos in a photocopy) to learn how to do the technique. --Keith Conover, M.D., FACEP http://www.pitt.edu/~kconover sent with freeware Pegasus high-security email www.pegasususa.com Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- Return-Path: Received: from post-ofc01.srv.cis.pitt.edu (root@post-ofc01.srv.cis.pitt.edu [136.142.185.25]) by imap.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisimap-7.2.2.3) ID ; Sun, 14 May 2000 12:31:12 -0400 (EDT) Received: from localhost (root@localhost) by post-ofc01.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Sun, 14 May 2000 12:30:40 -0400 (EDT) Received: via switchmail; Sun, 14 May 2000 12:30:39 -0400 (EDT) Received: from list.srv.cis.pitt.edu via qmail ID ; Sun, 14 May 2000 12:29:29 -0400 (EDT) Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.1) ID ; Sun, 14 May 2000 12:25:46 -0400 (EDT) Received: from hotmail.com (f191.law7.hotmail.com [216.33.237.191]) by list.srv.cis.pitt.edu with SMTP (8.8.8/8.8.8/cisls-7.2.2.1) ID for ; Sun, 14 May 2000 12:25:43 -0400 (EDT) Received: (qmail 50625 invoked by uid 0); 14 May 2000 16:25:12 -0000 Message-ID: <20000514162512.50624.qmail@hotmail.com> Received: from 12.79.212.152 by www.hotmail.com with HTTP; Sun, 14 May 2000 09:25:12 PDT X-Originating-IP: [12.79.212.152] From: "Craig Button" To: wilderness-emergency-medicine@list.pitt.edu Subject: W-EMED Nurses Date: Sun, 14 May 2000 12:25:12 EDT Mime-Version: 1.0 Content-Type: text/plain; format=flowed Sender: owner-wilderness-emergency-medicine@list.pitt.edu Precedence: bulk Reply-To: wilderness-emergency-medicine@list.pitt.edu Just wondering how many nurses out there are involved in WEMS. Specificly how much trouble if any you had with the State Nurse Practicc Act and the WEMT Thanks, Craig ________________________________________________________________________ Get Your Private, Free E-mail from MSN Hotmail at http://www.hotmail.com Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- Return-Path: Received: from post-ofc05.srv.cis.pitt.edu (root@post-ofc05.srv.cis.pitt.edu [136.142.185.10]) by imap.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisimap-7.2.2.3) ID ; Thu, 11 May 2000 16:21:31 -0400 (EDT) Received: from localhost (root@localhost) by post-ofc05.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Thu, 11 May 2000 16:18:10 -0400 (EDT) Received: via switchmail; Thu, 11 May 2000 16:18:10 -0400 (EDT) Received: from list.srv.cis.pitt.edu via qmail ID ; Thu, 11 May 2000 16:17:53 -0400 (EDT) Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.1) ID ; Thu, 11 May 2000 16:17:32 -0400 (EDT) Received: from inago.swcp.com (inago.swcp.com [198.59.115.17]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.1) ID for ; Thu, 11 May 2000 16:17:28 -0400 (EDT) Received: from localhost (tanman@localhost) by inago.swcp.com (8.8.7/8.8.7) with ESMTP id OAA20158 for ; Thu, 11 May 2000 14:17:27 -0600 (MDT) X-Authentication-Warning: inago.swcp.com: tanman owned process doing -bs Date: Thu, 11 May 2000 14:17:27 -0600 (MDT) From: TANMAN To: wilderness-emergency-medicine@list.pitt.edu Subject: RE: W-EMED The Los Alamos Fire In-Reply-To: <000001bfbb7b$76ea47a0$7b98490c@marlowmacht> Message-ID: MIME-Version: 1.0 Content-Type: TEXT/PLAIN; charset=US-ASCII Sender: owner-wilderness-emergency-medicine@list.pitt.edu Precedence: bulk Reply-To: wilderness-emergency-medicine@list.pitt.edu Marlow, They could use you out here. Many of the radio stations and three of the TV stations have the disaster on continuous, as it is getting worse. The winds are increasing and 3 more cities are getting evacuated. Only one accident so far, a fire fighter fell and broke his heel. It is well over 20,000 acres and still growing. There are 3 major fires out here now, Los Alamos, Grand Canyon and Ruidoso, all out of control. Thomas A. Naegele, DO Internet 9405 Lagrima de Oro NE 505-275-7267 Albuquerque, NM 87111 Board Certified Family Practice/Board Certified Quality Assurance MEDICAL WHITE PAPERS MAGAZINE FOR COMMUNITY PHYSICIANS http://www.swcp.com/~tanman/ FOR HUB Information Call MIKE at 303-220-1073 __________________________________________________________________ Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- Return-Path: Received: from post-ofc01.srv.cis.pitt.edu (root@post-ofc01.srv.cis.pitt.edu [136.142.185.25]) by imap.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisimap-7.2.2.3) ID ; Thu, 11 May 2000 15:08:55 -0400 (EDT) Received: from localhost (root@localhost) by post-ofc01.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Thu, 11 May 2000 15:08:22 -0400 (EDT) Received: via switchmail; Thu, 11 May 2000 15:08:22 -0400 (EDT) Received: from list.srv.cis.pitt.edu via qmail ID ; Thu, 11 May 2000 15:06:40 -0400 (EDT) Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.1) ID ; Thu, 11 May 2000 15:06:23 -0400 (EDT) Received: from mtiwmhc26.worldnet.att.net (mtiwmhc26.worldnet.att.net [204.127.131.51]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.1) ID for ; Thu, 11 May 2000 15:06:20 -0400 (EDT) Received: from marlowmacht ([12.73.152.123]) by mtiwmhc26.worldnet.att.net (InterMail vM.4.01.02.39 201-229-119-122) with SMTP id <20000511190548.MMLR9011.mtiwmhc26.worldnet.att.net@marlowmacht> for ; Thu, 11 May 2000 19:05:48 +0000 From: "Marlow MACHT" To: Subject: RE: W-EMED The Los Alamos Fire Date: Thu, 11 May 2000 12:02:33 -0700 Message-ID: <000001bfbb7b$76ea47a0$7b98490c@marlowmacht> MIME-Version: 1.0 Content-Type: text/plain; charset="iso-8859-1" Content-Transfer-Encoding: 7bit X-Priority: 3 (Normal) X-MSMail-Priority: Normal X-Mailer: Microsoft Outlook 8.5, Build 4.71.2173.0 In-reply-to: Importance: Normal X-MimeOLE: Produced By Microsoft MimeOLE V5.00.2919.6600 Sender: owner-wilderness-emergency-medicine@list.pitt.edu Precedence: bulk Reply-To: wilderness-emergency-medicine@list.pitt.edu Dr. Naegele: > If you are in a fire crew and there are 100 houses burning, > where does one start? At the risk of being off-topic, I'll respond. (My background: I fought forest fires for 8 years, 4 on hotshot crews and the last 2 as a helicopter manager with the Alaska Fire Service.) Just as you would with an MCI, you triage. In well-prepared fire districts, the responding agency has pre-attack plan, noting water sources, roof types, and relevant landscaping. A pre-attack plan allows you to triage quickly. However, in many places, triage happens when it first appears the fire might threaten structures. Firefighters go through the neighborhood and assess which ones are protectable. (Examples: shake shingles, trees overhanging the roof, an LPG tank and 3 snowmobiles, fire 10 minutes out--let it burn. Aluminum roof, trees well away from house, well-watered lawn: leave it, or just set up a sprinkler system if time permits--it won't burn anyway. Structures somewhere between those extremes may get some attention.) Wildland firefighters protect structures by setting up sprinkler systems to wet the surrounding area, covering the structures with a wrap (of the same material as the fire shelters), and thinning the fuel around the structures. In some cases, engines will set up around individual houses. This kind of defensive firefighting (as opposed starting at the cold heel of the fire and attacking the hot flanks) is very resource-intensive. Just as you wouldn't focus all your resources on one patient in an MCI, it's rare for a single burning house get attention when a whole neighborhood is threatened. I hope this is helpful. Other wildland people, feel free to correct and add. Marlow Macht, BS, EMT-B Paramedic Student Oregon Health Sciences University Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- Return-Path: Received: from post-ofc06.srv.cis.pitt.edu (root@post-ofc06.srv.cis.pitt.edu [136.142.185.43]) by imap.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisimap-7.2.2.3) ID ; Thu, 11 May 2000 11:57:00 -0400 (EDT) Received: from localhost (root@localhost) by post-ofc06.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Thu, 11 May 2000 11:56:23 -0400 (EDT) Received: via switchmail; Thu, 11 May 2000 11:56:23 -0400 (EDT) Received: from list.srv.cis.pitt.edu via qmail ID ; Thu, 11 May 2000 11:54:54 -0400 (EDT) Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.1) ID ; Thu, 11 May 2000 11:54:33 -0400 (EDT) Received: from imo24.mx.aol.com (imo24.mx.aol.com [152.163.225.68]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.1) ID for ; Thu, 11 May 2000 11:54:29 -0400 (EDT) From: Omikid@aol.com Received: from Omikid@aol.com by imo24.mx.aol.com (mail_out_v26.7.) id h.96.4a97727 (4240) for ; Thu, 11 May 2000 11:53:57 -0400 (EDT) Message-ID: <96.4a97727.264c3195@aol.com> Date: Thu, 11 May 2000 11:53:57 EDT Subject: Re: W-EMED The Los Alamos Fire To: wilderness-emergency-medicine@list.pitt.edu MIME-Version: 1.0 Content-Type: text/plain; charset="US-ASCII" Content-Transfer-Encoding: 7bit X-Mailer: AOL 5.0 for Windows sub 105 Sender: owner-wilderness-emergency-medicine@list.pitt.edu Precedence: bulk Reply-To: wilderness-emergency-medicine@list.pitt.edu My thoughts and prayers are with you and all of those affected. Love, Naomi Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- Return-Path: Received: from post-ofc03.srv.cis.pitt.edu (root@post-ofc03.srv.cis.pitt.edu [136.142.185.39]) by imap.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisimap-7.2.2.3) ID ; Thu, 11 May 2000 11:17:28 -0400 (EDT) Received: from localhost (root@localhost) by post-ofc03.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Thu, 11 May 2000 11:16:49 -0400 (EDT) Received: via switchmail; Thu, 11 May 2000 11:16:49 -0400 (EDT) Received: from list.srv.cis.pitt.edu via qmail ID ; Thu, 11 May 2000 11:10:51 -0400 (EDT) Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.1) ID ; Thu, 11 May 2000 11:10:39 -0400 (EDT) Received: from mb2i0.ns.pitt.edu (mb2i1.ns.pitt.edu [136.142.185.162]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.1) ID for ; Thu, 11 May 2000 11:10:36 -0400 (EDT) Received: from micron ("port 1149"@[136.142.23.206]) by mb2i0.ns.pitt.edu (PMDF V5.2-32 #41462) with ESMTP id <01JP9SHOL2ZM000DF5@mb2i0.ns.pitt.edu> for wilderness-emergency-medicine@list.pitt.edu; Thu, 11 May 2000 11:10:36 EST Date: Thu, 11 May 2000 11:10:32 -0400 From: "Keith Conover, M.D., FACEP" Subject: Re: sounds like a Brown Recluse Spider! Re: W-EMED Spider bite or something In-reply-to: <54.3b3fb28.264b91fb@aol.com> To: Caverbru@aol.com, wilderness-emergency-medicine@list.pitt.edu Message-id: <391A9528.30059.35B5B2B@localhost> MIME-version: 1.0 X-Mailer: Pegasus Mail for Win32 (v3.12c) Content-type: text/plain; charset=US-ASCII Content-transfer-encoding: 7BIT Sender: owner-wilderness-emergency-medicine@list.pitt.edu Precedence: bulk Reply-To: wilderness-emergency-medicine@list.pitt.edu On 11 May 2000, at 0:32, Caverbru@aol.com wrote: > Thank you all. > We thought a BRS bite would be bigger and nastier. We are keeping an > eye on it. It seems to be getting less red and no black center is > developing. We'll get some of new version Caladryl that Keith > mentioned. As with snakebite, there are sometime partial envenomations. Too, there are many toxic spiders out there -- al of them! Spiders, with rare exceptions, use poison for hunting and defense. So it could be not a brown recluse bite, but a "garden spider" bite (garbage term for other large spiders, many species), or a taupe recluse bite, or a beige recluse bite, or . . . Anyway, you get the point. The clinical appearance of the bite is what's most important. And if it's geting better, you don't need to worry about any specific treatment, just expect it to take a long time to heal. BTW, if you _know_ you were bitten by a brown recluse, there is evidence that, unlike with North American Pit Vipers, cold packs will help. (see http://www.netmedicine.com/img/img0043.jpg for a picture of the bite, and http://www.netmedicine.com/img/img0047.jpg for a picture of the spider), : 1. King LE, Jr., Rees RS. Brown recluse spider bites: stay cool. JAMA 1985; 254:2895-2896. --Keith Conover, M.D., FACEP http://www.pitt.edu/~kconover Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- Return-Path: Received: from post-ofc05.srv.cis.pitt.edu (root@post-ofc05.srv.cis.pitt.edu [136.142.185.10]) by imap.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisimap-7.2.2.3) ID ; Thu, 11 May 2000 10:27:33 -0400 (EDT) Received: from localhost (root@localhost) by post-ofc05.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Thu, 11 May 2000 10:26:59 -0400 (EDT) Received: via switchmail; Thu, 11 May 2000 10:26:59 -0400 (EDT) Received: from list.srv.cis.pitt.edu via qmail ID ; Thu, 11 May 2000 10:25:26 -0400 (EDT) Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.1) ID ; Thu, 11 May 2000 10:24:47 -0400 (EDT) Received: from inago.swcp.com (inago.swcp.com [198.59.115.17]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.1) ID for ; Thu, 11 May 2000 10:24:44 -0400 (EDT) Received: from localhost (tanman@localhost) by inago.swcp.com (8.8.7/8.8.7) with ESMTP id IAA16168 for ; Thu, 11 May 2000 08:24:43 -0600 (MDT) X-Authentication-Warning: inago.swcp.com: tanman owned process doing -bs Date: Thu, 11 May 2000 08:24:43 -0600 (MDT) From: TANMAN To: wilderness-emergency-medicine@list.pitt.edu Subject: W-EMED The Los Alamos Fire In-Reply-To: <38F24F4500000062@hotweb.notesdomino.com> (added by hotweb.notesdomino.com) Message-ID: MIME-Version: 1.0 Content-Type: TEXT/PLAIN; charset=US-ASCII Sender: owner-wilderness-emergency-medicine@list.pitt.edu Precedence: bulk Reply-To: wilderness-emergency-medicine@list.pitt.edu Living just south of the Los Alamos fire, the rescue and fire crews are coming in from all over. The winds are picking up and the situation is turning from bad to worse, as more towns and cities are being evacuated. If you are in a fire crew and there are 100 houses burning, where does one start? Thomas A. Naegele, DO Internet 9405 Lagrima de Oro NE 505-275-7267 Albuquerque, NM 87111 Board Certified Family Practice/Board Certified Quality Assurance MEDICAL WHITE PAPERS MAGAZINE FOR COMMUNITY PHYSICIANS http://www.swcp.com/~tanman/ FOR HUB Information Call MIKE at 303-220-1073 __________________________________________________________________ Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- Return-Path: Received: from post-ofc03.srv.cis.pitt.edu (root@post-ofc03.srv.cis.pitt.edu [136.142.185.39]) by imap.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisimap-7.2.2.3) ID ; Thu, 11 May 2000 00:35:18 -0400 (EDT) Received: from localhost (root@localhost) by post-ofc03.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Thu, 11 May 2000 00:34:40 -0400 (EDT) Received: via switchmail; Thu, 11 May 2000 00:34:40 -0400 (EDT) Received: from list.srv.cis.pitt.edu via qmail ID ; Thu, 11 May 2000 00:34:04 -0400 (EDT) Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.1) ID ; Thu, 11 May 2000 00:33:36 -0400 (EDT) Received: from imo20.mx.aol.com (imo20.mx.aol.com [152.163.225.10]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.1) ID for ; Thu, 11 May 2000 00:33:32 -0400 (EDT) From: Caverbru@aol.com Received: from Caverbru@aol.com by imo20.mx.aol.com (mail_out_v26.7.) id h.54.3b3fb28 (14380) for ; Thu, 11 May 2000 00:32:59 -0400 (EDT) Message-ID: <54.3b3fb28.264b91fb@aol.com> Date: Thu, 11 May 2000 00:32:59 EDT Subject: Re: sounds like a Brown Recluse Spider! Re: W-EMED Spider bite or something To: wilderness-emergency-medicine@list.pitt.edu MIME-Version: 1.0 Content-Type: text/plain; charset="US-ASCII" Content-Transfer-Encoding: 7bit X-Mailer: AOL 5.0 for Windows sub 70 Sender: owner-wilderness-emergency-medicine@list.pitt.edu Precedence: bulk Reply-To: wilderness-emergency-medicine@list.pitt.edu Thank you all. We thought a BRS bite would be bigger and nastier. We are keeping an eye on it. It seems to be getting less red and no black center is developing. We'll get some of new version Caladryl that Keith mentioned. Thanks again, Bru Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- Return-Path: Received: from post-ofc01.srv.cis.pitt.edu (root@post-ofc01.srv.cis.pitt.edu [136.142.185.25]) by imap.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisimap-7.2.2.3) ID ; Wed, 10 May 2000 21:12:08 -0400 (EDT) Received: from localhost (root@localhost) by post-ofc01.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Wed, 10 May 2000 21:11:35 -0400 (EDT) Received: via switchmail; Wed, 10 May 2000 21:11:35 -0400 (EDT) Received: from list.srv.cis.pitt.edu via qmail ID ; Wed, 10 May 2000 21:10:49 -0400 (EDT) Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.1) ID ; Wed, 10 May 2000 21:10:15 -0400 (EDT) Received: from hotweb.notesdomino.com ([209.150.239.206]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.1) ID for ; Wed, 10 May 2000 21:10:10 -0400 (EDT) Received: from officeweb (209.150.235.205) by hotweb.notesdomino.com (Worldmail 1.3.167); 10 May 2000 21:10:03 -0400 Message-ID: <38F24F4500000062@hotweb.notesdomino.com> (added by hotweb.notesdomino.com) X-Sender: ndh@pop3.lightlink.com X-Mailer: QUALCOMM Windows Eudora Pro Version 4.0 Date: Wed, 10 May 2000 21:09:15 -0400 To: wilderness-emergency-medicine@list.pitt.edu, Caverbru@aol.com From: nigel dyson-hudson Subject: sounds like a Brown Recluse Spider! Re: W-EMED Spider bite or something In-Reply-To: <3f.491aa08.264a9ade@aol.com> Mime-Version: 1.0 Content-Type: text/plain; charset="us-ascii" Sender: owner-wilderness-emergency-medicine@list.pitt.edu Precedence: bulk Reply-To: wilderness-emergency-medicine@list.pitt.edu Sounds like a Brown Recluse Spider! Kind of like the black fly of spiders, tiny in size with large sized bite reaction. The bite is very nasty. Brady, Paramedic Emergency Care, p 822 in 3rd ed. Now, for the Docs. nigel At 06:58 AM 05/10/2000 -0400, you wrote: >Greetings to all, >I am looking for information on insect bites, most probably a spider bite. >I've looked through my WEMT notes and a few other wilderness medicine books >and had little luck since they mostly refer to Black Widow and Brown Recluse >bites. > >This past Saturday evening my wife felt a bite on her arm similar to a >mosquito bite and brushed it away. Sunday morning she notice a small, 1cm >diameter, red spot where the bite had been. By the time we got Sunday night >the red spot was now about 3 cm in diameter with a 2 or 3 mm diameter white >head in the middle. Over the next 48 hours the redness increased in diameter >to 4 cm x 5 cm with a 1 cm diameter darker red center the white head has >popped several times and it is itching. At this point, finally deciding that >it wasn't going away and with it becoming more annoying we treated it with >topical Hydrocortisone cream, 1%, and oral Benadryl. This morning, now 80 >hours since the bite, the presentation is the same as it was last night. > >Any ideas? Was this a spider or something else? Suggestions on treatment if >any? My wife is reluctant to go to a doctor since it is only an annoyance at >this point. > >I welcome your comments. >Bru Randall >Pittsburgh, PA >Do not reproduce without author's express permission. >To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" >as the body of a message (no subject) To: Majordomo@list.pitt.edu >Submissions To: wilderness-emergency-medicine@list.pitt.edu > nigel dyson-hudson, InternetSmiths, ndh@InternetSmiths.com "mad dogs and Englishmen" and I am both! Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- Return-Path: Received: from post-ofc06.srv.cis.pitt.edu (root@post-ofc06.srv.cis.pitt.edu [136.142.185.43]) by imap.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisimap-7.2.2.3) ID ; Wed, 10 May 2000 10:43:48 -0400 (EDT) Received: from localhost (root@localhost) by post-ofc06.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Wed, 10 May 2000 10:43:12 -0400 (EDT) Received: via switchmail; Wed, 10 May 2000 10:43:11 -0400 (EDT) Received: from list.srv.cis.pitt.edu via qmail ID ; Wed, 10 May 2000 10:41:09 -0400 (EDT) Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.1) ID ; Wed, 10 May 2000 10:40:47 -0400 (EDT) Received: from imo20.mx.aol.com (imo20.mx.aol.com [152.163.225.10]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.1) ID for ; Wed, 10 May 2000 10:40:43 -0400 (EDT) From: BjmPAc@aol.com Received: from BjmPAc@aol.com by imo20.mx.aol.com (mail_out_v26.7.) id h.6.5c39a34 (4333) for ; Wed, 10 May 2000 10:40:08 -0400 (EDT) Message-ID: <6.5c39a34.264acec8@aol.com> Date: Wed, 10 May 2000 10:40:08 EDT Subject: Re: W-EMED Spider bite or something To: wilderness-emergency-medicine@list.pitt.edu MIME-Version: 1.0 Content-Type: text/plain; charset="US-ASCII" Content-Transfer-Encoding: 7bit X-Mailer: AOL 4.0 for Windows 95 sub 14 Sender: owner-wilderness-emergency-medicine@list.pitt.edu Precedence: bulk Reply-To: wilderness-emergency-medicine@list.pitt.edu In a message dated 5/10/00 7:34:37 AM Eastern Daylight Time, kconover+@pitt.edu writes: > Sounds like a pretty good description of a recluse or similar spider > bite. I'd have to agree, with dr. Keith on this one. I've seen a few brown recluse bites that don't fully necrotize in center, but are really annoying and last for weeks. Barbara J. Maggiani, PA-C Physician Assistant, Primary Care / Public Health North Carolina Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- Return-Path: Received: from post-ofc04.srv.cis.pitt.edu (root@post-ofc04.srv.cis.pitt.edu [136.142.185.11]) by imap.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisimap-7.2.2.3) ID ; Wed, 10 May 2000 07:59:43 -0400 (EDT) Received: from localhost (root@localhost) by post-ofc04.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Wed, 10 May 2000 07:59:09 -0400 (EDT) Received: via switchmail; Wed, 10 May 2000 07:59:09 -0400 (EDT) Received: from list.srv.cis.pitt.edu via qmail ID ; Wed, 10 May 2000 07:58:36 -0400 (EDT) Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.1) ID ; Wed, 10 May 2000 07:58:23 -0400 (EDT) Received: from smtp-server.nlr.nl (spider.nlr.nl [137.17.80.200]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.1) ID for ; Wed, 10 May 2000 07:58:20 -0400 (EDT) Received: from fripcy.nlr.nl (fripcy.nlr.nl [137.17.228.92]) by smtp-server.nlr.nl (8.10.0/8.10.0/NLR 29/03/2000) with ESMTP id e4ABvnu1269819; Wed, 10 May 2000 13:57:49 +0200 (CDT) Message-Id: <200005101157.e4ABvnu1269819@smtp-server.nlr.nl> Disclaimer: "The National Aerospace Laboratory NLR DOESNOT ACCEPT ANY FINANCIAL COMMITMENT derived from this message." From: "Frits van Doorn" To: Subject: Re: W-EMED Spider bite or something Date: Wed, 10 May 2000 13:57:50 +0200 X-MSMail-Priority: Normal X-Priority: 3 X-Mailer: Microsoft Internet Mail 4.70.1154 MIME-Version: 1.0 Content-Type: text/plain; charset=ISO-8859-1 Content-Transfer-Encoding: 7bit Sender: owner-wilderness-emergency-medicine@list.pitt.edu Precedence: bulk Reply-To: wilderness-emergency-medicine@list.pitt.edu please contact your local toxic department or go to a hospital to be sure. i've seen documentaries about spiders and what it can do to the human body. Just be sure and go to a professional person. Frits van Doorn the Netherlands fvdoorn@nlr.nl ---------- > From: Caverbru@aol.com > To: wilderness-emergency-medicine@list.pitt.edu > Subject: W-EMED Spider bite or something > Date: Wednesday, May 10, 2000 12:58 PM > > Greetings to all, > I am looking for information on insect bites, most probably a spider bite. > I've looked through my WEMT notes and a few other wilderness medicine books > and had little luck since they mostly refer to Black Widow and Brown Recluse > bites. > > This past Saturday evening my wife felt a bite on her arm similar to a > mosquito bite and brushed it away. Sunday morning she notice a small, 1cm > diameter, red spot where the bite had been. By the time we got Sunday night > the red spot was now about 3 cm in diameter with a 2 or 3 mm diameter white > head in the middle. Over the next 48 hours the redness increased in diameter > to 4 cm x 5 cm with a 1 cm diameter darker red center the white head has > popped several times and it is itching. At this point, finally deciding that > it wasn't going away and with it becoming more annoying we treated it with > topical Hydrocortisone cream, 1%, and oral Benadryl. This morning, now 80 > hours since the bite, the presentation is the same as it was last night. > > Any ideas? Was this a spider or something else? Suggestions on treatment if > any? My wife is reluctant to go to a doctor since it is only an annoyance at > this point. > > I welcome your comments. > Bru Randall > Pittsburgh, PA > Do not reproduce without author's express permission. > To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" > as the body of a message (no subject) To: Majordomo@list.pitt.edu > Submissions To: wilderness-emergency-medicine@list.pitt.edu Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- Return-Path: Received: from post-ofc04.srv.cis.pitt.edu (root@post-ofc04.srv.cis.pitt.edu [136.142.185.11]) by imap.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisimap-7.2.2.3) ID ; Wed, 10 May 2000 07:59:43 -0400 (EDT) Received: from localhost (root@localhost) by post-ofc04.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Wed, 10 May 2000 07:59:09 -0400 (EDT) Received: via switchmail; Wed, 10 May 2000 07:59:09 -0400 (EDT) Received: from list.srv.cis.pitt.edu via qmail ID ; Wed, 10 May 2000 07:58:36 -0400 (EDT) Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.1) ID ; Wed, 10 May 2000 07:58:23 -0400 (EDT) Received: from smtp-server.nlr.nl (spider.nlr.nl [137.17.80.200]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.1) ID for ; Wed, 10 May 2000 07:58:20 -0400 (EDT) Received: from fripcy.nlr.nl (fripcy.nlr.nl [137.17.228.92]) by smtp-server.nlr.nl (8.10.0/8.10.0/NLR 29/03/2000) with ESMTP id e4ABvnu1269819; Wed, 10 May 2000 13:57:49 +0200 (CDT) Message-Id: <200005101157.e4ABvnu1269819@smtp-server.nlr.nl> Disclaimer: "The National Aerospace Laboratory NLR DOESNOT ACCEPT ANY FINANCIAL COMMITMENT derived from this message." From: "Frits van Doorn" To: Subject: Re: W-EMED Spider bite or something Date: Wed, 10 May 2000 13:57:50 +0200 X-MSMail-Priority: Normal X-Priority: 3 X-Mailer: Microsoft Internet Mail 4.70.1154 MIME-Version: 1.0 Content-Type: text/plain; charset=ISO-8859-1 Content-Transfer-Encoding: 7bit Sender: owner-wilderness-emergency-medicine@list.pitt.edu Precedence: bulk Reply-To: wilderness-emergency-medicine@list.pitt.edu please contact your local toxic department or go to a hospital to be sure. i've seen documentaries about spiders and what it can do to the human body. Just be sure and go to a professional person. Frits van Doorn the Netherlands fvdoorn@nlr.nl ---------- > From: Caverbru@aol.com > To: wilderness-emergency-medicine@list.pitt.edu > Subject: W-EMED Spider bite or something > Date: Wednesday, May 10, 2000 12:58 PM > > Greetings to all, > I am looking for information on insect bites, most probably a spider bite. > I've looked through my WEMT notes and a few other wilderness medicine books > and had little luck since they mostly refer to Black Widow and Brown Recluse > bites. > > This past Saturday evening my wife felt a bite on her arm similar to a > mosquito bite and brushed it away. Sunday morning she notice a small, 1cm > diameter, red spot where the bite had been. By the time we got Sunday night > the red spot was now about 3 cm in diameter with a 2 or 3 mm diameter white > head in the middle. Over the next 48 hours the redness increased in diameter > to 4 cm x 5 cm with a 1 cm diameter darker red center the white head has > popped several times and it is itching. At this point, finally deciding that > it wasn't going away and with it becoming more annoying we treated it with > topical Hydrocortisone cream, 1%, and oral Benadryl. This morning, now 80 > hours since the bite, the presentation is the same as it was last night. > > Any ideas? Was this a spider or something else? Suggestions on treatment if > any? My wife is reluctant to go to a doctor since it is only an annoyance at > this point. > > I welcome your comments. > Bru Randall > Pittsburgh, PA > Do not reproduce without author's express permission. > To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" > as the body of a message (no subject) To: Majordomo@list.pitt.edu > Submissions To: wilderness-emergency-medicine@list.pitt.edu Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- X-cs: R From: Keith Conover, M.D., FACEP X-RS-ID: X-RS-Flags: 0,0,1,1,0,0,0 X-RS-Header: In-reply-to: <3f.491aa08.264a9ade@aol.com> X-RS-Sigset: 2 To: Caverbru@aol.com,wilderness-emergency-medicine@list.pitt.edu Subject: Re: W-EMED Spider bite or something Reply-to: kconover+@pitt.edu MIME-Version: 1.0 Content-type: text/plain; charset=ISO-8859-1 Content-transfer-encoding: 8BIT Date: Wed, 10 May 2000 07:33:07 -0400 On 10 May 2000, at 6:58, Caverbru@aol.com wrote: > This past Saturday evening my wife felt a bite on her arm similar to a > mosquito bite and brushed it away. Sunday morning she notice a small, > 1cm diameter, red spot where the bite had been. By the time we got > Sunday night the red spot was now about 3 cm in diameter with a 2 or 3 > mm diameter white head in the middle. Over the next 48 hours the > redness increased in diameter to 4 cm x 5 cm with a 1 cm diameter > darker red center the white head has popped several times and it is > itching. At this point, finally deciding that it wasn't going away > and with it becoming more annoying we treated it with topical > Hydrocortisone cream, 1%, and oral Benadryl. This morning, now 80 > hours since the bite, the presentation is the same as it was last > night. Sounds like a pretty good description of a recluse or similar spider bite. They are fairly common in your area, as in most of the U.S. However, as long as the center doesn't turn necrotic, I don't think I'd do much but put Caladryl on it -- steroids aren't effective for necrotoxic U.S. spider bites. However, the new, reformulated brand name Caladryl now has calamine and pramoxine -- and pramoxine is great for itching. The original Caladryl had calamine and diphenydramine (e.g., Benadryl), hence the name. However, Benadryl applied topically doesn't work worth squat, and tends to make you allergic to Benadryl! So if you decided to get a generic form of Caladryl, check the label carefully for ingredients. If the center turns black, and starts spreading, it may be worth a trial of the medication Dapsone -- it seems to prevent further necrosis in recluse bites. But this would require going to see your doctor. Hope this helps. -- End -- Return-Path: Received: from post-ofc06.srv.cis.pitt.edu (root@post-ofc06.srv.cis.pitt.edu [136.142.185.43]) by imap.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisimap-7.2.2.3) ID ; Wed, 10 May 2000 07:35:22 -0400 (EDT) Received: from localhost (root@localhost) by post-ofc06.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Wed, 10 May 2000 07:34:48 -0400 (EDT) Received: via switchmail; Wed, 10 May 2000 07:34:48 -0400 (EDT) Received: from list.srv.cis.pitt.edu via qmail ID ; Wed, 10 May 2000 07:33:41 -0400 (EDT) Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.1) ID ; Wed, 10 May 2000 07:33:28 -0400 (EDT) Received: from mb1i0.ns.pitt.edu (mb1i1.ns.pitt.edu [136.142.185.161]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.1) ID for ; Wed, 10 May 2000 07:33:26 -0400 (EDT) Received: from micron ("port 1053"@[136.142.23.41]) by mb1i0.ns.pitt.edu (PMDF V5.2-32 #41462) with ESMTP id <01JP86LXCE84000KON@mb1i0.ns.pitt.edu> for wilderness-emergency-medicine@list.pitt.edu; Wed, 10 May 2000 07:33:26 EST Date: Wed, 10 May 2000 07:33:15 -0400 From: "Keith Conover, M.D., FACEP" Subject: Re: W-EMED Spider bite or something In-reply-to: <3f.491aa08.264a9ade@aol.com> To: Caverbru@aol.com, wilderness-emergency-medicine@list.pitt.edu Message-id: <391910BB.26718.19A884@localhost> MIME-version: 1.0 X-Mailer: Pegasus Mail for Win32 (v3.12c) Content-type: text/plain; charset=US-ASCII Content-transfer-encoding: 7BIT Sender: owner-wilderness-emergency-medicine@list.pitt.edu Precedence: bulk Reply-To: wilderness-emergency-medicine@list.pitt.edu On 10 May 2000, at 6:58, Caverbru@aol.com wrote: > This past Saturday evening my wife felt a bite on her arm similar to a > mosquito bite and brushed it away. Sunday morning she notice a small, > 1cm diameter, red spot where the bite had been. By the time we got > Sunday night the red spot was now about 3 cm in diameter with a 2 or 3 > mm diameter white head in the middle. Over the next 48 hours the > redness increased in diameter to 4 cm x 5 cm with a 1 cm diameter > darker red center the white head has popped several times and it is > itching. At this point, finally deciding that it wasn't going away > and with it becoming more annoying we treated it with topical > Hydrocortisone cream, 1%, and oral Benadryl. This morning, now 80 > hours since the bite, the presentation is the same as it was last > night. Sounds like a pretty good description of a recluse or similar spider bite. They are fairly common in your area, as in most of the U.S. However, as long as the center doesn't turn necrotic, I don't think I'd do much but put Caladryl on it -- steroids aren't effective for necrotoxic U.S. spider bites. However, the new, reformulated brand name Caladryl now has calamine and pramoxine -- and pramoxine is great for itching. The original Caladryl had calamine and diphenydramine (e.g., Benadryl), hence the name. However, Benadryl applied topically doesn't work worth squat, and tends to make you allergic to Benadryl! So if you decided to get a generic form of Caladryl, check the label carefully for ingredients. If the center turns black, and starts spreading, it may be worth a trial of the medication Dapsone -- it seems to prevent further necrosis in recluse bites. But this would require going to see your doctor. Hope this helps. --Keith Conover, M.D., FACEP http://www.pitt.edu/~kconover Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- Return-Path: Received: from post-ofc06.srv.cis.pitt.edu (root@post-ofc06.srv.cis.pitt.edu [136.142.185.43]) by imap.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisimap-7.2.2.3) ID ; Wed, 10 May 2000 07:35:22 -0400 (EDT) Received: from localhost (root@localhost) by post-ofc06.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Wed, 10 May 2000 07:34:48 -0400 (EDT) Received: via switchmail; Wed, 10 May 2000 07:34:48 -0400 (EDT) Received: from list.srv.cis.pitt.edu via qmail ID ; Wed, 10 May 2000 07:33:41 -0400 (EDT) Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.1) ID ; Wed, 10 May 2000 07:33:28 -0400 (EDT) Received: from mb1i0.ns.pitt.edu (mb1i1.ns.pitt.edu [136.142.185.161]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.1) ID for ; Wed, 10 May 2000 07:33:26 -0400 (EDT) Received: from micron ("port 1053"@[136.142.23.41]) by mb1i0.ns.pitt.edu (PMDF V5.2-32 #41462) with ESMTP id <01JP86LXCE84000KON@mb1i0.ns.pitt.edu> for wilderness-emergency-medicine@list.pitt.edu; Wed, 10 May 2000 07:33:26 EST Date: Wed, 10 May 2000 07:33:15 -0400 From: "Keith Conover, M.D., FACEP" Subject: Re: W-EMED Spider bite or something In-reply-to: <3f.491aa08.264a9ade@aol.com> To: Caverbru@aol.com, wilderness-emergency-medicine@list.pitt.edu Message-id: <391910BB.26718.19A884@localhost> MIME-version: 1.0 X-Mailer: Pegasus Mail for Win32 (v3.12c) Content-type: text/plain; charset=US-ASCII Content-transfer-encoding: 7BIT Sender: owner-wilderness-emergency-medicine@list.pitt.edu Precedence: bulk Reply-To: wilderness-emergency-medicine@list.pitt.edu On 10 May 2000, at 6:58, Caverbru@aol.com wrote: > This past Saturday evening my wife felt a bite on her arm similar to a > mosquito bite and brushed it away. Sunday morning she notice a small, > 1cm diameter, red spot where the bite had been. By the time we got > Sunday night the red spot was now about 3 cm in diameter with a 2 or 3 > mm diameter white head in the middle. Over the next 48 hours the > redness increased in diameter to 4 cm x 5 cm with a 1 cm diameter > darker red center the white head has popped several times and it is > itching. At this point, finally deciding that it wasn't going away > and with it becoming more annoying we treated it with topical > Hydrocortisone cream, 1%, and oral Benadryl. This morning, now 80 > hours since the bite, the presentation is the same as it was last > night. Sounds like a pretty good description of a recluse or similar spider bite. They are fairly common in your area, as in most of the U.S. However, as long as the center doesn't turn necrotic, I don't think I'd do much but put Caladryl on it -- steroids aren't effective for necrotoxic U.S. spider bites. However, the new, reformulated brand name Caladryl now has calamine and pramoxine -- and pramoxine is great for itching. The original Caladryl had calamine and diphenydramine (e.g., Benadryl), hence the name. However, Benadryl applied topically doesn't work worth squat, and tends to make you allergic to Benadryl! So if you decided to get a generic form of Caladryl, check the label carefully for ingredients. If the center turns black, and starts spreading, it may be worth a trial of the medication Dapsone -- it seems to prevent further necrosis in recluse bites. But this would require going to see your doctor. Hope this helps. --Keith Conover, M.D., FACEP http://www.pitt.edu/~kconover Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- Return-Path: Received: from post-ofc06.srv.cis.pitt.edu (root@post-ofc06.srv.cis.pitt.edu [136.142.185.43]) by imap.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisimap-7.2.2.3) ID ; Wed, 10 May 2000 07:01:31 -0400 (EDT) Received: from localhost (root@localhost) by post-ofc06.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Wed, 10 May 2000 07:00:55 -0400 (EDT) Received: via switchmail; Wed, 10 May 2000 07:00:54 -0400 (EDT) Received: from list.srv.cis.pitt.edu via qmail ID ; Wed, 10 May 2000 07:00:22 -0400 (EDT) Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.1) ID ; Wed, 10 May 2000 06:59:19 -0400 (EDT) Received: from imo23.mx.aol.com (imo23.mx.aol.com [152.163.225.67]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.1) ID for ; Wed, 10 May 2000 06:59:17 -0400 (EDT) From: Caverbru@aol.com Received: from Caverbru@aol.com by imo23.mx.aol.com (mail_out_v26.7.) id h.3f.491aa08 (4231) for ; Wed, 10 May 2000 06:58:39 -0400 (EDT) Message-ID: <3f.491aa08.264a9ade@aol.com> Date: Wed, 10 May 2000 06:58:38 EDT Subject: W-EMED Spider bite or something To: wilderness-emergency-medicine@list.pitt.edu MIME-Version: 1.0 Content-Type: text/plain; charset="US-ASCII" Content-Transfer-Encoding: 7bit X-Mailer: AOL 5.0 for Windows sub 70 Sender: owner-wilderness-emergency-medicine@list.pitt.edu Precedence: bulk Reply-To: wilderness-emergency-medicine@list.pitt.edu Greetings to all, I am looking for information on insect bites, most probably a spider bite. I've looked through my WEMT notes and a few other wilderness medicine books and had little luck since they mostly refer to Black Widow and Brown Recluse bites. This past Saturday evening my wife felt a bite on her arm similar to a mosquito bite and brushed it away. Sunday morning she notice a small, 1cm diameter, red spot where the bite had been. By the time we got Sunday night the red spot was now about 3 cm in diameter with a 2 or 3 mm diameter white head in the middle. Over the next 48 hours the redness increased in diameter to 4 cm x 5 cm with a 1 cm diameter darker red center the white head has popped several times and it is itching. At this point, finally deciding that it wasn't going away and with it becoming more annoying we treated it with topical Hydrocortisone cream, 1%, and oral Benadryl. This morning, now 80 hours since the bite, the presentation is the same as it was last night. Any ideas? Was this a spider or something else? Suggestions on treatment if any? My wife is reluctant to go to a doctor since it is only an annoyance at this point. I welcome your comments. Bru Randall Pittsburgh, PA Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- Return-Path: Received: from post-ofc03.srv.cis.pitt.edu (root@post-ofc03.srv.cis.pitt.edu [136.142.185.39]) by imap.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisimap-7.2.2.3) ID ; Thu, 13 Apr 2000 09:45:42 -0400 (EDT) Received: from localhost (root@localhost) by post-ofc03.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Thu, 13 Apr 2000 09:45:07 -0400 (EDT) Received: via switchmail; Thu, 13 Apr 2000 09:45:06 -0400 (EDT) Received: from list.srv.cis.pitt.edu via qmail ID ; Thu, 13 Apr 2000 09:43:11 -0400 (EDT) Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.1) ID ; Thu, 13 Apr 2000 09:41:25 -0400 (EDT) Received: from post-ofc04.srv.cis.pitt.edu (root@post-ofc04.srv.cis.pitt.edu [136.142.185.11]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.1) ID for ; Thu, 13 Apr 2000 09:41:22 -0400 (EDT) Received: from klaptop (ehdup-d3-12.rmt.net.pitt.edu [136.142.20.242]) by post-ofc04.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Thu, 13 Apr 2000 09:41:15 -0400 (EDT) From: "Keith Conover, M.D., FACEP" To: wilderness-emergency-medicine@list.pitt.edu Date: Thu, 13 Apr 2000 09:41:02 -0400 MIME-Version: 1.0 Content-type: text/plain; charset=US-ASCII Content-transfer-encoding: 7BIT Subject: W-EMED (Fwd) Wilderness EMS in Pennsylvania CC: mra@altadena.net, NCRC@ontosystems.com Message-ID: <38F5962F.25168.1190B4D8@localhost> X-mailer: Pegasus Mail for Win32 (v3.12c) Sender: owner-wilderness-emergency-medicine@list.pitt.edu Precedence: bulk Reply-To: wilderness-emergency-medicine@list.pitt.edu Was just at the EMS Committee meeting of the Pennsylvania Chapter, American College of Emergency Physicians. Some good political news for wilderness EMS in Pennsylvania. The state EMS office has just about completed its new set of EMS regulations. They don't say anything about wilderness EMS, but now that they're done, the state is going to turn to working on a rewrite of the state EMS law, Acti 45 -- and changes in this law is what will in many ways legitimize wilderness EMS here. And, revising the act to allow for expanded scope of practice, including both wilderness and interfacility transport, is a high priority for the emergency physicians in the state. Not only that, but Doug Kupas, the new State EMS Medical Director, has run WEMSI Wilderness EMT courses on a regular basis in northern PA -- so wilderness EMS now has a friend in high places . Indeed, Doug says his recent WEMT and WCP class at Rickett's Glen State Park was very successful. Students included the manager and one State Park Ranger from Rickett's Glen State Park -- the first career State Park Rangers, certainly the first park manager, to take a WEMSI WEMT course as far as I know. BTW, as far as revising the PA EMS Act, there are various documents on the topic at: http://www.pehsc.org/ --Keith Conover, M.D., FACEP http://www.pitt.edu/~kconover Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- Return-Path: Received: from post-ofc05.srv.cis.pitt.edu (root@post-ofc05.srv.cis.pitt.edu [136.142.185.10]) by imap.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisimap-7.2.2.3) ID ; Tue, 11 Apr 2000 21:37:49 -0400 (EDT) Received: from localhost (root@localhost) by post-ofc05.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Tue, 11 Apr 2000 21:37:09 -0400 (EDT) Received: via switchmail; Tue, 11 Apr 2000 21:37:08 -0400 (EDT) Received: from list.srv.cis.pitt.edu via qmail ID ; Tue, 11 Apr 2000 21:35:31 -0400 (EDT) Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.1) ID ; Tue, 11 Apr 2000 21:32:21 -0400 (EDT) Received: from post-ofc06.srv.cis.pitt.edu (root@post-ofc06.srv.cis.pitt.edu [136.142.185.43]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.1) ID for ; Tue, 11 Apr 2000 21:32:18 -0400 (EDT) Received: from micron (ehdup-q-16.rmt.net.pitt.edu [136.142.22.106]) by post-ofc06.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Tue, 11 Apr 2000 21:32:12 -0400 (EDT) Received: from post-ofc09.srv.cis.pitt.edu (root@post-ofc09.srv.cis.pitt.edu [136.142.185.57]) by imap.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisimap-7.2.2.3) ID for ; Tue, 11 Apr 2000 17:58:12 -0400 (EDT) Received: from localhost (root@localhost) by post-ofc09.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.2) ID for kconover@imap.pitt.edu; Tue, 11 Apr 2000 17:58:11 -0400 (EDT) Received: via switchmail for kconover+@pitt.edu; Tue, 11 Apr 2000 17:58:11 -0400 (EDT) Received: from home.corecom.net (home.corecom.net [216.47.0.11]) by post-ofc09.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cispo-7.2.2.2) ID for ; Tue, 11 Apr 2000 17:58:07 -0400 (EDT) Received: from [216.47.2.60] (anc02-060.corecom.net [216.47.2.60]) by home.corecom.net (8.8.7/8.8.7) with ESMTP id NAA17895 for ; Tue, 11 Apr 2000 13:56:56 -0800 (AKDT) User-Agent: Microsoft-Outlook-Express-Macintosh-Edition/5.02.2022 Date: Tue, 11 Apr 2000 13:57:33 -0800 Subject: W-EMED Re: Rescue Temperature From: "Ken Zafren, MD" To: Message-ID: In-Reply-To: <38EE410F.6935.29CDF79@localhost> Mime-version: 1.0 Content-type: text/plain; charset="ISO-8859-1" Content-Transfer-Encoding: 8bit X-MIME-Autoconverted: from quoted-printable to 8bit by list.srv.cis.pitt.edu id VAA29063 Sender: owner-wilderness-emergency-medicine@list.pitt.edu Precedence: bulk Reply-To: wilderness-emergency-medicine@list.pitt.edu Keith - You have my permission to forward my reply. Ken on 4/7/00 4:11 PM, Keith Conover, M.D., FACEP at kconover+@pitt.edu wrote: > Ken, I am forwarding my reply and Gordon's to the various > appropriate lists (MRA, NCRC, sar-l, EMS-l). I would appreciate > permission to forward your reply, too. > > Thanks. > > On 15 Mar 2000, at 10:46, Ken Zafren wrote: > >>> I have jsut come back from a meeting in Sweden where there was >>> discussion about the correct/best temperature to keep in an >>> ambulance or helicopter when rescuing a victim of hypothermia. the >>> swedish policy is to keep the interior at 25C in order to keep the >>> vistim cool and avoid vasodilatation. >>> >>> What do you do or advise? Do you think this is important? Does the >>> length of the trip make a difference, i.e 15 min vs 2 hours? Do you >>> think that vasodilatation is a likely possibility, and a dangerous >>> one? >>> >>> The Swedish doctors are seeking an opinion and your help would be >>> valuable. Thanks. Bruce Paton >>> >> >> Bruce - >> >> Thank you for your inquiry. I think that the temperature of the >> ambulance or helicopter should be irrelevant, since it has been well >> demonstrated that forced-air rewarming of hypothermic patients is >> beneficial. I expect Gordon Giesbrecht to addrress this in more >> detail. He is currently working on research using a portable rigid >> forced air rewarming cover (PORIFAC). The rescue vehicle should be >> kept at a temperature that is comfortable for the rescuers while the >> patient is rewarmed using forced air. >> >> Other factors are also critically important in severely hypothermic >> patients - avoidance of rough handling and maintenance of the >> horizontal position. These help avoid ventricular fibrillation and >> inadequate filling of the heart. The length of the trip is probably >> irrelevant, except that air transport should be used whenever it would >> significantly shorten transport time to definitive care. >> >> It is well known that with current practices hypothermia victims >> continue to cool during transport whether or not attempts are made to >> rewarm them. To deliberately keep them cool merely guarantees >> increased heat loss and a lower core temperature on arrival at >> hospital. An interesting article on the use of helicopters for >> hypothermia patients is: Fox et al. A retrospective analysis of >> air-evacuated hypothermia patients. Aviat Space Environ Med 1988; 59: >> 1070-5. >> >> The danger of vasodilatation is the possibility of circulatory >> collapse. This has been ascribed by some to a decrease in core >> temperature from cold peripheral blood which leads to ventricular >> fibrillation. However, Evan Lloyd has written two overlapping >> articles, based on his research with sheep, with the thesis that >> "[d]eath following rescue is most commonly due either to inadequate >> venous return, or to fluid overload." But he adds that "[i]t should >> not be forgotten that death can still occur from VF fue to mechanical >> irritation of the heart or from a sudden surge of cold blood to the >> heart. Either of these may be caused by rough handling of the >> casualty." (Lloyd EL. Hypothermia: the cause of death after rescue. >> Alaska Med 1984; 26:74-6 and Lloyd EL. The cause of death after >> rescue. Int J Sports Med 1992; 13:S196-199) >> >> I am not familiar with any research about the air temperature inside >> ambulances or helicopters. In any case, 25°C sounds rather warm to >> me, probably warm enough to induce vasodilatation of exposed skin. >> Our policy in Alaska has been to keep ambulances and helicopters warm, >> but I'm not sure how warm we manage to make them in practice. I have >> so far been unsuccessful in my efforts to interest either the private >> sector or the military in forced air rewarming on helicopters, >> although I have not given up and Gordon Giesbrecht recently took a >> PORIFAC system to Kodiak. It appears that the Coast Guard will be >> using the Thermastat (recently renamed Thermorescue) system. >> >> To return to the original question, the temperature should be >> comfortable for the rescuers and probably, even better, a bit too warm >> for them. Other factors are of much greater importance. >> >> Ken >> -- >> Ken Zafren, MD, FACEP >> Chairman, Medical Committee >> Mountain Rescue Association >> home address: >> 10181 Curvi St. >> Anchorage, AK 99516 USA >> tel 1.907.346.2333 >> fax 1.907.346.4445 > > > --Keith Conover, M.D., FACEP > http://www.pitt.edu/~kconover > Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- X-cs: R From: Keith Conover, M.D., FACEP X-RS-ID: X-RS-Flags: 0,0,1,1,0,0,0 X-RS-Header: In-reply-to: <003c01bfa105$6342e4e0$1a188e88@snickers> X-RS-Sigset: 2 To: "Suzanne Atkinson" Subject: Re: (Fwd) Re: Rescue Temperature Reply-to: kconover+@pitt.edu MIME-Version: 1.0 Content-type: text/plain; charset=ISO-8859-1 Content-transfer-encoding: 8BIT Date: Sat, 8 Apr 2000 09:48:41 -0400 On 7 Apr 2000, at 22:51, Suzanne Atkinson wrote: > Keith, > > I suppose I don't know enough about hospital treatment of hypothermia > anyway, but why is there a concern about hypotension when you can > simply give IV fluids? Are warmed IV fluids sufficient to raise core > temperature? Why did this Swedish doctor's arm warming experiment not > do anything to raise core temp, when Peter Hacket's device presented > at the WMS Winter medicine meeting does a similar thing which is > effective in raising core temp...with the addition of negative > pressure on the arm/hand? (he actually demonstrated the device on > Colin Grissom, but I didn't stick around to see how hot he got) > > Also, if a patient is hypothermic enough to require transport via > ambulance, are insulating blankets going to do any good at all (i.e. > can the patient rewarm him/herself) without the aid of something like > warmed IV fluids? I guess I just don't see why someone would consider > keeping the patient cool in the first place. Even in a wilderness > setting, you would want to try and rewarm them regardless, right? > > Suzanne > I agree with all of your questions -- except remember that in many cases, ambulance personnel are not permitted, do not have the skills, or simply can't get an IV started on a hypothermic patient. And the volume of IV fluids required to raise the core temperature significantly would drown not only the patient but everyone else in the back of the ambulance! Figure it out, I know you're a medical student and had to take physics. Pretend you're a physicist, you know, as in the physicist's recipie for baked chicken that starts "assume a spherical chicken . . . " Assume the human body is 70 kg (a good average weight). Assume further that this is all water, thus 70 liters of water. Assume the core itself is, say half of this -- 35 liters of water. Assume the core temperature is a uniform 30 degrees C. Assume that all the warmth of the IV fluid you administer goes to warming the core. Assume that you admininster IV fluids at 40 degrees C. How many liters does it take to raise the core temperature to 35 degrees C? Remember, too, that the patient is volume depleted so each liter adds to the total volume of the core -- so your final core volume = 35 liters + added IV fluid. (Sorry, it's a reflex, you know they dock my pay if I stop pimping medical students.) P.S. with your permission, I would like to post your reply and my re- reply to the w-e-m list which is the best place to continue this conversation for the benefit of all, as well as sending back to Bruce Paton for his information. Thank you. -- End -- Return-Path: Received: from post-ofc05.srv.cis.pitt.edu (root@post-ofc05.srv.cis.pitt.edu [136.142.185.10]) by imap.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisimap-7.2.2.3) ID for ; Fri, 7 Apr 2000 22:50:28 -0400 (EDT) Received: from localhost (root@localhost) by post-ofc05.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.2) ID for kconover@imap.pitt.edu; Fri, 7 Apr 2000 22:50:26 -0400 (EDT) Received: via switchmail for kconover+@pitt.edu; Fri, 7 Apr 2000 22:50:26 -0400 (EDT) Received: from snickers (ehdup-v-16.rmt.net.pitt.edu [136.142.24.26]) by post-ofc05.srv.cis.pitt.edu with SMTP (8.8.8/8.8.8/cispo-7.2.2.2) ID for ; Fri, 7 Apr 2000 22:50:23 -0400 (EDT) Message-ID: <003c01bfa105$6342e4e0$1a188e88@snickers> From: "Suzanne Atkinson" To: References: <38EE410E.17773.29CDF1A@localhost> Subject: Re: (Fwd) Re: Rescue Temperature Date: Fri, 7 Apr 2000 22:51:48 -0400 MIME-Version: 1.0 Content-Type: text/plain; charset="iso-8859-1" Content-Transfer-Encoding: 7bit X-Priority: 3 X-MSMail-Priority: Normal X-Mailer: Microsoft Outlook Express 5.00.2615.200 X-MimeOLE: Produced By Microsoft MimeOLE V5.00.2615.200 Keith, I suppose I don't know enough about hospital treatment of hypothermia anyway, but why is there a concern about hypotension when you can simply give IV fluids? Are warmed IV fluids sufficient to raise core temperature? Why did this Swedish doctor's arm warming experiment not do anything to raise core temp, when Peter Hacket's device presented at the WMS Winter medicine meeting does a similar thing which is effective in raising core temp...with the addition of negative pressure on the arm/hand? (he actually demonstrated the device on Colin Grissom, but I didn't stick around to see how hot he got) Also, if a patient is hypothermic enough to require transport via ambulance, are insulating blankets going to do any good at all (i.e. can the patient rewarm him/herself) without the aid of something like warmed IV fluids? I guess I just don't see why someone would consider keeping the patient cool in the first place. Even in a wilderness setting, you would want to try and rewarm them regardless, right? Suzanne -- End -- Return-Path: Received: from post-ofc06.srv.cis.pitt.edu (root@post-ofc06.srv.cis.pitt.edu [136.142.185.43]) by imap.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisimap-7.2.2.3) ID ; Fri, 7 Apr 2000 20:14:30 -0400 (EDT) Received: from localhost (root@localhost) by post-ofc06.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Fri, 7 Apr 2000 20:13:54 -0400 (EDT) Received: via switchmail; Fri, 7 Apr 2000 20:13:53 -0400 (EDT) Received: from list.srv.cis.pitt.edu via qmail ID ; Fri, 7 Apr 2000 20:13:26 -0400 (EDT) Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.1) ID ; Fri, 7 Apr 2000 20:12:42 -0400 (EDT) Received: from post-ofc06.srv.cis.pitt.edu (root@post-ofc06.srv.cis.pitt.edu [136.142.185.43]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.1) ID for ; Fri, 7 Apr 2000 20:12:34 -0400 (EDT) Received: from micron (ehdup-t-56.rmt.net.pitt.edu [136.142.23.66]) by post-ofc06.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Fri, 7 Apr 2000 20:12:16 -0400 (EDT) From: "Keith Conover, M.D., FACEP" To: EMS-L@listserv.ACNS.NWU.EDU, mra@altadena.net, NCRC@ontosystems.com, sar-l@listserv.islandnet.com, Gordon Giesbrecht , wilderness-emergency-medicine@list.pitt.edu Date: Fri, 7 Apr 2000 20:11:58 -0400 MIME-Version: 1.0 Content-type: text/plain; charset=US-ASCII Content-transfer-encoding: 7BIT Subject: W-EMED (Fwd) Re: Rescue Temperature Message-ID: <38EE410E.17773.29CDF1A@localhost> X-mailer: Pegasus Mail for Win32 (v3.12c) Sender: owner-wilderness-emergency-medicine@list.pitt.edu Precedence: bulk Reply-To: wilderness-emergency-medicine@list.pitt.edu ------- Forwarded message follows ------- From: Keith Conover, M.D., FACEP To: Cardsurg@aol.com Subject: Re: Rescue Temperature Copies to: @TEMP2.PML,Jack Grandey Send reply to: kconover+@pitt.edu Date sent: Tue, 14 Mar 2000 12:23:28 -0500 On 14 Mar 2000, at 10:38, Cardsurg@aol.com wrote: > I have jsut come back from a meeting in Sweden where there was > discussion about the correct/best temperature to keep in an > ambulance or helicopter when rescuing a victim of hypothermia. the > swedish policy is to keep the interior at 25C in order to keep the > vistim cool and avoid vasodilatation. What do you do or advise? Do > you think this is important? Does the length of the trip make a > difference, i.e 15 min vs 2 hours? Do you think that vasodilatation > is a likely possibility, and a dangerous one? Disclaimer: as the advice below is not evidence-based, you get what you're paying for. From my review of the literature and the physiology of hypothermia, and experience in both street and wilderness EMS, and as I put into the new U.S. paramedic program as Subject Matter Expert on the topic, I recommend adding as much heat as possible in the prehoospital setting, realizing that until we either have ambulances with hot tubs or usable ambulance-based RF rewarming devices, _rapid_ rewarming and thus major rewarming shock are simply not possible in the back of an ambulance. The only thing that comes close is the HeatPac charcoal-burning rewarming device (see my web page, URL below, for an article about it). I think that raising the ambulance temperature from 25 degrees C (a comfortable room temperature) to, say, 33 degrees C (about as warm as most ambulances could probably get in a cold environment) would (a) not make much difference in rewarming of the patient, and (2) make the ambulance personnel sweat so much that they couldn't see, much less hold onto any equipment. But I really don't think it makes much difference. The temperature of a dry-air ambient environment just isn't going to have much effect on rewarming rate -- even less than warm IV fluids. Hope this helps provoke thought if nothing else. Take care. --Keith Conover, M.D., FACEP http://www.pitt.edu/~kconover Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- Return-Path: Received: from post-ofc01.srv.cis.pitt.edu (root@post-ofc01.srv.cis.pitt.edu [136.142.185.25]) by imap.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisimap-7.2.2.3) ID ; Fri, 7 Apr 2000 20:15:22 -0400 (EDT) Received: from localhost (root@localhost) by post-ofc01.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Fri, 7 Apr 2000 20:14:48 -0400 (EDT) Received: via switchmail; Fri, 7 Apr 2000 20:14:48 -0400 (EDT) Received: from list.srv.cis.pitt.edu via qmail ID ; Fri, 7 Apr 2000 20:13:31 -0400 (EDT) Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.1) ID ; Fri, 7 Apr 2000 20:12:21 -0400 (EDT) Received: from post-ofc06.srv.cis.pitt.edu (root@post-ofc06.srv.cis.pitt.edu [136.142.185.43]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.1) ID for ; Fri, 7 Apr 2000 20:12:13 -0400 (EDT) Received: from micron (ehdup-t-56.rmt.net.pitt.edu [136.142.23.66]) by post-ofc06.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Fri, 7 Apr 2000 20:12:01 -0400 (EDT) From: "Keith Conover, M.D., FACEP" To: wilderness-emergency-medicine@list.pitt.edu, Gordon Giesbrecht Date: Fri, 7 Apr 2000 20:11:58 -0400 MIME-Version: 1.0 Content-type: text/plain; charset=ISO-8859-1 Subject: W-EMED (Fwd) Re: Rescue Temperature CC: sar-l@listserv.islandnet.com, NCRC@ontosystems.com (NCRC Discussion List), mra@altadena.net, EMS-L@listserv.ACNS.NWU.EDU Message-ID: <38EE410E.1800.29CDE66@localhost> X-mailer: Pegasus Mail for Win32 (v3.12c) Content-Transfer-Encoding: 8bit X-MIME-Autoconverted: from Quoted-printable to 8bit by list.srv.cis.pitt.edu id UAA13105 Sender: owner-wilderness-emergency-medicine@list.pitt.edu Precedence: bulk Reply-To: wilderness-emergency-medicine@list.pitt.edu Forwarded to the lists with permssion. Will also forward my own comments. ------- Forwarded message follows ------- Date sent: Thu, 23 Mar 2000 05:09:47 -0600 To: Cardsurg@aol.com From: Gordon Giesbrecht Subject: Re: Rescue Temperature Copies to: HDBacker@aol.com, psalfkb@psal10.med.navy.mil, BOWWAR@aol.com, kconover+@pitt.edu, dandanz@pol.net, B.Durrer@popnet.ch, giesbrec@Ms.UManitoba.CA, phack@ruralhealth.org, Juhani.Hassi@occuphealth.fi, Lfrizzsolo@aol.com, tkovacs@goodnet.com, a.lloyd@iona.sms.ed.ac.uk, edward.otten@uc.edu, schoene@u.washington.edu, petersteele@yt.sympatico.ca, zafren@corecom.net, helge.brandstrom.us@vll.se >I have jsut come back from a meeting in Sweden where there was >discussion about the correct/best temperature to keep in an ambulance >or helicopter when rescuing a victim of hypothermia. the swedish >policy is to keep the interior at 25C in order to keep the vistim >cool and avoid vasodilatation. > >What do you do or advise? Do you think this is important? Does the >length of the trip make a difference, i.e 15 min vs 2 hours? Do you >think that vasodilatation is a likely possibility, and a dangerous >one? > >The Swedish doctors are seeking an opinion and your help would be >valuable. Thanks. Bruce Paton Bruce: Thank you for your inquiry, this is certainly a burning (no pun intended) question that we have discussed at length with Lars Lundberg of the Swedish Military. 1) As a background, I think the idea of not warming the hypothermic victim comes from two areas of thought: a) The original concept of the "metabolic icebox" (a condition where decreased temperature, decreased metabolic rate, respiration and cardiac output is quite compatable with lif), has been described by Dr. Bill Mills. This is OK as long as the temperature doesn't fall further or something else (like rough handling) induces VF. This concept has been misinterpreted such that some (i.e., the swedish military) feel the metabolic icebox is a "safe" condition and that warming the heart may bring it to a warmer range (28-32°C) where the heart is MORE susceptable to VF. This premise seems unfounded as the threshold for VF clearly decreases as heart temperature continues to drop. I would much rather have a heart at 30°C than 25°C. We have demonstrated in a human model for severe hypothermia (mildly hypothermic subjects with shivering inhibited with meperiding/pithidine) that, without active warming, core temperature drops for as much as 2 more °C and can remain at these low levels for 3-4 hours (J. Applied Physiol 83:1630-34, 1997 and 83:11635-40, 1997). b) The other issue is the fear of massive vasodilation and hypotension caused by surface warming. First if someone is mildly hypothermic (Tcore 32-35°C), he/she will surive unless you really try to kill them. Our treatment decisions are much more important at moderate (28-32°C) or severe (<28°C) hypothermia. At these core temperatures, I cannot think of a way that you will induce massive vasodilation with any means available in an ambulance or helicopter. I have tried applying a Thermostat (arm warming device) to a mildly hypothermic subject in my lab, and applied a water perfused blanket at 45°C to the lower arm for 60 minutes. The only response was a 1st degree burn to the entire lower arm. This significant surface warming did not induce vasodilation, such that the heat applied to the arm was not conducted to the core via blood flow. Many other studies and reports indicate that peripheral vasodilation in a severely hypothermic victim is not seen. Leif Vanggard and I have published a paper (Aviat.Space Environ. Med. 1999: 70, 1081-8) where we immersed both lower legs and warms of mildly hypothermic subjects in 45°C water. Only with this massive heat load on the periphery could we induce vasodilation, and in these cases, there was no evidence of hyptension. I suspect that any cardiac problems seen during pre-hospital teatment is due to mechanically-induced reflex effects on the heart or sudden increases in heart work (therefore be very gentle and keep the patient horizontal). 2) I would agree with Ken Zafren and Keith Conover that: rewarming shock is not possible without jostling or verticle positioning, that you should avoid rough handling (to the point of cutting cloths off as a matter of practice). 3) I also feel that warming the vehicle temperature will have little or no effect on vasodilation for another reason. Presumably the patient will be covered, thus insulating from the warm air just as it would be from cold air. 4) I recently hosted a "Cold Injury: Clinical Consensus Meeting" in Winnipeg with several guests including Bruce Paton, Bill Mills, Murray Hamlet, Martin Nemirof, Dan Danzl, Bill Keatings, Leif Vanggard and others. After some discussion we agreed that it was benificial to warm the core of hypothermic patients in a controlled manner (i.e., a target rate of 1-2°C/hr). Once the core temperature reaches 35°C or so, warming could be cut back to prevent overheating and vasodilation. At this point the best way to do this is via torso warming with either forced-air warming (a portable unit has been developed for use in ambulance or helicopters) or the Norweigan charcoal heater (HeatPac). We are just publishing a paper showing that these devices warm non-shivering hypothermic subjects at 1-2 °C/hr. The HeatPac is very easy to use and compact but doesn't warm quite as fast as the more powerful forced-air warming. The choice depends on budget, room, power availability, etc. From our work it also seems that the warming effect requires 20-30 minutes to be apparant. 5) In summary I would recommend that vehicle ambient temperature be kept at a level that provides rescue personnel comfort. Active warming of the patient torso should be initiated especially if the transport time is longer than 20-30 minutes. As usual, continuous monitoring of the patient will allow identification of any untoward effects such as skin burning, drops in blood pressure etc. I trust this is helpful and I would be interested in any feedback on this position. Gord Gordon G. Giesbrecht, Ph.D. Professor Laboratory for Exercise and Environmental Medicine 211 Max Bell Center University of Manitoba Winnipeg, Canada, R3T 2N2 Phone (204) 474-8646; Fax (204) 261-4802; Email ; Lab Web Site http://www.umanitoba.ca/faculties/physed/research/lab1/lab1index.html ------- End of forwarded message ------- --Keith Conover, M.D., FACEP http://www.pitt.edu/~kconover Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- Return-Path: Received: from post-ofc01.srv.cis.pitt.edu (root@post-ofc01.srv.cis.pitt.edu [136.142.185.25]) by imap.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisimap-7.2.2.3) ID ; Thu, 6 Apr 2000 21:32:42 -0400 (EDT) Received: from localhost (root@localhost) by post-ofc01.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Thu, 6 Apr 2000 21:32:10 -0400 (EDT) Received: via switchmail; Thu, 6 Apr 2000 21:32:10 -0400 (EDT) Received: from list.srv.cis.pitt.edu via qmail ID ; Thu, 6 Apr 2000 21:18:41 -0400 (EDT) Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.1) ID ; Thu, 6 Apr 2000 21:17:42 -0400 (EDT) Received: from post-ofc06.srv.cis.pitt.edu (root@post-ofc06.srv.cis.pitt.edu [136.142.185.43]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.1) ID ; Thu, 6 Apr 2000 21:17:33 -0400 (EDT) Received: from micron (ehdup-m-10.rmt.net.pitt.edu [136.142.22.20]) by post-ofc06.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Thu, 6 Apr 2000 21:17:29 -0400 (EDT) From: "Keith Conover, M.D., FACEP" To: wilderness-emergency-medicine@list.pitt.edu, asrc@list.pitt.edu Date: Thu, 6 Apr 2000 21:17:27 -0400 MIME-Version: 1.0 Content-type: text/plain; charset=US-ASCII Content-transfer-encoding: 7BIT Subject: W-EMED (Fwd) VIRUS ALERT: 911 Worm will destroy system files Message-ID: <38ECFEE7.30733.2BCF2E0@localhost> X-mailer: Pegasus Mail for Win32 (v3.12c) Sender: owner-wilderness-emergency-medicine@list.pitt.edu Precedence: bulk Reply-To: wilderness-emergency-medicine@list.pitt.edu I am not in favor of forwarding virus messages (especially as most of them are urban legends or hoaxes) but this one appears real and legitimate, and thus as listowner for these lists, I am forwarding the information to permit as wide distribution as possible. Given the possibility of swamping 9-1-1 centers, it's even close to on-topic. Thank you. ------- Forwarded message follows ------- Date sent: Mon, 3 Apr 2000 09:26:30 -0700 Send reply to: EMS-L@listserv.ACNS.NWU.EDU From: "EMS-L Moderator" To: "EMS-L" Subject: VIRUS ALERT: 911 Worm will destroy system files Alert: 911 Worm (Alias: bat.chode) Updated: 10:00 a.m. April 3, 2000 At 8:00 am on Saturday, April 1 (This is not an April Fool's joke!) the FBI announced it had discovered malicious code wiping out the data on hard drives and dialing 911. This is a vicious worm (see note at end on worms vs. viruses) and needs to be stopped quickly. That can only be done through wide-scale individual action. The FBI Advisory is posted at http://www.nipc.gov/nipc/advis00-038.htm The Symantec alert (called Bat.CHODE.worm) is posted at http://www.symantec.com/avcenter/venc/data/bat.chode.worm.html The McAfee alert (called W95/Firkin.worm) is posted at http://vil.mcafee.com/dispVirus.asp?virus_k=98557 The Global Incident Advisory Center has reports from people who have computers that have been damaged. It is posted at www.sans.org/giac.htm. Difference among the antivirus advisories and the GIAC data appear to imply that there are multiple versions of this malicious code (if only because the McAfee quoted hacker's "got you" statement differs from the found on an infected computer reported to GIAC.) The 911 Worm is one of the first to exploit "Windows shares." Unlike recent viruses that propagate though email, the 911 Worm silently jumps directly from machine to machine across the Internet by scanning for, and exploiting, open Windows shares. After successfully reproducing itself in other Internet-connected machines (to assure its continued survival), one out of five times it uses the machine's modem to dial 911 and erases the local machine's hard drive. The worm is operational; victims are already reporting wiped-out hard drives. Symantec reports that the trigger date is the 19th of the month, but variants could change that date. The worm was launched through AOL, AT&T, and as many as seven other major ISPs. Action 1: Defense Verify that your system and those of all our coworkers, friends, and associates are not vulnerable by verifying that file sharing is turned off. On a Windows 95/98 system, systemwide file sharing is managed by selecting My Computer, Control Panel, Networks, and clicking on the File and Print Sharing button. For folder-by-folder controls, you can use Windows Explorer (Start, Programs, Windows Explorer) and highlight a primary folder such as My Documents and then right mouse click and select properties. There you will find a tab for sharing. On a Windows NT, check Control Panel, Server, Shares. For an excellent way to instantly check system vulnerability, and for detailed assistance in managing Windows file sharing, see: Shields Up! A free service at http://grc.com/ Action 2: Forensics If you find that you did have file sharing turned on, search your hard drive for hidden directories named "chode", "foreskin", or "dickhair" (we apologize for the indiscretion - but those are the real directory names). These are HIDDEN directories, so you must configure the Find command to show hidden directories. Under the Windows Explorer menu choose View/Options: "Show All Files". If you find those directories: remove them. And, if you find them, and want help from law enforcement, call the FBI National Infrastructure Protection Center (NIPC) Watch Office at 202-323-3204/3205/3206. The FBI/NIPC has done an extraordinary job of getting data out early on this worm and deserves both kudos and cooperation. You can help the whole community by letting both the FBI and SANS (intrusion@sans.org) know if you've been hit, so we can monitor the spread of this worm. Moving Forward The virus detection companies received a copy of the code for the 911 Worm late on the March 31, and at least Symantec's Norton AntiVirus has signatures for the 911 Worm. Keep your virus signature files up-to-date. Note: This malicious code is called a worm because it requires no specific action on the part of the user to enable infection and propagation. It just spreads. If the code required the user to open an email or load a screen saver or take some other action, then it would be called a virus. ------- End of forwarded message ------- --Keith Conover, M.D., FACEP http://www.pitt.edu/~kconover Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- X-cs: R From: Keith Conover, M.D., FACEP X-RS-ID: X-RS-Flags: 0,0,1,1,0,0,0 X-RS-Sigset: 2 To: wilderness-emergency-medicine@list.pitt.edu,asrc@list.pitt.edu Subject: (Fwd) VIRUS ALERT: 911 Worm will destroy system files Reply-to: kconover+@pitt.edu MIME-Version: 1.0 Content-type: text/plain; charset=ISO-8859-1 Content-transfer-encoding: 8BIT Date: Thu, 6 Apr 2000 21:17:21 -0400 I am not in favor of forwarding virus messages (especially as most of them are urban legends or hoaxes) but this one appears real and legitimate, and thus as listowner for these lists, I am forwarding the information to permit as wide distribution as possible. Given the possibility of swamping 9-1-1 centers, it's even close to on-topic. Thank you. ------- Forwarded message follows ------- Date sent: Mon, 3 Apr 2000 09:26:30 -0700 Send reply to: EMS-L@listserv.ACNS.NWU.EDU From: "EMS-L Moderator" To: "EMS-L" Subject: VIRUS ALERT: 911 Worm will destroy system files Alert: 911 Worm (Alias: bat.chode) Updated: 10:00 a.m. April 3, 2000 At 8:00 am on Saturday, April 1 (This is not an April Fool's joke!) the FBI announced it had discovered malicious code wiping out the data on hard drives and dialing 911. This is a vicious worm (see note at end on worms vs. viruses) and needs to be stopped quickly. That can only be done through wide-scale individual action. The FBI Advisory is posted at http://www.nipc.gov/nipc/advis00-038.htm The Symantec alert (called Bat.CHODE.worm) is posted at http://www.symantec.com/avcenter/venc/data/bat.chode.worm.html The McAfee alert (called W95/Firkin.worm) is posted at http://vil.mcafee.com/dispVirus.asp?virus_k=98557 The Global Incident Advisory Center has reports from people who have computers that have been damaged. It is posted at www.sans.org/giac.htm. Difference among the antivirus advisories and the GIAC data appear to imply that there are multiple versions of this malicious code (if only because the McAfee quoted hacker's "got you" statement differs from the found on an infected computer reported to GIAC.) The 911 Worm is one of the first to exploit "Windows shares." Unlike recent viruses that propagate though email, the 911 Worm silently jumps directly from machine to machine across the Internet by scanning for, and exploiting, open Windows shares. After successfully reproducing itself in other Internet-connected machines (to assure its continued survival), one out of five times it uses the machine's modem to dial 911 and erases the local machine's hard drive. The worm is operational; victims are already reporting wiped-out hard drives. Symantec reports that the trigger date is the 19th of the month, but variants could change that date. The worm was launched through AOL, AT&T, and as many as seven other major ISPs. Action 1: Defense Verify that your system and those of all our coworkers, friends, and associates are not vulnerable by verifying that file sharing is turned off. On a Windows 95/98 system, systemwide file sharing is managed by selecting My Computer, Control Panel, Networks, and clicking on the File and Print Sharing button. For folder-by-folder controls, you can use Windows Explorer (Start, Programs, Windows Explorer) and highlight a primary folder such as My Documents and then right mouse click and select properties. There you will find a tab for sharing. On a Windows NT, check Control Panel, Server, Shares. For an excellent way to instantly check system vulnerability, and for detailed assistance in managing Windows file sharing, see: Shields Up! A free service at http://grc.com/ Action 2: Forensics If you find that you did have file sharing turned on, search your hard drive for hidden directories named "chode", "foreskin", or "dickhair" (we apologize for the indiscretion - but those are the real directory names). These are HIDDEN directories, so you must configure the Find command to show hidden directories. Under the Windows Explorer menu choose View/Options: "Show All Files". If you find those directories: remove them. And, if you find them, and want help from law enforcement, call the FBI National Infrastructure Protection Center (NIPC) Watch Office at 202-323-3204/3205/3206. The FBI/NIPC has done an extraordinary job of getting data out early on this worm and deserves both kudos and cooperation. You can help the whole community by letting both the FBI and SANS (intrusion@sans.org) know if you've been hit, so we can monitor the spread of this worm. Moving Forward The virus detection companies received a copy of the code for the 911 Worm late on the March 31, and at least Symantec's Norton AntiVirus has signatures for the 911 Worm. Keep your virus signature files up-to-date. Note: This malicious code is called a worm because it requires no specific action on the part of the user to enable infection and propagation. It just spreads. If the code required the user to open an email or load a screen saver or take some other action, then it would be called a virus. ------- End of forwarded message ------- -- End -- Return-Path: Received: from post-ofc04.srv.cis.pitt.edu (root@post-ofc04.srv.cis.pitt.edu [136.142.185.11]) by imap.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisimap-7.2.2.3) ID ; Tue, 4 Apr 2000 15:08:40 -0400 (EDT) Received: from localhost (root@localhost) by post-ofc04.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Tue, 4 Apr 2000 15:07:46 -0400 (EDT) Received: via switchmail; Tue, 4 Apr 2000 15:07:46 -0400 (EDT) Received: from list.srv.cis.pitt.edu via qmail ID ; Tue, 4 Apr 2000 15:05:41 -0400 (EDT) Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.1) ID ; Tue, 4 Apr 2000 15:03:21 -0400 (EDT) Received: from mail1.toronto.istar.net (mail1.toronto.istar.net [209.89.75.17]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.1) ID for ; Tue, 4 Apr 2000 15:03:14 -0400 (EDT) Received: from ip46.ottawa7.dialup.canada.psi.net ([154.5.69.46]) by mail1.toronto.istar.net with smtp (Exim 2.02 #1) id 12cXTd-0002Qe-00 for wilderness-emergency-medicine@list.pitt.edu; Tue, 4 Apr 2000 13:50:58 -0400 Message-Id: Mime-Version: 1.0 Content-Type: text/plain; charset="us-ascii" Date: Tue, 4 Apr 2000 15:03:31 -0500 To: wilderness-emergency-medicine@list.pitt.edu From: pirie@istar.ca (Steven D. Pirie) Subject: W-EMED Fluids in dehydration Sender: owner-wilderness-emergency-medicine@list.pitt.edu Precedence: bulk Reply-To: wilderness-emergency-medicine@list.pitt.edu Jay and others... >As I mentioned, I heard a report (can't remember where) of IV saline being >given via the PR route -- presumably at a relatively brisk rate -- to wounded >British soldiers during the Falklands war, with apparently good results. >(Reportedly, no British soldier who was treated this way died of hypovolemic >shock). Does anybody have anything "official" on this? I think that you took a fact and a statistic and crushed them together... The British soldiers in the Falklands war did use rectal IV therapy. I am not sure if it was N/S or R/L. The statistic is that in the Falklands, no soldier who was picked up alive died later of wounds. The reference is as follows: St John Priory of Canada Properties. (1992). Military First Aid: safety oriented. Ottawa, Canada: Ministry of National Defence. Now are the two corelated? Who knows. Hope that helps... Steven ---------------------------------------------------------- Lt. Steven D. Pirie, RN, BScN, UE General Duty Ward Officer - Military In-Patient Unit Canadian Forces Support Unit Ottawa - Civic Hospital Site 2 Health Support Operational Training Unit ---------------------------------------------------------- Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- Return-Path: Received: from post-ofc01.srv.cis.pitt.edu (root@post-ofc01.srv.cis.pitt.edu [136.142.185.25]) by imap.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisimap-7.2.2.3) ID ; Mon, 3 Apr 2000 15:59:24 -0400 (EDT) Received: from localhost (root@localhost) by post-ofc01.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Mon, 3 Apr 2000 15:58:31 -0400 (EDT) Received: via switchmail; Mon, 3 Apr 2000 15:58:31 -0400 (EDT) Received: from list.srv.cis.pitt.edu via qmail ID ; Mon, 3 Apr 2000 15:57:04 -0400 (EDT) Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.1) ID ; Mon, 3 Apr 2000 15:52:34 -0400 (EDT) Received: from imo25.mx.aol.com (imo25.mx.aol.com [152.163.225.69]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.1) ID for ; Mon, 3 Apr 2000 15:51:29 -0400 (EDT) From: JadedMedic@aol.com Received: from JadedMedic@aol.com by imo25.mx.aol.com (mail_out_v25.3.) id h.54.281730e (9762) for ; Mon, 3 Apr 2000 15:50:56 -0400 (EDT) Message-ID: <54.281730e.261a5020@aol.com> Date: Mon, 3 Apr 2000 15:50:56 EDT Subject: Re: W-EMED Fluids in dehydration To: wilderness-emergency-medicine@list.pitt.edu MIME-Version: 1.0 Content-Type: text/plain; charset="US-ASCII" Content-Transfer-Encoding: 7bit X-Mailer: AOL 5.0 for Windows sub 100 Sender: owner-wilderness-emergency-medicine@list.pitt.edu Precedence: bulk Reply-To: wilderness-emergency-medicine@list.pitt.edu In a message dated 3/29/00 3:44:31 PM Pacific Daylight Time, tanman@swcp.com writes: > When working in Asia in the rural jungle in a typhoid epidemic > and also working with dysenteries of numerous sorts, > > We found that giving fluids rectally worked very well in most > cases. > > In the rural areas, IVs and other high tech equipment may not > be available. > > As I recall, one of our Presidents that was very sick was > kept alive by rectal fluids for 90 days or something such as > that. > > Thomas A. Naegele, DO Internet > 9405 Lagrima de Oro NE 505-275-7267 > Albuquerque, NM 87111 > Board Certified Family Practice/Board Certified Quality Assurance > MEDICAL WHITE PAPERS MAGAZINE FOR COMMUNITY PHYSICIANS Hi, Thanks for the comment. Just out of curiosity, what sort of rate of administration did you find to be generally workable? I know that if you give too much too fast via this route, you'll likely provoke an expulsion reaction, but I've never found anything specific in terms of the maximum rate for retention versus the minimum rate for expulsion. As I mentioned, I heard a report (can't remember where) of IV saline being given via the PR route -- presumably at a relatively brisk rate -- to wounded British soldiers during the Falklands war, with apparently good results. (Reportedly, no British soldier who was treated this way died of hypovolemic shock). Does anybody have anything "official" on this? Regards, Jay Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- Return-Path: Received: from post-ofc05.srv.cis.pitt.edu (root@post-ofc05.srv.cis.pitt.edu [136.142.185.10]) by imap.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisimap-7.2.2.3) ID ; Sat, 1 Apr 2000 09:43:50 -0500 (EST) Received: from localhost (root@localhost) by post-ofc05.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Sat, 1 Apr 2000 09:43:16 -0500 (EST) Received: via switchmail; Sat, 1 Apr 2000 09:43:15 -0500 (EST) Received: from list.srv.cis.pitt.edu via qmail ID ; Sat, 1 Apr 2000 09:42:30 -0500 (EST) Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.1) ID ; Sat, 1 Apr 2000 09:41:51 -0500 (EST) Received: from imo12.mx.aol.com (imo12.mx.aol.com [152.163.225.2]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.1) ID for ; Sat, 1 Apr 2000 09:41:47 -0500 (EST) From: SRTMedic@aol.com Received: from SRTMedic@aol.com by imo12.mx.aol.com (mail_out_v25.3.) id h.61.274c031 (3946) for ; Sat, 1 Apr 2000 09:41:13 -0500 (EST) Message-ID: <61.274c031.26176488@aol.com> Date: Sat, 1 Apr 2000 09:41:12 EST Subject: Re: W-EMED Glutose Paste vs. Glucose Tablets To: wilderness-emergency-medicine@list.pitt.edu MIME-Version: 1.0 Content-Type: text/plain; charset="US-ASCII" Content-Transfer-Encoding: 7bit X-Mailer: AOL 5.0 for Windows sub 100 Sender: owner-wilderness-emergency-medicine@list.pitt.edu Precedence: bulk Reply-To: wilderness-emergency-medicine@list.pitt.edu Rather than using tablets, how about regular packets of sugar from a restaurant? I learned this trick from my EMT teacher many years ago. Instead of having them swallow it, simply sprinkle it between their lip and their gum. I've done this a couple of times over the years when other means either weren't available or wouldn't work. (i.e., the patient's awake enough to refuse the IV, but willing to "eat" some sugar.) My experience has been that it works pretty good. Even when I give a patient the Insta-glucose gel I usually stick it between their lips and their gum. Of course down here in Florida the hypoglycemic diabetic's drink of choice is Orange Juice with several spoons of sugar. Just my thoughts on the subject, Stewart Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End --