Received: from post-ofc03.srv.cis.pitt.edu (post-ofc03.srv.cis.pitt.edu [136.142.185.39]) by shadow-blue.cis.pitt.edu with ESMTP (8.7.5/cispop-1.6.1.3) ID for ; Tue, 2 Apr 1996 08:15:38 -0500 Received: from local (root@localhost) by post-ofc03.srv.cis.pitt.edu (8.7.5/cispo-2.0.1.1) ID ; Tue, 2 Apr 1996 08:15:36 -0500 (EST) Received: via switchmail; Tue, 2 Apr 1996 08:15:36 -0500 (EST) Received: from list.srv.cis.pitt.edu via qmail ID ; Tue, 2 Apr 1996 08:13:47 -0500 (EST) Received: from local (majordom@localhost) by list.srv.cis.pitt.edu (8.7.5/cisls-2.4) ID ; Tue, 2 Apr 1996 08:13:01 -0500 (EST) X-Authentication-Warning: list.srv.cis.pitt.edu: majordom set sender to owner-wilderness-emergency-medicine using -f Received: from vines12.acf.dhhs.gov ([158.71.1.12]) by list.srv.cis.pitt.edu with SMTP (8.7.5/cisls-2.4) ID for ; Tue, 2 Apr 1996 08:12:54 -0500 (EST) Received: by vines12.acf.dhhs.gov; Tue, 2 Apr 96 8:12:31 EST Date: Tue, 2 Apr 96 7:34:49 EST Message-ID: X-Priority: 3 (Normal) To: , From: "Dave Matthews" Subject: re: O2 for Hypothermic Patients - Summary of Comments X-Incognito-SN: 458 X-Incognito-Format: VERSION=2.01a ENCRYPTED=NO Sender: owner-wilderness-emergency-medicine@list.pitt.edu Precedence: bulk X-PMFLAGS: 33554560 0 ****************************************************************************** ****************************************************************************** Dear Friends, A relatively new gizmo in the camping equipment marketplace (as contrasted with lighter weight backpacking equipment) may have some relevance to the question of heating O2 for administration to hypothermia victims. Its weight & bulk may limit applications for remote area rescues, however. The device is a campsite water heater called a "Hotman." It consists of a horizontal concentric coil of lightweight copper tubing, connected at its two ends by two plastic tubes that run, respectively, to the top and bottom of a 3 or 4 gallon plastic water container. The copper coil is to be laid on a heat source such as a campfire. The water container is placed a couple of feet higher, and hot water flows by convection from the copper coil up the plastic tube connected to the top of the container, while the cooler water flows out of the tube at the container's bottom down to the copper coil to be heated. The apparatus probably weighs about four pounds empty. Obviously, the water must be either carried with it or found on site. If the apparatus components and water were distributed among several members of a rescue party, it might be manageable. Unless a campfire is feasible, a stove would obviously be necessary as well. I'll have to leave it to the creative minds on this List to figure out just how the Hotman could be used, or modified, to heat oxygen for treating hypothermia. Hope it might prove helpful. As an afterthought, maybe it would be possible to fabricate a scaled-down version of this device, such that the copper coil could be heated in a coffeepot or teakettle. Perhaps the water container could be dispensed with, and the plastic tubing coiled around the oxygen delivery hose. -- Hmmmm. Best wishes, Dave Matthews Internet address: dmatthews@acf.dhhs.gov ****************************************************************************** ****************************************************************************** -- End -- Received: from post-ofc02.srv.cis.pitt.edu (post-ofc02.srv.cis.pitt.edu [136.142.185.11]) by shadow-blue.cis.pitt.edu with ESMTP (8.7.5/cispop-1.6.1.3) ID for ; Tue, 2 Apr 1996 13:10:10 -0500 Received: from local (root@localhost) by post-ofc02.srv.cis.pitt.edu (8.7.5/cispo-2.0.1.1) ID ; Tue, 2 Apr 1996 13:10:02 -0500 (EST) Received: via switchmail; Tue, 2 Apr 1996 13:10:02 -0500 (EST) Received: from list.srv.cis.pitt.edu via qmail ID ; Tue, 2 Apr 1996 13:08:20 -0500 (EST) Received: from local (majordom@localhost) by list.srv.cis.pitt.edu (8.7.5/cisls-2.4) ID ; Tue, 2 Apr 1996 13:06:35 -0500 (EST) X-Authentication-Warning: list.srv.cis.pitt.edu: majordom set sender to owner-wilderness-emergency-medicine using -f Received: from mail1.new-york.net (mail1.new-york.net [165.254.2.54]) by list.srv.cis.pitt.edu with ESMTP (8.7.5/cisls-2.4) ID for ; Tue, 2 Apr 1996 13:06:22 -0500 (EST) From: grenard@herpmed.com Received: from herpmed.com by mail1.new-york.net (PMDF V4.3-10 #5880) id <01I32FD1QKK0003I2K@mail1.new-york.net>; Tue, 02 Apr 1996 13:05:31 -0500 (EST) Date: Tue, 02 Apr 1996 01:03:15 -0800 (PST) Subject: FW: Re: FW: O2 for Hypothermic Patients - Summary of Comments To: gbutler@tcd.ie, wilderness-emergency-medicine@list.pitt.edu Message-id: MIME-version: 1.0 X-Mailer: Chameleon - TCP/IP for Windows by NetManage, Inc. Content-type: TEXT/PLAIN; charset=US-ASCII Content-transfer-encoding: 7BIT Sender: owner-wilderness-emergency-medicine@list.pitt.edu Precedence: bulk X-PMFLAGS: 34078848 0 I posted Dr. Butler's message to our respiratory therapist forum and got back the following reply which may be of interest./Steve Grenard, RRT ---------------Original Message--------------- Dr. Butler, I suppose warmed gas is better than nothing, but it is a lousy heat exchange medium: 1000 times less dense than water and about 1/1000th as effective. In serious hypthermia rapid transport and core rewarming are the best approach, as I'm sure you know. We do a lot of deep hypthothermic work here (asanguineous perfusion to 4 C and rewarming and resuscitation in dogs) and we find little if any effect of heated gas on rewarming. In a few years LiquiVent (perflubron) will very likely be released clinically and that will raise the possibility of liquid ventilation with appropriately CONTROLLED warming fluid delived to the surface area of the lungs (large!) thru which the entire CO flows. In the meantime, warm PD fluid (minus glucose!!!!!!) like Noromsol-R pH 7.4 would be far more effective and easier to keep warm. 4-liters in an igloo chest with chemical heating packs will give you an easy 2C warming within minutes. I have data using this to COOL humans with if you'd like to see it (both PD and liquid ventilation). Mike Darwin 21st Century Medicine Rancho Cucamonga, CA (909)987-3883 ----------End of Original Message---------- ================================================= Steve Grenard e-mail: grenard@herpmed.com POB 40825 - Staten Island, NY 10304-0825 Tel/Fax: 1-718-447-6144 Web: http://www.herpmed.com/ Resp: http://www.xmission.com/~gastown/herpmed/respi.htm ================================================= -- End -- Received: from post-ofc02.srv.cis.pitt.edu (post-ofc02.srv.cis.pitt.edu [136.142.185.11]) by shadow-blue.cis.pitt.edu with ESMTP (8.7.5/cispop-1.6.1.3) ID for ; Tue, 2 Apr 1996 04:36:26 -0500 Received: from local (root@localhost) by post-ofc02.srv.cis.pitt.edu (8.7.5/cispo-2.0.1.1) ID ; Tue, 2 Apr 1996 04:36:23 -0500 (EST) Received: via switchmail; Tue, 2 Apr 1996 04:36:23 -0500 (EST) Received: from list.srv.cis.pitt.edu via qmail ID ; Tue, 2 Apr 1996 04:36:02 -0500 (EST) Received: from local (majordom@localhost) by list.srv.cis.pitt.edu (8.7.5/cisls-2.4) ID ; Tue, 2 Apr 1996 04:34:46 -0500 (EST) X-Authentication-Warning: list.srv.cis.pitt.edu: majordom set sender to owner-wilderness-emergency-medicine using -f Received: from sun1.tcd.ie (sun1.tcd.ie [134.226.1.29]) by list.srv.cis.pitt.edu with ESMTP (8.7.5/cisls-2.4) ID for ; Tue, 2 Apr 1996 04:34:41 -0500 (EST) Received: from ee97.mee.tcd.ie (pc97.mee.tcd.ie [134.226.86.97]) by sun1.tcd.ie (8.7.1/8.6.10) with SMTP id KAA11973 for ; Tue, 2 Apr 1996 10:34:35 +0100 (BST) Date: Tue, 2 Apr 1996 10:34:35 +0100 (BST) Message-Id: <199604020934.KAA11973@sun1.tcd.ie> X-Sender: gbutler@mail.tcd.ie X-Mailer: Windows Eudora Light Version 1.5.2 Mime-Version: 1.0 Content-Type: text/plain; charset="us-ascii" To: wilderness-emergency-medicine@list.pitt.edu From: Dr Gerry Butler Subject: O2 for Hypothermic Patients - Summary of Comments Sender: owner-wilderness-emergency-medicine@list.pitt.edu Precedence: bulk X-PMFLAGS: 34078848 0 Field Warming Oxygen for Hypothermic Patients This is a summary of replies and some further information relating to my recent post on this question. The object of the post was to enquire if any simple, low cost, lightweight method of warming oxygen for delivery to hypothermic patients in the field (mountain rescue scenarios) existed. The question was raised as a result of a discussion paper by the UK Lake District Search and Mountain Rescue Association indicating that the provision of oxygen was contra indicated due to the inability to effectively warm the oxygen in the field and possible thermal reduction from a cold gas supply. Correspondence on this report should be addressed to Dr Peter Hodkin, 32 Foster Street, Penrith, CA11 7PA, UK. Since them I have become aware of additional information. Most notably, according to Wm. Forgey M>D> in "Death by Exposure - Hypothermia", ICS Books Merrillville Illinois, 1985, The Alaske state protocols for EMTs (all levels including paramedics) recommends that oxygen not be given unless CPR is in progress or specific medical orders have been received. It would appear that the reasoning is similar to that listed above. Wilkerson J A, in "Hypothermia, Frostbite and Other Cold Injuries", The Mountaineers, Seattle, 1986, says that not only should oxygen be warmed but humidification is also necessary as considerable heat can be lost be the patient in humidifying dry oxygen in the airway. In the replies received to the posting, the following points were noted: The national Ski Patrol has several devices, some illustrated in "Outdoor Emergency Care". These warm and humidify the oxygen. Dr Keith Conover raised the necessity of humidifying the oxygen, and mentioned that lightweight warming equipment seems to be no longer available. Humidification was also mentioned as necessary by Dante Landucci of NIH. Dave Matthews (dmatthews@acf.dhhs.gov) Suggested using a heated hunting sock or chemical heat packs to warm the oxygen tank. Brian Mannix pointed out that the oxygen expanding on exit from the tank will cool and this is likely to be more of a problem than the tank temperature itself. It would appear therefore, that heating must be carried out after the oxygen leaves the tank. Raymond Thielke an EMT/P from New York suggested wrapping the oxygen delivery tubing around the arm of the rescuer (under clothing) and using that to heat the line. This would be slightly impractical during a stretcher carry-out as the rescuer would be committed to remain alongside the patient. Paul Cooper RN EMT-P suggested running the line up the leg of the patients trousers for a similar heating effect. Given that the patients limbs are likely to be colder than the trunk this is probably not a good idea in itself, but modifying this suggestion slightly by running the line around the patients chest area, or under the arms where heat packs could usefully be applied, may be an idea worth trying. It seems that there is no definitive solution. Humidification would appear to be essential, but the problem of transporting a patient with a humidifier/heater attached still remains. I would like to thank everybody for their input and, if anybody comes up with further ideas please feel free to post or e-mail suggestions Gerry Dr Gerry Butler (gbutler@tcd.ie) TELTEC Radio Propagation Group Electronics Dept, Trinity College Dublin, Ireland Dublin+Wicklow Mountain Rescue, EMT-D, EI0CH -- End -- Received: from post-ofc03.srv.cis.pitt.edu (post-ofc03.srv.cis.pitt.edu [136.142.185.39]) by shadow-blue.cis.pitt.edu with ESMTP (8.7.5/cispop-1.6.1.3) ID for ; Thu, 4 Apr 1996 09:03:09 -0500 From: BRITTONDL@k1023.a1.ornl.gov Received: from local (root@localhost) by post-ofc03.srv.cis.pitt.edu (8.7.5/cispo-2.0.1.1) ID ; Thu, 4 Apr 1996 09:03:06 -0500 (EST) Received: via switchmail; Thu, 4 Apr 1996 09:03:06 -0500 (EST) Received: from list.srv.cis.pitt.edu via qmail ID ; Thu, 4 Apr 1996 09:02:00 -0500 (EST) Received: from oaunx1.ctd.ornl.GOV (oaunx1.ctd.ornl.gov [128.219.128.17]) by list.srv.cis.pitt.edu with ESMTP (8.7.5/cisls-2.4) ID for ; Thu, 4 Apr 1996 09:01:55 -0500 (EST) Received: from ctdvx5.priv.ornl.gov (ctdvx5.priv.ornl.gov [172.17.1.9]) by oaunx1.ctd.ornl.GOV (8.7.4/8.7.3) with ESMTP id JAA30180 for ; Thu, 4 Apr 1996 09:01:55 -0500 (EST) Received: from oax-from-mr.mr.ornl.gov by OAX.PRIV.ORNL.GOV (PMDF V5.0-6 #12522) id <01I34ZEZEWKG8ZELCM@OAX.PRIV.ORNL.GOV> for owner-wilderness-emergency-medicine@list.pitt.edu; Thu, 04 Apr 1996 09:01:49 -0500 (EST) Received: with PMDF-MR; Thu, 04 Apr 1996 09:02:12 -0500 (EST) MR-Received: by mta KMOV; Relayed; Thu, 04 Apr 1996 09:02:12 -0500 MR-Received: by mta OAX; Relayed; Thu, 04 Apr 1996 09:01:26 -0500 Alternate-recipient: prohibited Date: Thu, 04 Apr 1996 08:54:11 -0500 (EST) Subject: Warm Gase To: in@"owner-wilderness-emergency-medicine@list.pitt.edu" Message-id: MIME-version: 1.0 Content-type: TEXT/PLAIN; CHARSET=US-ASCII Content-transfer-encoding: 7BIT Posting-date: Thu, 04 Apr 1996 09:02:00 -0500 (EST) Importance: normal Priority: normal UA-content-id: E1528ZWFYCX1HM X400-MTS-identifier: [;21209040406991/2130783@K1023] A1-type: MAIL Hop-count: 2 X-PMFLAGS: 34078848 0 I am not a medical type, but I think a point is missing in the use of warm gase inhalation. I think that it is not that we need to rewarm patients, but to prevent future decline in core temperature during evacuation. I think this is where warm gase inhalation come in. in the cave rescue community, there are a few home brewed warm gase systems which use ?? baron lime?? and CO2. These are compact, provide warm, oxygen enriched, and humidified breathing gase. Not only were these just considered for the patient but also could be used by cold rescuers. Danny Britton -- End -- Received: from post-ofc02.srv.cis.pitt.edu (post-ofc02.srv.cis.pitt.edu [136.142.185.11]) by shadow-blue.cis.pitt.edu with ESMTP (8.7.5/cispop-1.6.1.3) ID for ; Thu, 4 Apr 1996 16:16:18 -0500 Received: from local (root@localhost) by post-ofc02.srv.cis.pitt.edu (8.7.5/cispo-2.0.1.1) ID ; Thu, 4 Apr 1996 16:16:13 -0500 (EST) Received: via switchmail; Thu, 4 Apr 1996 16:16:12 -0500 (EST) Received: from list.srv.cis.pitt.edu via qmail ID ; Thu, 4 Apr 1996 16:15:23 -0500 (EST) Received: from local (majordom@localhost) by list.srv.cis.pitt.edu (8.7.5/cisls-2.4) ID ; Thu, 4 Apr 1996 16:14:23 -0500 (EST) X-Authentication-Warning: list.srv.cis.pitt.edu: majordom set sender to owner-wilderness-emergency-medicine using -f Received: from vines12.acf.dhhs.gov ([158.71.1.12]) by list.srv.cis.pitt.edu with SMTP (8.7.5/cisls-2.4) ID for ; Thu, 4 Apr 1996 16:14:19 -0500 (EST) Received: by vines12.acf.dhhs.gov; Thu, 4 Apr 96 16:14:01 EST Date: Thu, 4 Apr 96 15:37:01 EST Message-ID: X-Priority: 3 (Normal) To: From: "Dave Matthews" Subject: MORE HOT AIR FOR THE "HOT AIR THREAD" X-Incognito-SN: 458 X-Incognito-Format: VERSION=2.01a ENCRYPTED=NO Sender: owner-wilderness-emergency-medicine@list.pitt.edu Precedence: bulk X-PMFLAGS: 33554560 0 ****************************************************************************** ****************************************************************************** This afternoon's post from Dr. Mathews recalls to mind that the new chemical heat packs for military rations have been receiving rave reviews from National Public Radio correspondents who apparently have memories of frigid ham and lima beans from previous wars. Haven't tried 'em myself, but they might put out a few more calories than commercial hand-warmer packs. By the way, a few years ago, a couple U.S. mail order houses were offering a lightweight Norwegian Army tent heater that burned some type of compacted charcoal fuel brickettes, reputed to put out little or no carbon monoxide. Sounded as if it might be something like a big brother to those velvet- covered handwarmers which burn solid fuel sticks. Must not have sold well, since it seems to have disappeared from the catalogs. Don't know if the Norwegians are still using it. If still obtainable, the question is whether it would have any possible use for the application under discussion. Given all the experimental approaches for generating "hot (or warm) air" and regulating its humidity, I trust due consideration will continue to be focused upon monitoring the temperature of the product, to ensure its kept within acceptable ranges. Further, maybe some of these "Rube Goldberg" gizmos could be looked at to determine whether they offer new possibilities for warming the PATIENT -- as well as (or instead of) his/her oxygen. Best wishes, Dave Matthews Internet address: dmatthews@acf.dhhs.gov ****************************************************************************** ****************************************************************************** -- End -- Received: from post-ofc02.srv.cis.pitt.edu (post-ofc02.srv.cis.pitt.edu [136.142.185.11]) by shadow-blue.cis.pitt.edu with ESMTP (8.7.5/cispop-1.6.1.3) ID for ; Thu, 4 Apr 1996 15:01:15 -0500 Received: from local (root@localhost) by post-ofc02.srv.cis.pitt.edu (8.7.5/cispo-2.0.1.1) ID ; Thu, 4 Apr 1996 15:01:07 -0500 (EST) Received: via switchmail; Thu, 4 Apr 1996 15:01:06 -0500 (EST) Received: from list.srv.cis.pitt.edu via qmail ID ; Thu, 4 Apr 1996 15:00:15 -0500 (EST) Received: from local (majordom@localhost) by list.srv.cis.pitt.edu (8.7.5/cisls-2.4) ID ; Thu, 4 Apr 1996 14:58:14 -0500 (EST) X-Authentication-Warning: list.srv.cis.pitt.edu: majordom set sender to owner-wilderness-emergency-medicine using -f Received: from POBOX.CC.UKANS.EDU (kushare1.cc.ukans.edu [129.237.35.157]) by list.srv.cis.pitt.edu with SMTP (8.7.5/cisls-2.4) ID for ; Thu, 4 Apr 1996 14:58:08 -0500 (EST) Received: from KU_Lawrence_1-Message_Server by POBOX.CC.UKANS.EDU with Novell_GroupWise; Thu, 04 Apr 1996 13:57:59 -0600 Message-Id: X-Mailer: Novell GroupWise 4.1 Date: Thu, 04 Apr 1996 14:05:03 -0600 From: Paul Mathews To: wilderness-emergency-medicine@list.pitt.edu Subject: FW: re: O2 for Hypothermic Patients - Summary of Comments Sender: owner-wilderness-emergency-medicine@list.pitt.edu Precedence: bulk -Reply -Forwarded X-PMFLAGS: 33554560 0 Date: 04/04/1996 01:01 pm (Thursday) From: Paul Mathews To: IN:dmatthews@acf.dhhs.gov Subject: FW: re: O2 for Hypothermic Patients - Summary of Comments -Reply Perhaps a solution to this problem could be acheived by using chemical heat sources (HOT Hands) designed for sporting events and either wrappping the O2 tubing around the warmer or using the warmer to heat a water source which could then have the O2 tubing coiled in it. Paul Mathews Assoc Prof Resp care Educ University of Kansas pmathews@kumc.edu -- End -- Received: from post-ofc03.srv.cis.pitt.edu (post-ofc03.srv.cis.pitt.edu [136.142.185.39]) by shadow-blue.cis.pitt.edu with ESMTP (8.7.5/cispop-1.6.1.3) ID for ; Fri, 5 Apr 1996 11:35:53 -0500 Received: from local (root@localhost) by post-ofc03.srv.cis.pitt.edu (8.7.5/cispo-2.0.1.1) ID ; Fri, 5 Apr 1996 11:35:50 -0500 (EST) Received: via switchmail; Fri, 5 Apr 1996 11:35:50 -0500 (EST) Received: from list.srv.cis.pitt.edu via qmail ID ; Fri, 5 Apr 1996 11:35:13 -0500 (EST) Received: from local (majordom@localhost) by list.srv.cis.pitt.edu (8.7.5/cisls-2.4) ID ; Fri, 5 Apr 1996 11:34:43 -0500 (EST) X-Authentication-Warning: list.srv.cis.pitt.edu: majordom set sender to owner-wilderness-emergency-medicine using -f Received: from mail1.new-york.net (mail1.new-york.net [165.254.2.54]) by list.srv.cis.pitt.edu with ESMTP (8.7.5/cisls-2.4) ID for ; Fri, 5 Apr 1996 11:34:34 -0500 (EST) From: grenard@herpmed.com Received: from herpmed.com by mail1.new-york.net (PMDF V4.3-10 #5880) id <01I36J15ZJ9S004E1F@mail1.new-york.net>; Fri, 05 Apr 1996 11:33:38 -0500 (EST) Date: Thu, 04 Apr 1996 23:26:38 -0800 (PST) Subject: RE: Hypoxic, Hypothermic Patients To: wilderness-emergency-medicine@list.pitt.edu, Dante_Landucci@NIH.gov Message-id: MIME-version: 1.0 X-Mailer: Chameleon - TCP/IP for Windows by NetManage, Inc. Content-type: TEXT/PLAIN; CHARSET=us-ascii Content-transfer-encoding: 7BIT Sender: owner-wilderness-emergency-medicine@list.pitt.edu Precedence: bulk X-PMFLAGS: 34078848 0 There are any number of commercial devices available for humidifying dry oxygen and bubbling a portable source through such devices with some minor modification. While difficult during transport it is not impossible. For the most part oxygen under normal conditions of transport for short hops is not humidifed because of this. Such devices are known as oxygen humidifer bottles, numerous compaies make disposable, prefilled versions and the O2 can be bubbed through them. If you also wanted to warm the gas, just stick the bubble bottle in a canister surrounded by handwarmers or chemical heat packs. This is a problem that is easily solved and if a long transport (time? I dunno) of a hypothermic patient is contemplated and warmed, humidifed oxygen is to be given I think it can be readily accomplised with a small amount of ingenuity. ================================================= Steve Grenard, RRT e-mail: grenard@herpmed.com POB 40825 - Staten Island, NY 10304-0825 Tel/Fax: 1-718-447-6144 Web: http://www.herpmed.com/ Resp: http://www.xmission.com/~gastown/herpmed/respi.htm ================================================= -- End -- Received: from post-ofc03.srv.cis.pitt.edu (post-ofc03.srv.cis.pitt.edu [136.142.185.39]) by shadow-blue.cis.pitt.edu with ESMTP (8.7.5/cispop-1.6.1.3) ID for ; Fri, 5 Apr 1996 10:38:14 -0500 Received: from local (root@localhost) by post-ofc03.srv.cis.pitt.edu (8.7.5/cispo-2.0.1.1) ID ; Fri, 5 Apr 1996 10:38:10 -0500 (EST) Received: via switchmail; Fri, 5 Apr 1996 10:38:09 -0500 (EST) Received: from list.srv.cis.pitt.edu via qmail ID ; Fri, 5 Apr 1996 10:36:07 -0500 (EST) Received: from local (majordom@localhost) by list.srv.cis.pitt.edu (8.7.5/cisls-2.4) ID ; Fri, 5 Apr 1996 10:35:18 -0500 (EST) X-Authentication-Warning: list.srv.cis.pitt.edu: majordom set sender to owner-wilderness-emergency-medicine using -f Received: from pop.cc.nih.gov (pop.cc.nih.gov [137.187.120.140]) by list.srv.cis.pitt.edu with ESMTP (8.7.5/cisls-2.4) ID for ; Fri, 5 Apr 1996 10:35:15 -0500 (EST) Received: from [128.231.80.73] ([128.231.80.73]) by pop.cc.nih.gov (8.7.4/8.7.3) with SMTP id KAA29809 for ; Fri, 5 Apr 1996 10:35:13 -0500 (EST) X-Sender: dlanducci@pop.cc.nih.gov Message-Id: Mime-Version: 1.0 Content-Type: text/plain; charset="us-ascii" Date: Fri, 5 Apr 1996 10:37:58 -0500 To: wilderness-emergency-medicine@list.pitt.edu From: Dante_Landucci@NIH.gov (Dante Landucci, MD) Subject: Hypoxic, Hypothermic Patients Sender: owner-wilderness-emergency-medicine@list.pitt.edu Precedence: bulk X-PMFLAGS: 35127424 0 The continued discussion of heating delivered oxygen to wilderness trauma vcitms continues to perplex me. I believe it safe to state that the major concern is not the heat content of the gas (or lack of it), which is quite low. Evaporative heat loss associated with breathing any dry gas IS a significant factor in the prevention or management of hypothermia. Thus, one first should be focusing on saturating the gas with water vapor. Does anyone go to remote trauma sites with the appropriate equipment to accomplish this? If so, what gear is used? If not, can we abandon this line of speculation, which so far has proven fruitless? ----- Reply RE: FW: re: O2 for Hypothermic Patients - Summary of Comments ======================== At 14:05 4/4/96, Paul Mathews wrote: -Reply -Forwarded Date: 04/04/1996 01:01 pm (Thursday) From: Paul Mathews To: IN:dmatthews@acf.dhhs.gov Subject: FW: re: O2 for Hypothermic Patients - Summary of Comments -Reply Perhaps a solution to this problem could be acheived by using chemical heat sources (HOT Hands) designed for sporting events and either wrappping the O2 tubing around the warmer or using the warmer to heat a water source which could then have the O2 tubing coiled in it. Paul Mathews Assoc Prof Resp care Educ University of Kansas pmathews@kumc.edu -- End -- X-cs: From: Self To: Dante_Landucci@NIH.gov (Dante Landucci, MD) Subject: Re: Hypoxic, Hypothermic Patients Reply-to: kconover@pitt.edu Date: Fri, 5 Apr 1996 18:00:26 On 5 Apr 96 at 10:37, Dante Landucci, MD wrote: > The continued discussion of heating delivered oxygen to wilderness > trauma vcitms continues to perplex me. I believe it safe to state > that the major concern is not the heat content of the gas (or lack > of it), which is quite low. > > Evaporative heat loss associated with breathing any dry gas IS a > significant factor in the prevention or management of hypothermia. > Thus, one first should be focusing on saturating the gas with water > vapor. Agreed that warm air, even humidified, doesn't do much to rewarm patients in the wilderness. But if the air temperature is -5 degrees F, and the air coming out of the D cylinder is even colder from expansion, then it can be a significant source of cooling. So I view warm, humidified oxygen (or air) as "active insulation." I think it's just as important as a sleeping bag and Ensolite pad for keeping the patient warm during the evac. A cheap alternative is an "artificial nose" which is the medical equivalent of a wool scarf across the nose and mouth for winter travelers. It traps some water, and as long as it doesn't ice up too much, humidifes the air that one breathes back in. It does cause a little CO2 retention. So, yes, humidifed air or oxygen is important -- but because it provides "insulation" not "rewarming." -- End -- Received: from post-ofc03.srv.cis.pitt.edu (post-ofc03.srv.cis.pitt.edu [136.142.185.39]) by shadow-blue.cis.pitt.edu with ESMTP (8.7.5/cispop-1.6.1.3) ID for ; Mon, 8 Apr 1996 02:24:35 -0400 Received: from local (root@localhost) by post-ofc03.srv.cis.pitt.edu (8.7.5/cispo-2.0.1.1) ID ; Mon, 8 Apr 1996 02:24:30 -0400 (EDT) Received: via switchmail; Mon, 8 Apr 1996 02:24:30 -0400 (EDT) Received: from list.srv.cis.pitt.edu via qmail ID ; Mon, 8 Apr 1996 02:24:26 -0400 (EDT) Received: from local (majordom@localhost) by list.srv.cis.pitt.edu (8.7.5/cisls-2.4) ID ; Mon, 8 Apr 1996 02:21:59 -0400 (EDT) X-Authentication-Warning: list.srv.cis.pitt.edu: majordom set sender to owner-wilderness-emergency-medicine using -f Received: from ns.defence.gov.au ([203.5.216.130]) by list.srv.cis.pitt.edu with SMTP (8.7.5/cisls-2.4) ID for ; Mon, 8 Apr 1996 02:21:45 -0400 (EDT) Received: from dsdn.dcg.fe.defence.gov.au by ns.defence.gov.au; (5.65/1.1.8.2/05Jun95-0326PM) id AA21878; Mon, 8 Apr 1996 15:52:14 +0930 Received: from [144.97.132.33] by dsdn (5.x/SMI-SVR4) id AA02948; Mon, 8 Apr 1996 16:16:19 +1000 Message-Id: <9604080616.AA02948@dsdn> To: "Dante Landucci, MD" , Wilderness Emergency Medicine list Subject: Re: Hypoxic, Hypothermic Patients Date: Mon, 08 Apr 96 17:24:15 -0500 From: Lyle Williams X-Mailer: E-Mail Connection v2.5.03 Sender: owner-wilderness-emergency-medicine@list.pitt.edu Precedence: bulk X-PMFLAGS: 33554560 0 -- [ From: Lyle Williams * EMC.Ver #2.5.02 ] -- > The continued discussion of heating delivered oxygen to wilderness trauma > vcitms continues to perplex me. I believe it safe to state that the major > concern is not the heat content of the gas (or lack of it), which is quite low. > > Evaporative heat loss associated with breathing any dry gas IS a significant > factor in the prevention or management of hypothermia. Thus, one first should > be focusing on saturating the gas with water vapor. > > Does anyone go to remote trauma sites with the appropriate equipment to > accomplish this? If so, what gear is used? If not, can we abandon this line of > speculation, which so far has proven fruitless? I seem to recall reading a New Zealand Mountain Safety Council document on hypothermia that covered various airway rewarming systems. One of them used a hydrogen/oxygen mix and a catalyst in the delivery system. I would hope the H2 & O2 mix was not explosive! Anyway, the idea was to have an exothermic reaction with water vapour as the by-product. It seemed like a neat sort of idea, other than needing a special gas mix. I will track down the book at home and send another message tomorrow. Lyle Williams dsm@dcg.fe.defence.gov.au -- End -- Received: from post-ofc03.srv.cis.pitt.edu (post-ofc03.srv.cis.pitt.edu [136.142.185.39]) by shadow-blue.cis.pitt.edu with ESMTP (8.7.5/cispop-1.6.1.3) ID for ; Tue, 9 Apr 1996 07:16:11 -0400 Received: from local (root@localhost) by post-ofc03.srv.cis.pitt.edu (8.7.5/cispo-2.0.1.1) ID ; Tue, 9 Apr 1996 07:16:07 -0400 (EDT) Received: via switchmail; Tue, 9 Apr 1996 07:16:07 -0400 (EDT) Received: from list.srv.cis.pitt.edu via qmail ID ; Tue, 9 Apr 1996 07:15:19 -0400 (EDT) Received: from local (majordom@localhost) by list.srv.cis.pitt.edu (8.7.5/cisls-2.4) ID ; Tue, 9 Apr 1996 07:14:43 -0400 (EDT) X-Authentication-Warning: list.srv.cis.pitt.edu: majordom set sender to owner-wilderness-emergency-medicine using -f Received: from mailhost.iuol.cn.net ([202.96.26.246]) by list.srv.cis.pitt.edu with SMTP (8.7.5/cisls-2.4) ID for ; Tue, 9 Apr 1996 07:14:37 -0400 (EDT) Received: from [202.96.26.131] by mailhost.iuol.cn.net id aa23684; 9 Apr 96 19:02 PDT Message-ID: <316AB751.26C6@iuol.cn.net> Date: Tue, 09 Apr 1996 19:15:29 +0000 From: Lee Weingrad Reply-To: surgate@iuol.cn.net X-Mailer: Mozilla 2.0 (Macintosh; I; 68K) MIME-Version: 1.0 To: wilderness-emergency-medicine@list.pitt.edu CC: Parasol@tristero.io.com Subject: Disaster in E. Tibet Content-Type: text/plain; charset=us-ascii Content-Transfer-Encoding: 7bit Sender: owner-wilderness-emergency-medicine@list.pitt.edu Precedence: bulk X-PMFLAGS: 34078848 0 Dear Friends, The following report was delivered to my by the Government of Xiao Surmang Township, Yushu Prefecture, Qinghai Province, China. Yushu County is one of the most remote places in the world, with 900 peaks over 500 meters. Xiao Surmang (Dutsi Til) Township includes Dutsi Til, a 400 year-old monastery where we are building a primary care clinic. The village in this report, Modi, lies about 5 km south of the monastery, along the confluence of two tributaries of the upper reaches of the Mekong River. It is a small part of this years bitter winter in E. Tibet. This winter's heavy snows have killed an estimated 600,000 heads of livestock and left 100,000 nomads facing starvation. Friends of Surmang, Inc., will be mounting a relief effort this summer to feed the hungry in Yushu County and to replenish lost livestock. I urge all those who can, to aid us in this effort, be it financially, or with your medical expertise. We are not connected with any religious or political organization. Please email Friends of Surmang (Surmang Foundation) at --surgate@iuol.cn.net or phone or fax at --8610 849 9306. Remember we are 12 hours ahead of New York. address: Lido Hotel/Beijing 100004/PR China Thank you, Lee Weingrad REPORT ON THE SNOWSTORM IN MODI VILLAGE, XIAO SURMANG TOWNSHIP, YUSHU COUNTY Dear Mr. Wang Li (Lee Weingrad): Modi Village was severely affected by snowstorm in Xiao Surmang Township. The whole village has 128 families with a total population of 589. Working labor: 159, 11 families are on State support. The total cattle including sheep and yak, 7721 head. It has been snowing heavily and continuously from mid November 1995 until January 24, 1996. During this storm, exteme blizzard conditions have existed on 15 occasions from Jan.10th through the 24th. The depth of snow is one meter. All the grasslands are covered in snow. Livestock have been unable to find grass to eat. The result was great damage to agricultural and nomadic production. The blizzard has caused the death of 4798 heads of livestock, or 62% of their entire herds. If it snows again, all the cattle may die. Because this time the snows are long in duration and deep, all together 65 people suffered frostbite and 20-26 people got snowblindness. So far, 32 families have lost all their livestock. 18 families have no food. 48 families have very little yak and sheep left. Xiao Surmang Township Government, Yushu County Yushu Prefecture, Qinghai Province Feb 29, 1996 -- End -- Received: from post-ofc02.srv.cis.pitt.edu (post-ofc02.srv.cis.pitt.edu [136.142.185.11]) by shadow-blue.cis.pitt.edu with ESMTP (8.7.5/cispop-1.6.1.3) ID for ; Tue, 9 Apr 1996 07:20:49 -0400 Received: from local (root@localhost) by post-ofc02.srv.cis.pitt.edu (8.7.5/cispo-2.0.1.1) ID ; Tue, 9 Apr 1996 07:20:46 -0400 (EDT) Received: via switchmail; Tue, 9 Apr 1996 07:20:46 -0400 (EDT) Received: from list.srv.cis.pitt.edu via qmail ID ; Tue, 9 Apr 1996 07:20:02 -0400 (EDT) Received: from local (majordom@localhost) by list.srv.cis.pitt.edu (8.7.5/cisls-2.4) ID ; Tue, 9 Apr 1996 07:19:50 -0400 (EDT) X-Authentication-Warning: list.srv.cis.pitt.edu: majordom set sender to owner-wilderness-emergency-medicine using -f Received: from mailhost.iuol.cn.net ([202.96.26.246]) by list.srv.cis.pitt.edu with SMTP (8.7.5/cisls-2.4) ID for ; Tue, 9 Apr 1996 07:19:43 -0400 (EDT) Received: from [202.96.26.131] by mailhost.iuol.cn.net id aa23740; 9 Apr 96 19:07 PDT Message-ID: <316AB888.528A@iuol.cn.net> Date: Tue, 09 Apr 1996 19:20:40 +0000 From: Lee Weingrad Reply-To: surgate@iuol.cn.net X-Mailer: Mozilla 2.0 (Macintosh; I; 68K) MIME-Version: 1.0 To: Emergency Wilderness Medicine Subject: Correction Content-Type: text/plain; charset=us-ascii Content-Transfer-Encoding: 7bit Sender: owner-wilderness-emergency-medicine@list.pitt.edu Precedence: bulk X-PMFLAGS: 34078848 0 Sorry, that should read 900 peaks over 5000 meters. BTW, we need doc volunteers, something not entirely clear from the text. Lee Weingrad Beijing -- End -- Received: from post-ofc03.srv.cis.pitt.edu (post-ofc03.srv.cis.pitt.edu [136.142.185.39]) by shadow-blue.cis.pitt.edu with ESMTP (8.7.5/cispop-1.6.1.3) ID for ; Tue, 9 Apr 1996 02:57:49 -0400 Received: from local (root@localhost) by post-ofc03.srv.cis.pitt.edu (8.7.5/cispo-2.0.1.1) ID ; Tue, 9 Apr 1996 02:57:37 -0400 (EDT) Received: via switchmail; Tue, 9 Apr 1996 02:57:37 -0400 (EDT) Received: from list.srv.cis.pitt.edu via qmail ID ; Tue, 9 Apr 1996 02:55:41 -0400 (EDT) Received: from local (majordom@localhost) by list.srv.cis.pitt.edu (8.7.5/cisls-2.4) ID ; Tue, 9 Apr 1996 02:53:09 -0400 (EDT) X-Authentication-Warning: list.srv.cis.pitt.edu: majordom set sender to owner-wilderness-emergency-medicine using -f Received: from ns.defence.gov.au ([203.5.216.130]) by list.srv.cis.pitt.edu with SMTP (8.7.5/cisls-2.4) ID for ; Tue, 9 Apr 1996 02:52:59 -0400 (EDT) Received: from dsdn.dcg.fe.defence.gov.au by ns.defence.gov.au; (5.65/1.1.8.2/05Jun95-0326PM) id AA17355; Tue, 9 Apr 1996 16:23:28 +0930 Received: from [144.97.132.33] by dsdn (5.x/SMI-SVR4) id AA05645; Tue, 9 Apr 1996 16:47:19 +1000 Message-Id: <9604090647.AA05645@dsdn> To: Wilderness Emergency Medicine list Subject: Heated, humidified O2 Date: Tue, 09 Apr 96 17:55:26 -0500 From: Lyle Williams X-Mailer: E-Mail Connection v2.5.03 Sender: owner-wilderness-emergency-medicine@list.pitt.edu Precedence: bulk X-PMFLAGS: 33554560 0 -- [ From: Lyle Williams * EMC.Ver #2.5.02 ] -- >I seem to recall reading a New Zealand Mountain Safety Council document on hypothermia that covered various >airway rewarming systems. One of them used a hydrogen/oxygen mix and a catalyst in the delivery system. I >would hope the H2 & O2 mix was not explosive! Anyway, the idea was to have an exothermic reaction with water >vapour as the by-product. It seemed like a neat sort of idea, other than needing a special gas mix. > >I will track down the book at home and send another message tomorrow. Sorry, I couldn't find the book. It was called "Hypothermia", and was pitched mainly at lay people, but included a chapter aimed at GPs and small town hospitals. The reference to the above system was only a line or two long. Thinking about the system, I guess two major problems would be ensuring a complete reaction between H2 and O2, and draining condensation from the system. These problems may well have been addressed already. Lyle Williams. -- End -- Received: from post-ofc03.srv.cis.pitt.edu (post-ofc03.srv.cis.pitt.edu [136.142.185.39]) by shadow-blue.cis.pitt.edu with ESMTP (8.7.5/cispop-1.6.1.3) ID for ; Wed, 10 Apr 1996 09:13:49 -0400 Received: from local (root@localhost) by post-ofc03.srv.cis.pitt.edu (8.7.5/cispo-2.0.1.1) ID ; Wed, 10 Apr 1996 09:13:42 -0400 (EDT) Received: via switchmail; Wed, 10 Apr 1996 09:13:42 -0400 (EDT) Received: from list.srv.cis.pitt.edu via qmail ID ; Wed, 10 Apr 1996 09:12:04 -0400 (EDT) Received: from local (majordom@localhost) by list.srv.cis.pitt.edu (8.7.5/cisls-2.4) ID ; Wed, 10 Apr 1996 09:11:44 -0400 (EDT) X-Authentication-Warning: list.srv.cis.pitt.edu: majordom set sender to owner-wilderness-emergency-medicine using -f Received: from inet.ed.gov (inet.ed.gov [192.239.34.1]) by list.srv.cis.pitt.edu with SMTP (8.7.5/cisls-2.4) ID for ; Wed, 10 Apr 1996 09:11:39 -0400 (EDT) Received: from ccMail by ed.gov (SMTPLINK V2.11 PreRelease 4) id AA829152603; Wed, 10 Apr 96 08:11:18 EST Date: Wed, 10 Apr 96 08:11:18 EST From: "Peter McCabe" Encoding: 2 Text Message-Id: <9603108291.AA829152603@ed.gov> To: "Dave Matthews" , wilderness-emergency-medicine@list.pitt.edu Subject: Re[2]: Disaster in E. Tibet Sender: owner-wilderness-emergency-medicine@list.pitt.edu Precedence: bulk X-PMFLAGS: 33554560 0 I concur. This can probably be done by contacting the State Department and talking to people at the "Chinese" desk. -- End -- Received: from post-ofc02.srv.cis.pitt.edu (post-ofc02.srv.cis.pitt.edu [136.142.185.11]) by shadow-blue.cis.pitt.edu with ESMTP (8.7.5/cispop-1.6.1.3) ID for ; Wed, 10 Apr 1996 11:04:30 -0400 Received: from local (root@localhost) by post-ofc02.srv.cis.pitt.edu (8.7.5/cispo-2.0.1.1) ID ; Wed, 10 Apr 1996 11:04:23 -0400 (EDT) Received: via switchmail; Wed, 10 Apr 1996 11:04:21 -0400 (EDT) Received: from list.srv.cis.pitt.edu via qmail ID ; Wed, 10 Apr 1996 11:02:16 -0400 (EDT) Received: from local (majordom@localhost) by list.srv.cis.pitt.edu (8.7.5/cisls-2.4) ID ; Wed, 10 Apr 1996 10:59:33 -0400 (EDT) X-Authentication-Warning: list.srv.cis.pitt.edu: majordom set sender to owner-wilderness-emergency-medicine using -f Received: from mailhost.iuol.cn.net ([202.96.26.246]) by list.srv.cis.pitt.edu with SMTP (8.7.5/cisls-2.4) ID for ; Wed, 10 Apr 1996 10:59:16 -0400 (EDT) Received: from [202.96.26.137] by mailhost.iuol.cn.net id aa12793; 10 Apr 96 22:46 PDT Message-ID: <316C3D65.F20@iuol.cn.net> Date: Wed, 10 Apr 1996 22:59:49 +0000 From: Lee Weingrad Reply-To: surgate@iuol.cn.net X-Mailer: Mozilla 2.0 (Macintosh; I; 68K) MIME-Version: 1.0 To: Dave Matthews CC: wilderness-emergency-medicine@list.pitt.edu Subject: Re: Disaster in E. Tibet References: Content-Type: text/plain; charset=us-ascii Content-Transfer-Encoding: 7bit Sender: owner-wilderness-emergency-medicine@list.pitt.edu Precedence: bulk X-PMFLAGS: 34078848 0 Dear Dave, You wrote: >At the risk of seeming excessively cautious, can any confirmation of >the reputed Eastern Tibet Disaster be obtained through official >Chinese,U.S. diplomatic, or news sources ?? No, I don't think you are excessively cautious. The following fax was received by me in my office. It was sent by the Government of Xiao Surmang Township. I think I posted it on your usenet discussion group. I would be happy to fax you the original as well as another letter from Yushu County Government Office of Emergency Assistance. Here is the letter from the Township Government: REPORT ON THE SNOWSTORM IN MODI VILLAGE, XIAO SURMANG TOWNSHIP, YUSHU COUNTY Dear Mr. Wang Li (Lee Weingrad): Modi Village was severely affected by snowstorm in Xiao Surmang Township. The whole village has 128 families with a total population of 589. Working labor: 159, 11 families are on State support. The total cattle including sheep and yak, 7721 head. It has been snowing heavily and continuously from mid November 1995 until January 24, 1996. During this storm, exteme blizzard conditions have existed on 15 occasions from Jan.10th through the 24th. The depth of snow is one meter. All the grasslands are covered in snow. Livestock have been unable to find grass to eat. The result was great damage to agricultural and nomadic production. The blizzard has caused the death of 4798 heads of livestock, or 62% of their entire herds. If it snows again, all the cattle may die. Because this time the snows are long in duration and deep, all together 65 people suffered frostbite and 20 26 people got snowblindness. So far, 32 families have lost all their livestock. 18 families have no food. 48 families have very little yak and sheep left. Xiao Surmang Township Government, Yushu County Yushu Prefecture, Qinghai Province Feb 29, 1996 This is from today's letter from the Yushu County Government: (Yushu County is one of 5 counties affected by the snowstorm.) According to this latest letter, "there were over 50 blizzards in Yushu County this year. In the flatlands the snow is over 1 m. high. A few hundred families, 7,000 people, 400,000 head of cattle were trapped. So far over 250,000 head of livestock are dead and the number is increasing. People's lives and property are seriously threatened. There were no deaths and all the trapped people have been saved. "We firmly believe as long as we have people like you, with your care and help, we will definitely overcome all these obstacles...." The general lack of knowledge of this tragedy is because it is not adequately covered in the media. Nonetheless, there were many stories from Reuters and other agencies that we have on file here. I'd be happy to send them to you personally or post them if that is not too much bother to the other members of the usenet group. In addition you might check WTN, World Tibetnet News. Their address is WTN-L@VM1.MCGILL.CA. Current relief efforts are by Medicins Sans Frontiers, but they will quit quite soon. Our organization, Friends of Surmang, with the Lido Hotel address, is a US-based NGO that is a 501 c(3) non profit incorporated in 1988 in Colorado. We are engaged in the construction of primary care clinics in Yushu County (SE Qinghai Province, China), Xiao Surmang Township. We are funded by the governments of the Netherlands, Canada, Germany, as well as UNESCO and some large private foundations. We are working in an area that is ethnically Tibetan and very very poor even by rural Chinese standards. We will start construction of a language training and skills training school this summer. We are also beginning to bear responsibility for relief and livestock replacement. I would be happy to share copies of any relevant documentation or reference materials you might want to see. I hope we can magnitize the help of medical professionals in your usenet group. It is a very great challenge. Please write or call (8610 849 9306) with any questions or suggestions. Sincerely Lee Weingrad Beijing -- End -- Received: from post-ofc03.srv.cis.pitt.edu (post-ofc03.srv.cis.pitt.edu [136.142.185.39]) by shadow-blue.cis.pitt.edu with ESMTP (8.7.5/cispop-1.6.1.3) ID for ; Wed, 10 Apr 1996 12:03:34 -0400 Received: from local (root@localhost) by post-ofc03.srv.cis.pitt.edu (8.7.5/cispo-2.0.1.1) ID ; Wed, 10 Apr 1996 12:03:25 -0400 (EDT) Received: via switchmail; Wed, 10 Apr 1996 12:03:25 -0400 (EDT) Received: from list.srv.cis.pitt.edu via qmail ID ; Wed, 10 Apr 1996 12:01:59 -0400 (EDT) Received: from local (majordom@localhost) by list.srv.cis.pitt.edu (8.7.5/cisls-2.4) ID ; Wed, 10 Apr 1996 12:00:08 -0400 (EDT) X-Authentication-Warning: list.srv.cis.pitt.edu: majordom set sender to owner-wilderness-emergency-medicine using -f Received: from mailhost.iuol.cn.net ([202.96.26.246]) by list.srv.cis.pitt.edu with SMTP (8.7.5/cisls-2.4) ID for ; Wed, 10 Apr 1996 11:59:59 -0400 (EDT) Received: from [202.96.26.142] by mailhost.iuol.cn.net id aa13492; 10 Apr 96 23:47 PDT Message-ID: <316C4B9E.B4C@iuol.cn.net> Date: Thu, 11 Apr 1996 00:00:30 +0000 From: Lee Weingrad Reply-To: surgate@iuol.cn.net X-Mailer: Mozilla 2.0 (Macintosh; I; 68K) MIME-Version: 1.0 To: Peter McCabe CC: wilderness-emergency-medicine@list.pitt.edu Subject: Re: Re[2]: Disaster in E. Tibet References: <9603108291.AA829152603@ed.gov> Content-Type: text/plain; charset=us-ascii Content-Transfer-Encoding: 7bit Sender: owner-wilderness-emergency-medicine@list.pitt.edu Precedence: bulk X-PMFLAGS: 34078848 0 Peter McCabe wrote: > > I concur. This can probably be done by contacting the State > Department and talking to people at the "Chinese" desk. Peter, If you hit a wall there, (really likely) you might try asking these people about Friends of Surmang and myself: Mr. Takei, Head of Mission, UNESCO China, Mongolia, DPR Korea 86 10 532 1725 or Scot Slessor, Director, Canada Fund, Beijing 86 10 501 1365 or Vichter Slagter, First Secretary, Royal Netherlands Embassy Beijing 86 10 532 1131 or Christianne Schiebe, German Embassy Beijing 86 10 532 5556 If there are any questions at all, please let me know. Sincerely, Lee Weingrad Friends of Surmang Beijing -- End -- X-cs: From: Self To: axc135@psu.edu (Gusty Colangelo) Subject: Re: wilderness medicine interest Cc: wilderness-emergency-medicine@list.pitt.edu Reply-to: kconover+@pitt.edu Date: Wed, 24 Apr 1996 14:45:11 Sorry it took me so long to reply, Gusty. On 4 Jan 96 at 11:20, Gusty Colangelo wrote: > Dr. Conover, > > I am a first year medical student at the Penn State College of > Medicine with an interest in wilderness and emergency medicine. I am also a > PA EMT with 5 years active experience plus BTLS, AED, NREMT, etc. I hope > that you will not mind answering a few questions. > First, would it be to my advantage to take an SAR course and a WEMT > course, given my interest in wilderness medicine? I would guess that with your interests and background you will end up working with a SAR team at some point, so I'd say yes. > Also, my BTLS > certification expires next year, and my EMT cert. will come up for > recertification again in two years. Should recertify these, or should I let > them expire (by then I will be a third or fourth year med. student). If you want to run on an ambulance while in medical school, or as an intern or second-year resident, renew them, or at least your EMT. If you want to go into emergency medicine and want to keep up your EMT for political reasons, by all means do so -- I did. But I'd forget the BTLS; you'll probably end up having to take ATLS anyway. > I > would also like to know if you could supply me with the names and/or > addresses of some organizations (such as the Wilderness Medicine Society) > that could give me more information about wilderness medicine (you may wish > to post these on the listserver). The best source for information is, as you said, the WMS: Wilderness Medical Society P.O. Box 2463 Indianapolis, IN 46206 1-317-631-1745 WEMSI's web page, listed in my .SIG below, also has some information related specifically to wilderness _EMS_. (We'll be upgrading it and adding some information soon.) > Thank you for taking the time to answer these questions. > > Sincerely, > > Gusty Colangelo You're welcome. Sorry it took so long. -- End -- X-cs: From: Self To: wilderness-emergency-medicine@list.pitt.edu Subject: (Fwd) Re: On-line text (long) Cc: splantz@tcgcs.com (Scott H. Plantz) Reply-to: kconover@pitt.edu Date: Sat, 18 May 1996 17:33:02 Scott asked me to post this to the w-e-m list. I suggested he add a section on Wilderness EMS, and told him I'd be happy to handle such a section for him. (That is, with the help of other WEMSI staff and the other members of the Wilderness EMS community, mostly represented on this list.) ------- Forwarded Message Follows ------- Date: Sat, 18 May 1996 18:09:04 GMT To: kconover@pitt.edu From: splantz@tcgcs.com (Scott H. Plantz) Subject: Re: On-line text Please circulate to your associates. Thank you, shp TO: Emergency Physicians FROM: The Editorial Staff, EM On-line Reference: Scott Plantz, M.D., Jon Adler, M.D., Dwight Collman, M.D., Ed Panacek, M.D., J. Douglas White, M.D., Dan Danzl, M.D. Bob McNamara, M.D., Paul Auerbach, M.D., Lance Kreplick, M.D., J. Stephen Huff, M.D., Richard Lavely, M.D., J.D., M.S., M.P.H., Bill Gossman, M.D., Robin R. Hemphill, M.D., & J. Berezin, M.S. Imagine a textbook that can be improved or updated 24 hours a day, 365 days a year. Further, imagine a textbook that allows unlimited color x-rays, illustrations, pictures, and even includes heart and lung sounds. Finally, imagine a textbook that allows the reader to instantly send comments, questions, and potential new pictorial additions to the topic author. In the near future, imagine a textbook that allows on-line viewing of author lectures. Welcome to the two newest, most up-to-date textbooks in Emergency Medicine! The Emergency Medicine On-line Reference & The Emergency Medicine Reference A major publishing company, an on-line physician service, and the Collman Institute are on the verge of bringing this new state of the art technology to Emergency Medicine. No other field in medicine has anything like it! How does it work? Over 600 authors in the specialty are being asked to write on one or two topics. The topic will be written in a preset, highly abbreviated outline format on the Internet. Once the topic is completed, authors, using a coded access, will be allowed to update their topic at anytime, day or night. Pictures can be added at anytime to a topic via pictorial files or sent to the Collman Institute for on-line production. Fifteen editors will be involved in review of the text. The entire text will be on-line and available in just 60 days! How much will it cost? The publishing company, The Collman Institute, and several companies have agreed to cover the cost of keeping the text on-line. All physicians will be able to access the book on-line on the Internet free-of-charge. In addition, the publisher will publish an annual up-to-date hard copy version of the book for quick reference. What do I have to do? Select four or five topics you are interest in and ask your associates if they would be interested as well. Return the list as quickly as possible. You will receive your assigned topics and instructions by June 1, 1996 via email. What do I get? Given enough private company funding and book sales, we hope to pay at least a $100.00 honorarium per year. Of course, what you really get is the opportunity to help your colleagues, medical students, and other professionals have an extensive, up-to-date, on-line and hard-copy text that will be a valuable reference and teaching tool. You also get an opportunity to put Emergency Medicine at the forefront of medical education. Thank you for your participation in this project. EMAIL OR SEND ALL RESPONSES AS QUICKLY AS POSSIBLE TO: Email - splantz@tcgcs.com Scott Plantz, M.D. , Box 242, Juniata, NE 68955 - U.S. Mail Scott Plantz, M.D., Juniata Spur, Juniata, NE 68955 - FedEx, UPS or AirExp Ph. 402-751-2157 or 312-341-1176 IF YOU WOULD LIKE TO AUTHOR A TOPIC OR TOPICS, PLEASE EMAIL YOUR REQUEST TO: splantz@tcgcs.com NAME ADDRESS PHONE NUMBER 10 TOPIC REQUESTS BRIEF CV - Training, previous text chapters/articles, etc. IF YOUR FAVORITE TOPIC IS NOT LISTED, PLEASE EMAIL THE NEW TOPIC AND WE WILL CONSIDER ITS ADDITION. ABOUT 1/2 THE TOPICS HAVE BEEN ASSIGNED, PLEASE INCLUDE A FEW OF THE LESS COMMON TOPICS IN YOUR LIST. THANK YOU! MEDICAL TOPICS "Abdominal pain, medical - DDX" "Abdominal pain, surgical - DDX" "Hooker", "Eddie" "Abdominal pain, elderly - DDX", "Abdominal trauma, blunt" "Abdominal trauma, penetrating" "Abortion - Threatened," "Abortion, Inevitable" "Abortion, Incomplete" "Abortion, Complete" "Abortion, Missed" "Abortion, Septic" "Abortion, Postabortion bleeding" "Abortion, acute hematometra" "Abortion, retained products of conception" "Abortion, DDX of complications" "Abruptio placentae" "Acetaminophen poisoning", "Acromioclavicular injury" "Adult Respiratory Distress Syndrome" Adrenal insufficiency and adrenal crisis" "Airway obstruction, upper" "Alcohols", " "Alcoholic ketoacidosis", "Altered Mental Status - DDX" "Altitude illness" "Amenorrhea", "Amphentamines poisoning", "Amyotrophic lateral sclerosis", "Anaphylaxis", "Anemia" "Anemia, sickle cell", "Aneurysms, Abdominal" "Aneurysms, Thoracic" "Anisocoria", "Ankle, soft-tissue injures" "Angina", "Angioedema", "Anthrax" "Anorexia nervosa", "Anxiety", "Anticholinergic poisoning", "Antidepressant poisoning", "Antihistamine poisoning", "Antimalarial poisoning", "Aortic regurgitation", "Aortic stenosis", "Appendicitis, acute", "Arsenic poisoning", "Arterial gas embolism" "Asplenic patients", "Asthma, adults", "Asystole", "Antidysrhythmic drug poisoning" "Atelectasis", "Atrial fibrillation", "Atrial flutter", "Arthritis, monarticular - DDX", "Arthritis, polyarticular - DDX" "Arthritis, rheumatoid" "Babesiosis", "Back pain, low - DDX" "Bacteremia" "Balanitis" "Barbiturate toxicity", "Barotruama", "Bartholin gland abscess", "Bee or hymenoptera stings", "Bell's palsy", "Hooker", "Eddie" "Benign positional vertigo" "Benzodiazepine poisoning" "Beta-blocker poisoning" "Birth control regulation, complications" "Bites, animal", "Stump", "Jack" "Bites, human" "Bites, insects", "Black widow spider envenomations" "Bladder injury" "Blast injuries" "Botulism" "Bowel obstruction, large" "Bowel obstruction, small" "Brain abscess" "Brain death" "Breast abscess and masses" "Breech birth" "Bronchitis" "Brown-Sequard syndrome" "Brown recluse spider bite" "Bulimia nervosa" "Burns, thermal" "Burns, chemical" "Bursitis" "Calcium channel blocker poisoning", "Candidiasis", "Carbamazepine poisoning", "Carbon monoxide poisoning", "Cardiac tamponade", "Cardiomyopathy, dilated", "Cardiomyopathy, restrictive", "Carpal tunnel syndrome", "Cat scratch disease", "Cauda equina syndrome", "Caustic ingestions", "Cavernous sinus thrombosis", "Cellulitis", "Central Retinal Vein Occlusion", "Cerebellopontine angle tumors", "Cervical strain", " "Chalazion", "Chancroid", " "Chest pain - DDX" "Cholangitis", "Cholelithiasis", "Cholecystitis and biliary colic", "Chronic obstructive pulmonary disease and emphysema", "Ciguatera poisoning", "Clonidine poisoning", "Cocaine poisoning", "Coelenterate envenomations", "Colitis, Crohns", "Colitis, Ulcerative", "Coma - DDX", "Compartment syndrome", "Confusion - DDX", " "Computed tomography", " "Conidae envenomations", " "Condyloma acuminata", " "Congestive heart failure and pulmonary edema", " "Conjunctivitis", "" "Constipation", " "Conversion disorder", " "Coratid dissection", " "Corneal abrasion", " "Corneal laceration", "" "Corneal ulceration or ulcerative keratitis", " "Corrosive ingestions", " "Costochondritis", " "Cushing's Syndrome", ", "Cyanide poisoning", " "Cystic fibrosis", " "Cystitis and pyelonephritis", , "Decompression sickness", "" "Deep venous thrombosis and thrombophlebitis", " "Delirium tremens", " "Dengue fever", "" "Dentate, avulsed", " "Dentate, displaced", "" "Dentate, fractures", " "Dentate, infections", "" "Depression and suicide", " "Dermatitis, atopic", " "Dermatitis, contact", " "Dermatitis, diaper", "" "Dermatitis, exfoliative", " "Dermatitis, lichen simplix chronicus", " "Dermatitis, seborrheic", "" "Dermatitis, stasis", " "Dermatomyositis", "" "Diabetes mellitus, Type I", " "Diabetes mellitus, Type II", "" "Diabetic ketoacidosis", " "Diarrhea - DDX", "" "Diaphragmatic injuries", "", "Digitalis toxicity", " "Diphtheria", " "Disk battery ingestion", " "Dislocations, ankle", "" "Dislocations, foot", "" "Dislocations, elbow", " "Dislocations, hand", " "Dislocations, hip", "Dislocations, knee", "Dislocations, interphalangeal", " "Dislocations, shoulder", "" "Dislocations, wrist", "" "Disseminated intravascular coagulation (DIC)", "" "Disulfiram poisoning", "" "Diverticular disease", "", "Domestic violence", "Rhodes", "Karen" "Dysbarism", "" "Dysphagia - DDX", "" "Dysfunctional uterine bleeding", "" "Dysmenorrhea", "" "Dystonic reactions", "" "Echinoderm envenomations", " "Edema - DDX", " "Elderly abuse", "" "Electric injuries", "" "Encephalitis", "" "Endocarditis", "" "Endometriosis", "" "Epididymitis", "" "Epidural hematoma", "" "Epidural and subdural infections", "" "Epiglottitis, Adult", ", "Epistaxis", "" "Ergot alkaloid poisoning", "" "Erysipelas", "" "Erythema multiforme", "" "Erythema nodosum", "" "Esophagitis", " "Esophageal hiatal hernia" "Esophageal perforation, rupture, and tears", "Ethylene glycol poisoning", "Eye trauma" "Felon" "Fingertip injuries" "Flail chest" "Fluoride poisoning" "Fluid exposures" "Folliculitis", "Food poisoning", "Foreign bodies, ear", "Foreign bodies, nose", "Foreign bodies, rectum", "Foreign bodies, swallowed" "Fractures, ankle" "Fractures, cervical spine" "Fractures, clavicle", "Fractures, elbow", "Fractures, face", "Fractures, femur", " "Fractures, forearm" "Fractures, foot" "Fractures, frontal", "Fractures, hand", "Fractures, hip", "Fractures, humerus", "Fractures, knee", "Fractures, mandible", "Fractures, orbital", "Fractures, pelvic", "Fractures, rib", "Fractures, scapular" "Fractures, sternal", "Fractures, tibia and fibula" "Fratures, wrist" "Frostbite" "Gamekeeper thumb (Skier thumb)", "" "Gas gangrene", " "Gastritis", " "Gastroenteritis", "" "Gastrointestinal bleeding, upper", "" "Gastrointestinal bleeding, lower", " "Gastrointestinal foreign bodies", "" "Giant cell or temporal arteritis", "" "Giardiasis", "" "Gingival hemorrhage", "." "Gingivitis", "Amsterdam", "" "Glaucoma, Acute angle-closure", "", "Globe rupture", " "Glomerulonephritis, acute", " "Gonorrhea", "" "Gout and Pseudogout", " "Granulocytopenia", " "Granuloma, annulare", " "Granuloma, pyogenic", " "Guillain-Barre syndrome" "Hallucinogen poisoning", " "Hand-foot-and-mouth disease", "" "Hand infections", "" "Hand injuries, soft-tissue", " "Hand injuries, high-pressure", "" "Hanging injuries", "" "Headache - DDX" "Headache, cluster", "Headache, migraine", "Headache, tension", "Hearing loss, acute", "Heart block, first degree" "Heart block, second degree", "Heart block, third degree" "Heat exhaustion & heat stroke" "Heavy metals" "Hematuria - DDX" "Hemolytic uremic syndrome" "Hemophilia, Type A" "Hemophilia, Type B", "Hemopytsis - DDX" "Hemothorax" "Hemorrhoids" "Henoch-Schonlein Purpura" "Hepatic failure" "Hepatitis" "Herbicide poisoning" "Herpes simplex" "Herpes simplex meningoencephalitis" "Herpes zoster" "Herpes zoster ophalmic" "Herpes zoster oticus" "Herpes, genital" "Herpetic whitlow" "Hernias" "Hiccups" "HIV infection and AIDS" "Hordeolum (Stye)" "Huntington's chorea" "Hydrocarbon insecticide poisoning" "Hydrocele" "Hydrocephalus shunts" "Hydrogen sulfide poisoning" "Hydradenitis supperativa" "Hyperbaric oxygen therapy" "Hypercalcemia" "Hyperemesis gravidarum" "Hyperkalemia" "Hypermagnesemia" "Hypernatremia" "Hyperosmolar hyperglycemic nonketotic coma" "Hyperparathyroidism" "Hyperphosphatemia" "Hypertensive, emergencies" "Hypertensive, urgencies" "Hyperthyroidism, thyroid storm, and Graves' disease" "Hyperventilation syndrome" "Hypocalcemia" "Hypoglycemia" "Hypokalemia" "Hypomagnesemia" "Hyponatremia" "Hypoparathyroidism" "Hypopituitarism" "Hypophosphatemia" "Hypothermia" "Hypothyroidism and myxedema coma" "Idiopathic hypertrophic subaortic stenosis (IHSS)" "Idiopathic thrombocytopenic purpura (ITP)" "Ileitis" "Impetigo" "Inappropriate secretion of antidiuretic hormone" "Influenza" "Intussusception" "Iritis and uveitis" "Iron poisoning" "Irritant gas inhalation" "Isoniazid poisoning" "Knee, soft tissue injuries" "Knife wounds" "Labyrinthitis" "Lactic acidosis" "Lambert-Eaton Myasthenic Syndrome" "Laryngitis" "Lead poisoning" "Legg-Calve-Perthes disease" "Legionnaire's disease" "Leishmaniasis" "Leptospirosis" "Lice" "Lichen planus" "Lightning injuries" "Lithium poisoning, "Lumbar (intervertebral) disk disorders" "Lyphogranuloma venereum" "Malaria" "Mastoiditis" "Mediastinitis" "Meniere's disease" "Meningitis" "Mercury poisoning" "Mesenteric ischemia" "Methemoglobinemia" "Mitral regurgitation" "Mitral stenosis" "Mitral valve prolapse" "Molluscum contagiosum" "Monoamine oxidase inhibitor poisoning" "Mononucleosis" "MRI: Principles" "Multiple myeloma", "Multiple sclerosis" "Munchausen's syndrome" "Mumps" "Mushroom poisoning" "Myasthenia gravis" "Myocarditis" "Myocardial infarction" "Myopathies" "Nail bed injuries" "Narcotics" "Neck mass - DDX" "Neck trauma" "Needle-stick protocol" "Neoplasms, bladder" "Neoplasms, bone and soft tissue" "Neoplasms, brain" "Neoplasms, colon" "Neoplasms, Esophageal and gastric tumors", "Neoplasms, genitourinary" "Neoplasms, intracranial" "Neoplasms, leukemia" "Neoplasms, lung" "Neoplasms, neck" "Neoplasms, ovarian" "Neoplasms, oral" "Neoplasms, pancreatic" "Neoplasms, prostate" "Neoplasms, renal" "Neoplasms, skin" "Neoplasms, spinal cord" "Neoplasms, testicular" "Neuroleptic poisoning" "Neurogenic bladder" "Neuroleptic malignant syndrome" "Neuropathies, plexopathy" "Neuropathies, mono" "Neuropathies, poly" "Nocardiosis" "Nonsteroidal anti-flammatory agent poisoning" "Nystagmus" "Octopuse envenomations" "Ocular chemical burns" "Odynophagia" "Optic neuritis" "Oral surgery complications" "Orbital infections" "Orchitis" "Organic brain syndrome" "Organophosphate and carbamate poisoning" "Osgood-Schlatter disease" "Osteomyelitis" "Otitis externa" "Otitis media", "Ovarian torsion" "Pancreatitis" "Parenteral drug abuse associated infections" "Parasitic diseases" "Parkinsonism" "Paronychia" "Patent ductus arteriosus" "Pediatrics, abdominal pain - DDX" "Pediatrics, aids" "Pediatrics, appendicitis" "Pediatrics, apnea" "Pediatrics, asthma" "Pediatrics, bacteremia" "Pediatrics, bronchiolitis" "Pediatrics, cellulitis" "Pediatrics, chicken pox or varicella" "Pediatrics, child abuse" "Pediatrics, child sexual abuse" "Pediatrics, croup or laryngotracheobronchitis" "Pediatrics, dehydration" "Pediatrics, diabetic ketoacidosis" "Pediatrics, diaper rash" "Pediatrics, epiglottitis" "Pediatrics, fever" "Pediatrics, fifth disease or erythema infectiosum" "Pediatrics, foreign body ingestion" "Pediatrics, gastroenteritis" "Pediatrics, gastrointestinal bleeding" "Pediatrics, headache" "Pediatrics, intussusception" "Pediatrics, kawasaki disease" "Pediatrics, limp" "Pediatrics, measles or rubella" "Pediatrics, measles or rubeola" "Pediatrics, meningitis and encephalitis" "Pediatrics, mumps" "Pediatrics, nursemaid's elbow", "Hooker", "Eddie" "Pediatrics, otitis media" "Pediatrics, pertussis" "Pediatrics, pharyngitis" "Pediatrics, pneumonia" "Pediatrics, pyloric stenosis" "Pediatrics, respiratory distress syndrome" "Pediatrics, reye syndrome" "Pediatrics, rheumatic fever" "Pediatrics, roseola infantum" "Pediatrics, rotavirus" "Pediatrics, scarlet fever" "Pediatrics, seizures and status epilepticus" "Pediatrics, sepsis" "Pediatrics, shunt problems" "Pediatrics, sickle cell disease" "Pediatrics, sudden infant death syndrome" "Pediatrics, torticollis" "Pediatrics, urinary tract infections" "Pediculosis" "Pelvic inflammatory disease (PID)" "Pelvic pain - DDX" "Pemphigoid, bullous" "Pemphigus vulgaris" "Peptic ulcer disease" "Perforated viscus" "Pericarditis and cardiac tamponade" "Paronychia" "Perforated viscus" "Perilymph fistula" "Periorbital infections" "Peritonitis, acute" "Peritonsillar abscess" "Pharyngitis" "Phencyclidine poisoning" "Phenytoin poisoning" "Pheochromocytoma" "Phimosis and paraphimosis" "Pilonidal cyst" "Pinworms or enterobiasis" "Pityriasis alba" "Pityriasis rosea" "Placenta previa" "Plague" "Plantar fasciitis" "Plants poisons" "Pleural effusion" "Pneumonia, empyema, and abscess" "Pneumonia, aspiration" "Pneumonia, bacterial" "Pneumonia, immunocompromised" "Pneumonia, mycoplasma" "Peumonia, viral" "Pneumothorax, iatrogenic, spontaneous and pneumomediastinum" "Pneumothorax, tension and traumatic" "Poliomyelitis" "Polyarteritis nodosa" "Polycythemias" "Polymyalgia rheumatica" "Polymyositis" "Porphyria" "Postpartum hemorrhage" "Postpartum puerperal fever" "Preeclampsia" "Pregnancy, sickle cell anemia" "Pregnancy, asthma" "Pregnancy, delivery" "Pregnancy, diabetes" "Pregnancy, ectopic" "Pregnancy, late hemorrhage" "Pregnancy, preeclampsia and eclampsia" "Pregnancy, postpartum hemorrhage" "Pregnancy, postpartum infections" "Pregnancy, postprtum puerperal fever" "Pregnancy, seizures and altered level of consciousness" "Pregnancy, sickle cell disease" "Pregnancy, trauma" "Pregnancy, urinary track infections" "Premature ventricular contraction (PAC)" "Priapism" "Proctitis" "Prostatitis" "Puritis - DDX" "Pruritus ani" "Psoriasis" "Pulmonary embolism" "Pulmonic valvular stenosis" "Purpuric eruptions" "Pyelonephritis" "Q fever" "Rabies" "Radiation accidents" "Radionuclide imaging" "Rectal abscesses", "Rectal fistulas and fissures" "Rectal prolapse", "Bouzoukis" "Reiter's syndrome" "Renal calculi" "Renal failure, acute (ARF)" "Renal failure, chronic and dialysis complications" "Replantation" "Respiratory distress syndrome, adult" "Retinal detachment" "Retinal vein occlusion" "Retropharyngeal abscess" "Reye's syndrome" "Rh incompatibility" "Rhabdomyolysis" "Rheumatic fever" "Rhinitis", "Rib fractures" "Rocky Mountain spotted fever" "Rodenticide poisoning" "Rotator cuff injuries" "Roundworms" "Salicylate poisoning", "Kreplick", "Lance" "Salmonella infection" "Sarcoidosis" "Scabies" "Scarlet fever" "Schistosomiasis" "Schizophrenia" "Scleritis" "Scleroderma" "Scombroid poisoning" "Scorpion envenomations" "Scorpionfish envenomations" "Sedative-hypnotic poisoning" "Seizures - DDX " "Sepsis" "Serum sickness" "Sexual assault" "Shellfish poisoning" "Shigellosis" "Shock - DDX" "Shock, cardiogenic", "Shock, hemorrhagic" "Shock, hypovolemic" "Shock, septic" "Shock, traumatic" "Shortness of breath - DDX" "Sinoatrial arrest or block" "Sinus bradycardia" "Sinus tachycardia" "Sinusitis" "Sjogren's syndrome" "Smoke inhalation" "Snake envenomations, crotalidae" "Snake envenomations: Elapidae" "Spinal cord compression" "Spinal cord infections" "Spinal cord injuries" "Staphylococcal scalded skin syndrome" "Status epilepticus" "Sternoclavicular joint injury" "Steven-Johnson syndrome" "Sting ray envenomations" "Stroke, hemorrhagic" "Stroke, ischemic" "Subarachnoid hemorrhage" "Subclavian steal syndrome" "Subdural hematoma" "Submersion injuries" "Suicide", "Superior vena cava syndrome" "Syncope - DDX" "Sympathomimitic poisoning", "Syphilis", "Systemic lupus erythematosus (SLE)", "Tachyarrhythmias", "Tapeworm infestation", "Temporomandibular joint (TMJ) syndrome",", "Tendinitis", "" "Tenosynovitis", "" "Terpene poisoning", "Testicular torsion", " "Tetanus", "" "Tetralogy of Fallot", " "Tetrodotoxin poisoning" "Theophylline poisoning", "", "Thoracic (intervertebral) disk disorders", "" "Thrombocytopenic purpura", " "Thrombolytic therapy", " "Thrombophlebitis, septic", "Thrombophlebitis, superficial", " "Thyroid hormone poisoning", "" "Tick diseases, Babesiosis", "" "Tick diseases, Colorado", " "Tick diseases, Ehrlichiosis", "Tick diseases, Lyme", "" "Tick diseases, Q fever", " "Tick diseases, Relapsing fever", "" "Tick diseases, Tularemia", "" "Tinea", "" "Toenails, ingrown", "" "Toluene poisoning", " "Torsion of the appendicies and epididymis", "" "Toothache", "", "Torsades de pointes", "" "Torticollis" "Toxaphene poisoning", "" "Toxic epidermal necrolysis", "" "Toxic shock syndrome", " "Toxoplasmosis", " "Tracheitis", " "Transfusion reactions", "" "Transient ischemic attack", "" "Transplants, heart", "" "Transplants, liver", "" "Transplants, lung", "" "Transplants, renal", "" "Trauma, upper genitourinary", "" "Trauma, lower genitourinary", "" "Trauma, external genitalia", "" "Trauma, peripheral vascular injuries", "" "Trichinosis", "" "Trichomoniasis", "" "Tricuspid regurgitation", "Tricuspid stenosis", "Tricyclic antidepresssants toxicity", "Trigeminal neuralgia", "Tuberculosis", "Typhoid fever", "Ultrasound, cardiac", " "Ultrasound, abdominal", 'Ultrasound, pelvic", "Urethritis, male", "Urinary incontinence and retention", "Urinary tract infection in men", "Urinary tract infection, female", "Urinary tract infection, pregnancy", "Urolithiasis", "Urticaria", "Uterine prolapse", "Vaginal bleeding, nonpregnant", "Vaginitis", "Valproate poisoning", "Valvular heart disease", "Venous air embolism", "Ventricular fibrillation" "Ventricular tachycardia (VT)" Ventricular septal defect (VSD) "Vertigo - DDX" "Vetreous Hemorrhage" "Vertebrobasilar insufficiency" "Vestibular neuronitis" "Visual loss, acute - DDX" "Vitamin poisoning" "Vulvovaginitis" "Warts, genital" "Warts, plantar" "Weakness - DDX" "Wegener's granulomatosis" "Wernicke's encephalopathy" "Withdrawal syndromes" "Wolff-Parkinson-White syndrome" "Wounds" "Yellow fever" "Yersinia" MANAGING THE EMERGENCY DEPARTMENT Management Options * Contract Companies * Sole Proprietorships * Independent Groups * Hospital Employees Understanding Emergency Physicians * What They Are Looking For * Physician Training Independent Groups vs. Sole Proprietors vs. Contract Companies vs. Hospital Employees * Advantages and Disadvantages Marketing Your Group And How to Find The Right Hospital Setting up Independent Democratic Groups * Structure * Getting help Starting A Contract Company Ups and Downs of "Taking Over" A Contract From A Sole Proprietor or Contract Company * The "Non-Compete" Clause * Torches interference * Planning Ahead To Obtain Physicians Hospital Contracts * Legal Principles * Key Contract Clauses Physician Contracts Malpractice Insurance Reimbursements Administrative Responsibilities Physician Administrator Scheduling and Coverage * How Many Physicians Do You Need * Recruiting Securing a line of credit to support the Accounts Receivable Emergency Department Billing Negotiating Contracts * How To Find Help * Feasibility studies for a particular hospital Negotiating A Managed Care Contract Keeping A Group In-place * Medical staff interrelationships Establishing a CQI Program Patient Satisfaction Nursing and Ancillary Staff Physician Call and Emergency Department Back Up Academic Emergency Departments * Residency Programs A Well Run Emergency Department Hospital Liability Legal Aspects of Emergency Medicine * Commitment from the original group * "Due Process" * Hospital Bylaws * Emergency physician contracts + Key contract clauses * Employee versus independent contractor status * Confidentiality * Malpractice issues * Understanding malpractice insurance contracts * Contracting with managed care plans * Contracting with a billing company * Understanding Cobra Laws State legislation * How to write a bill * How to get a bill proposed * How to lobby effectively * Environmental issues in the organization and delivery of health care The system and art of negotiating SPECIAL ASPECTS OF EMERGENCY MEDICINE Analgesics Sedation Principles of Wound Management Bioethics Aeromedical Transport Resuscitation "D", "Death and Dying Child", "Wolfram", "Wayne", IMPLANTABLE DEVICES CNS GI Urologic CV Orthopedics Airway EMERGENCY MEDICAL SYSTEMS Prehospital EMT and Paramedic Training Prehospital Devices Operations Design EMS Systems EMS and Cardiac Arrest EMS and Trauma EMS and Terrorism EMS in Rural Areas EMS and Mass Gatherings Medical Control Air transport Disaster Planning EMS QA SPECIAL ASPECTS OF FOREIGN AND MISSIONARY EMERGENCY MEDICINE Hatai - John Carroll, M.D. Bosnia Russia Africa ORGANIZATIONS IN EMERGENCY MEDICINE American Academy of Emergency Medicine American College of Emergency Physicians Association of Emergency Physicians Society of Academic Emergency Medicine -- End -- X-cs: From: Self To: RussOpland@aol.com Subject: Re: Warming IV fluid with microwave Cc: wilderness-emergency-medicine@list.pitt.edu Reply-to: kconover@pitt.edu Date: Sun, 26 May 1996 15:34:35 On 25 May 96 at 17:46, RussOpland@aol.com wrote: > Dear Dr. Conover, > > Thank you for taking the time to reply to my post (the only response > so far). You mentioned a study in your e-mail: I would be interested > in performing or collaborating on it, if you have some suggetions > and/or interest in this regard. > > Some of my preliminary thoughts and questions are: what would the > hypothesis and the control(s) be? What is the dependent variable? > > I suspect that the null hypothesis would be something to the effect > that commercial heat packs are ineffective at maintaining a > consistent temperature within a given range when wrapped around IV > tubing. The control would be plain tubing, and the independent > variables might be the configuration of the heat packs > (distal/proximal tubing, and/or around the bag, with and without > some form of insulation [Ensolite]). The dependent variable might be > the temperature of the fluid at the distal end of the tubing. We > could also measure the temperature in relation to time. > > Thanks for your consideration and time. > Sincerely, > Russ Opland > Paramedic/Firefighter > South Metro Fire District > Raymore, MO I was thinking in even more practical terms. The null hypothesis I was thinking about would be "it is not possible to develop, from inexpensive materials, a protocol and insulation/warming apparatus for an IV bag and tubing, that will provide reliably produce, at the end of the IV tubing, fluid with a temperature between 35 and 40 degrees C, in ambient temperatures between -10 and +35 degrees C and wind speeds from 0 to 30 MPH." Then just start playing with duct tape and Ensolits, using a particular common brand of heat pack in an environmental chamber that can be set for various temperatures. The protocol could us varying numbers of heat packs (one inside a blood-warming coil with Ensolite around it with just Ensolite around the bag; for colder conditions, a heat pack on the bag as well) depending on the temperature and wind. Parka zip-pull thermometers are readily available and cheap. The protocol could be set up to use some combination of: - ambient temp greater or equal to some value - calm or windy - bag prewarmed or at ambient temperature Important points: - we don't want to get the temperature above 40-44 degrees C for risk of burning the vein. - IV fluid doesn't do diddly-squat for rewarming, so our goal is just to get it somewhere near normal body temp, say 30-40 degrees C; it really doesn't have to be any warmer than about 30 to be OK.. --Keith Conover, M.D. P.S. I think we might get some good feedback from the w-e-m list so I'll post this reply there, too. -- End -- X-cs: From: Self To: SkiGraham@aol.com Subject: Re: Clearing the Spine... Cc: Sam Chewning <75537.2201@compuserve.com>,wilderness-emergency-medicine@list.pitt.edu Reply-to: kconover@pitt.edu Date: Mon, 27 May 1996 15:57:41 On 27 May 96 at 11:40, SkiGraham@aol.com wrote: > Dear Dr. Conover: > What an amazing Web Site you have! I am most pleased to find a site > devoted to the Wilderness pre-hospital caregiver. > > I do have one question though... In clearing the Spine using the > guidelines given on your page, I believe the spine should not be > cleared unless the criteria given can be met at the time of initial > inspection by an EMT, and at 1 hour following the accident. This > will allow for swelling to occur, which could put pressure on the > Spinal Cord, and change the ability of the injured to meet the > criteria. In other words, isn't it possible to clear the spine too > fast if the EMT arrives on scene within the first hour after the > injury occurs? > > Keep up the great job on your Web site, and I'd love to hear from > you regarding my question, if you have the time to respond. > > Graham Kane > NR-WEMT-I > > PS: I live and work in summit county colorado. I'm an > administrator at the keystone science school, and volunteer for > summit county ambulance, and the local mountain rescue organization. > Occasionally I teach Snow Physics and Avalanche classes, or other > Natural Science units to Outward Bound and NOLS instructors. My > long term goals are to reach Paramedic status, and to attend a > physicians assistant program, specializing in emergency medecine. > Any insight you can offer me into this career path would also be > greatly appreciated. Thx, GK > Good question. I will answer, and also forward this to Dr. Sam Chewning, WEMSI Medical Command Officer and an orthopedic surgeon specializing in spine trauma. Dr. Peter Goth, formerly of Wilderness Medical Associates, has also suggested that one not clear the cervical spine until after the initial accident, but he suggests that this just be a few minutes. And his reason is that the adrenaline surge causes what he terms the autonomic stress reaction, and this could mask the pain briefly. He was unable to provide any scientific references to justify this, but intuitively it makes at least a little sense to wait a few minutes (five?) before clearing. In most rescues this has _not_ been a problem -- more likely you're trying to clear the c-spine about _12_hours_ later . As far as swelling causing pain, and requirinig you to wait an hour, I don't think so. If the spine is cracked, it will hurt _right_away_. Swelling may make it hurt worse later, but it should hurt plenty enough right away (but remember the other caveats -- no mind-altering drugs, no confusion from head injury, no distracting injury, and must have a _need_ to clear the cervical spine in the field). However, muscular stiffness and then pain starts developing soon after injury, even as soon as an hour. So I'd jump in there _right away_ and clear the cervical spine so you can still do it before the spasm sets in. Also note that the cervical spine clearing we talk about for the wilderness is considerably more aggressive than that people are talking about for the street, as in the pilot programs in San Mateo County CA and the whole state of Maine. There is one problem that might show up a bit later -- it's rare though. It's called central cord syndrome, usually when a drunk gets the neck bent _a_lot_ and without actuall bony or ligamentous damage, the center of the spinal cord gets bruised -- and as it swells the arms but not the legs become paralyzed. But if such a person is alert, I'm not sure that immoblization will make much difference. (And you can't clear the cervical spine in a drunk. Believe me, I leave a lot of drunks in hard cervical collars until they sober, even when the x-rays look OK; just did one like that about 8 hours ago in the ED in fact.) I hope you don't mind -- this is a good discussion, and I'll be posting this answer to the wilderness-emergency-medicine discussion list. You are welcome to join if you wish -- the instructions are below, in my signature file. Thanks for the good question. And as far as career plans, the only thing I can suggest is that you consider going to a paramedic program with a good reputation. The Center for Emergency Medicine's program, at which I teach (next time tomorrow AM in fact) is widely regarded as the best around, and you can find more information from the Center's Web site but it's not quite up (? next couple of weeks) -- the link will be posted at the Center's EMT-P revision web page: http://www.pitt.edu/~paramed/ Take care and good luck. -- End -- X-cs: From: Self To: wilderness-emergency-medicine@list.pitt.edu Subject: (Fwd) Re: Clearing the Spine... Reply-to: kconover+@pitt.edu Date: Wed, 29 May 1996 22:09:19 ------- Forwarded Message Follows ------- Date: 28 May 96 23:40:25 EDT From: Samuel J Chewning <75537.2201@CompuServe.COM> To: "\"Keith Conover, M.D.\"" Cc: "\"Barry J. Burton, D.O.\"" , "\"Jack T. Grandey\"" Subject: Re: Clearing the Spine... Keith , as far as clearing c-spine "too early". Part of caring for a patient is constant re-evaluation. If the C-spine can be cleared early fine. Any significant injury will make it self known early (assuming no other distracting injury). If the pt's condition changes, or your re eval changes the change the treatment to match. Most likely in the "outback" setting real "early" evaluation is not going to happen anyway. SJC -- End -- Received: from post-ofc03.srv.cis.pitt.edu (post-ofc03.srv.cis.pitt.edu [136.142.185.39]) by shadow-blue.cis.pitt.edu with ESMTP (8.7.5/cispop-1.6.1.3) ID for ; Fri, 31 May 1996 01:51:29 -0400 Received: from local (root@localhost) by post-ofc03.srv.cis.pitt.edu (8.7.5/cispo-2.0.1.1) ID ; Fri, 31 May 1996 01:51:24 -0400 (EDT) Received: via switchmail; Fri, 31 May 1996 01:51:24 -0400 (EDT) Received: from list.srv.cis.pitt.edu via qmail ID ; Fri, 31 May 1996 01:50:54 -0400 (EDT) Received: from local (majordom@localhost) by list.srv.cis.pitt.edu (8.7.5/cisls-2.4) ID ; Fri, 31 May 1996 01:49:36 -0400 (EDT) X-Authentication-Warning: list.srv.cis.pitt.edu: majordom set sender to owner-wilderness-emergency-medicine using -f Received: from emout15.mail.aol.com (emout15.mx.aol.com [198.81.11.41]) by list.srv.cis.pitt.edu with SMTP (8.7.5/cisls-2.4) ID for ; Fri, 31 May 1996 01:49:30 -0400 (EDT) From: DoctrRick@aol.com Received: by emout15.mail.aol.com (8.6.12/8.6.12) id BAA25629 for wilderness-emergency-medicine@list.pitt.edu; Fri, 31 May 1996 01:48:59 -0400 Date: Fri, 31 May 1996 01:48:59 -0400 Message-ID: <960531014858_404326778@emout15.mail.aol.com> To: wilderness-emergency-medicine@list.pitt.edu Subject: Question Sender: owner-wilderness-emergency-medicine@list.pitt.edu Precedence: bulk X-PMFLAGS: 34603136 0 Greetings, A number of hospitals in the West have been ranked by the time of reception of a MI patient to the adminstration of thrombolytics. Many hospitals are boasting a 100 minute reduction in the delay.... the upshot of all the fanfare is a strong recommendation from several cardiac docs that all persons with possible MI should be given oral asprin, ASAP, in home or in the field by pre-hospital EMS personnel. In the wilderness setting, with a middle age person experiencing chest pain in the absence of trauma, is asprin indicated? What are the possible contra-indications? Given the length of time it may take to get the patient to the CCU, is asprin even more highly indicated in our middle aged weekend warrior? Thanks for your thoughts. Rick Bennett Ph.D. WEMT, aka d.r. Instructor, Wilderness Medicine Institute PS. I am old enough to qualify and trying like hell to stay in 30's shape {a risk factor in and of itself, Should I carry Asprin in the back county? I typically carry Ibuprofen as the only NSAID} -- End -- Received: from post-ofc02.srv.cis.pitt.edu (post-ofc02.srv.cis.pitt.edu [136.142.185.11]) by shadow-blue.cis.pitt.edu with ESMTP (8.7.5/cispop-1.6.1.3) ID for ; Fri, 31 May 1996 03:54:08 -0400 Received: from local (root@localhost) by post-ofc02.srv.cis.pitt.edu (8.7.5/cispo-2.0.1.1) ID ; Fri, 31 May 1996 03:54:03 -0400 (EDT) Received: via switchmail; Fri, 31 May 1996 03:54:03 -0400 (EDT) Received: from list.srv.cis.pitt.edu via qmail ID ; Fri, 31 May 1996 03:53:21 -0400 (EDT) Received: from local (majordom@localhost) by list.srv.cis.pitt.edu (8.7.5/cisls-2.4) ID ; Fri, 31 May 1996 03:50:15 -0400 (EDT) X-Authentication-Warning: list.srv.cis.pitt.edu: majordom set sender to owner-wilderness-emergency-medicine using -f Received: from sun1.tcd.ie (sun1.tcd.ie [134.226.1.29]) by list.srv.cis.pitt.edu with ESMTP (8.7.5/cisls-2.4) ID for ; Fri, 31 May 1996 03:50:11 -0400 (EDT) Received: from ee97.mee.tcd.ie (pc97.mee.tcd.ie [134.226.86.97]) by sun1.tcd.ie (8.7.1/8.6.10) with SMTP id IAA15446; Fri, 31 May 1996 08:50:00 +0100 (BST) Date: Fri, 31 May 1996 08:50:00 +0100 (BST) Message-Id: <199605310750.IAA15446@sun1.tcd.ie> X-Sender: gbutler@mail.tcd.ie X-Mailer: Windows Eudora Light Version 1.5.2 Mime-Version: 1.0 Content-Type: text/plain; charset="us-ascii" To: DoctrRick@aol.com From: Dr Gerry Butler Subject: Re: Question (asprin) Cc: wilderness-emergency-medicine@list.pitt.edu Sender: owner-wilderness-emergency-medicine@list.pitt.edu Precedence: bulk X-PMFLAGS: 34078848 0 At 01:48 31/05/96 -0400, you wrote: >Greetings, > >A number of hospitals in the West have been ranked by the time of >reception of a MI patient to the adminstration of thrombolytics. Many >hospitals are boasting a 100 minute reduction in the delay.... the upshot of >all the fanfare is a strong recommendation from several cardiac docs that >all persons with possible MI should be given oral asprin, ASAP, in home or in >the field by pre-hospital EMS personnel. > >In the wilderness setting, with a middle age person experiencing chest pain >in the absence of trauma, is asprin indicated? What are the possible >contra-indications? < > > >Thanks for your thoughts. > >Rick Bennett Ph.D. WEMT, aka d.r. >Instructor, Wilderness Medicine Institute > Asprin (one 300 mg tablet, if possible sub-lingual) is recommended in the basic first aid manual (use for a 16 hour first aid course) in the UK and Ireland. As this level of training is low, it must be presumed that those who wrote the manual (it is a combined manual of all the first-aid organisations) percieved no contra-indications. This manual is written for street/home first-aid with very much faster response times than occur in the wilderness. One Cardiologist has commented to me that one asprin at the time of commencement of chest-pain is better than definitive trombolytics one to two hours later. While we have no protocol requiring that we give it, based on the first-aid manual as reasonable, most of the EMTs and the Advanced first-aiders in our team carry asprin for this situation. Hope this helps Gerry Dr Gerry Butler (gbutler@tcd.ie) TELTEC Radio Propagation Group Electronics Dept, Trinity College Dublin, Ireland Dublin+Wicklow Mountain Rescue, EMT-D, EI0CH -- End -- Received: from post-ofc03.srv.cis.pitt.edu (post-ofc03.srv.cis.pitt.edu [136.142.185.39]) by shadow-blue.cis.pitt.edu with ESMTP (8.7.5/cispop-1.6.1.3) ID for ; Fri, 31 May 1996 09:02:06 -0400 Received: from local (root@localhost) by post-ofc03.srv.cis.pitt.edu (8.7.5/cispo-2.0.1.1) ID ; Fri, 31 May 1996 09:01:54 -0400 (EDT) Received: via switchmail; Fri, 31 May 1996 09:01:54 -0400 (EDT) Received: from list.srv.cis.pitt.edu via qmail ID ; Fri, 31 May 1996 09:01:20 -0400 (EDT) Received: from local (majordom@localhost) by list.srv.cis.pitt.edu (8.7.5/cisls-2.4) ID ; Fri, 31 May 1996 09:00:41 -0400 (EDT) X-Authentication-Warning: list.srv.cis.pitt.edu: majordom set sender to owner-wilderness-emergency-medicine using -f Received: from vines12.acf.dhhs.gov ([158.71.1.12]) by list.srv.cis.pitt.edu with SMTP (8.7.5/cisls-2.4) ID for ; Fri, 31 May 1996 09:00:36 -0400 (EDT) Received: by vines12.acf.dhhs.gov; Fri, 31 May 96 9:00:23 EDT Date: Fri, 31 May 96 8:26:09 EDT Message-ID: X-Priority: 3 (Normal) To: From: "Dave Matthews" Subject: WARMING & HUMIDIFYING O2 REVISITED X-Incognito-SN: 458 X-Incognito-Format: VERSION=2.01a ENCRYPTED=NO Sender: owner-wilderness-emergency-medicine@list.pitt.edu Precedence: bulk X-PMFLAGS: 33554560 0 **************************************************************************** **************************************************************************** Dear Friends, The distinguished subscribers to this list batted around the question of warming and humidifying O2 for hypothermia victims at considerable length several weeks ago, but was a workable "field expedient" method finally established ?? Perhaps the gentleman who mentioned a bubbler provided the basis for a solution. Following that line of thought, I wonder whether a wide-mouth screw-top nalgene bottle rigged similar to a Turkish water pipe or "hookah" could be useful ?? The oxygen inlet would replace the pipe bowl, the bottle would be heated by MRE heating packs, and the oxygen outlet tube might need some styrofoam insulation to reduce cooling prior to reaching the patient. Thermometers to carefully monitor outflow and delivery temperatures would certainly be required. Perhaps medical supply houses have available ready-made versions of such a contraption. Please forgive me for revisiting a thread of discussion that some subscribers may have had quite enough of already. Also, to be sure, I hope the suggestion outlined above doesn't duplicate or conflict with a previously agreed upon and fully satisfactory method of addressing the problem. Best wishes, Dave Matthews Internet address: dmatthews@acf.dhhs.gov ***************************************************************************** ***************************************************************************** -- End -- X-cs: From: Self To: "Philip V. Gormley" Subject: Re: Web Page Cc: Bernie Roche Reply-to: kconover@pitt.edu Date: Fri, 31 May 1996 14:16:31 On 30 May 96 at 14:11, Philip V. Gormley wrote: > 30 May 1996 > > Keith, > > Will you let the folks on your mailing list know about Wilderness > Medical Associates' web page: http://wildmed.com. > > Thanks, > > > - Philip V. Gormley (pgormley@orion.bdc.bethel.me.us, > http://wildmed.com) Happy to, Phil. I'll post this reply to the wilderness- emergency-medicine list. (BTW, even though WEMSI set it up, it's a completely open list, available to any and all, for discussing anything related to wilderness emergency medicine. I occasionally tell people who post totally unrelated stuff to cease and desist but that's about all the control we have.) And with your permission, I'll ask Bernie to add a link to your site from the new WEMSI pages that should be up soon. OK? -- End -- Received: from post-ofc03.srv.cis.pitt.edu (post-ofc03.srv.cis.pitt.edu [136.142.185.39]) by shadow-blue.cis.pitt.edu with ESMTP (8.7.5/cispop-1.6.1.3) ID for ; Fri, 31 May 1996 11:37:10 -0400 Received: from local (root@localhost) by post-ofc03.srv.cis.pitt.edu (8.7.5/cispo-2.0.1.1) ID ; Fri, 31 May 1996 11:37:00 -0400 (EDT) Received: via switchmail; Fri, 31 May 1996 11:36:59 -0400 (EDT) Received: from list.srv.cis.pitt.edu via qmail ID ; Fri, 31 May 1996 11:35:18 -0400 (EDT) Received: from local (majordom@localhost) by list.srv.cis.pitt.edu (8.7.5/cisls-2.4) ID ; Fri, 31 May 1996 11:34:35 -0400 (EDT) X-Authentication-Warning: list.srv.cis.pitt.edu: majordom set sender to owner-wilderness-emergency-medicine using -f Received: from nef.ens.fr (nef.ens.fr [129.199.96.12]) by list.srv.cis.pitt.edu with SMTP (8.7.5/cisls-2.4) ID for ; Fri, 31 May 1996 11:34:30 -0400 (EDT) Received: from clipper.ens.fr (clipper-gw.ens.fr) by nef.ens.fr (5.65c8/ULM-1.0) Id AA06882 ; Fri, 31 May 1996 17:32:59 +0200 From: czarneck@clipper.ens.fr (Fabrice Czarnecki) Date: Fri, 31 May 1996 17:32:33 +0200 (MET DST) Received: from trimaran.ens.fr (trimaran [129.199.129.9]) by clipper.ens.fr (8.7.5/jb-1.1) id RAA26553 for ; Fri, 31 May 1996 17:32:33 +0200 (MET DST) Message-Id: <199605311532.RAA26553@clipper.ens.fr> To: wilderness-emergency-medicine@list.pitt.edu Subject: Aspirin Sender: owner-wilderness-emergency-medicine@list.pitt.edu Precedence: bulk X-PMFLAGS: 33554560 0 Aspirin 300mg p.o. is indicated for MI suspicion. The major contra-indication is an aorta aneurysm, which is quite difficult to diagnose. Signs of that aneurysm include : asymetric BP, asymetric pulse, no distal pulse. So you have to check BP at both arms, if you have a BP cuff, and you have to check pulse at both arms and feet. Aspirin alone can act as a thrombolytic. Fabrice Czarnecki, MD (France) -- End -- Received: from post-ofc02.srv.cis.pitt.edu (post-ofc02.srv.cis.pitt.edu [136.142.185.11]) by shadow-blue.cis.pitt.edu with ESMTP (8.7.5/cispop-1.6.1.3) ID for ; Fri, 31 May 1996 13:23:18 -0400 Received: from local (root@localhost) by post-ofc02.srv.cis.pitt.edu (8.7.5/cispo-2.0.1.1) ID ; Fri, 31 May 1996 13:23:07 -0400 (EDT) Received: via switchmail; Fri, 31 May 1996 13:23:07 -0400 (EDT) Received: from list.srv.cis.pitt.edu via qmail ID ; Fri, 31 May 1996 13:21:37 -0400 (EDT) Received: from local (majordom@localhost) by list.srv.cis.pitt.edu (8.7.5/cisls-2.4) ID ; Fri, 31 May 1996 13:19:47 -0400 (EDT) X-Authentication-Warning: list.srv.cis.pitt.edu: majordom set sender to owner-wilderness-emergency-medicine using -f Received: from Access.Mountain.Net (root@Access.Mountain.Net [198.77.1.3]) by list.srv.cis.pitt.edu with SMTP (8.7.5/cisls-2.4) ID for ; Fri, 31 May 1996 13:19:43 -0400 (EDT) Received: from Slip21-5.Mountain.Net (Slip21-5.Mountain.Net [198.77.1.210]) by Access.Mountain.Net (8.6.12/8.6.9) with SMTP id NAA19857 for ; Fri, 31 May 1996 13:19:41 -0400 Date: Fri, 31 May 1996 13:19:41 -0400 Message-Id: <1.5.4.16.19960531131956.0f27e402@access.mountain.net> X-Sender: kimberly@access.mountain.net X-Mailer: Windows Eudora Light Version 1.5.4 (16) Mime-Version: 1.0 Content-Type: text/plain; charset="us-ascii" To: wilderness-emergency-medicine@list.pitt.edu From: KDWilliams Subject: Aspirin Sender: owner-wilderness-emergency-medicine@list.pitt.edu Precedence: bulk X-PMFLAGS: 34078848 0 In the EMS system that I work for we have adopted a protocol for field use of aspirin in all patients with chest pains. We carry baby aspirin, therefore eliminating the need for water which is sometimes not available. The only contraindications we have listed are allergy to aspirin and suspected aortic aneurysm. So after oxygen therapy the patient is administered 324 mg of baby aspirin. While they are chewing these we establish an iv with saline lock, nitro SL, and call medical command for further pain meds as needed during transport. With the rural areas that we cover (up to 40 minutes of transport time) this has found to be an effective treatment in preventing the delay of thrombolytic therapy. Hope this is useful information. *********************************************** * Kimberly Williams * * "I would rather ask some of the questions * * than know all of the answers." J. Thurber * * * *********************************************** *********************************************** *********************************************** -- End -- X-cs: From: Self To: wilderness-emergency-medicine@list.pitt.edu Subject: (Fwd) aspirin Reply-to: kconover@pitt.edu Date: Fri, 31 May 1996 19:24:00 ------- Forwarded Message Follows ------- From: rrt01@health.state.ny.us Date: Fri, 31 May 96 16:36:30 EDT Subject: aspirin To: "Keith Conover, M.D." Another reason to withhold aspirin in chest pain is if the patient is already taking/compliant with daily ASA Tx. Take Care... * Raymond R. Thielke, EMT/P, Sr EMS Rep * NYS Dept Of Health, Bureau of Emerg Med Svcs * 217 S. Salina St. E-mail: RRT01@health.state.ny.us * Syracuse, NY 13202 Phone# (315)426-7711 Right, and right on the aortic dissection as contraindications (thanks to you both). --KC -- End -- X-cs: From: Self To: wilderness-emergency-medicine@list.pitt.edu Subject: Voltaren eye drops Cc: EMED List Reply-to: kconover+@pitt.edu Date: Mon, 3 Jun 1996 15:58:05 WEMSI is getting ready to revise its Personal Wilderness Medical kit list. Though it is designed specifically for WEMSI Wilderness Medics practicing in our Wilderness EMS system here in Pennsylvania, it serves as a model and reference for others interested in wilderness medical kits. One big advance (I think) has occurred in the management of corneal abrasions. First I should mention that eye patches are "out." Though the theory was that they would speed up healing, this has not been borne out in studies. And indeed patching can make some infections (e.g., pseudomonas in those who wear contacts) considerably worse. Here is a recent article that supports this. [Patterson J; Fetzer D; Krall J; Wright E; Heller M. Eye patch treatment for the pain of corneal abrasion. South Med J 1996 Feb;89(2):227-9. (Emergency Medicine Residency of the Lehigh Valley, Bethlehem, PA)] ABSTRACT: The traditional use of patching and topical antibiotics in the treatment of corneal abrasion has recently been challenged, particularly after foreign body removal. In a prospective, controlled, randomized study of 33 patients treated in the emergency department for eye pain and corneal abrasion, we attempted to determine whether eye patching affected the pain of simple corneal abrasions. After fluorescein examination with magnification (x 5), a visual analog pain score was recorded and the patient was randomized to either the patched or nonpatched group. A standard analgesic was supplied, and all patients had follow-up at 24 hours, when repeat pain scores and analgesic use were recorded. The groups were compared by using the Wilcoxon's rank sum test, Student's t test, and analysis of covariance as required. There was no significant difference in the mean changes in pain scores between the patched and nonpatched groups. Analgesic use was also similar. We conclude that routine eye patching does not favorably affect the pain associated with the treatment of simple corneal abrasion. [end citation] My opthalmologist friend also says he saw an article, in the past 6 months or so, from some people at the Massachussets Eye and Ear Infirmary that showed that, for abrasions less than 4 mm, patching wasn't helpful. I couldn't locate that one. But the real advance is the use of NSAID (NonSteroidal AntiInflammatory Drug) eye drops. NSAIDs such as ibuprofen (e.g. Motrin) are found in most wilderness medical kits and widely used for pain relief. Now, diclofenac sodium (Voltaren) drops and ketorolac tromethamine drops (Toradol oral/IM/IV, Acular drops). These drops can be used for topical pain relief after a corneal abrasion (and, I assume, for actinic keratitis=snowblindness). I used some on a patient in the ED last night, and she got excellent pain relief. But what about the problem of delaying healing? We have been told not to give patients tetracaine or equivalent anaesthetic drops to take home, because continued use will delay healing. (I've never found the literature to really substantiate it but it's the standard teaching.) However, an ophthalmologist friend told me that there is good evidence that Voltaren drops will not delay healing significantly. Some ophthalmologists do a surgical procedure for nearsightedness: they strip off the corneal epithelium (basically a corneal abrasion of most of the cornea) and then use a laser to reshape the layer of the cornea under this. When they use Voltaren drops for this, it does reduce the pain a lot, and it retards healing only slightly. Based on this, he treats all his corneal abrasions with Voltaren drops. And I've heard the same from other ophthalmologists. (He said most of their experience is with the Voltaren drops which is why they mostly use them rather than the Acular drops.) For a backcountry corneal abrasion or snowblindness, Voltaren drops could be _very_ handy. Pain relief without narcotics -- without disturbing one's balance and judgment -- and without patching -- could really help speed one's trip out of the wilderness. My ophthalmologist friend also suggests using a disposable contact lens as a "bandage" over the corneal abrasion. I've not tried this yet but have been carrying one around in my pack for the last year waiting for a chance to try. He seems to think that this would make a bad abrasion feel better. Here is an article that supports this: [Donnenfeld ED; Selkin BA; Perry HD; Moadel K; Selkin GT; Cohen AJ; Sperber LT. Controlled evaluation of a bandage contact lens and a topical nonsteroidal anti-inflammatory drug in treating traumatic corneal abrasions. Ophthalmology 1995 Jun;102(6):979-84. (Lions Eye Bank for Long Island, North Shore University Hospital, Manhasset, NY)] ABSTRACT: BACKGROUND: Treating traumatic corneal abrasions is a common problem for the ophthalmologist. Traditional management has been the use of a pressure patch. Three different therapeutic modalities were evaluated for their efficacy in treating traumatic corneal abrasions. METHODS: Forty-seven consecutive patients with traumatic corneal abrasions were randomized prospectively in a single-masked, controlled clinical trial which compared the efficacy of (1) pressure patching, (2) a bandage contact lens, and (3) a bandage contact lens with a topical nonsteroidal anti-inflammatory drug (0.5% ketorolac tromethamine). RESULTS: There was no significant difference in the healing time of the three groups. However, psychometric analysis showed a significant decrease in pain in the group that received a bandage contact lens with a topical nonsteroidal anti-inflammatory drug. There was a significant difference in the ability to return to normal activities in both contact lens groups compared with the pressure-patch group. There was no significant difference among the three groups with respect to photophobia, redness, ocular irritation, headache, or tearing. CONCLUSION: Use of a bandage contact lens significantly shortens the time required for a patient to return to normal activities. Moreover, addition of a nonsteroidal anti-inflammatory drug to a treatment regimen significantly decreases the pain associated with traumatic corneal abrasions. Use of a bandage contact lens with a topical nonsteroidal anti-inflammatory may prove to be an effective adjunct in treating traumatic corneal abrasions. So, based on this, I think we should add Voltaren drops to the WEMSI Wilderness Medical Kit list. To get additional comments on this new and somewhat controversial treatment for corneal abrasions, I'll also post this to the emed-l emergency medicine list and see what people think. -- End -- X-cs: From: Self To: "Charles P. Kollar" Subject: Re: (Fwd) aspirin Cc: wilderness-emergency-medicine@list.pitt.edu Reply-to: kconover@pitt.edu Date: Tue, 4 Jun 1996 15:28:28 On 2 Jun 96 at 20:52, Charles P. Kollar wrote: > > Another reason to withhold aspirin in chest pain is if the patient is > > already taking/compliant with daily ASA Tx. > > Does the additional 160-320 mg ASA cause any problems, or is there > just not point to it? The "best" dose of ASA is still being studied, and at this point the answers are not all in. But there is theoretical reason to suspect that more than the optimal dose is less effective. ASA makes platelets less sticky, but makes the insides of arteries _more_ sticky. The goal, according to theory, is to take enough ASA so that all your platelets are acetylated, to make them less "sticky," but there is no effect on the endothelium (lining) of blood vessels to make them more sticky. This is accomplished by taking enough ASA to acetylate all the platelets that pass through the portal circulation (the vein that takes blood from the intestine to the liver). But at the same time, taking a small enough dose that the liver clears all the ASA out, and there is not any left to go to the heart and thence to the arteries to make the insides of the arteries "sticky." "As little as 40 mg a day of aspirin inhibits cyclooxygenase-dependent platelet aggregation." (Rosen, quoting Patrono C et al: Clinical pharmacology of platelet cyclo-oxygenase inhibition, Circulation 72:1177, 1985.) > > Right, and right on the aortic dissection as contraindications > > (thanks to you both). > > It is said that this is an issue (and I'm taking your word for it). > However, is this "in fact" an issue. That is, > > 1) If a person is having cardiac symptoms (minus the clasic pain going to > the back let's say) how more (less) likely is it that they are having an > MI than a dissecting aneurism? Especially if they have no past HX of such. > Or, stated somewhat differently, if you "randomly" gave the asprin, would > it do more good (statistically.. not that I would want to be that .001 > person with the aneurism, or a bleeding ulcer for that matter) than harm. > > 2) I understand that the ASA causes the platelets to tend to aggregate > less quickly, but is this amount of ASA significant for an aneurism. In > other words, has the effect of low doses of ASA on mortality/morbidity in > this situation been studied. Is there reason to believe (other than > through speculation based on general mechanisms) that a low doese of ASA > increases m/m (probably mortality) here. > > I really should do a literature search... By all means, please do! But let me dredge up some figures. "The incidence of aortic dissection is estimated at 5 to 10 per million population per year . . ." (quotes are from Rosen's textbook of EM, current CD-ROM edition.) "Each year in the United States, coronary artery disease causes the death of 650,000 people and produces a nonfatal AMI in 1,300,000 more." And the population of the U.S. is, very roughly, 250 million. So this means 2600 deaths and 5200 nonfatal MIs per million. So MIs are on the order of 1000 times more common than aortic dissection. Aspirin, in studies such as ISIS-2, reduces mortality from MI by about 20%. And ASA is a very effective treatment for unstable ungina, too. And I suspect that in the wilderness unstable angina will be about as common as MI. And how bad is a dose of aspirin for dissecting aortic aneurysm? No figures for that, I'm afraid. But I suspect it may increase the mortality by maybe 20%. So we've got a treatment that, given undiscriminately to those with chest pain from either MI or dissection, will decrease mortality overally by (very slightly less) than 20%. This, of course, neglects those whose chest pain is from a bleeding ulcer, or from other problems. But even factoring in these other causes of chest pain (including PE, for which ASA might help) the overall statistics point to the benefit of aspirin. But if you can say "gee, this sounds a lot more like aortic dissection than unstable angina or MI" you can withhold the ASA and maybe improve these figures somewhat. But given the thousand-fold difference in incidence, you'd probably be best to withhold ASA only when it _really_ sounds like a classic dissection, you have big unequalities of pulses or BPs in the arms, or your backpackable x-ray machine shows widening of the aortic knob on x-ray. Hope this helps put this all in context. -- End -- X-cs: From: Self To: Riverwood@BLomand.Net Subject: Re: D.C. Voltage for Snakebite Cc: wilderness-emergency-medicine@list.pitt.edu,Gene Harrison Reply-to: kconover@pitt.edu Date: Wed, 5 Jun 1996 21:02:18 On 3 Jun 96 at 22:10, Riverwood@BLomand.Net wrote: > Hi Keith, > > Gene L. Harrison saw an article I wrote on Tag-Net and asked me to > E-Mail the article to you.. > > > The new article on Tag-Net about Chiggers reminded me of a > Chiggering Experience. Several years ago I was reading in , one of > the outdoor magazines, possibly, Outdoor Life, about the use of > D.C. Voltage for Snakebite. According to the articles, D.C. > Voltage has been used all of the world for the treatment of > snakebite. Folks have connected a longer wire to the sparkkplug > wire from chainsaws, 4-Wheelers, motorcycles, automobiles,etc. and > any thing else with a coil to shock themselves with the 30-40 > thousand volts produced from the coil. As memory serves, the > thought was that snake venom contained charged copper particles and > the shock from the coil wire changed the polarity of this charge. > The results were reduced swelling within 15-20 minutes, no tissue > damage, and pain reduction. After reading these articles I found a > device, called, The Snake Doctor, which is really a modified Stun > Gun, with the voltage Reduced to put out only 25,000 volts and in a > package the size of a pack of cigarettes. For a snake bite you were > supposed to hold the Snake Doctor to the area where you were bitten > and shock yourself for 2 seconds, then let the unit recharge for 10 > seconds and do this routine 5 times. The company supplied me with > testimonials from the world over, telling how D.C. Voltage had > saved many peoples lives. The Snake Doctor operates from a nine > volt battery and the shock is localized to an area about 1.5 inches > wide. I later found out this was a lot safer than the shock from a > coil, as the voltage from the coil passes through your heart, and > the same kind of shock which doctors use to start non beating hearts > can also stop a heart from beating. I had already tried a lawnmower > coil on a wasp sting, luckily the shock did nothing but hurt. I > soon became a believer in The Snake Doctor. I have worked for a > large lumber company for the past 11 years and I am in the woods > almost daily. I have a 1/2 Lab, 1/2 Golden Retriever, named Jack > who most of the time goes to work with me on a daily basis. Jack > has been bitten twice, once on the nose and the other time in the > gum, inside of his mouth. On both occasions, I used The Snake > Doctor on Jack. The first time my dog was bitten, his head doubled > in size. I only got to shock him once as I could not catch him to > give him the rest of the shocks. The amazing part was that in 4 > hours the swelling was receding , the dog was eating and wanted to > play ball. This happened on both occasions when he was bitten. > People whom I have talked to whose dogs were bitten said their dogs > had laid around for days, sometimes having large amounts of tissue > damage at the bite site.. The last article which I read stated that > scientists we not able to duplicate these results in the lab, so if > you are interested, I would do more investigation. > > Back to the Chiggers: A few years back I happened to have to cross > a long, grassy field in late June or July. The result was my legs > were almost eaten off with chiggers. The itching became almost > unbearable, so I thought, why not try the Snake Doctor. I applied > the 25,000 volts to the calf of my legs and the calf muscle shook > like Jell-O, but the good news was the itching stopped instantly. I > must have fried those chiggers. > > If I get bitten by a snake, will I use the Extractor and then the > Snake Doctor and hopefully, calmly, head to the hospital. > > Ross Cardwell > > I forgot to mention what an Extractor was, however, I'm sure you > already know that it is a suction devise for the extraction of > venom, which pulls about 750 millibars of vacumn and requires not > cutting. > > I came across a site on the internet called: > http://www.xmission.com/~gastown/herpmed/med.htm > No one on that sites recommends the use of shock for snakebite. Thanks for your thoughts. I'll be posting this reply to the wilderness-emergency-medicine list, as well. Basically, electric shock does nothing for snakebite. Franz Anton Mesmer tried it back when he was first experimenting with electricity for medical purposes. The Sawyer extractor, however, _does_ work, at least if used within the first half-hour after an envenomated bite. In lab studies, it removed about 30% of the venom. (Without any cutting.) Never heard of using it for chiggers, and I have to admit to being suspicious. It could all be placebo effect. Being very skeptical, I'm not particularly interested in putting any time and effort to investigate it. If, however, someone motivated (? you) were to put together a placebo-controlled trial with good controls, and it showed benefit, I'd be interested. If you look at the references to the quote below from the WEMSI WEMT Curriculum, you'll find good scientific references that essentially prove that electric shock is not helpful, and may be harmful, for pit viper bites. Electric shock treatments for snakebites are useless. The few studies that showed positive effect are flawed.[1] There are now good studies that show electric shocks useless.[2,3,4] As some lecturer s put it: "Electric shocks were tried on snakebite back when electricity was first discovered. It didn't work then, and it doesn't work now." 1. Guderian RH, Mackenzie CD, Williams JF. High voltage shock treatment for snake bite. Lancet 1986;2(8500):229. 2. Sutherland SK, Coulter AR. Early management of bites by the eastern diamondback rattlesnake (Crotalus adamanteus): Studies in monkeys (Macaca fascicularis). Am J Trop Med Hyg 1981;30(2):497-500. 3. Howe NR, Meisenheimer JLJ. Electric shock does not save snakebitten rats. Ann Emerg Med 1988;17(3):254-6. 4. Davis D, Branch K, Egen NB, Russell FE, Gerrish K, Auerbach PS. The effect of an electrical current on snake venom toxicity. J Wild Med 1992;3(1):48-53. -- End -- X-cs: From: Self To: Dante_Landucci@NIH.gov (Dante Landucci, MD) Subject: Re: (Fwd) aspirin Cc: wilderness-emergency-medicine@list.pitt.edu Reply-to: kconover@pitt.edu Date: Wed, 5 Jun 1996 21:16:19 On 5 Jun 96 at 10:10, Dante Landucci, MD wrote: > Reply RE: Re: (Fwd) aspirin > > ======================== > At 11:46 6/4/96, Keith Conover, M.D. wrote: > > "The incidence of aortic dissection is estimated at 5 to 10 per > million population per year . . ." (quotes are from Rosen's > textbook of EM, current CD-ROM edition.) > > Yes, but what's the incidence of aortic injury/dissection in > patients encountered in the wilderness? How does this compare with > the incidence of angina/myocardial infarction in the same > population? I suspect the proportion of the former is significantly > greater in this population than in general. > > Dante Landucci, MD > Critical Care Medicine Department > National Institutes of Health > 301/435-2330, 496-9320; FAX: 301/402-1213 Dante, maybe I'm dense, but . . . why? --Keith Conover, M.D. -- End -- Received: from post-ofc01.srv.cis.pitt.edu (post-ofc01.srv.cis.pitt.edu [136.142.185.10]) by shadow-blue.cis.pitt.edu with ESMTP (8.7.5/cispop-1.6.1.3) ID for ; Wed, 5 Jun 1996 22:12:40 -0400 From: grenard@herpmed.com Received: from local (daemon@localhost) by post-ofc01.srv.cis.pitt.edu (8.7.5/cispo-2.0.1.1) ID for kconover@pop.pitt.edu; Wed, 5 Jun 1996 22:12:31 -0400 (EDT) Received: via switchmail for kconover+@pitt.edu; Wed, 5 Jun 1996 22:12:31 -0400 (EDT) Received: from mail1.new-york.net (mail1.new-york.net [165.254.2.54]) by post-ofc01.srv.cis.pitt.edu with ESMTP (8.7.5/cispo-2.0.1.1) ID for ; Wed, 5 Jun 1996 22:11:33 -0400 (EDT) Received: from herpmed.com by mail1.new-york.net (PMDF V4.3-10 #5880) id <01I5KD2ZW8M8008ZOO@mail1.new-york.net>; Wed, 05 Jun 1996 22:11:24 -0500 (EST) Date: Wed, 05 Jun 1996 21:48:32 -0700 (PDT) Subject: Re: D.C. Voltage for Snakebite To: Riverwood@BLomand.Net, kconover+@pitt.edu Cc: wilderness-emergency-medicine@list.pitt.edu, Gene Harrison Message-id: MIME-version: 1.0 X-Mailer: Chameleon - TCP/IP for Windows by NetManage, Inc. Content-type: TEXT/PLAIN; charset=US-ASCII Content-transfer-encoding: 7BIT X-PMFLAGS: 34078848 0 Passing an electric current through venom to rearrange its molecular structure or change its polarity does not work. The divalent metallic ions present in snake venoms include Calcium (+2), Magnesium (+2) and Zinc (+2). While it is true that many of the harmful enzymes (proteases) present in snake venom are dependent on these metallic ions for their activity, researchers are looking at inhibiting them by physicochemical methods using carboxyalkyl peptide indihibitors and citrates which form strong complexes with such ions. And while such enzymes are reponsible for much of the damage caused by snakebite there are other substances as well which remain basically unaffected by altering metallic ions. The fact that your dogs got better has nothing to do with the modified stun gun. They may have received a non-lethal bite and would've recovered anyway. The test of any treatment for snakebite is its success on bites that result in significant venom injection. Such tests have been conducted on laboratory animals and they have proved electric shock is worthless. It could, of course, be harmful. The "current" (excuse the pun) electric shock craze started with a letter in the journal Lancet some years ago of an anecdotal report of South American Indians who used a sparkplug wire to treat a snakebite. Again it is impossible to say whether this was a venomous bite and if so whether it resulted in any venom deposition. Outdoor magazines, the popular press and, of course, the manufacturers of stun guns picked up on this letter and capitalized on it. Many respected researchers at the outset, while skeptical, were willing to give this treatment the benefit of the doubt. Today, these many years later, the results show such treatment ineffective and potentially harmful. ------------------------------------- Steve Grenard E-mail: grenard@herpmed.com http://www.xmission.com/~gastown/herpmed/med.htm POB 40825-Staten Island NY 10304-0825 USA Telephone: 1-718-447-6144 This message was sent by Chameleon ------------------------------------- -- End -- X-cs: From: Self To: rrt01@health.state.ny.us Subject: Re: D.C. Voltage for Snakebite Cc: wilderness-emergency-medicine@list.pitt.edu Reply-to: kconover@pitt.edu Date: Fri, 14 Jun 1996 09:14:27 On 6 Jun 96 at 10:54, rrt01@health.state.ny.us wrote: > > A Thought: > > Mr. Cardwell experienced relief of his ithcing after using applying > DC current to his legs. Perhaps this "treatment" produced an effect > similar to using transcutaneous nerve stimulation (TNS). TNS is > commonly used for post-surgical & chronic pain control. > > Take Care... > > * Raymond R. Thielke, EMT/P, Sr EMS Rep > * NYS Dept Of Health, Bureau of Emerg Med Svcs > * 217 S. Salina St. E-mail: RRT01@health.state.ny.us * > Syracuse, NY 13202 Phone# (315)426-7711 A reasonable thought. On the other hand, we know that itching and pain are very similar -- for instance, tylenol will help decrease itching. Maybe the pain of the electrical shock simply overwhelmed the itch sensation. In which case hitting yourself in the head would work as well. --Keith Conover, M.D. -- End -- Received: from post-ofc02.srv.cis.pitt.edu (post-ofc02.srv.cis.pitt.edu [136.142.185.11]) by shadow-blue.cis.pitt.edu with ESMTP (8.7.5/cispop-1.6.1.3) ID ; Fri, 21 Jun 1996 15:37:03 -0400 Received: from local (root@localhost) by post-ofc02.srv.cis.pitt.edu (8.7.5/cispo-2.0.1.1) ID ; Fri, 21 Jun 1996 15:36:56 -0400 (EDT) Received: via switchmail; Fri, 21 Jun 1996 15:36:55 -0400 (EDT) Received: from list.srv.cis.pitt.edu via qmail ID ; Fri, 21 Jun 1996 15:35:40 -0400 (EDT) Received: from local (majordom@localhost) by list.srv.cis.pitt.edu (8.7.5/cisls-2.4) ID ; Fri, 21 Jun 1996 15:35:08 -0400 (EDT) X-Authentication-Warning: list.srv.cis.pitt.edu: majordom set sender to owner-wilderness-emergency-medicine using -f Received: from kitsune.swcp.com (swcp.com [198.59.115.2]) by list.srv.cis.pitt.edu with SMTP (8.7.5/cisls-2.4) ID for ; Fri, 21 Jun 1996 15:35:04 -0400 (EDT) Received: (from tanman@localhost) by kitsune.swcp.com (8.6.9/8.6.9) id NAA06086; Fri, 21 Jun 1996 13:35:03 -0600 Date: Fri, 21 Jun 1996 13:35:02 -0600 (MDT) From: TANMAN To: wilderness-emergency-medicine@list.pitt.edu Subject: Re: Laceration care in the marine (ocean) environment In-Reply-To: <31CACBC1.21F4@ucs.orst.edu> Message-ID: MIME-Version: 1.0 Content-Type: TEXT/PLAIN; charset=US-ASCII Sender: owner-wilderness-emergency-medicine@list.pitt.edu Precedence: bulk X-PMFLAGS: 34078848 0 When in Catanduanes, Philippines, I was working as a Doctor, (go there every two years). There is a nice surfing beach on the east coast (Pacific). A lot of Australians go there to practice for world competition because it is secluded and the waves are big and constant. I helped a number of surfers with "Reef Rash" abrasions and lacerations from falling on to the reef. Washed the wounds with soap and water on the beach, sutured up the large lacerations and then washed then every 12 hours with soap and water, they healed in under 10 days. Thomas A. Naegele, DO Internet 9405 Lagrima de Oro NE 505-275-7267 Albuquerque, NM 87111 Board Certified Family Practice/Board Certified Quality Assurance Practice Guidelines/Clinical Paths>http://www.swcp.com/~tanman/ __________________________________________________________________ -- End -- Received: from post-ofc03.srv.cis.pitt.edu (post-ofc03.srv.cis.pitt.edu [136.142.185.39]) by shadow-blue.cis.pitt.edu with ESMTP (8.7.5/cispop-1.6.1.3) ID ; Sat, 22 Jun 1996 00:17:29 -0400 Received: from local (root@localhost) by post-ofc03.srv.cis.pitt.edu (8.7.5/cispo-2.0.1.1) ID ; Sat, 22 Jun 1996 00:17:22 -0400 (EDT) Received: via switchmail; Sat, 22 Jun 1996 00:17:22 -0400 (EDT) Received: from list.srv.cis.pitt.edu via qmail ID ; Sat, 22 Jun 1996 00:15:14 -0400 (EDT) Received: from local (majordom@localhost) by list.srv.cis.pitt.edu (8.7.5/cisls-2.4) ID ; Sat, 22 Jun 1996 00:14:46 -0400 (EDT) X-Authentication-Warning: list.srv.cis.pitt.edu: majordom set sender to owner-wilderness-emergency-medicine using -f Received: from postoffice4.mail.cornell.edu (POSTOFFICE4.MAIL.CORNELL.EDU [132.236.56.12]) by list.srv.cis.pitt.edu with ESMTP (8.7.5/cisls-2.4) ID for ; Sat, 22 Jun 1996 00:14:40 -0400 (EDT) Received: from [132.236.155.168] (CU-DIALUP-1126.CIT.CORNELL.EDU [132.236.155.168]) by postoffice4.mail.cornell.edu (8.7.5/8.7.3) with SMTP id AAA09994 for ; Sat, 22 Jun 1996 00:14:36 -0400 (EDT) X-Sender: prk5@postoffice4.mail.cornell.edu Message-Id: Mime-Version: 1.0 Content-Type: text/plain; charset="us-ascii" Date: Sat, 22 Jun 1996 00:11:26 -0500 To: wilderness-emergency-medicine@list.pitt.edu From: prk5@cornell.edu (Paul Rogers Kennedy) Subject: Knees and Joints (Orthopedic Questions) Sender: owner-wilderness-emergency-medicine@list.pitt.edu Precedence: bulk X-PMFLAGS: 35127424 0 Hey I finally have a question for folks on this list. Actually I may have a number in the near future as I am doing some research for some writing. I have two questions for the MD's &/or any Physical therapists on the list: 1) What does "cracking" your fingers do?? Is it a bad idea to do this before you climb??? Might it help or hinder your performance and/or the fingers themselves? 2) What are the issues around reconstructive ACL surgery and climbing? (Primarily looking at Rock climbing here, But I suppose Mountaineering (ie. Pack carrying. and skiing too might be considerations) Anything beyond the obvious that someone should look out for. I understand that every case will be different in terms of when someone can climb again, but what are the variables that effect the quality of a recovery following and injury and reconstructive surgery? Also a note to Dr Conover: If these questions would be better asked/answered somewhere else please let me know. Thanks, Paul Paul R. Kennedy, WEMT-B Cornell University email: prk5@cornell.edu phone: (607)539-3148 snail mail: P.O. Box 184 Saratoga Springs, NY 12866 -- End -- X-cs: From: Self To: wilderness-emergency-medicine@list.pitt.edu Subject: thermometer/hygrometer and heat stress Cc: Computers_In_SAR Digest Reply-to: kconover@pitt.edu Date: Wed, 26 Jun 1996 10:43:42 The Wilderness EMS Institute is in the process of adding information on heat stress to its Wilderness EMT Curriculum. This is in aid of the WEMT's role as a medical officer for a search base camp. The wildfire service has long recognized the dangers of heat stress for wildfire suppression personnel, but this knowledge hasn't always made it across to the wilderness SAR community. In the past, the standard technique for measuring heat and humidity is a sling psychrometer (wet/dry bulb thermometer). These devices are somewhat fragile, moderately expensive, and take a bit of training to use. A couple of days ago, I found an inexpensive ($25) thermometer/hygrometer at Radio Shack: Cat. No. 63-855. It is pocket-sized, gives a constant digital readout, and appears relatively sturdy. As with the sling psychrometer, it will take some training for WEMTs to use it (e.g., positioning relative to the sun and shade and sources of moisture). I also suspect it is not quite as accurate as a sling psychrometer. Nonetheless, it seems a reasonable alternative to keep in a search OPSKIT; or, at the price, the OPSKIT could even keep another as a backup. My questions: 1. are there any SAR teams that routinely use heat/humidity readings to determine task length, or to advise Field Team Leaders about watching for signs of heat stress in SAR personnel? 2. Has anyone had experience with these electronic psychrometers compared to the standard sling types? 3. Has anyone had experience with electronic psychrometers in field use? Thanks very much for your replies. -- End -- Received: from post-ofc01.srv.cis.pitt.edu (post-ofc01.srv.cis.pitt.edu [136.142.185.10]) by shadow-blue.cis.pitt.edu with ESMTP (8.7.5/cispop-1.6.1.3) ID for ; Wed, 26 Jun 1996 14:03:25 -0400 Received: from local (daemon@localhost) by post-ofc01.srv.cis.pitt.edu (8.7.5/cispo-2.0.1.1) ID for kconover@pop.pitt.edu; Wed, 26 Jun 1996 14:03:24 -0400 (EDT) Received: via switchmail for kconover+@pitt.edu; Wed, 26 Jun 1996 14:03:24 -0400 (EDT) Received: from mercury.Sun.COM (mercury.Sun.COM [192.9.25.1]) by post-ofc01.srv.cis.pitt.edu with SMTP (8.7.5/cispo-2.0.1.1) ID for ; Wed, 26 Jun 1996 13:58:45 -0400 (EDT) Received: by mercury.Sun.COM (Sun.COM) id KAA01324; Wed, 26 Jun 1996 10:57:32 -0700 Received: from rmtc.Central.Sun.COM by Central.Sun.COM (SMI-8.6/SMI-5.3) id MAA23658; Wed, 26 Jun 1996 12:57:17 -0500 Received: from caveman.Central.Sun.COM by rmtc.Central.Sun.COM (5.x/SMI-SVR4) id AA00260; Wed, 26 Jun 1996 11:57:18 -0600 Received: from caveman by caveman.Central.Sun.COM (5.x/SMI-SVR4) id AA03428; Wed, 26 Jun 1996 11:56:02 -0600 Date: Wed, 26 Jun 1996 11:56:02 -0600 (MDT) From: Howard Alt Reply-To: Howard Alt Subject: Re: thermometer/hygrometer and heat stress To: kconover+@pitt.edu In-Reply-To: "Your message with ID" <199606261445.KAA12868@post-ofc01.srv.cis.pitt.edu> Message-Id: Content-Type: text X-Sun-Text-Type: ascii X-PMFLAGS: 34603136 0 My humble opinion... It seems to me that it's more important to focus on assessment of individuals, rather than having people use toys and memorize tables of humidity+temperature and risk levels. If you have limited instruction time, spending that time talking about all the different ways patients present and what risky conditions feel like would be much more valuable. I know that "feeling" is hard to teach, but it's a start. I believe that what you have in your head is more important than what you have in your kit. Carry too much stuff, and your pack will cause you heat stress :-). Don't get me wrong... I love gear. I might even go out and buy one of these toys just for fun. Seems like it's more of a toy to learn about in the field rather in a class. By the way, I visited the WEMSI home page. I think you guys have developed an excellent program. By the way, if you guys have your protocols printed up in a more convenient form for field use, I'd love to get one. Any hope? I'm happy to pay for it, of course. Howard Alt, WEMT > The Wilderness EMS Institute is in the process of adding information > on heat stress to its Wilderness EMT Curriculum. This is in aid of > the WEMT's role as a medical officer for a search base camp. The > wildfire service has long recognized the dangers of heat stress for > wildfire suppression personnel, but this knowledge hasn't always made > it across to the wilderness SAR community. > > In the past, the standard technique for measuring heat and humidity > is a sling psychrometer (wet/dry bulb thermometer). These devices > are somewhat fragile, moderately expensive, and take a bit of > training to use. > > A couple of days ago, I found an inexpensive ($25) > thermometer/hygrometer at Radio Shack: Cat. No. 63-855. It is > pocket-sized, gives a constant digital readout, and appears > relatively sturdy. As with the sling psychrometer, it will take > some training for WEMTs to use it (e.g., positioning relative to the > sun and shade and sources of moisture). I also suspect it is not > quite as accurate as a sling psychrometer. > > Nonetheless, it seems a reasonable alternative to keep in a search > OPSKIT; or, at the price, the OPSKIT could even keep another as a > backup. My questions: > > 1. are there any SAR teams that routinely use heat/humidity readings > to determine task length, or to advise Field Team Leaders about > watching for signs of heat stress in SAR personnel? > > 2. Has anyone had experience with these electronic psychrometers > compared to the standard sling types? > > 3. Has anyone had experience with electronic psychrometers in field > use? > > Thanks very much for your replies. > > > Keith Conover, M.D. (NSS 12893, WD4PSY) > - Information Systems Coordinator, Dept. of EM, Mercy Hospital > - Clinical Assistant Professor, Dept. of Emergency Medicine, > Univ. of Pittsburgh (EM Residency and Center for Emergency Medicine) > - Medical Director, Wilderness EMS Institute > (http://www.pitt.edu/DOC/95/30/32686/Wemsi.html) > (for a WEMSI-sponsored list, send "subscribe > wilderness-emergency-medicine" to Majordomo@list.pitt.edu) > - Eastern Region, Natl. Cave Rescue Comm./Appalachian SAR Conf. -- End -- Received: from post-ofc02.srv.cis.pitt.edu (post-ofc02.srv.cis.pitt.edu [136.142.185.11]) by shadow-blue.cis.pitt.edu with ESMTP (8.7.5/cispop-1.6.1.3) ID for ; Sun, 30 Jun 1996 14:46:16 -0400 Received: from local (daemon@localhost) by post-ofc02.srv.cis.pitt.edu (8.7.5/cispo-2.0.1.1) ID for kconover@pop.pitt.edu; Sun, 30 Jun 1996 14:46:15 -0400 (EDT) Received: via switchmail for kconover+@pitt.edu; Sun, 30 Jun 1996 14:46:15 -0400 (EDT) Received: from aehn2.einstein.edu (root@aehn2.einstein.edu [205.245.103.237]) by post-ofc02.srv.cis.pitt.edu with SMTP (8.7.5/cispo-2.0.1.1) ID for ; Sun, 30 Jun 1996 14:41:45 -0400 (EDT) Received: from LOCALNAME (tfx-us7-03.ix.netcom.com [205.186.65.35]) by aehn2.einstein.edu (8.6.12/8.6.9) with SMTP id NAA00555; Sun, 30 Jun 1996 13:43:26 GMT Date: Sun, 30 Jun 1996 13:43:26 GMT Message-Id: <199606301343.NAA00555@aehn2.einstein.edu> X-Sender: burtonb@aehn2.einstein.edu X-Mailer: Windows Eudora Light Version 1.5.2 Mime-Version: 1.0 Content-Type: text/plain; charset="us-ascii" To: kconover+@pitt.edu, wemsi-staff@list.pitt.edu From: "Barry J. Burton, D.O." Subject: Re: thermometer/hygrometer and heat stress Cc: burtonb@aehn2.einstein.edu, bjburton@IX.NETCOM.COM, GrandeyE@jeflin.tju.edu X-PMFLAGS: 34078848 0 Keith... First, sorry we missed each other at the OTR site. I'm corresp6nding vie Florida (Heat stress capital? gg) Secondly, thanks for picking up the challenge. I attempted to do some initial research on this topic prior to the weeklong, for this purpose, and, much like my difficulty in finding sanitation info, I came up short here, also. A radiation safety engineer for PECO referred me to an electronic heat stress monitor, with ALL the bells and whistles, for about 2 grand. A little steep for everyone but Sam. I found the heat stress index calculation and such in the Occ Med arena, but no easy way to determine the black globe temp (radiant absorption). Now, although I havn't yet contacted her, a friend of mine from the ACEP teaching fellowship, Linda Lawrence, informed me the Military have a fairly portable, cheap set up. I was to get the details before weeklong, but got jammed up with real work. Perhaps this would be another place to look? Cheers. BJ At 10:44 AM 6/26/96 +0000, you wrote: >The Wilderness EMS Institute is in the process of adding information >on heat stress to its Wilderness EMT Curriculum. This is in aid of >the WEMT's role as a medical officer for a search base camp. The >wildfire service has long recognized the dangers of heat stress for >wildfire suppression personnel, but this knowledge hasn't always made >it across to the wilderness SAR community. > >In the past, the standard technique for measuring heat and humidity >is a sling psychrometer (wet/dry bulb thermometer). These devices >are somewhat fragile, moderately expensive, and take a bit of >training to use. > >A couple of days ago, I found an inexpensive ($25) >thermometer/hygrometer at Radio Shack: Cat. No. 63-855. It is >pocket-sized, gives a constant digital readout, and appears >relatively sturdy. As with the sling psychrometer, it will take >some training for WEMTs to use it (e.g., positioning relative to the >sun and shade and sources of moisture). I also suspect it is not >quite as accurate as a sling psychrometer. > >Nonetheless, it seems a reasonable alternative to keep in a search >OPSKIT; or, at the price, the OPSKIT could even keep another as a >backup. My questions: > >1. are there any SAR teams that routinely use heat/humidity readings >to determine task length, or to advise Field Team Leaders about >watching for signs of heat stress in SAR personnel? > >2. Has anyone had experience with these electronic psychrometers >compared to the standard sling types? > >3. Has anyone had experience with electronic psychrometers in field >use? > >Thanks very much for your replies. > > >Keith Conover, M.D. (NSS 12893, WD4PSY) >- Information Systems Coordinator, Dept. of EM, Mercy Hospital >- Clinical Assistant Professor, Dept. of Emergency Medicine, > Univ. of Pittsburgh (EM Residency and Center for Emergency Medicine) >- Medical Director, Wilderness EMS Institute > (http://www.pitt.edu/DOC/95/30/32686/Wemsi.html) > (for a WEMSI-sponsored list, send "subscribe > wilderness-emergency-medicine" to Majordomo@list.pitt.edu) >- Eastern Region, Natl. Cave Rescue Comm./Appalachian SAR Conf. > > Barry J. Burton, D.O. EMS Fellowship Director Albert Einstein Medical Center Philadelphia, PA burtonb@aehn2.einstein.edu -- End -- X-cs: From: Self To: Patton M Turner Subject: Re: thermometer/hygrometer and heat stress Cc: wilderness-emergency-medicine@list.pitt.edu Reply-to: kconover@pitt.edu Date: Sun, 30 Jun 1996 16:39:10 On 29 Jun 96 at 14:32, Patton M Turner wrote: > > 2. Has anyone had experience with these electronic psychrometers > > compared to the standard sling types? > > In college, I was told not to trust electronic or dial type > hygrometers, by a prof. They used sling psychrometers, or a model > with a electric fan in the field and a dew point sensor in the lab > or in stationary applications. I know the FAA/NWS still uses sling > psychrometers. > > > > > 3. Has anyone had experience with electronic psychrometers in > > field use? > > I have used the electrical models (wet bulb + battery powered fan) > they work fine, but I doubt they will survive much of a G shock. > > > How accuarate does it really need to be? If you can answer that > question, I bet the NWS could give a good recomendation. > > Pat > I think we only need to be accurate within a degree or two -- microclimate variation within a search area is so great that we're just talking about rough estimates. And in response to other comments, I agree that team leaders must be responsible for monitoring their own teams, and they shouldn't need to be "baby-sat" by a WEMT at base. But the IC may be able to use the measurements to better gauge the reasonable task lengths and performance of field teams, and thus get a better estimate of personnel and logistics needs. -- End --