Received: from post-ofc05.srv.cis.pitt.edu (root@post-ofc05.srv.cis.pitt.edu [136.142.185.10]) by pop.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cispop-7.2.2.1) ID ; Thu, 30 Dec 1999 16:55:16 -0500 (EST) Received: from localhost (root@localhost) by post-ofc05.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Thu, 30 Dec 1999 16:54:44 -0500 (EST) Received: via switchmail; Thu, 30 Dec 1999 16:54:44 -0500 (EST) Received: from list.srv.cis.pitt.edu via qmail ID ; Thu, 30 Dec 1999 16:53:46 -0500 (EST) Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.1) ID ; Thu, 30 Dec 1999 16:52:41 -0500 (EST) Received: from quint.somtel.com (Quint.somtel.com [206.139.114.2]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.1) ID for ; Thu, 30 Dec 1999 16:52:38 -0500 (EST) Received: from oemcomputer (dialup-na-8.somtel.com [216.227.178.28]) by quint.somtel.com (8.8.5/8.8.5) with SMTP id QAA28722; Thu, 30 Dec 1999 16:52:35 -0500 Message-ID: <000a01bf5310$e443e460$1cb2e3d8@oemcomputer> From: "James Bender" To: , , "gillian Salton" , "Jeff Capobianco" , "John James Griffin" , "Kirsten Bender" , "Larry Gellman" , , "Matt Russell" , "Matt Sholl" , "Michael Campbell" , "Paul Morton" , "Ted Curcio" , "Timothy E. Burdick" Subject: W-EMED Our web site is updated Date: Thu, 30 Dec 1999 16:57:36 -0500 MIME-Version: 1.0 Content-Type: multipart/alternative; boundary="----=_NextPart_000_0007_01BF52E6.F8E0C8E0" X-Priority: 3 X-MSMail-Priority: Normal X-Mailer: Microsoft Outlook Express 5.00.2615.200 X-MimeOLE: Produced By Microsoft MimeOLE V5.00.2615.200 Sender: owner-wilderness-emergency-medicine@list.pitt.edu Precedence: bulk Reply-To: wilderness-emergency-medicine@list.pitt.edu X-PMFLAGS: 570950016 0 1 P38C10.CNM This is a multi-part message in MIME format. ------=_NextPart_000_0007_01BF52E6.F8E0C8E0 Content-Type: text/plain; charset="iso-8859-1" Content-Transfer-Encoding: quoted-printable Hello everyone, This is James in Maine, with the dissapointing snow fall. I have = finished updating the MATI website if anyone is interested. More = updates will come weekly now that I am done with the majority of my = college classes. www.mati-online.org James ------=_NextPart_000_0007_01BF52E6.F8E0C8E0 Content-Type: text/html; charset="iso-8859-1" Content-Transfer-Encoding: quoted-printable
Hello everyone,
 
This is James in Maine, with the = dissapointing snow=20 fall.  I have finished updating the MATI website if anyone is=20 interested.  More updates will come weekly now that I am done with = the=20 majority of my college classes.
 
www.mati-online.org
 
James
------=_NextPart_000_0007_01BF52E6.F8E0C8E0-- Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- X-NAV-TimeoutProtection0: X X-NAV-TimeoutProtection1: X X-NAV-TimeoutProtection2: X X-NAV-TimeoutProtection3: X X-NAV-TimeoutProtection4: X X-NAV-TimeoutProtection5: X X-NAV-TimeoutProtection6: X Received: from post-ofc03.srv.cis.pitt.edu (root@post-ofc03.srv.cis.pitt.edu [136.142.185.39]) by pop.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cispop-7.2.2.1) ID ; Thu, 30 Dec 1999 21:22:22 -0500 (EST) Received: from localhost (root@localhost) by post-ofc03.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Thu, 30 Dec 1999 21:21:48 -0500 (EST) Received: via switchmail; Thu, 30 Dec 1999 21:21:48 -0500 (EST) Received: from list.srv.cis.pitt.edu via qmail ID ; Thu, 30 Dec 1999 21:21:39 -0500 (EST) Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.1) ID ; Thu, 30 Dec 1999 21:21:05 -0500 (EST) Received: from hotmail.com (f313.hotmail.com [207.82.251.226]) by list.srv.cis.pitt.edu with SMTP (8.8.8/8.8.8/cisls-7.2.2.1) ID for ; Thu, 30 Dec 1999 21:21:02 -0500 (EST) Received: (qmail 58555 invoked by uid 0); 31 Dec 1999 02:20:31 -0000 Message-ID: <19991231022031.58554.qmail@hotmail.com> Received: from 206.172.255.49 by www.hotmail.com with HTTP; Thu, 30 Dec 1999 18:20:31 PST X-Originating-IP: [206.172.255.49] From: "Mike Webster" To: wilderness-emergency-medicine@list.pitt.edu Subject: Re: W-EMED Wilderness EMT refresher/recert Date: Thu, 30 Dec 1999 19:20:31 MST Mime-Version: 1.0 Content-Type: text/plain; format=flowed Sender: owner-wilderness-emergency-medicine@list.pitt.edu Precedence: bulk Reply-To: wilderness-emergency-medicine@list.pitt.edu X-PMFLAGS: 34078848 0 1 P5B930.CNM ----Original Message Follows---- From: Bernie Roche Reply-To: wilderness-emergency-medicine@list.pitt.edu To: wilderness-emergency-medicine@list.pitt.edu Subject: Re: W-EMED Wilderness EMT refresher/recert Date: Wed, 29 Dec 1999 02:30:42 -0600 At 07:21 PM 12/28/99 -0800, you wrote: >I am looking for a W-EMT refresher/recert course. I live in Toronto, >Ontario in Canada and would like something in Ontario or one of the >states boardering/near to Ontario. Can anyone help me ??? > >You can email me directly at shannon@artraining.on.ca Hi: I don't know of any courses closer than those in Pennsylvania. I wouold suggest you might like to consider car-pooling with us to the next one. If this would help, e-mail me back. I'm also in Toronto, by the way Best Wishes, Bernie Roche, RN, BScN, W-EMT, OSJ WEMSI Web Site Administrator Hi: For anyone else that is interested Wilderness Medical Associates does a WEMT upgrade in Ontario. I believe a date is set for March of 2000 near the Toronto area. For details, location, etc. phone 1-877-945-3633 or 1-905-304-4442. Ask for Len James. Sincerely, Mike Webster WEMT (Barrie, Ontario, Canada) ______________________________________________________ Get Your Private, Free Email at http://www.hotmail.com Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- X-NAV-TimeoutProtection0: X X-NAV-TimeoutProtection1: X X-NAV-TimeoutProtection2: X X-NAV-TimeoutProtection3: X X-NAV-TimeoutProtection4: X X-NAV-TimeoutProtection5: X X-NAV-TimeoutProtection6: X Received: from post-ofc04.srv.cis.pitt.edu (root@post-ofc04.srv.cis.pitt.edu [136.142.185.11]) by pop.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cispop-7.2.2.1) ID ; Wed, 29 Dec 1999 11:45:06 -0500 (EST) Received: from localhost (root@localhost) by post-ofc04.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Wed, 29 Dec 1999 11:12:33 -0500 (EST) Received: via switchmail; Wed, 29 Dec 1999 11:12:33 -0500 (EST) Received: from list.srv.cis.pitt.edu via qmail ID ; Wed, 29 Dec 1999 11:11:33 -0500 (EST) Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.1) ID ; Wed, 29 Dec 1999 11:10:46 -0500 (EST) Received: from mailhub.Dartmouth.EDU (mailhub.dartmouth.edu [129.170.16.6]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.1) ID for ; Wed, 29 Dec 1999 11:10:42 -0500 (EST) Received: from donner.Dartmouth.EDU (donner.dartmouth.edu [129.170.208.3]) by mailhub.Dartmouth.EDU (8.9.3+DND/8.9.3) with ESMTP id LAA11372 for ; Wed, 29 Dec 1999 11:09:11 -0500 (EST) Message-id: <30790955@donner.Dartmouth.EDU> Date: 29 Dec 1999 11:10:41 EST From: Timothy.E.Burdick@Dartmouth.EDU (Timothy E. Burdick) Subject: Re: W-EMED Wilderness EMT refresher/recert To: wilderness-emergency-medicine@list.pitt.edu MIME-Version: 1.0 Content-Type: text/plain; charset=iso-8859-1 Content-Disposition: inline Content-Transfer-Encoding: 8bit X-MIME-Autoconverted: from quoted-printable to 8bit by list.srv.cis.pitt.edu id LAA05636 Sender: owner-wilderness-emergency-medicine@list.pitt.edu Precedence: bulk Reply-To: wilderness-emergency-medicine@list.pitt.edu X-PMFLAGS: 34078848 0 1 P0F4C0.CNM --- You wrote: I am looking for a W-EMT refresher/recert course. --- end of quote --- Nothing specific for you, but if you can find 10+ people interested, MATI might be able to do a contract W-EMT course for you in Toronto. Details avaliable at www.mati-online.org or email me back with questions. (If the sit is down for updating, try again in a few days.) Good luck, tim ---------- Tim Burdick, MATI Instuctor Moutain Aid Training International, INC www.mati-online.org timmer@dartmouth.edu Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- X-NAV-TimeoutProtection0: X X-NAV-TimeoutProtection1: X X-NAV-TimeoutProtection2: X X-NAV-TimeoutProtection3: X X-NAV-TimeoutProtection4: X X-NAV-TimeoutProtection5: X X-NAV-TimeoutProtection6: X Received: from post-ofc05.srv.cis.pitt.edu (root@post-ofc05.srv.cis.pitt.edu [136.142.185.10]) by pop.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cispop-7.2.2.1) ID ; Wed, 29 Dec 1999 02:29:36 -0500 (EST) Received: from localhost (root@localhost) by post-ofc05.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Wed, 29 Dec 1999 02:29:04 -0500 (EST) Received: via switchmail; Wed, 29 Dec 1999 02:29:04 -0500 (EST) Received: from list.srv.cis.pitt.edu via qmail ID ; Wed, 29 Dec 1999 02:27:58 -0500 (EST) Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.1) ID ; Wed, 29 Dec 1999 02:27:26 -0500 (EST) Received: from titan.tcn.net (root@titan.tcn.net [199.166.4.2]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.1) ID for ; Wed, 29 Dec 1999 02:27:23 -0500 (EST) Received: from Two (comp11.tcn.net [209.135.79.11]) by titan.tcn.net (8.8.5/8.6.9) with SMTP id CAA01816 for ; Wed, 29 Dec 1999 02:21:33 -0500 (EST) Message-Id: <199912290721.CAA01816@titan.tcn.net> X-Sender: broche@titan.tcn.net X-Mailer: QUALCOMM Windows Eudora Pro Version 4.0 Date: Wed, 29 Dec 1999 02:30:42 -0600 To: wilderness-emergency-medicine@list.pitt.edu From: Bernie Roche Subject: Re: W-EMED Wilderness EMT refresher/recert In-Reply-To: <84bun4$cj5n@eGroups.com> Mime-Version: 1.0 Content-Type: text/plain; charset="us-ascii" Sender: owner-wilderness-emergency-medicine@list.pitt.edu Precedence: bulk Reply-To: wilderness-emergency-medicine@list.pitt.edu X-PMFLAGS: 34078848 0 1 P0E6F0.CNM At 07:21 PM 12/28/99 -0800, you wrote: >I am looking for a W-EMT refresher/recert course. I live in Toronto, >Ontario in Canada and would like something in Ontario or one of the >states boardering/near to Ontario. Can anyone help me ??? > >You can email me directly at shannon@artraining.on.ca Hi: I don't know of any courses closer than those in Pennsylvania. I wouold suggest you might like to consider car-pooling with us to the next one. If this would help, e-mail me back. I'm also in Toronto, by the way. Best Wishes, Bernie Roche, RN, BScN, W-EMT, OSJ WEMSI Web Site Administrator http://www.wemsi.org/ broche@tcn.net Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- X-NAV-TimeoutProtection0: X X-NAV-TimeoutProtection1: X X-NAV-TimeoutProtection2: X X-NAV-TimeoutProtection3: X X-NAV-TimeoutProtection4: X X-NAV-TimeoutProtection5: X X-NAV-TimeoutProtection6: X Received: from post-ofc01.srv.cis.pitt.edu (root@post-ofc01.srv.cis.pitt.edu [136.142.185.25]) by pop.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cispop-7.2.2.1) ID ; Tue, 28 Dec 1999 22:22:55 -0500 (EST) Received: from localhost (root@localhost) by post-ofc01.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Tue, 28 Dec 1999 22:22:23 -0500 (EST) Received: via switchmail; Tue, 28 Dec 1999 22:22:23 -0500 (EST) Received: from list.srv.cis.pitt.edu via qmail ID ; Tue, 28 Dec 1999 22:22:05 -0500 (EST) Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.1) ID ; Tue, 28 Dec 1999 22:21:23 -0500 (EST) Received: from mu.egroups.com (mu.egroups.com [207.138.41.151]) by list.srv.cis.pitt.edu with SMTP (8.8.8/8.8.8/cisls-7.2.2.1) ID for ; Tue, 28 Dec 1999 22:21:18 -0500 (EST) X-eGroups-Return: shannon@artraining.on.ca Received: from [10.1.2.119] by mu.egroups.com with NNFMP; 29 Dec 1999 03:21:17 -0000 Date: Tue, 28 Dec 1999 19:21:08 -0800 From: "Shannon Koppenhoefer" To: wilderness-emergency-medicine@list.pitt.edu Subject: W-EMED Wilderness EMT refresher/recert Message-ID: <84bun4$cj5n@eGroups.com> User-Agent: eGroups-EW/0.82 X-Mailer: eGroups Message Poster Sender: owner-wilderness-emergency-medicine@list.pitt.edu Precedence: bulk Reply-To: wilderness-emergency-medicine@list.pitt.edu X-PMFLAGS: 33554560 0 1 P31060.CNM I am looking for a W-EMT refresher/recert course. I live in Toronto, Ontario in Canada and would like something in Ontario or one of the states boardering/near to Ontario. Can anyone help me ??? You can email me directly at shannon@artraining.on.ca Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- X-cs: R From: Keith Conover, M.D., FACEP X-RS-ID: X-RS-Flags: 0,0,1,1,0,0,0 X-RS-Sigset: 2 To: abuse@hotmail.com, abuse@houseit.com, postmaster@houseit.com Subject: (Fwd) W-EMED FREE SEX, Free forever, forever free! From: 203.1 Reply-to: kconover+@pitt.edu MIME-Version: 1.0 Content-type: text/plain; charset=ISO-8859-1 Content-transfer-encoding: 8BIT Date: Sun, 19 Dec 1999 19:39:44 -0500 Spam sent via your domain to an academic medicine list. Please do your best to track down this user and terminate all mail privileges. ------- Forwarded message follows ------- From: mbhdkp5@hotmail.com Date sent: Sun, 19 Dec 1999 19:06:12 -0500 (EST) To: wilderness-emergency-medicine@list.pitt.edu Subject: W-EMED FREE SEX, Free forever, forever free! From: 203.151.51.96 Send reply to: wilderness-emergency-medicine@list.pitt.edu Ok, I'll keep this short! At the following site... http://www.geocities.com/ilovethisfreeplacex/enter.html you can download a program called Sextracker that finds you free sex on the internet, download is forever free, and free forever, no credit cards, no memberships, no hassles!. However, if you feel like spending some money, you can buy a legitimate password that would give you access to over 70,000 high quality adult sites 24/7 for a whole year (or a whole lifetime), your choice! 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To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu ------- End of forwarded message ------- -- End -- X-NAV-TimeoutProtection0: X X-NAV-TimeoutProtection1: X X-NAV-TimeoutProtection2: X X-NAV-TimeoutProtection3: X X-NAV-TimeoutProtection4: X X-NAV-TimeoutProtection5: X X-NAV-TimeoutProtection6: X Received: from post-ofc05.srv.cis.pitt.edu (root@post-ofc05.srv.cis.pitt.edu [136.142.185.10]) by pop.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cispop-7.2.2.1) ID ; Sun, 19 Dec 1999 15:29:20 -0500 (EST) Received: from localhost (root@localhost) by post-ofc05.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Sun, 19 Dec 1999 15:28:48 -0500 (EST) Received: via switchmail; Sun, 19 Dec 1999 15:28:48 -0500 (EST) Received: from list.srv.cis.pitt.edu via qmail ID ; Sun, 19 Dec 1999 15:27:34 -0500 (EST) Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.1) ID ; Sun, 19 Dec 1999 15:26:13 -0500 (EST) Received: from boofura.swcp.com (boofura.swcp.com [198.59.115.28]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.1) ID for ; Sun, 19 Dec 1999 15:26:09 -0500 (EST) Received: from localhost (tanman@localhost) by boofura.swcp.com (8.8.5/8.8.0) with SMTP id NAA14160 for ; Sun, 19 Dec 1999 13:26:03 -0700 (MST) X-Authentication-Warning: boofura.swcp.com: tanman owned process doing -bs Date: Sun, 19 Dec 1999 13:26:03 -0700 (MST) From: TANMAN To: Wilderness Subject: W-EMED Wilderness Knots Message-ID: MIME-Version: 1.0 Content-Type: TEXT/PLAIN; charset=US-ASCII Sender: owner-wilderness-emergency-medicine@list.pitt.edu Precedence: bulk Reply-To: wilderness-emergency-medicine@list.pitt.edu X-PMFLAGS: 34078848 0 1 P142B0.CNM I have found these knots to be of use as an outdoorsman. STOPPER KNOTS Stopper Knots Overhand Knot Slipped Overhand Knot Double Overhand Knot Figure Eight Knot Stopper Knot Manrope Knot Monkey Fist Knot Sink Stopper Stevedore Knot Crown Knot Wall Knot Diamond Knot Double Diamond Knot BINDING KNOTS Binding Knots True Lover's Knot Sailor's Cross Square Knot Slipped Square Knot Granny Knot Thief Knot Surgeon's Knot Turquoise Turtle Knot Packer's Knot Clove Hitch Knot Constrictor Knot Timber Hitch Knot Boa Knot Turk's Head (Three-lead Four-bight) Turk's Head (Four-lead Five-bight) BENDS Bends Hunter's Bend Sheet Bend Double Sheet Bend Fisherman's knot Water Knot Double Fisherman's Knot Carrick Bend Blood Knot Ashley's Bend Lanyard Knot HITCHES Hitches Rolling Hitch Round Turn and Two Half Hitches Buntline Hitch Fisherman's Bend Cow Hitch Cow Hitch with Toggle Sheepshank Sheepshank Man O' War Marlingspike Hitch Highwayman's Hitch Waggorner's Hitch Snelling a Hook Clinch Knot Palomar Knot Improved Clinch Knot Square Lash Clove Hitch Diagnal Lashing Sheer Lashing Prusik Knot Bachmann Knot Klemheist Knot Italian Hitch LOOPS Loops Alpine Butterfly Bowline Bowline with Stopper Bowline with Two Turns Figure-Eight Loop Threaded Figure-Eight Loop Double Overhand Loop Double Overhand Sliding Loop Bowline on the Bight Portuguese Bowline Spanish Bowline Angler's Loop Jury Mast Knot Fisherman's Loop Double Fisherman's Loop Blood Dropper Knot Bimini Twist BRANDS and SENNITS Brands and Sennits Three-Strand Braid Four-Strand Sennit Five-Strand Sennit Six-Strand Sennit Ocean-Braid Mat Four-Strand Round Sennit Chain Sennit Round Crown Sennit Square Crown Sennit SPLICES and WHIPPINGS Splices and Whippings Back Splice Tapering a Splice Eye Splice Short Splice Long Splice Grommet Common Whipping French Whipping Moku Whipping Sailmaker's Whipping Palm and Needle Whipping West Country Whipping Seizing Stitch and Seize Thomas A. Naegele, DO Internet 9405 Lagrima de Oro NE 505-275-7267 Albuquerque, NM 87111 Board Certified Family Practice/Board Certified Quality Assurance MEDICAL WHITE PAPERS MAGAZINE FOR COMMUNITY PHYSICIANS http://www.swcp.com/~tanman/ FOR HUB Information Call MIKE at 303-220-1073 __________________________________________________________________ Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- X-NAV-TimeoutProtection0: X X-NAV-TimeoutProtection1: X X-NAV-TimeoutProtection2: X X-NAV-TimeoutProtection3: X X-NAV-TimeoutProtection4: X X-NAV-TimeoutProtection5: X X-NAV-TimeoutProtection6: X Received: from post-ofc05.srv.cis.pitt.edu (root@post-ofc05.srv.cis.pitt.edu [136.142.185.10]) by pop.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cispop-7.2.2.1) ID ; Fri, 10 Dec 1999 21:31:57 -0500 (EST) Received: from localhost (root@localhost) by post-ofc05.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Fri, 10 Dec 1999 21:31:06 -0500 (EST) Received: via switchmail; Fri, 10 Dec 1999 21:31:05 -0500 (EST) Received: from list.srv.cis.pitt.edu via qmail ID ; Fri, 10 Dec 1999 21:29:10 -0500 (EST) Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.1) ID ; Fri, 10 Dec 1999 19:31:26 -0500 (EST) Received: from post-ofc06.srv.cis.pitt.edu (root@post-ofc06.srv.cis.pitt.edu [136.142.185.43]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.1) ID for ; Fri, 10 Dec 1999 19:31:06 -0500 (EST) Received: from micron (ehdup-u-38.rmt.net.pitt.edu [136.142.23.148]) by post-ofc06.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Fri, 10 Dec 1999 19:30:40 -0500 (EST) Message-Id: <199912110030.TAA28907@post-ofc06.srv.cis.pitt.edu> From: "Keith Conover, M.D., FACEP" To: pirie@istar.ca (Steven D. Pirie), wilderness-emergency-medicine@list.pitt.edu Date: Fri, 10 Dec 1999 18:57:54 -0500 MIME-Version: 1.0 Content-type: text/plain; charset=US-ASCII Content-transfer-encoding: 7BIT Subject: Re: W-EMED New WEMSI Personal Wilderness Medical Kit document In-reply-to: X-mailer: Pegasus Mail for Win32 (v3.12b) Sender: owner-wilderness-emergency-medicine@list.pitt.edu Precedence: bulk Reply-To: wilderness-emergency-medicine@list.pitt.edu X-PMFLAGS: 34078848 0 1 P30120.CNM On 10 Dec 99, at 2:47, Steven D. Pirie wrote: > The high strength steroid cream, mentioned is fluocinolone acetonide > cream 0.2%... I did not realize it came in this strength, as far as I > can tell it comes in the following... > > Potency (1-7) Strength > (1 High 7 Low) > > IV - fluocinolone acetonide 0.025% > VI - fluocinolone acetonide 0.01% > > How strong should we go? To be truthful, I don't think it really matters. According to my notes, Synalar HP comes in 0.2%, but it would probably be better to leave off the percentage because, for limited use, it just doesn't matter. > Does Zithromax have coverage for Giardia lamblia? If not should flagyl > be in the kit (as bismuth subsalicylate [another G. lamblia treatment] > was removed from the kit). I am not sure if "beaver fever" is a > problem down south, but it is up here. As far as I know, azithromycin doesn't cover Giardia -- on the other hand, think about the incubation period of Giardia -- most people develop it _after_ getting back from a trip. And, since this kit is for WEMTs with rescue teams, the chance a team will be out for a week and need to treat Giardia seems slim to none. And, if your patient has Giardia and say is dehydrated, would starting an antibiotic _now_ as opposed to a day from now make a big impact? > With respect to Zithromax (based on my limited understanding of the > drug) that it has comparable antimicrobial effect on Gram positive > bacteria (with cipro being the slightly more effective drug) but lacks > effectiveness (MIC-90 <30% sensitive) on Gram negative bacteria for > the most part (with the exception of M. catarrhalis, H. influenzae, > Legionella spp. and H. ducreyi. Cipro is far more effective on Gram > negative bacteria). Lastly Zithro is more effective with respect to > anaerobes. Maybe we should keep Cipro in the kit? Then again, I really > don't know a lot about the drug clinically and I am going on the > microbio angle (and my Sanford guide is 1996). Well, we wanted to standardize on a single antibiotic if possible. And how many gram negative infections is one likely to get in the wilderness on a SAR task? And how many patients are likely to need treatment for a gram negative infection? Azithromycin will cover most gram negatives that cause UTIs, and this is the most likely gram negative problem in the backcountry. > Maybe an oral airway (adult) should be in the minimum kit, incase > buddy falls, is uncon. and you have to go for help. Likewise if your > stabilizing the C-spine in an uncon pt. and waiting for the rest of > the team to arrive it is nice to place an OPA. It is also better then > nothing if digital intubation fails, and your left doing mouth to > mask. It is cheep and does not weigh much. If intubation fails, just stick the ET tube in the nose into the nasopharynx and use as a nasal airway -- should do the same thing as an oral airway without adding bulk and weight. > Instead of hydrocodone have you contemplated hydromorphone? > Hydromorphone is a better PO med for pain control, then again, it will > not help a cough like the hydrocodone will... Multiple uses is good. And hydrocodone is much more commonly used clinically - which means that medical control physicians will be more familiar with it. Thanks very much for your comments! --Keith Conover, M.D., FACEP http://www.pitt.edu/~kconover Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- X-NAV-TimeoutProtection0: X X-NAV-TimeoutProtection1: X X-NAV-TimeoutProtection2: X X-NAV-TimeoutProtection3: X X-NAV-TimeoutProtection4: X X-NAV-TimeoutProtection5: X X-NAV-TimeoutProtection6: X Received: from post-ofc03.srv.cis.pitt.edu (root@post-ofc03.srv.cis.pitt.edu [136.142.185.39]) by pop.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cispop-7.2.2.1) ID ; Fri, 10 Dec 1999 03:11:08 -0500 (EST) Received: from localhost (root@localhost) by post-ofc03.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Fri, 10 Dec 1999 03:10:35 -0500 (EST) Received: via switchmail; Fri, 10 Dec 1999 03:10:35 -0500 (EST) Received: from list.srv.cis.pitt.edu via qmail ID ; Fri, 10 Dec 1999 03:10:32 -0500 (EST) Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.1) ID ; Fri, 10 Dec 1999 02:59:45 -0500 (EST) Received: from mail1.toronto.istar.net (mail1.toronto.istar.net [209.89.75.17]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.1) ID for ; Fri, 10 Dec 1999 02:47:20 -0500 (EST) Received: from ip237.ottawa4.dialup.canada.psi.net ([154.5.13.237]) by mail1.toronto.istar.net with smtp (Exim 2.02 #1) id 11wKkY-00071N-00 for wilderness-emergency-medicine@list.pitt.edu; Fri, 10 Dec 1999 02:45:59 -0500 X-Sender: pirie@istar.ca (Unverified) Message-Id: Mime-Version: 1.0 Content-Type: text/plain; charset="us-ascii" Date: Fri, 10 Dec 1999 02:47:36 -0500 To: wilderness-emergency-medicine@list.pitt.edu From: pirie@istar.ca (Steven D. Pirie) Subject: W-EMED New WEMSI Personal Wilderness Medical Kit document Sender: owner-wilderness-emergency-medicine@list.pitt.edu Precedence: bulk Reply-To: wilderness-emergency-medicine@list.pitt.edu X-PMFLAGS: 34078848 0 1 P56770.CNM Dr. Conover and others, >A new WEMSI Personal Wilderness Medical Kit document has been released for >>public review. I was looking over the kit and though of a few things... The high strength steroid cream, mentioned is fluocinolone acetonide cream 0.2%... I did not realize it came in this strength, as far as I can tell it comes in the following... Potency (1-7) Strength (1 High 7 Low) IV - fluocinolone acetonide 0.025% VI - fluocinolone acetonide 0.01% How strong should we go? Does Zithromax have coverage for Giardia lamblia? If not should flagyl be in the kit (as bismuth subsalicylate [another G. lamblia treatment] was removed from the kit). I am not sure if "beaver fever" is a problem down south, but it is up here. With respect to Zithromax (based on my limited understanding of the drug) that it has comparable antimicrobial effect on Gram positive bacteria (with cipro being the slightly more effective drug) but lacks effectiveness (MIC-90 <30% sensitive) on Gram negative bacteria for the most part (with the exception of M. catarrhalis, H. influenzae, Legionella spp. and H. ducreyi. Cipro is far more effective on Gram negative bacteria). Lastly Zithro is more effective with respect to anaerobes. Maybe we should keep Cipro in the kit? Then again, I really don't know a lot about the drug clinically and I am going on the microbio angle (and my Sanford guide is 1996). Maybe an oral airway (adult) should be in the minimum kit, incase buddy falls, is uncon. and you have to go for help. Likewise if your stabilizing the C-spine in an uncon pt. and waiting for the rest of the team to arrive it is nice to place an OPA. It is also better then nothing if digital intubation fails, and your left doing mouth to mask. It is cheep and does not weigh much. Instead of hydrocodone have you contemplated hydromorphone? Hydromorphone is a better PO med for pain control, then again, it will not help a cough like the hydrocodone will... That is it for me, excuse any bizarre oversights, as it is the wee hours of the morning. Overall the kit revision looks great and I look forward to seeing the completed document. Keep up the good work. Cheers, Steven ---------------------------------------------------------- Lt. Steven D. Pirie, RN, BScN, UE General Duty Ward Officer - Military In-Patient Unit Canadian Forces Support Unit Ottawa - Civic Hospital Site 2 Health Support Operational Training Unit ---------------------------------------------------------- Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- X-NAV-TimeoutProtection0: X X-NAV-TimeoutProtection1: X X-NAV-TimeoutProtection2: X X-NAV-TimeoutProtection3: X X-NAV-TimeoutProtection4: X X-NAV-TimeoutProtection5: X X-NAV-TimeoutProtection6: X Received: from post-ofc01.srv.cis.pitt.edu (root@post-ofc01.srv.cis.pitt.edu [136.142.185.25]) by pop.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cispop-7.2.2.1) ID ; Tue, 7 Dec 1999 13:13:03 -0500 (EST) Received: from localhost (root@localhost) by post-ofc01.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Tue, 7 Dec 1999 13:12:30 -0500 (EST) Received: via switchmail; Tue, 7 Dec 1999 13:12:30 -0500 (EST) Received: from list.srv.cis.pitt.edu via qmail ID ; Tue, 7 Dec 1999 13:10:32 -0500 (EST) Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.1) ID ; Tue, 7 Dec 1999 13:08:20 -0500 (EST) Received: from wdcrobims02.ed.gov (wdcrobims02.ed.gov [165.224.216.148]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.1) ID for ; Tue, 7 Dec 1999 13:08:14 -0500 (EST) Received: by wdcrobims02.ed.gov with Internet Mail Service (5.5.2448.0) id ; Tue, 7 Dec 1999 13:07:05 -0500 Message-ID: From: "McCabe, Peter" To: "'wilderness-emergency-medicine@list.pitt.edu'" Subject: RE: W-EMED Wilderness Bike Race/ Foot Race Experience? Date: Tue, 7 Dec 1999 11:36:50 -0500 MIME-Version: 1.0 X-Mailer: Internet Mail Service (5.5.2448.0) Content-Type: text/plain Sender: owner-wilderness-emergency-medicine@list.pitt.edu Precedence: bulk Reply-To: wilderness-emergency-medicine@list.pitt.edu X-PMFLAGS: 34078848 0 1 P439D0.CNM Over the years we have provided course marshall and emerg first aid services for many off road mountain bike races in state parks and other areas. For some time we also did the 24 Hours of Canaan mountain bike race which is considered one of the top 5 in the country. Most major injuries we have seen are shoulder injuries where the rider has gone over the handlebars. Some have been head injuries where the helmet has shattered. There is, of course, a lot of "road rash" type injuries with some deep cuts requiring multiple layers of suturing. Our experience indicates few broken bones. Our services have always been in the field with local EMS standing by to assist with packaging, carry out and full EMT services at the trail-roadhead. At the 24 Hours of Canaan, the organizers have a pretty complete medical team on site with capability to respond both into the field on ATVs with litters, and to also provide fixed site services at the race event base. In some instances, ambulance runs can take 45-60 minutes one way so having available ambulance response is important. Our first aid services are free. Always! The charge is for marshalling services where we station people along the course, often at difficult terrain or junctions. This marshalling provides early alerts from passing racers re: injuries back on the trail. And, of course, we have people where the probabilities of accidents is high. Hope this helps. /s/ Peter McCabe Maryland Search & Rescue Group Peter A. McCabe Compliance Reports Project Coordinator, OCR/ED Telephone: (202) 205-9567 FAX: (202) 205-3698 > -----Original Message----- > From: Tim Kovacs [SMTP:Tkovacs@goodnet.com] > Sent: Monday, December 06, 1999 8:32 PM > To: MRA List > Cc: SAR-L; WEMS News > Subject: W-EMED Wilderness Bike Race/ Foot Race Experience? > > Which of your units have experience in Mtn Bike and Foot Races in the > wilderness? > > 1. Types of injuries you see. > > 2. General Logistics of staffing such an event for EMS-Rescue standby > different from an outdoor bouldering contest. > > Thanks for your input. > > Please respond privately to > > Tim Kovacs, > Operations Leader/ Paramedic, > C.A.M.R.A./ MCSO MR > tkovacs@goodnet.com > www.mra.org Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- X-NAV-TimeoutProtection0: X X-NAV-TimeoutProtection1: X X-NAV-TimeoutProtection2: X X-NAV-TimeoutProtection3: X X-NAV-TimeoutProtection4: X X-NAV-TimeoutProtection5: X X-NAV-TimeoutProtection6: X X-NAV-TimeoutProtection7: X X-NAV-TimeoutProtection8: X Received: from post-ofc06.srv.cis.pitt.edu (root@post-ofc06.srv.cis.pitt.edu [136.142.185.43]) by pop.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cispop-7.2.2.1) ID ; Mon, 6 Dec 1999 20:50:44 -0500 (EST) Received: from localhost (root@localhost) by post-ofc06.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Mon, 6 Dec 1999 20:19:34 -0500 (EST) Received: via switchmail; Mon, 6 Dec 1999 20:19:33 -0500 (EST) Received: from list.srv.cis.pitt.edu via qmail ID ; Mon, 6 Dec 1999 20:18:05 -0500 (EST) Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.1) ID ; Mon, 6 Dec 1999 20:13:23 -0500 (EST) Received: from mx0-smtp.goodnet.com (sloth.goodnet.com [207.98.129.103]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.1) ID for ; Mon, 6 Dec 1999 20:13:19 -0500 (EST) Received: from Ptkovacs (d5-38.phoenix.goodnet.com [209.140.135.39]) by mx0-smtp.goodnet.com with SMTP id SAA13584; Mon, 6 Dec 1999 18:12:59 -0700 (MST) Message-ID: <02dc01bf4052$ea1f9ee0$c1618dd1@Ptkovacs> From: "Tim Kovacs" To: "MRA List" Cc: "SAR-L" , "WEMS News" Subject: W-EMED Wilderness Bike Race/ Foot Race Experience? Date: Mon, 6 Dec 1999 18:32:18 -0700 MIME-Version: 1.0 Content-Type: multipart/alternative; boundary="----=_NextPart_000_02D9_01BF4018.3A3F8F60" X-Priority: 3 X-MSMail-Priority: Normal X-Mailer: Microsoft Outlook Express 5.00.2314.1300 X-MimeOLE: Produced By Microsoft MimeOLE V5.00.2314.1300 Sender: owner-wilderness-emergency-medicine@list.pitt.edu Precedence: bulk Reply-To: wilderness-emergency-medicine@list.pitt.edu This is a multi-part message in MIME format. ------=_NextPart_000_02D9_01BF4018.3A3F8F60 Content-Type: text/plain; charset="iso-8859-1" Content-Transfer-Encoding: quoted-printable Which of your units have experience in Mtn Bike and Foot Races in the = wilderness? 1. Types of injuries you see. 2. General Logistics of staffing such an event for EMS-Rescue standby = different from an outdoor bouldering contest.=20 Thanks for your input. Please respond privately to=20 Tim Kovacs,=20 Operations Leader/ Paramedic, C.A.M.R.A./ MCSO MR tkovacs@goodnet.com www.mra.org ------=_NextPart_000_02D9_01BF4018.3A3F8F60 Content-Type: text/html; charset="iso-8859-1" Content-Transfer-Encoding: quoted-printable
Which of your units have experience in = Mtn Bike and=20 Foot Races in the wilderness?
 
1.    Types of injuries = you=20 see.
 
2.    General Logistics = of staffing=20 such an event for EMS-Rescue standby different from an outdoor = bouldering=20 contest.
 
Thanks for your input.
 
Please respond privately to =
 
Tim Kovacs,
Operations Leader/=20 Paramedic,
C.A.M.R.A./ MCSO MR
tkovacs@goodnet.com
www.mra.org
------=_NextPart_000_02D9_01BF4018.3A3F8F60-- Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- X-NAV-TimeoutProtection0: X X-NAV-TimeoutProtection1: X X-NAV-TimeoutProtection2: X X-NAV-TimeoutProtection3: X X-NAV-TimeoutProtection4: X X-NAV-TimeoutProtection5: X X-NAV-TimeoutProtection6: X Received: from post-ofc01.srv.cis.pitt.edu (root@post-ofc01.srv.cis.pitt.edu [136.142.185.25]) by pop.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cispop-7.2.2.1) ID ; Fri, 3 Dec 1999 07:25:01 -0500 (EST) Received: from localhost (root@localhost) by post-ofc01.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Fri, 3 Dec 1999 07:24:27 -0500 (EST) Received: via switchmail; Fri, 3 Dec 1999 07:24:26 -0500 (EST) Received: from list.srv.cis.pitt.edu via qmail ID ; Fri, 3 Dec 1999 07:23:28 -0500 (EST) Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.1) ID ; Fri, 3 Dec 1999 07:22:38 -0500 (EST) Received: from post-ofc06.srv.cis.pitt.edu (root@post-ofc06.srv.cis.pitt.edu [136.142.185.43]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.1) ID ; Fri, 3 Dec 1999 07:22:30 -0500 (EST) Received: from micron (ehdup-t-74.rmt.net.pitt.edu [136.142.23.84]) by post-ofc06.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Fri, 3 Dec 1999 07:22:25 -0500 (EST) Message-Id: <199912031222.HAA13654@post-ofc06.srv.cis.pitt.edu> From: "Keith Conover, M.D., FACEP" To: wilderness-emergency-medicine@list.pitt.edu, asrc@list.pitt.edu Date: Fri, 3 Dec 1999 07:22:22 -0500 MIME-Version: 1.0 Content-type: text/plain; charset=US-ASCII Content-transfer-encoding: 7BIT Subject: W-EMED New WEMSI Personal Wilderness Medical Kit document CC: sar-l@listserv.islandnet.com, mra@altadena.net, NCRC@ontosystems.com (NCRC Discussion List) X-mailer: Pegasus Mail for Win32 (v3.12b) Sender: owner-wilderness-emergency-medicine@list.pitt.edu Precedence: bulk Reply-To: wilderness-emergency-medicine@list.pitt.edu A new WEMSI Personal Wilderness Medical Kit document has been released for public review. Note: because of the delay in posting this, the public comment period has been extended until MARCH 1 2000 despite what it says in the document itself. The following documents are available for your review at http://www.pitt.edu/~kconover/ 1. WEMSI Personal Wilderness Medical Kit version 1.2 This document contains a recommended personal medical kit for Wilderness EMTs with search and rescue teams. It includes an explanatory preface, of use to anyone building any kind of wilderness medical kit. There are also many detailed notes about why certain items were chosen or left out, and where to obtain some items. Again this should be invaluable for anyone designing a wilderness medical kit. Comments are solicited, as this version will be updated March 1 2000. Comments may be emailed to the address in the file, but we prefer that commentors join the wilderness-emergency-medicine Internet discussion list and discuss their comments with others on the list. Information on subscribing to this list may be found here: http://www.wemsi.org/mailing.html Some discussion of previoius versions may be found in the wilderness-emergency-medicine list archives, found here: http://www.wemsi.org/arch01.html 2. Errata and proposed changes for the above document This listing will be updated on a regular basis with the typographical errors to be fixed, formatting changes, and any substantial changes or corrections. http://www.pitt.edu/~kconover/ftp/errata.htm 3. Discussion of Trilisate as a potential replacement for ibuprofen/naproxen This document provides a detailed proposal for changing one of the medications in the listing. http://www.pitt.edu/~kconover/ftp/trilisate.htm 4. WEMSI Personal Wilderness Medical Kit (short) version 1.2 This contains only the listing of items from the above document, no discussion or notes. May be of use as a checkoff and to place in the kit. Adobe Acrobat PDF format MS Word 2000 format 5. WEMSI Team Medical Kit list This document outlines a "pie in the sky" list of everything a completely-equipped wilderness EMS team might have available. Primarily a planning and reference document, and unlike the Personal Kit above, this is not a kit that his been tested in the field in this configuration. http://www.wemsi.org/teammedkit1.pdf Also, I recently got some emails saying "where can I buy one of your medical kits." The WEMSI Personal Wilderness Medical Kit is NOT available for sale, unfortunately. We don't think that anyone sees enough commercial profit in making an expensive kit like this available for sale. If we're wrong, and someone does decide to start makking WEMSI kits available, please let us know and we will be certain to announce that fact widely. [Unfortunately, due to personal reasons, our webmaster hasn't been able to update www.wemsi.org with this document for almost two months. That's why it's on my personal page. But it will be transferred to www.wemsi.org as soon as possible, and a link will stay on my personal web page.] Thank you. --Keith Conover, M.D., FACEP http://www.pitt.edu/~kconover Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- X-NAV-TimeoutProtection0: X X-NAV-TimeoutProtection1: X X-NAV-TimeoutProtection2: X X-NAV-TimeoutProtection3: X X-NAV-TimeoutProtection4: X X-NAV-TimeoutProtection5: X X-NAV-TimeoutProtection6: X Received: from post-ofc02.srv.cis.pitt.edu (root@post-ofc02.srv.cis.pitt.edu [136.142.185.24]) by pop.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cispop-7.2.2.1) ID ; Wed, 1 Dec 1999 22:43:56 -0500 (EST) Received: from localhost (root@localhost) by post-ofc02.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Wed, 1 Dec 1999 22:43:23 -0500 (EST) Received: via switchmail; Wed, 1 Dec 1999 22:43:23 -0500 (EST) Received: from list.srv.cis.pitt.edu via qmail ID ; Wed, 1 Dec 1999 22:43:14 -0500 (EST) Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.1) ID ; Wed, 1 Dec 1999 22:42:11 -0500 (EST) Received: from post-ofc05.srv.cis.pitt.edu (root@post-ofc05.srv.cis.pitt.edu [136.142.185.10]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.1) ID for ; Wed, 1 Dec 1999 22:42:06 -0500 (EST) Received: from micron (ehdup-t-35.rmt.net.pitt.edu [136.142.23.45]) by post-ofc05.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Wed, 1 Dec 1999 22:41:42 -0500 (EST) Message-Id: <199912020341.WAA20026@post-ofc05.srv.cis.pitt.edu> From: "Keith Conover, M.D., FACEP" To: mra@altadena.net Date: Wed, 1 Dec 1999 22:41:34 -0500 MIME-Version: 1.0 Content-type: text/plain; charset=US-ASCII Content-transfer-encoding: 7BIT Subject: W-EMED WEMT in Wales CC: wilderness-emergency-medicine@list.pitt.edu, NCRC@ontosystems.com (NCRC Discussion List), sar-l@listserv.islandnet.com X-mailer: Pegasus Mail for Win32 (v3.12b) Sender: owner-wilderness-emergency-medicine@list.pitt.edu Precedence: bulk Reply-To: wilderness-emergency-medicine@list.pitt.edu AMRG (Allegheny, not Alaska, Mountain Rescue Group) members Jack Grandey and I volunteered for part of November in North Wales. We were with a number of UK mountain rescue people, running the first WEMSI Wilderness EMT and Wilderness Command Physician courses in the UK. I kept a diary, with pictures (aren't digital cameras wonderful?), and turned it into a set of Web pages. You won't see any big wall rescue scenes -- this was a medical course, not a rescue course (though there was a weeklong rescue course associated with the WEMT course last year in Ireland). However, it may be of some interest, even if just for the scenes of North Wales. The link is at the top of my personal Web page, URL below. Thank you. --Keith Conover, M.D., FACEP http://www.pitt.edu/~kconover Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- X-NAV-TimeoutProtection0: X X-NAV-TimeoutProtection1: X X-NAV-TimeoutProtection2: X X-NAV-TimeoutProtection3: X X-NAV-TimeoutProtection4: X X-NAV-TimeoutProtection5: X X-NAV-TimeoutProtection6: X Received: from post-ofc04.srv.cis.pitt.edu (root@post-ofc04.srv.cis.pitt.edu [136.142.185.11]) by pop.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cispop-7.2.2.1) ID ; Mon, 29 Nov 1999 13:35:27 -0500 (EST) Received: from localhost (root@localhost) by post-ofc04.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Mon, 29 Nov 1999 13:34:52 -0500 (EST) Received: via switchmail; Mon, 29 Nov 1999 13:34:51 -0500 (EST) Received: from list.srv.cis.pitt.edu via qmail ID ; Mon, 29 Nov 1999 13:33:36 -0500 (EST) Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.1) ID ; Mon, 29 Nov 1999 13:31:25 -0500 (EST) Received: from imo-d08.mx.aol.com (imo-d08.mx.aol.com [205.188.157.40]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.1) ID for ; Mon, 29 Nov 1999 13:31:16 -0500 (EST) From: JadedMedic@aol.com Received: from JadedMedic@aol.com by imo-d08.mx.aol.com (mail_out_v24.4.) id h.0.8f33a269 (4588) for ; Mon, 29 Nov 1999 13:30:36 -0500 (EST) Message-ID: <0.8f33a269.2574204c@aol.com> Date: Mon, 29 Nov 1999 13:30:36 EST Subject: Re: W-EMED Aspirin & heart attacks in the wilderness To: wilderness-emergency-medicine@list.pitt.edu MIME-Version: 1.0 Content-Type: text/plain; charset="us-ascii" Content-Transfer-Encoding: 7bit X-Mailer: Windows AOL sub 45 Sender: owner-wilderness-emergency-medicine@list.pitt.edu Precedence: bulk Reply-To: wilderness-emergency-medicine@list.pitt.edu X-PMFLAGS: 34078848 0 1 P5B420.CNM In a message dated 11/28/99 9:47:43 AM Pacific Standard Time, morgan@icon.co.za writes: > Tom, > Add up the price of an aspirin a day for perhaps 40 years, for each of > several hundred people per live saved. Add the cost of the extra > medication to treat peptic ulcers, asthma, internal bleeding caused by > all these aspirin doses. > The maths does not encourage this as a good preventative treatment. > It is better to eat correctly, exercise, NO SMOKING. Treat high blood > pressure and high cholesterol. Take aspirin if there is a risk factor > for heart disease. > Arthur Hi WMED, I don't have the epidemiology here in front of me, but in addition to the "aspirin regimen" preventing MIs and CVAs, there are journal articles that suggest that pursuing the "aspirin regimen" for twenty years significantly decreases one's risk of getting colon cancer. In any event, if I'm "out there" and someone starts to "walk, talk, and look" like they are having an MI, I'm certainly going to be very strongly tempted to have them chew four baby aspirin except in those _very_ rare circumstances where they (1) are simultaneously also right in the middle of a hypertensive crisis or (2) are certain that they have allergic reactions to aspirin of anaphylactic-level severity. Regards, Jay Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- X-NAV-TimeoutProtection0: X X-NAV-TimeoutProtection1: X X-NAV-TimeoutProtection2: X X-NAV-TimeoutProtection3: X X-NAV-TimeoutProtection4: X X-NAV-TimeoutProtection5: X X-NAV-TimeoutProtection6: X Received: from post-ofc03.srv.cis.pitt.edu (root@post-ofc03.srv.cis.pitt.edu [136.142.185.39]) by pop.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cispop-7.2.2.1) ID ; Sun, 28 Nov 1999 16:59:31 -0500 (EST) Received: from localhost (root@localhost) by post-ofc03.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Sun, 28 Nov 1999 16:58:57 -0500 (EST) Received: via switchmail; Sun, 28 Nov 1999 16:58:56 -0500 (EST) Received: from list.srv.cis.pitt.edu via qmail ID ; Sun, 28 Nov 1999 16:58:03 -0500 (EST) Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.1) ID ; Sun, 28 Nov 1999 16:57:37 -0500 (EST) Received: from apollo.cloudnet.com (apollo.cloudnet.com [204.221.240.12]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.1) ID for ; Sun, 28 Nov 1999 16:57:33 -0500 (EST) Received: from customer (sat045.cloudnet.com [204.221.241.45]) by apollo.cloudnet.com (8.9.3/8.9.3) with SMTP id PAA20839 for ; Sun, 28 Nov 1999 15:57:05 -0600 Message-ID: <004f01bf39ed$4a70c4c0$2df1ddcc@customer> From: "Tom Danzl" To: References: <3.0.1.16.19991122003540.2d47ee8c@pop.mindspring.com> <001801bf35c1$81afb700$4a8ccfd8@oemcomputer> <383A5E6C.89FCA610@icon.co.za> <002801bf36a5$491cef40$1df1ddcc@customer> <383F5D8C.1BDFCF7D@icon.co.za> Subject: Re: W-EMED Aspirin & heart attacks in the wilderness Date: Sun, 28 Nov 1999 16:09:48 -0600 MIME-Version: 1.0 Content-Type: text/plain; charset="iso-8859-1" Content-Transfer-Encoding: 7bit X-Priority: 3 X-MSMail-Priority: Normal X-Mailer: Microsoft Outlook Express 5.00.2014.211 X-MIMEOLE: Produced By Microsoft MimeOLE V5.00.2014.211 Sender: owner-wilderness-emergency-medicine@list.pitt.edu Precedence: bulk Reply-To: wilderness-emergency-medicine@list.pitt.edu X-PMFLAGS: 34078848 0 1 P3D910.CNM Arthur I see your point about the complications. But if 40 mg every other day is effective, is there really still a concern about the side effects? At least in 99.9% of the population? As regards the cost of the aspirin, I'm looking at a bottle of generic aspirin of 500 tablets for $2.49. At 40 mg every other day (if they can be cut that small!!!), we're talking about two tablets a month, or 24 tablets a year (skip the days you take them for a cold, headache or sore back). That's a 40 year cost of about $10.00 (seems like not much.....better check that math). I'm really playing the devil's advocate here. I don't know what the answer is, but would like to believe that an eight of an aspirin every other day would have some real beneficial effects. Tom Thomas J. Danzl Central Minnesota Cytogenetic Services 320-259-8708 http://www.cloudnet.com/~cmcs ----- Original Message ----- From: Arthur Morgan To: Sent: Friday, November 26, 1999 10:26 PM Subject: Re: W-EMED Aspirin & heart attacks in the wilderness > Tom, > Add up the price of an aspirin a day for perhaps 40 years, for each of > several hundred people per live saved. Add the cost of the extra > medication to treat peptic ulcers, asthma, internal bleeding caused by > all these aspirin doses. > The maths does not encourage this as a good preventative treatment. > It is better to eat correctly, exercise, NO SMOKING. Treat high blood > pressure and high cholesterol. Take aspirin if there is a risk factor > for heart disease. > Arthur > > Tom Danzl wrote: > > > > ----- Original Message ----- > > From: Arthur Morgan > > Subject: Re: W-EMED Aspirin & heart attacks in the wilderness > > > > > Michelle, > > > Taking aspirin ( as little as 40 mg on alternate days ) will certainly > > > decrease the chance of a fatal heart attack. However the financial cost > > > will be very large. > > > > I don't undestand why the financial cost will be so large. > > > > Do not reproduce without author's express permission. > To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" > as the body of a message (no subject) To: Majordomo@list.pitt.edu > Submissions To: wilderness-emergency-medicine@list.pitt.edu > Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- X-NAV-TimeoutProtection0: X X-NAV-TimeoutProtection1: X X-NAV-TimeoutProtection2: X X-NAV-TimeoutProtection3: X X-NAV-TimeoutProtection4: X X-NAV-TimeoutProtection5: X X-NAV-TimeoutProtection6: X Received: from post-ofc06.srv.cis.pitt.edu (root@post-ofc06.srv.cis.pitt.edu [136.142.185.43]) by pop.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cispop-7.2.2.1) ID ; Sun, 28 Nov 1999 12:20:09 -0500 (EST) Received: from localhost (root@localhost) by post-ofc06.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Sun, 28 Nov 1999 12:19:35 -0500 (EST) Received: via switchmail; Sun, 28 Nov 1999 12:19:35 -0500 (EST) Received: from list.srv.cis.pitt.edu via qmail ID ; Sun, 28 Nov 1999 12:17:49 -0500 (EST) Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.1) ID ; Sun, 28 Nov 1999 12:15:19 -0500 (EST) Received: from cgi.icon.co.za (cgi.icon.co.za [196.35.95.41]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.1) ID for ; Sun, 28 Nov 1999 12:15:14 -0500 (EST) Received: from mail450.icon.co.za (smtp.icon.co.za [196.35.95.40]) by cgi.icon.co.za (Postfix) with ESMTP id 44279464F9 for ; Sun, 28 Nov 1999 19:20:53 +0200 (SAST) Received: from icon.co.za (c3-ndf-46.dial-up.net [196.34.159.46]) by mail450.icon.co.za (8.9.3/8.9.3) with ESMTP id TAA17767 for ; Sun, 28 Nov 1999 19:14:56 +0200 (GMT) Message-ID: <383F5D8C.1BDFCF7D@icon.co.za> Date: Sat, 27 Nov 1999 06:26:52 +0200 From: Arthur Morgan X-Mailer: Mozilla 4.7 [en] (Win95; I) X-Accept-Language: en-GB,en,en-US,af,pl MIME-Version: 1.0 To: wilderness-emergency-medicine@list.pitt.edu Subject: Re: W-EMED Aspirin & heart attacks in the wilderness References: <3.0.1.16.19991122003540.2d47ee8c@pop.mindspring.com> <001801bf35c1$81afb700$4a8ccfd8@oemcomputer> <383A5E6C.89FCA610@icon.co.za> <002801bf36a5$491cef40$1df1ddcc@customer> Content-Type: text/plain; charset=us-ascii Content-Transfer-Encoding: 7bit Sender: owner-wilderness-emergency-medicine@list.pitt.edu Precedence: bulk Reply-To: wilderness-emergency-medicine@list.pitt.edu X-PMFLAGS: 34078848 0 1 P5F440.CNM Tom, Add up the price of an aspirin a day for perhaps 40 years, for each of several hundred people per live saved. Add the cost of the extra medication to treat peptic ulcers, asthma, internal bleeding caused by all these aspirin doses. The maths does not encourage this as a good preventative treatment. It is better to eat correctly, exercise, NO SMOKING. Treat high blood pressure and high cholesterol. Take aspirin if there is a risk factor for heart disease. Arthur Tom Danzl wrote: > > ----- Original Message ----- > From: Arthur Morgan > Subject: Re: W-EMED Aspirin & heart attacks in the wilderness > > > Michelle, > > Taking aspirin ( as little as 40 mg on alternate days ) will certainly > > decrease the chance of a fatal heart attack. However the financial cost > > will be very large. > > I don't undestand why the financial cost will be so large. > Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- X-NAV-TimeoutProtection0: X X-NAV-TimeoutProtection1: X X-NAV-TimeoutProtection2: X X-NAV-TimeoutProtection3: X X-NAV-TimeoutProtection4: X X-NAV-TimeoutProtection5: X X-NAV-TimeoutProtection6: X X-NAV-TimeoutProtection7: X X-NAV-TimeoutProtection8: X Received: from post-ofc01.srv.cis.pitt.edu (root@post-ofc01.srv.cis.pitt.edu [136.142.185.25]) by pop.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cispop-7.2.2.1) ID ; Thu, 25 Nov 1999 08:32:49 -0500 (EST) Received: from localhost (root@localhost) by post-ofc01.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.3) ID ; Thu, 25 Nov 1999 08:32:18 -0500 (EST) Received: via switchmail; Thu, 25 Nov 1999 08:32:17 -0500 (EST) Received: from list.srv.cis.pitt.edu via qmail ID ; Thu, 25 Nov 1999 08:31:28 -0500 (EST) Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.1) ID ; Thu, 25 Nov 1999 08:29:32 -0500 (EST) Received: from titan.janrix.com (titan.janrix.com [207.22.155.3]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.1) ID for ; Thu, 25 Nov 1999 08:29:28 -0500 (EST) Received: from tacker ([207.22.155.84]) by titan.janrix.com (Build 93 8.9.3/NT-8.9.3) with SMTP id IAA03012 for ; Thu, 25 Nov 1999 08:29:12 -0500 Message-ID: <017901bf3748$cae2d6e0$549b16cf@tacker> From: "Tacker Vordemberge" To: "Wilderness E.M.T." Subject: W-EMED Happy Thanksgiving! Date: Thu, 25 Nov 1999 08:27:15 -0500 MIME-Version: 1.0 Content-Type: multipart/alternative; boundary="----=_NextPart_000_0176_01BF371E.E0E65040" X-Priority: 3 X-MSMail-Priority: Normal X-Mailer: Microsoft Outlook Express 5.00.2014.211 X-MimeOLE: Produced By Microsoft MimeOLE V5.00.2014.211 Sender: owner-wilderness-emergency-medicine@list.pitt.edu Precedence: bulk Reply-To: wilderness-emergency-medicine@list.pitt.edu X-PMFLAGS: 570950016 0 1 P37550.CNM This is a multi-part message in MIME format. ------=_NextPart_000_0176_01BF371E.E0E65040 Content-Type: text/plain; charset="iso-8859-1" Content-Transfer-Encoding: quoted-printable Retter and I want to wish you a joyful and safe Thanksgiving. We = also would ask that you say a prayer for all those, who could not be = with there families, serving around the world for your freedom as well = as the freedom of others. Thank you=20 "THAT OTHERS MAY LIVE!!!!!!" Retter Vordemberge John 'Tacker' Vordemberge = E.M.T. S.A.R. K-9 (in training) SAR DOG 110 SPC. U.S. ARMY ------=_NextPart_000_0176_01BF371E.E0E65040 Content-Type: text/html; charset="iso-8859-1" Content-Transfer-Encoding: quoted-printable
    Retter and I want to wish you a = joyful and=20 safe Thanksgiving. We also would ask that you say a prayer for all = those, who=20 could not be with there families, serving around the world for your = freedom as=20 well as the freedom of others.
          &nbs= p;            = ;            = =20 Thank you
        =    =20             =    =20         "THAT OTHERS MAY = LIVE!!!!!!"
 
Retter=20 Vordemberge          &n= bsp;           =20 John 'Tacker' Vordemberge E.M.T.
S.A.R. K-9 (in=20 training)          &nbs= p;         SAR=20 DOG 110
          &nbs= p;            = ;            =             &= nbsp;   =20 SPC. U.S. ARMY
 
------=_NextPart_000_0176_01BF371E.E0E65040-- Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- X-NAV-TimeoutProtection0: X X-NAV-TimeoutProtection1: X X-NAV-TimeoutProtection2: X X-NAV-TimeoutProtection3: X X-NAV-TimeoutProtection4: X X-NAV-TimeoutProtection5: X X-NAV-TimeoutProtection6: X Received: from post-ofc02.srv.cis.pitt.edu (root@post-ofc02.srv.cis.pitt.edu [136.142.185.24]) by pop.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cispop-7.2.2.1) ID ; Wed, 24 Nov 1999 12:45:45 -0500 (EST) Received: from localhost (root@localhost) by post-ofc02.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Wed, 24 Nov 1999 12:45:09 -0500 (EST) Received: via switchmail; Wed, 24 Nov 1999 12:45:09 -0500 (EST) Received: from list.srv.cis.pitt.edu via qmail ID ; Wed, 24 Nov 1999 12:44:42 -0500 (EST) Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.1) ID ; Wed, 24 Nov 1999 12:44:19 -0500 (EST) Received: from apollo.cloudnet.com (apollo.cloudnet.com [204.221.240.12]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.1) ID for ; Wed, 24 Nov 1999 12:44:13 -0500 (EST) Received: from customer (sat029.cloudnet.com [204.221.241.29]) by apollo.cloudnet.com (8.9.3/8.9.3) with SMTP id LAA06906 for ; Wed, 24 Nov 1999 11:43:44 -0600 Message-ID: <002801bf36a5$491cef40$1df1ddcc@customer> From: "Tom Danzl" To: References: <3.0.1.16.19991122003540.2d47ee8c@pop.mindspring.com> <001801bf35c1$81afb700$4a8ccfd8@oemcomputer> <383A5E6C.89FCA610@icon.co.za> Subject: Re: W-EMED Aspirin & heart attacks in the wilderness Date: Wed, 24 Nov 1999 11:56:46 -0600 MIME-Version: 1.0 Content-Type: text/plain; charset="iso-8859-1" Content-Transfer-Encoding: 7bit X-Priority: 3 X-MSMail-Priority: Normal X-Mailer: Microsoft Outlook Express 5.00.2014.211 X-MimeOLE: Produced By Microsoft MimeOLE V5.00.2014.211 Sender: owner-wilderness-emergency-medicine@list.pitt.edu Precedence: bulk Reply-To: wilderness-emergency-medicine@list.pitt.edu X-PMFLAGS: 524416 0 1 P1EDA0.CNM ----- Original Message ----- From: Arthur Morgan To: ; Michelle Sent: Tuesday, November 23, 1999 3:29 AM Subject: Re: W-EMED Aspirin & heart attacks in the wilderness > Michelle, > Taking aspirin ( as little as 40 mg on alternate days ) will certainly > decrease the chance of a fatal heart attack. However the financial cost > will be very large. I don't undestand why the financial cost will be so large. > Other ways of decreasing risk of death may be > cheaper over the life time of the person. There needs to be more > research into the dangers of long term aspirin before it can be > recommended. > Contraindications of aspirin ..................... Tom Danzl Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- X-NAV-TimeoutProtection0: X X-NAV-TimeoutProtection1: X X-NAV-TimeoutProtection2: X X-NAV-TimeoutProtection3: X X-NAV-TimeoutProtection4: X X-NAV-TimeoutProtection5: X X-NAV-TimeoutProtection6: X Received: from post-ofc01.srv.cis.pitt.edu (root@post-ofc01.srv.cis.pitt.edu [136.142.185.25]) by pop.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cispop-7.2.2.1) ID ; Wed, 24 Nov 1999 12:31:54 -0500 (EST) Received: from localhost (root@localhost) by post-ofc01.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.3) ID ; Wed, 24 Nov 1999 12:31:18 -0500 (EST) Received: via switchmail; Wed, 24 Nov 1999 12:31:17 -0500 (EST) Received: from list.srv.cis.pitt.edu via qmail ID ; Wed, 24 Nov 1999 12:29:13 -0500 (EST) Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.1) ID ; Wed, 24 Nov 1999 12:28:49 -0500 (EST) Received: from wdcrobims01.ed.gov (wdcrobims01.ed.gov [165.224.216.147]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.1) ID for ; Wed, 24 Nov 1999 12:28:42 -0500 (EST) Received: by wdcrobims01.ed.gov with Internet Mail Service (5.5.2448.0) id ; Wed, 24 Nov 1999 12:26:51 -0500 Message-ID: From: "McCabe, Peter" To: "'wilderness-emergency-medicine@list.pitt.edu'" , Michelle Subject: RE: W-EMED Aspirin & heart attacks in the wilderness Date: Wed, 24 Nov 1999 12:30:22 -0500 MIME-Version: 1.0 X-Mailer: Internet Mail Service (5.5.2448.0) Content-Type: text/plain Sender: owner-wilderness-emergency-medicine@list.pitt.edu Precedence: bulk Reply-To: wilderness-emergency-medicine@list.pitt.edu X-PMFLAGS: 524416 0 1 P43270.CNM Continued high end usage of aspirin will cause mild to moderate hearing impairment. On cessation of aspirin hearing acuity will usually return. Peter A. McCabe Compliance Reports Project Coordinator, OCR/ED Telephone: (202) 205-9567 FAX: (202) 205-3698 > -----Original Message----- > From: Arthur Morgan [SMTP:morgan@icon.co.za] > Sent: Tuesday, November 23, 1999 4:29 AM > To: wilderness-emergency-medicine@list.pitt.edu; Michelle > Subject: Re: W-EMED Aspirin & heart attacks in the wilderness > > Michelle, > Taking aspirin ( as little as 40 mg on alternate days ) will > certainly > decrease the chance of a fatal heart attack. However the financial cost > will be very large. Other ways of decreasing risk of death may be > cheaper over the life time of the person. There needs to be more > research into the dangers of long term aspirin before it can be > recommended. > Contraindications of aspirin type drugs include any history of > peptic > ulcers, stroke, allergy, asthma. > If a patient has a typical story of heart attack ( crushing chest > pain, > weakness, altered sensation [including pain] in the arm, neck or jaw, > palpitations ) a single adult aspirin taken early will save as many > lives as all other treatment put together. However you will have to > accept a small number of fatalities due to bleeding ulcers, strokes, and > other vascular catastrophes. It will prevent, to some extent, > enlargement of the volume of death of heart muscle by limiting the clot > formation within the arteries of the heart. > One dose is enough. The action will last for at least a day. > Arthur > BTW distrust everything that you see on TV. > > Michelle Schonzeit wrote: > > > > After just finishing my yearly CPR-FPR and Outdoor Emergency Care > > refreshers for Ski Patrol, I happened to see the commercial for Bayer > > aspirin that says 'if taken before a heart attack Bayer aspirin can save > > your life', or something to that affect. At that time, it occurred to me > no > > where in my first aid courses have I ever heard such advice given, but I > > assume if they can broadcast it on TV it must have some legitimacy some > > where. > > So, I thought maybe someone on the list would know if this actually > > works, & under what circumstances, and if so why doesn't anyone like the > Red > > Cross or American Heart ever mention it (besides the legal consideration > > that you are then providing medication), and if used in the backcountry, > how > > long would the affect (if any) last, (i.e.. is it enough time to > evacuate > > someone with out having to do CPR in route) or would you need to > > readminister it every so often. Any thoughts anyone? > > > > Michelle Schonzeit - schonzeit@slic.com > > > Do not reproduce without author's express permission. > To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" > as the body of a message (no subject) To: Majordomo@list.pitt.edu > Submissions To: wilderness-emergency-medicine@list.pitt.edu Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- X-NAV-TimeoutProtection0: X X-NAV-TimeoutProtection1: X X-NAV-TimeoutProtection2: X X-NAV-TimeoutProtection3: X X-NAV-TimeoutProtection4: X X-NAV-TimeoutProtection5: X X-NAV-TimeoutProtection6: X Received: from post-ofc04.srv.cis.pitt.edu (root@post-ofc04.srv.cis.pitt.edu [136.142.185.11]) by pop.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cispop-7.2.2.1) ID ; Wed, 24 Nov 1999 16:25:37 -0500 (EST) Received: from localhost (root@localhost) by post-ofc04.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Wed, 24 Nov 1999 16:25:00 -0500 (EST) Received: via switchmail; Wed, 24 Nov 1999 16:25:00 -0500 (EST) Received: from list.srv.cis.pitt.edu via qmail ID ; Wed, 24 Nov 1999 16:24:11 -0500 (EST) Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.1) ID ; Wed, 24 Nov 1999 16:23:11 -0500 (EST) Received: from macs.mxim.com (macs.mxim.com [204.17.143.130]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.1) ID for ; Wed, 24 Nov 1999 16:22:59 -0500 (EST) Received: from localhost (localhost [127.0.0.1]) by macs.mxim.com (8.7/8.6.9) with SMTP id NAA28748 for ; Wed, 24 Nov 1999 13:22:19 -0800 (PST) Message-Id: <199911242122.NAA28748@macs.mxim.com> X-Mailer: exmh version 2.0.1 12/23/97 To: wilderness-emergency-medicine@list.pitt.edu Subject: Re: W-EMED Stupid Anaphylaxis Trick # 2 In-reply-to: Your message of "Tue, 23 Nov 1999 14:23:01 PST." Mime-Version: 1.0 Content-Type: text/plain; charset=us-ascii Date: Wed, 24 Nov 1999 13:22:19 PST From: Hal Lillywhite Sender: owner-wilderness-emergency-medicine@list.pitt.edu Precedence: bulk Reply-To: wilderness-emergency-medicine@list.pitt.edu X-PMFLAGS: 34078848 0 1 P468F0.CNM >Hal (and group) - Actually, Oregon is one of the few states (AFAIK) >that allows non-medical personnel who have had specific training to >administer epi (and glucagon). [1997 law quote deleted] It sounds like my information is outdated and positive changes have been made. That is good. Many years ago in a re-cert class we actually practiced giving each other sub-c shots as we would if we were using epi. Then a few years later they told us that 1st responder training wasn't enough to administer this med (even though otherwise untrained parents of asthmatics were allowed to do it). I'm glad to see the change. Obviously I hope other jurisdictions will take a similarly enlightened approach. I don't have access to the web so can't easily look up the law you reference. However I hope they have also changed things to allow people at my level to administer O2 when necessary. I was once taught how to use it (quite simple really), then 2-3 years ago at re-cert the instructor said we were no longer allowed to administer O2 "because it is a drug." Apparently the reasoning was that someone might overdose a COPD patient. >At our last epi class, taught by an RN who is a member of one of >the units and authorized by our physician advisor, we had about >20-25 people, only about 5 of whom are EMT's. The Sheriff's office >even sprung for 8 epi kits to be kept in key locations and vehicles. Good for them. Will they also spring for replacement costs when these are used, or better yet, become outdated without being used? This indeed addresses my concern that there is always a first reaction and we should be prepared in case the yellow jackets or something else causes this on a search operation. Having seen first hand what happened to a teammate in that event (and also having lost an office mate who had a reaction working at home), I am concerned about this problem. I suspect most of us could carry epi for years and never have need for it. However if we do need it we will need it *immediately*. Even in town the ambulance may not arrive in time to deal with a severe reaction. Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- X-NAV-TimeoutProtection0: X X-NAV-TimeoutProtection1: X X-NAV-TimeoutProtection2: X X-NAV-TimeoutProtection3: X X-NAV-TimeoutProtection4: X X-NAV-TimeoutProtection5: X X-NAV-TimeoutProtection6: X Received: from post-ofc01.srv.cis.pitt.edu (root@post-ofc01.srv.cis.pitt.edu [136.142.185.25]) by pop.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cispop-7.2.2.1) ID ; Wed, 24 Nov 1999 12:26:06 -0500 (EST) Received: from localhost (root@localhost) by post-ofc01.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.3) ID ; Wed, 24 Nov 1999 12:25:30 -0500 (EST) Received: via switchmail; Wed, 24 Nov 1999 12:25:30 -0500 (EST) Received: from list.srv.cis.pitt.edu via qmail ID ; Wed, 24 Nov 1999 12:23:29 -0500 (EST) Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.1) ID ; Wed, 24 Nov 1999 12:23:03 -0500 (EST) Received: from imo15.mx.aol.com (imo15.mx.aol.com [198.81.17.5]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.1) ID for ; Wed, 24 Nov 1999 12:22:47 -0500 (EST) From: JadedMedic@aol.com Received: from JadedMedic@aol.com by imo15.mx.aol.com (mail_out_v24.4.) id h.0.51fac633 (4233) for ; Wed, 24 Nov 1999 12:22:11 -0500 (EST) Message-ID: <0.51fac633.256d78c3@aol.com> Date: Wed, 24 Nov 1999 12:22:11 EST Subject: W-EMED Re: Chewable Benadryl tablets To: wilderness-emergency-medicine@list.pitt.edu MIME-Version: 1.0 Content-Type: text/plain; charset="us-ascii" Content-Transfer-Encoding: 7bit X-Mailer: Windows AOL sub 45 Sender: owner-wilderness-emergency-medicine@list.pitt.edu Precedence: bulk Reply-To: wilderness-emergency-medicine@list.pitt.edu X-PMFLAGS: 524416 0 1 P44EC0.CNM Hi WMED, I picked up some of the chewable benadryl tablets at my local drugstore. They contain 12.5 mg of diphenhydramine per tablet (and are grape flavored! ). So an adult would get at least four such tablets, maybe as many as eight. BTW, at about seven bucks for a 24-pack, they're _expensive_ little buggers. I could have bought a much bigger bottle of the regular "sleeping pills" for the same price. So I guess these really are "only for emergency" usage. Also, shelf life -- under the presumably ideal conditions of sitting still on a shelf in a dry place -- seems to be about two years, and they come with twelve tablets in individual (and not particularly easy to open) blisters on a sheet of plastic. Anyhow, all things considered, they look promising. Regards, Jay Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- X-NAV-TimeoutProtection0: X X-NAV-TimeoutProtection1: X X-NAV-TimeoutProtection2: X X-NAV-TimeoutProtection3: X X-NAV-TimeoutProtection4: X X-NAV-TimeoutProtection5: X X-NAV-TimeoutProtection6: X Received: from post-ofc05.srv.cis.pitt.edu (root@post-ofc05.srv.cis.pitt.edu [136.142.185.10]) by pop.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cispop-7.2.2.1) ID ; Tue, 23 Nov 1999 20:52:14 -0500 (EST) Received: from localhost (root@localhost) by post-ofc05.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Tue, 23 Nov 1999 17:25:43 -0500 (EST) Received: via switchmail; Tue, 23 Nov 1999 17:25:38 -0500 (EST) Received: from list.srv.cis.pitt.edu via qmail ID ; Tue, 23 Nov 1999 17:23:36 -0500 (EST) Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.1) ID ; Tue, 23 Nov 1999 17:23:19 -0500 (EST) Received: from smtp2.teleport.com (smtp2.teleport.com [192.108.254.20]) by list.srv.cis.pitt.edu with SMTP (8.8.8/8.8.8/cisls-7.2.2.1) ID for ; Tue, 23 Nov 1999 17:23:14 -0500 (EST) Received: (qmail 26654 invoked from network); 23 Nov 1999 22:23:05 -0000 Received: from user2.teleport.com (qmailr@192.108.254.12) by smtp2.teleport.com with SMTP; 23 Nov 1999 22:23:05 -0000 Received: (qmail 14685 invoked by uid 7893); 23 Nov 1999 22:23:02 -0000 Date: Tue, 23 Nov 1999 14:23:01 -0800 (PST) From: Richard Ries To: wilderness-emergency-medicine@list.pitt.edu Subject: Re: W-EMED Stupid Anaphylaxis Trick # 2 In-Reply-To: <199911231927.LAA22931@macs.mxim.com> Message-ID: MIME-Version: 1.0 Content-Type: TEXT/PLAIN; charset=US-ASCII Sender: owner-wilderness-emergency-medicine@list.pitt.edu Precedence: bulk Reply-To: wilderness-emergency-medicine@list.pitt.edu X-PMFLAGS: 524416 0 1 P00870.CNM On Tue, 23 Nov 1999, Hal Lillywhite wrote: > Unfortunately current regulations in Oregon do not encourage us > folks trained at lower levels (I'm a first responder) to carry and > administer epi (or even oxygen if you can believe that). If I > carried and used epi I would technically be in violation. One more > way the system puts silly rules ahead of saving lives. Hal (and group) - Actually, Oregon is one of the few states (AFAIK) that allows non-medical personnel who have had specific training to administer epi (and glucagon). Check out Oregon Revised Statutes (ORS) 433.800 thru 433.830 at http://landru.leg.state.or.us/ors/433.html ORS 433.805 summarizes the Legislature's intent: 433.805 Policy. It is the purpose of ORS 433.800 to 433.830 to provide a means of authorizing certain individuals when a licensed health care professional is not immediately available to administer lifesaving treatment to persons who have severe allergic responses to insect stings and other specific allergens and to persons who are experiencing severe hypoglycemia when other treatment has failed or cannot be initiated. [1981 c.367 s.1; 1989 c.299 s.3; 1997 c.345 s.2] At our last epi class, taught by an RN who is a member of one of the units and authorized by our physician advisor, we had about 20-25 people, only about 5 of whom are EMT's. The Sheriff's office even sprung for 8 epi kits to be kept in key locations and vehicles. Rick Ries Marion Co. SAR Salem, OR Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- X-NAV-TimeoutProtection0: X X-NAV-TimeoutProtection1: X X-NAV-TimeoutProtection2: X X-NAV-TimeoutProtection3: X X-NAV-TimeoutProtection4: X X-NAV-TimeoutProtection5: X X-NAV-TimeoutProtection6: X Received: from post-ofc04.srv.cis.pitt.edu (root@post-ofc04.srv.cis.pitt.edu [136.142.185.11]) by pop.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cispop-7.2.2.1) ID ; Tue, 23 Nov 1999 16:34:12 -0500 (EST) Received: from localhost (root@localhost) by post-ofc04.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Tue, 23 Nov 1999 16:33:39 -0500 (EST) Received: via switchmail; Tue, 23 Nov 1999 16:33:38 -0500 (EST) Received: from list.srv.cis.pitt.edu via qmail ID ; Tue, 23 Nov 1999 16:31:47 -0500 (EST) Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.1) ID ; Tue, 23 Nov 1999 16:31:16 -0500 (EST) Received: from argohouston.com (mail.argolink.net [209.144.1.128]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.1) ID for ; Tue, 23 Nov 1999 16:31:09 -0500 (EST) Received: from h1z2r9 [209.176.43.17] by argohouston.com (SMTPD32-5.05) id A773A201EC; Tue, 23 Nov 1999 15:30:27 -0600 From: "SouthWest PaddleSports" To: Subject: RE: W-EMED Stupid Anaphylaxis Trick # 2 Date: Tue, 23 Nov 1999 15:35:28 -0600 Message-ID: <005e01bf35fa$aaa1f4a0$172bb0d1@h1z2r9> MIME-Version: 1.0 Content-Type: text/plain; charset="iso-8859-1" Content-Transfer-Encoding: 7bit X-Priority: 3 (Normal) X-MSMail-Priority: Normal X-Mailer: Microsoft Outlook 8.5, Build 4.71.2173.0 X-MimeOLE: Produced By Microsoft MimeOLE V5.00.2314.1300 Importance: Normal In-reply-to: <0.14c4de10.256c288f@aol.com> Sender: owner-wilderness-emergency-medicine@list.pitt.edu Precedence: bulk Reply-To: wilderness-emergency-medicine@list.pitt.edu X-PMFLAGS: 524416 0 1 P60740.CNM I'm concerned that First-aiders do not have the "authority" from AHA or ARC to promote this inhaler trick. Those with the medical background to understand & substantiate their case (in court, as it were) may or may not want to overstep their license or credentials to find & offer an inhaler from a bystander to a victim. I think this is a great idea, personally, but then I'm a risk-taker like many of us in this field. This is something that should be in wilderness medical books if it is not. Patti Carothers, RN SouthWest PaddleSports 26322 I-45 North The Woodlands, TX 77386-1022 281-292-5600 or 1-800-We Paddle http://www.paddlesports.com > -----Original Message----- > From: owner-wilderness-emergency-medicine@list.pitt.edu > [mailto:owner-wilderness-emergency-medicine@list.pitt.edu]On Behalf Of > JadedMedic@aol.com > Sent: Tuesday, November 23, 1999 11:28 AM > To: wilderness-emergency-medicine@list.pitt.edu > Subject: W-EMED Stupid Anaphylaxis Trick # 2 > > > > Hi WMED folks, > > This is the "part two" that I posted to the First Aid list. > > Regards, > > Jay > > XXXXXXXXXXXXXXXXXXXXX > > > Hi (again) folks, > > We all know how serious an anaphylactic reaction can be. It's > right up there > with airway obstruction and cardiac arrest as a condition that > can kill the > patient within a very few minutes. > > More importantly from a first aid viewpoint, anaphylaxis is a > condition that > has a very real potential to kill the patient before the "formal" > EMS troops > can arrive. Thus, it is especially important that a patient > having a severe > anaphylatic reaction receive treatment that has a reasonable > chance of being > helpful as soon as possible. Therefore First Aiders have an > especially high > need to know how to deal with this particular condition. > > (By the way, when I attended a series of wilderness emergency > care lectures > last year, the ER doc who gave the presentation on anaphylaxis was of the > opinion that deaths from this condition were far more common than > they are > believed to be.) > > Most of the time (hopefully) a patient prone to anaphyxaxis will have a > self-injector of epinephrine (Epipen, Anakit) available, with possible > back-up from epinephrine inhalers, diphenhydramine syrup or > tablets, etc., > that First Aiders might have on hand. However, what if none of these are > available? (Obviously, the "EMS troops" should be summoned immediately.) > > One possible means of helping such a patient would be to call out "does > anybody have an asthma inhaler?" > > While OTC asthma inhalers contain epinephrine -- which affects the heart, > blood vessels, and lungs, prescription inhalers may contain more > selective > drugs that (mostly) affect only the lungs. One such drug is called > albuterol. It's marketed under the trade names of Proventil and > Ventolin. > Another such drug is metaproterenol. It's marketed under the > trade names of > Alupent and Metaprel. > > A patient experiencing a severe anaphylactic reaction often has three > problems: (1) vasodialation, (2) bronchospasm, and (3) generalized edema, > with edema of the laryngeal area being the most worrisome. > > It's my belief that the bronchospasm of anaphylaxis is the aspect > of it that > is most fequently life-threatening, and both albuterol and metaproterenol > relax bronchospasm. Thus, if the anaphylaxis patient is experiencing a > dangerous level of respiratory compromise right there in front of > you, and > you have an albuterol or metaproterenol inhaler in your hand, and > you don't > hear the sound of a siren approaching, it seems to me that it only makes > sense to give the patient one or two puffs. > > A few comments. > > 1. These drugs reportedly have a stronger effect on the muscles > involved in > bronchospasm than epinephrine has. Also, epinephrine may be more poorly > absorbed via inhalation than either drug is. Thus, while the therapeutic > dose of epinephrine in such a situation is 10 to 20 puffs, I would be > considerably more conservative with how many albuterol or metaproterenol > puffs I gave the patient. The "party line" is apparently to give no more > than two puffs, and then wait at least ten minutes before giving more. I > know of no reason to disagree with this. > > 2. Not all inhalers carried by asthmatics contain > bronchodialators. Some > contain anti-inflammatory drugs such as corticosteroids. These > drugs take > several _days_ to become effective. Read the label. > > 3. Another drug commonly carried in inhaler form by asthmatics > is cromolyn. > This drug is an antihistamine and inhibits mast cell release. However, I > gather that its onset is relatively slow so it probably wouldn't be of > significant value in the situation I'm describing. > > 4. All of these measures are intended _only_ for very severe, > "there's no > tomorrow" type of situations in which more mainstream treatments are not > immediately available. If the patient is having only a mild to moderate > allergic reaction, especially without respiratory distress, I > would hold off > on giving them any albuterol or metaproterenol. > > 5. These selective bronchodialators will hopefully relieve the > bronchospasm > associated with anaphylaxis, and thus will (again, hopefully) > mitigate the > most common, major, immediate threat to the victim's life, but it > should not > be expected that they will have any significanct effect on the > other major > problems of anaphylaxis -- vasodialation and laryngeal edema. > > 6. BTW, one of my books mentioned in passing that oxygen was itself a > bronchodialator. > > What think? > > Regards, > > Jay Wiseman > FA/CPR Instructor at large > Do not reproduce without author's express permission. > To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" > as the body of a message (no subject) To: Majordomo@list.pitt.edu > Submissions To: wilderness-emergency-medicine@list.pitt.edu > Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- X-NAV-TimeoutProtection0: X X-NAV-TimeoutProtection1: X X-NAV-TimeoutProtection2: X X-NAV-TimeoutProtection3: X X-NAV-TimeoutProtection4: X X-NAV-TimeoutProtection5: X X-NAV-TimeoutProtection6: X Received: from post-ofc01.srv.cis.pitt.edu (root@post-ofc01.srv.cis.pitt.edu [136.142.185.25]) by pop.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cispop-7.2.2.1) ID ; Tue, 23 Nov 1999 18:12:48 -0500 (EST) Received: from localhost (root@localhost) by post-ofc01.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.3) ID ; Tue, 23 Nov 1999 18:12:15 -0500 (EST) Received: via switchmail; Tue, 23 Nov 1999 18:12:15 -0500 (EST) Received: from list.srv.cis.pitt.edu via qmail ID ; Tue, 23 Nov 1999 18:10:40 -0500 (EST) Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.1) ID ; Tue, 23 Nov 1999 18:10:13 -0500 (EST) Received: from imo28.mx.aol.com (imo28.mx.aol.com [152.163.225.72]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.1) ID for ; Tue, 23 Nov 1999 18:10:09 -0500 (EST) From: Omikid@aol.com Received: from Omikid@aol.com by imo28.mx.aol.com (mail_out_v24.4.) id h.0.56f321c6 (4239) for ; Tue, 23 Nov 1999 18:09:33 -0500 (EST) Message-ID: <0.56f321c6.256c78ad@aol.com> Date: Tue, 23 Nov 1999 18:09:33 EST Subject: Re: W-EMED Stupid Anaphylaxis Trick # 2 To: wilderness-emergency-medicine@list.pitt.edu MIME-Version: 1.0 Content-Type: text/plain; charset="us-ascii" Content-Transfer-Encoding: 7bit X-Mailer: Windows AOL sub 45 Sender: owner-wilderness-emergency-medicine@list.pitt.edu Precedence: bulk Reply-To: wilderness-emergency-medicine@list.pitt.edu X-PMFLAGS: 524416 0 1 P68400.CNM In a message dated 11/23/1999 05:53:53 PM Eastern Standard Time, rcries@teleport.com writes: > Unfortunately current regulations in Oregon do not encourage us > > folks trained at lower levels (I'm a first responder) to carry and > > administer epi (or even oxygen if you can believe that). If I > > carried and used epi I would technically be in violation. One more > > way the system puts silly rules ahead of saving lives. > I myself carry, for personal use, 2 epi pens at all times. One time I came across a jogger in the state park where I often go running who was in obvious respiratory distress/swollen face/tongue, and immediately, with little hesitation used my epi-pen., and summoned for help via amateur radio. Weather I overstepped my boundaries (as a senior nursing student at the time, by the way) or not, the epi obviously helped the woman a great deal, and gave her some time, although by the time EMS arrived, she was pretty bad. I am not sure what happened to the lady, or how things turned out, but I have this gut feeling that that Epi saved her life. Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- X-NAV-TimeoutProtection0: X X-NAV-TimeoutProtection1: X X-NAV-TimeoutProtection2: X X-NAV-TimeoutProtection3: X X-NAV-TimeoutProtection4: X X-NAV-TimeoutProtection5: X X-NAV-TimeoutProtection6: X Received: from post-ofc05.srv.cis.pitt.edu (root@post-ofc05.srv.cis.pitt.edu [136.142.185.10]) by pop.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cispop-7.2.2.1) ID ; Tue, 23 Nov 1999 20:52:52 -0500 (EST) Received: from localhost (root@localhost) by post-ofc05.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Tue, 23 Nov 1999 10:18:02 -0500 (EST) Received: via switchmail; Tue, 23 Nov 1999 10:17:58 -0500 (EST) Received: from list.srv.cis.pitt.edu via qmail ID ; Tue, 23 Nov 1999 10:15:50 -0500 (EST) Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.1) ID ; Tue, 23 Nov 1999 10:14:17 -0500 (EST) Received: from truxa1.tcd.ie (truxa1.tcd.ie [134.226.1.158]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.1) ID for ; Tue, 23 Nov 1999 10:14:13 -0500 (EST) Received: from tcd.ie (pc155.mee.tcd.ie [134.226.86.155]) by truxa1.tcd.ie (8.9.3/8.9.3) with ESMTP id PAA14216 for ; Tue, 23 Nov 1999 15:14:10 GMT Message-ID: <383AAF0F.9A9BC345@tcd.ie> Date: Tue, 23 Nov 1999 15:13:19 +0000 From: Gerry Butler Organization: TELTEC-TCD, Ireland X-Mailer: Mozilla 4.7 [en] (WinNT; I) X-Accept-Language: en MIME-Version: 1.0 To: wilderness-emergency-medicine@list.pitt.edu Subject: Re: W-EMED Aspirin & heart attacks in the wilderness References: <3.0.1.16.19991122003540.2d47ee8c@pop.mindspring.com> <001801bf35c1$81afb700$4a8ccfd8@oemcomputer> Content-Type: text/plain; charset=us-ascii Content-Transfer-Encoding: 7bit Sender: owner-wilderness-emergency-medicine@list.pitt.edu Precedence: bulk Reply-To: wilderness-emergency-medicine@list.pitt.edu X-PMFLAGS: 524416 0 1 P09440.CNM Here in Ireland and the UK, the standard 'First Aid Manual', which is a 16 hour course, says that in the event of chest pain which may be cardiac related then one standard aspirin tablet (300 mg) should be given to the patient to chew. There are no contra-indications mentioned in the manual. This protocol is approved by all of the voluntary aid organizations, e.g. Red Cross, St. John Ambulance, etc. While I do not know of any direct legal challenge, it is known that in other cases where an attempt was made to sue a first aid provider it was dismissed by the courts on the grounds that the procedure in the manual was followed. Gerry Michelle Schonzeit wrote: > > After just finishing my yearly CPR-FPR and Outdoor Emergency Care > refreshers for Ski Patrol, I happened to see the commercial for Bayer > aspirin that says 'if taken before a heart attack Bayer aspirin can save > your life', or something to that affect. At that time, it occurred to me no > where in my first aid courses have I ever heard such advice given, but I > assume if they can broadcast it on TV it must have some legitimacy some > where. > So, I thought maybe someone on the list would know if this actually > works, & under what circumstances, and if so why doesn't anyone like the Red > Cross or American Heart ever mention it (besides the legal consideration > that you are then providing medication), and if used in the backcountry, how > long would the affect (if any) last, (i.e.. is it enough time to evacuate > someone with out having to do CPR in route) or would you need to > readminister it every so often. Any thoughts anyone? > > Michelle Schonzeit - schonzeit@slic.com > http://www.angelfire.com/mt/schonzeit > Whiteface Mt. Ski Patrol > Search & Rescue of the Northern Adirondacks > & Owner of an '89 Subaru!!! (my first car & I think the nicest car on the > road!!!) > > Do not reproduce without author's express permission. > To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" > as the body of a message (no subject) To: Majordomo@list.pitt.edu > Submissions To: wilderness-emergency-medicine@list.pitt.edu -- Dr. Gerard Butler CEng MIEE, (EI0CH, WEMT) TELTEC Radio Systems and Propagation Group, Trinity College, Dublin Ireland Dublin+Wicklow Mountain Rescue Team Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- X-NAV-TimeoutProtection0: X X-NAV-TimeoutProtection1: X X-NAV-TimeoutProtection2: X X-NAV-TimeoutProtection3: X X-NAV-TimeoutProtection4: X X-NAV-TimeoutProtection5: X X-NAV-TimeoutProtection6: X Received: from post-ofc07.srv.cis.pitt.edu (root@post-ofc07.srv.cis.pitt.edu [136.142.185.73]) by pop.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cispop-7.2.2.1) ID ; Tue, 23 Nov 1999 10:12:54 -0500 (EST) Received: from localhost (root@localhost) by post-ofc07.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.3) ID ; Tue, 23 Nov 1999 10:12:52 -0500 (EST) Received: via switchmail; Tue, 23 Nov 1999 10:12:52 -0500 (EST) Received: from list.srv.cis.pitt.edu via qmail ID ; Tue, 23 Nov 1999 10:11:35 -0500 (EST) Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.1) ID ; Tue, 23 Nov 1999 10:09:47 -0500 (EST) Received: from post-ofc05.srv.cis.pitt.edu (root@post-ofc05.srv.cis.pitt.edu [136.142.185.10]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.1) ID for ; Tue, 23 Nov 1999 10:09:44 -0500 (EST) Received: from unixs2.cis.pitt.edu (jmbst85@unixs2.cis.pitt.edu [136.142.185.53]) by post-ofc05.srv.cis.pitt.edu with SMTP (8.8.8/8.8.8/cispo-7.2.2.2) ID for ; Tue, 23 Nov 1999 10:09:35 -0500 (EST) Date: Tue, 23 Nov 1999 10:09:33 -0500 (EST) From: Jonnathan M Busko X-Sender: jmbst85@unixs2.cis.pitt.edu To: wilderness-emergency-medicine@list.pitt.edu Subject: Re: W-EMED Aspirin & heart attacks in the wilderness In-Reply-To: <001801bf35c1$81afb700$4a8ccfd8@oemcomputer> Message-ID: MIME-Version: 1.0 Content-Type: TEXT/PLAIN; charset=US-ASCII Sender: owner-wilderness-emergency-medicine@list.pitt.edu Precedence: bulk Reply-To: wilderness-emergency-medicine@list.pitt.edu X-PMFLAGS: 524416 0 1 P0A110.CNM I'm sure that those on the list with access to more immediate references than I have with me right now can provide the huge mass of literature available on the use of ASA for the prevention and partial mitigation of MI, but the essence is as follows... Asprin irreversibly binds to platelets, essentially making them less "sticky." Because this is an irreversible process, it's effective for the life of the platelet (5-7 days) and does not need to be immediately repeated. However, if you read the literature, all of us should probably be taking a baby asprin a day to decrease our risk of MI. On the other hand, whoever decided that dying of AMI was less preferable than dying from degenerative neurological disease, CHF, or neoplasm certainly had a few screws loose (side editorial). Understand that the implications of this recommendation is that you are taking ASA to prevent the MI, and says nothing about taking the ASA once the MI starts... However, there is certainly enough literature to assure that taking the ASA once an MI starts is also quite beneficial. I'm sure someone will post the reference, but a fairly recent reference compared ASA to Thrombolytics (clot-busting medications) to ASA + thrombolytics looking at, I believe, just mortality (correct me if I'm wrong). ASA or Thrombolytics each reduced mortality by about 25%; that is, if all you had was one or the other, and you were having an MI, it didn't matter which you took in terms of your mortality. However, the combination of the two reduced mortality by about 48%; that is, if you used them both, you did better. From a weight / cost effectiveness perspective, I'd rather carry ASA in my wilderness field kit than a thrombolytic (although Keith has his own views on this). None of this tells you very much about the effectiveness in preventing primary lethal arrythmias of the sort that would cause a patient to go into cardiac arrest and need CPR. However, since platelet acelyation keeps a clot from getting LARGER, and since presumably more blockage is bad, I can only assume that giving chronic ASA therapy and/or giving 81-325 mg of ASA on first suspicion of MI will reduce the incidence of lethal arrythmias in MI. But since heart attack does not = Cardiac arrest, I'm not sure if the MI literature can be extrapolated to cardiac arrest. Any other input would be greatly appreciated. In terms of providing ASA to patients, the principle of stump medicine may apply. That is, if you happen to have ASA with you, and it happens to be sitting on a stump beside a patient, and you happen to mention to the patient that taking the ASA will decrease his/her risk of death from MI, and you happen to look away, no one can control what the patient does with that ASA. As a side note, as a care provider, you can't give ASA (unless specifically authorized to do so under a medical command system), but you certainly can give anyone anything you've got if you're a private civilian (not that I'm advocating that anyone share their haldol, but ASA is usually pretty benign.) Anyone and everyone else, feel free to chime in (or provide references for my babbling). Jonnathan Jonnathan M. Busko, MPH, NREMT-P, CCEMT-P MS IV, University of Pittsburgh School Of Medicine. -_---__----___-----____------_____-------______--------_______---------_______- Primum Non Nocere -_______---------_______--------______-------_____------____-----___----__---_- On Tue, 23 Nov 1999, Michelle Schonzeit wrote: > After just finishing my yearly CPR-FPR and Outdoor Emergency Care > refreshers for Ski Patrol, I happened to see the commercial for Bayer > aspirin that says 'if taken before a heart attack Bayer aspirin can save > your life', or something to that affect. At that time, it occurred to me no > where in my first aid courses have I ever heard such advice given, but I > assume if they can broadcast it on TV it must have some legitimacy some > where. > So, I thought maybe someone on the list would know if this actually > works, & under what circumstances, and if so why doesn't anyone like the Red > Cross or American Heart ever mention it (besides the legal consideration > that you are then providing medication), and if used in the backcountry, how > long would the affect (if any) last, (i.e.. is it enough time to evacuate > someone with out having to do CPR in route) or would you need to > readminister it every so often. Any thoughts anyone? > > Michelle Schonzeit - schonzeit@slic.com > http://www.angelfire.com/mt/schonzeit > Whiteface Mt. Ski Patrol > Search & Rescue of the Northern Adirondacks > & Owner of an '89 Subaru!!! (my first car & I think the nicest car on the > road!!!) > > > Do not reproduce without author's express permission. > To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" > as the body of a message (no subject) To: Majordomo@list.pitt.edu > Submissions To: wilderness-emergency-medicine@list.pitt.edu > Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- X-NAV-TimeoutProtection0: X X-NAV-TimeoutProtection1: X X-NAV-TimeoutProtection2: X X-NAV-TimeoutProtection3: X X-NAV-TimeoutProtection4: X X-NAV-TimeoutProtection5: X X-NAV-TimeoutProtection6: X Received: from post-ofc04.srv.cis.pitt.edu (root@post-ofc04.srv.cis.pitt.edu [136.142.185.11]) by pop.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cispop-7.2.2.1) ID ; Tue, 23 Nov 1999 09:43:15 -0500 (EST) Received: from localhost (root@localhost) by post-ofc04.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Tue, 23 Nov 1999 09:43:13 -0500 (EST) Received: via switchmail; Tue, 23 Nov 1999 09:43:13 -0500 (EST) Received: from list.srv.cis.pitt.edu via qmail ID ; Tue, 23 Nov 1999 09:42:46 -0500 (EST) Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.1) ID ; Tue, 23 Nov 1999 09:40:52 -0500 (EST) Received: from buzz.slic.com (buzz.slic.com [206.25.233.41]) by list.srv.cis.pitt.edu with SMTP (8.8.8/8.8.8/cisls-7.2.2.1) ID for ; Tue, 23 Nov 1999 09:40:48 -0500 (EST) Received: (qmail 18548 invoked by uid 0); 23 Nov 1999 14:40:47 -0000 Received: from saratoga-async74.slic.com (HELO oemcomputer) (216.207.140.74) by buzz.slic.com with SMTP; 23 Nov 1999 14:40:47 -0000 Message-ID: <001801bf35c1$81afb700$4a8ccfd8@oemcomputer> From: "Michelle Schonzeit" To: References: <3.0.1.16.19991122003540.2d47ee8c@pop.mindspring.com> Subject: W-EMED Aspirin & heart attacks in the wilderness Date: Tue, 23 Nov 1999 09:46:15 -0500 MIME-Version: 1.0 Content-Type: text/plain; charset="iso-8859-1" Content-Transfer-Encoding: 7bit X-Priority: 3 X-MSMail-Priority: Normal X-Mailer: Microsoft Outlook Express 5.00.2014.211 X-MimeOLE: Produced By Microsoft MimeOLE V5.00.2014.211 Sender: owner-wilderness-emergency-medicine@list.pitt.edu Precedence: bulk Reply-To: wilderness-emergency-medicine@list.pitt.edu X-PMFLAGS: 524416 0 1 P358B0.CNM After just finishing my yearly CPR-FPR and Outdoor Emergency Care refreshers for Ski Patrol, I happened to see the commercial for Bayer aspirin that says 'if taken before a heart attack Bayer aspirin can save your life', or something to that affect. At that time, it occurred to me no where in my first aid courses have I ever heard such advice given, but I assume if they can broadcast it on TV it must have some legitimacy some where. So, I thought maybe someone on the list would know if this actually works, & under what circumstances, and if so why doesn't anyone like the Red Cross or American Heart ever mention it (besides the legal consideration that you are then providing medication), and if used in the backcountry, how long would the affect (if any) last, (i.e.. is it enough time to evacuate someone with out having to do CPR in route) or would you need to readminister it every so often. Any thoughts anyone? Michelle Schonzeit - schonzeit@slic.com http://www.angelfire.com/mt/schonzeit Whiteface Mt. Ski Patrol Search & Rescue of the Northern Adirondacks & Owner of an '89 Subaru!!! (my first car & I think the nicest car on the road!!!) Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- X-NAV-TimeoutProtection0: X X-NAV-TimeoutProtection1: X X-NAV-TimeoutProtection2: X X-NAV-TimeoutProtection3: X X-NAV-TimeoutProtection4: X X-NAV-TimeoutProtection5: X X-NAV-TimeoutProtection6: X Received: from post-ofc02.srv.cis.pitt.edu (root@post-ofc02.srv.cis.pitt.edu [136.142.185.24]) by pop.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cispop-7.2.2.1) ID ; Tue, 23 Nov 1999 12:29:17 -0500 (EST) Received: from localhost (root@localhost) by post-ofc02.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Tue, 23 Nov 1999 12:29:15 -0500 (EST) Received: via switchmail; Tue, 23 Nov 1999 12:29:15 -0500 (EST) Received: from list.srv.cis.pitt.edu via qmail ID ; Tue, 23 Nov 1999 12:28:58 -0500 (EST) Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.1) ID ; Tue, 23 Nov 1999 12:28:21 -0500 (EST) Received: from imo-d04.mx.aol.com (imo-d04.mx.aol.com [205.188.157.36]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.1) ID for ; Tue, 23 Nov 1999 12:28:17 -0500 (EST) From: JadedMedic@aol.com Received: from JadedMedic@aol.com by imo-d04.mx.aol.com (mail_out_v24.4.) id h.0.14c4de10 (4558) for ; Tue, 23 Nov 1999 12:27:44 -0500 (EST) Message-ID: <0.14c4de10.256c288f@aol.com> Date: Tue, 23 Nov 1999 12:27:43 EST Subject: W-EMED Stupid Anaphylaxis Trick # 2 To: wilderness-emergency-medicine@list.pitt.edu MIME-Version: 1.0 Content-Type: text/plain; charset="us-ascii" Content-Transfer-Encoding: 7bit X-Mailer: Windows AOL sub 45 Sender: owner-wilderness-emergency-medicine@list.pitt.edu Precedence: bulk Reply-To: wilderness-emergency-medicine@list.pitt.edu X-PMFLAGS: 524416 0 1 P1DBC0.CNM Hi WMED folks, This is the "part two" that I posted to the First Aid list. Regards, Jay XXXXXXXXXXXXXXXXXXXXX Hi (again) folks, We all know how serious an anaphylactic reaction can be. It's right up there with airway obstruction and cardiac arrest as a condition that can kill the patient within a very few minutes. More importantly from a first aid viewpoint, anaphylaxis is a condition that has a very real potential to kill the patient before the "formal" EMS troops can arrive. Thus, it is especially important that a patient having a severe anaphylatic reaction receive treatment that has a reasonable chance of being helpful as soon as possible. Therefore First Aiders have an especially high need to know how to deal with this particular condition. (By the way, when I attended a series of wilderness emergency care lectures last year, the ER doc who gave the presentation on anaphylaxis was of the opinion that deaths from this condition were far more common than they are believed to be.) Most of the time (hopefully) a patient prone to anaphyxaxis will have a self-injector of epinephrine (Epipen, Anakit) available, with possible back-up from epinephrine inhalers, diphenhydramine syrup or tablets, etc., that First Aiders might have on hand. However, what if none of these are available? (Obviously, the "EMS troops" should be summoned immediately.) One possible means of helping such a patient would be to call out "does anybody have an asthma inhaler?" While OTC asthma inhalers contain epinephrine -- which affects the heart, blood vessels, and lungs, prescription inhalers may contain more selective drugs that (mostly) affect only the lungs. One such drug is called albuterol. It's marketed under the trade names of Proventil and Ventolin. Another such drug is metaproterenol. It's marketed under the trade names of Alupent and Metaprel. A patient experiencing a severe anaphylactic reaction often has three problems: (1) vasodialation, (2) bronchospasm, and (3) generalized edema, with edema of the laryngeal area being the most worrisome. It's my belief that the bronchospasm of anaphylaxis is the aspect of it that is most fequently life-threatening, and both albuterol and metaproterenol relax bronchospasm. Thus, if the anaphylaxis patient is experiencing a dangerous level of respiratory compromise right there in front of you, and you have an albuterol or metaproterenol inhaler in your hand, and you don't hear the sound of a siren approaching, it seems to me that it only makes sense to give the patient one or two puffs. A few comments. 1. These drugs reportedly have a stronger effect on the muscles involved in bronchospasm than epinephrine has. Also, epinephrine may be more poorly absorbed via inhalation than either drug is. Thus, while the therapeutic dose of epinephrine in such a situation is 10 to 20 puffs, I would be considerably more conservative with how many albuterol or metaproterenol puffs I gave the patient. The "party line" is apparently to give no more than two puffs, and then wait at least ten minutes before giving more. I know of no reason to disagree with this. 2. Not all inhalers carried by asthmatics contain bronchodialators. Some contain anti-inflammatory drugs such as corticosteroids. These drugs take several _days_ to become effective. Read the label. 3. Another drug commonly carried in inhaler form by asthmatics is cromolyn. This drug is an antihistamine and inhibits mast cell release. However, I gather that its onset is relatively slow so it probably wouldn't be of significant value in the situation I'm describing. 4. All of these measures are intended _only_ for very severe, "there's no tomorrow" type of situations in which more mainstream treatments are not immediately available. If the patient is having only a mild to moderate allergic reaction, especially without respiratory distress, I would hold off on giving them any albuterol or metaproterenol. 5. These selective bronchodialators will hopefully relieve the bronchospasm associated with anaphylaxis, and thus will (again, hopefully) mitigate the most common, major, immediate threat to the victim's life, but it should not be expected that they will have any significanct effect on the other major problems of anaphylaxis -- vasodialation and laryngeal edema. 6. BTW, one of my books mentioned in passing that oxygen was itself a bronchodialator. What think? Regards, Jay Wiseman FA/CPR Instructor at large Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- X-NAV-TimeoutProtection0: X X-NAV-TimeoutProtection1: X X-NAV-TimeoutProtection2: X X-NAV-TimeoutProtection3: X X-NAV-TimeoutProtection4: X X-NAV-TimeoutProtection5: X X-NAV-TimeoutProtection6: X Received: from post-ofc06.srv.cis.pitt.edu (root@post-ofc06.srv.cis.pitt.edu [136.142.185.43]) by pop.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cispop-7.2.2.1) ID ; Tue, 23 Nov 1999 14:29:53 -0500 (EST) Received: from localhost (root@localhost) by post-ofc06.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.3) ID ; Tue, 23 Nov 1999 14:29:20 -0500 (EST) Received: via switchmail; Tue, 23 Nov 1999 14:29:20 -0500 (EST) Received: from list.srv.cis.pitt.edu via qmail ID ; Tue, 23 Nov 1999 14:28:46 -0500 (EST) Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.1) ID ; Tue, 23 Nov 1999 14:28:03 -0500 (EST) Received: from macs.mxim.com (macs.mxim.com [204.17.143.130]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.1) ID for ; Tue, 23 Nov 1999 14:27:53 -0500 (EST) Received: from localhost (localhost [127.0.0.1]) by macs.mxim.com (8.7/8.6.9) with SMTP id LAA22931 for ; Tue, 23 Nov 1999 11:27:14 -0800 (PST) Message-Id: <199911231927.LAA22931@macs.mxim.com> X-Mailer: exmh version 2.0.1 12/23/97 To: wilderness-emergency-medicine@list.pitt.edu Subject: Re: W-EMED Stupid Anaphylaxis Trick # 2 In-reply-to: Your message of "Tue, 23 Nov 1999 12:27:43 EST." <0.14c4de10.256c288f@aol.com> Mime-Version: 1.0 Content-Type: text/plain; charset=us-ascii Date: Tue, 23 Nov 1999 11:27:14 PST From: Hal Lillywhite Sender: owner-wilderness-emergency-medicine@list.pitt.edu Precedence: bulk Reply-To: wilderness-emergency-medicine@list.pitt.edu X-PMFLAGS: 524416 0 1 P33380.CNM JadedMedic@aol.com writes: >Most of the time (hopefully) a patient prone to anaphyxaxis will >have a self-injector of epinephrine (Epipen, Anakit) available, >with possible back-up from epinephrine inhalers, diphenhydramine >syrup or tablets, etc., that First Aiders might have on hand. >However, what if none of these are available? (Obviously, the >"EMS troops" should be summoned immediately.) An excellent comment. Usually those who know they are subject to anaphyxaxis are prepared. However not everybody with this problem is aware of it, there is always a first reaction. I was on a search for a lost hunter several years ago. One of our searchers had never had a reaction before. Well the yellow jackets got him good, many stings and bites. Fortunately a paramedic in the group had epi and treated him. The guy went through two kits of epi, a couple of bottles of O2, then went critical in the hospital. Had we not had someone along with the appropriate meds he would have been dead! Unfortunately current regulations in Oregon do not encourage us folks trained at lower levels (I'm a first responder) to carry and administer epi (or even oxygen if you can believe that). If I carried and used epi I would technically be in violation. One more way the system puts silly rules ahead of saving lives. At least we have a "lesser of evils" defense in this state so if I did save someone's life by using these treatments I could defend myself but the burden of proof would be on me. I would like to see any SAR group in the yellow jacket season equipped and trained to deal with anaphyxaxis. I've been stung by such critters several times and never had a problem but you never know when my body might decide it's had enough of those venoms and it's time to react seriously to them. If that ever happens I would like a teammate to be able to deal with the problem. Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- X-NAV-TimeoutProtection0: X X-NAV-TimeoutProtection1: X X-NAV-TimeoutProtection2: X X-NAV-TimeoutProtection3: X X-NAV-TimeoutProtection4: X X-NAV-TimeoutProtection5: X X-NAV-TimeoutProtection6: X Received: from post-ofc05.srv.cis.pitt.edu (root@post-ofc05.srv.cis.pitt.edu [136.142.185.10]) by pop.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cispop-7.2.2.1) ID ; Wed, 24 Nov 1999 12:09:05 -0500 (EST) Received: from localhost (root@localhost) by post-ofc05.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Wed, 24 Nov 1999 12:08:25 -0500 (EST) Received: via switchmail; Wed, 24 Nov 1999 12:08:24 -0500 (EST) Received: from list.srv.cis.pitt.edu via qmail ID ; Wed, 24 Nov 1999 12:06:53 -0500 (EST) Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.1) ID ; Wed, 24 Nov 1999 12:05:59 -0500 (EST) Received: from cgi.icon.co.za (cgi.icon.co.za [196.35.95.41]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.1) ID for ; Wed, 24 Nov 1999 12:05:50 -0500 (EST) Received: from mail450.icon.co.za (smtp.icon.co.za [196.35.95.40]) by cgi.icon.co.za (Postfix) with ESMTP id 0926D46510; Wed, 24 Nov 1999 19:11:10 +0200 (SAST) Received: from icon.co.za (c6-ndf-71.dial-up.net [196.34.160.199]) by mail450.icon.co.za (8.9.3/8.9.3) with ESMTP id TAA15350; Wed, 24 Nov 1999 19:05:32 +0200 (GMT) Message-ID: <383A5E6C.89FCA610@icon.co.za> Date: Tue, 23 Nov 1999 11:29:16 +0200 From: Arthur Morgan X-Mailer: Mozilla 4.7 [en] (Win95; I) X-Accept-Language: en-GB,en,en-US,af,pl MIME-Version: 1.0 To: wilderness-emergency-medicine@list.pitt.edu, Michelle Subject: Re: W-EMED Aspirin & heart attacks in the wilderness References: <3.0.1.16.19991122003540.2d47ee8c@pop.mindspring.com> <001801bf35c1$81afb700$4a8ccfd8@oemcomputer> Content-Type: text/plain; charset=us-ascii Content-Transfer-Encoding: 7bit Sender: owner-wilderness-emergency-medicine@list.pitt.edu Precedence: bulk Reply-To: wilderness-emergency-medicine@list.pitt.edu X-PMFLAGS: 524416 0 1 P5B410.CNM Michelle, Taking aspirin ( as little as 40 mg on alternate days ) will certainly decrease the chance of a fatal heart attack. However the financial cost will be very large. Other ways of decreasing risk of death may be cheaper over the life time of the person. There needs to be more research into the dangers of long term aspirin before it can be recommended. Contraindications of aspirin type drugs include any history of peptic ulcers, stroke, allergy, asthma. If a patient has a typical story of heart attack ( crushing chest pain, weakness, altered sensation [including pain] in the arm, neck or jaw, palpitations ) a single adult aspirin taken early will save as many lives as all other treatment put together. However you will have to accept a small number of fatalities due to bleeding ulcers, strokes, and other vascular catastrophes. It will prevent, to some extent, enlargement of the volume of death of heart muscle by limiting the clot formation within the arteries of the heart. One dose is enough. The action will last for at least a day. Arthur BTW distrust everything that you see on TV. Michelle Schonzeit wrote: > > After just finishing my yearly CPR-FPR and Outdoor Emergency Care > refreshers for Ski Patrol, I happened to see the commercial for Bayer > aspirin that says 'if taken before a heart attack Bayer aspirin can save > your life', or something to that affect. At that time, it occurred to me no > where in my first aid courses have I ever heard such advice given, but I > assume if they can broadcast it on TV it must have some legitimacy some > where. > So, I thought maybe someone on the list would know if this actually > works, & under what circumstances, and if so why doesn't anyone like the Red > Cross or American Heart ever mention it (besides the legal consideration > that you are then providing medication), and if used in the backcountry, how > long would the affect (if any) last, (i.e.. is it enough time to evacuate > someone with out having to do CPR in route) or would you need to > readminister it every so often. Any thoughts anyone? > > Michelle Schonzeit - schonzeit@slic.com Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- X-NAV-TimeoutProtection0: X X-NAV-TimeoutProtection1: X X-NAV-TimeoutProtection2: X X-NAV-TimeoutProtection3: X X-NAV-TimeoutProtection4: X X-NAV-TimeoutProtection5: X X-NAV-TimeoutProtection6: X Received: from post-ofc05.srv.cis.pitt.edu (root@post-ofc05.srv.cis.pitt.edu [136.142.185.10]) by pop.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cispop-7.2.2.1) ID ; Tue, 23 Nov 1999 03:15:11 -0500 (EST) Received: from localhost (root@localhost) by post-ofc05.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Tue, 23 Nov 1999 03:14:31 -0500 (EST) Received: via switchmail; Tue, 23 Nov 1999 03:14:29 -0500 (EST) Received: from list.srv.cis.pitt.edu via qmail ID ; Tue, 23 Nov 1999 03:13:56 -0500 (EST) Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.1) ID ; Tue, 23 Nov 1999 03:13:18 -0500 (EST) Received: from mtiwmhc02.worldnet.att.net (mtiwmhc02.worldnet.att.net [204.127.131.37]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.1) ID for ; Tue, 23 Nov 1999 03:13:15 -0500 (EST) Received: from yumwind ([12.74.22.54]) by mtiwmhc02.worldnet.att.net (InterMail v03.02.07.07 118-134) with ESMTP id <19991123081244.XXWL1865@yumwind> for ; Tue, 23 Nov 1999 08:12:44 +0000 From: "D. Carp" To: wilderness-emergency-medicine@list.pitt.edu Date: Tue, 23 Nov 1999 02:04:34 -0600 Subject: Re: W-EMED The Benedryl trick In-reply-to: <3.0.1.16.19991122003540.2d47ee8c@pop.mindspring.com> References: <001f01bf33dd$307c3a60$214122cf@lana-s-computer> X-mailer: Pegasus Mail for Win32 (v3.12a) Message-Id: <19991123081244.XXWL1865@yumwind> Sender: owner-wilderness-emergency-medicine@list.pitt.edu Precedence: bulk Reply-To: wilderness-emergency-medicine@list.pitt.edu X-PMFLAGS: 128 0 1 P28BB0.CNM > Ana-Kit's come with 4 doses of chewable chlorpheniramine. I have I find that these guys don't do a whole heck of a lot for me *personally*; OTOH Benadryl is Very Good [ignoring the side effects]. Of course, I know people for whom Benadryl does little good but chlorapheniramine does very well... > As to the firefighter who felt this wasn't on topic, my only first > hand experience with an alergic reaction came when strip firing behind > their first aid kits implies this isn't an uncommon event. IMO, the subject is on topic. of course, I may be biasd, since I have multiple allergies that result in anaphylaxis. However, I think it is on topic for reasons other than that. First of all, the wilderness protocols that I learned in the WEMT course I took have anaphylaxis as the only protocol for which "X time from definitive medical care" is NOT a requirement [which makes sense!]. So ANY anaphylaxis could/should be considered 'in the wilderness context'... Further, as the poster that I am replying to notes, anaphylaxis can [frequently?] occur when one is isolated from immediate medical attention, especially insect sting reactions... And, in some cases, even if one is right next to a phone in a location with a decent EMS response time -- the few to several minutes before EMS arrives can be an eternity or even fatal... In a more typical 'wilderness context' [i.e. out in "the middle of nowhere" ;) ], stopping the progression of an anaphylactic reaction ASAP would, I think, be highly desirable. And if that means chewing Benadryl vs. not chewing it, then I think that is important. Even if it only 'buys' a couple of minutes... that couple of minutes can make a world of difference. And understanding the side effects of taking that action is also important -- knowing that one's tongue is SUPPOSED to go numb and feel strange when you chew Benadryl is reassuring -- yes, it may be the reaction getting worse quickly, but it may also be just the normal side effect of the med [and it is important to determine which it is; but it is also good to know that it could be something else than the reaction getting worse -- the patient is less inclined to panic, and so hopefully are those around them]. Having been the patient on more than one occasion, waiting as the reaction progresses and wondering when the meds will finally kick in ... all the while well aware of what will happen if the meds do NOT kick in [and the fact that I am however far away from help beyond myself and whoever I am with (if anyone), even if that is a relatively few minutes], I can assure you that anything to speed up the 'medication working' process is a Very Good Thing. Heck, even doing something that you think speeds up the process, but which may actually not [but that doesn't slow it down] is at least reassuring because at least you are doing *something* instead of just sitting there waiting as it gets more and more difficult to breathe, you itch like crazy, your lips and tongue are swelling, and you are wondering if THIS will be the time when you loose your airway... If nothing else, it gives you something to do to maybe sort of somewhat a little itty bit keep your mind of off what will happen should the reaction continue on its present course... Besides, complaining about how downright NASTY Benadryl tastes can cheer one up somewhat, and the people around you will calm down just a little bit if they think you are healthy enough to *complain* -- they may not think you will die any *second*, maybe just any *minute*... Trust me, having been with people who are... well... 'freaking out' might be a good phrase to use... while you are trying to survive is not exactly the most enjoyable situation, and just about anything that can be done to calm THEM down is also a Good Thing, especially if you need them to help you do things for you [e.g. uncap the Epi-Pen, open the annoying Benadryl blister pack, set up a nebulizer because you can't coordinate it sufficiently while concentating on breathing, etc]... Deanne. Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- X-NAV-TimeoutProtection0: X X-NAV-TimeoutProtection1: X X-NAV-TimeoutProtection2: X X-NAV-TimeoutProtection3: X X-NAV-TimeoutProtection4: X X-NAV-TimeoutProtection5: X X-NAV-TimeoutProtection6: X Received: from post-ofc07.srv.cis.pitt.edu (root@post-ofc07.srv.cis.pitt.edu [136.142.185.73]) by pop.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cispop-7.2.2.1) ID ; Sun, 21 Nov 1999 23:24:16 -0500 (EST) Received: from localhost (root@localhost) by post-ofc07.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.3) ID ; Sun, 21 Nov 1999 23:23:45 -0500 (EST) Received: via switchmail; Sun, 21 Nov 1999 23:23:45 -0500 (EST) Received: from list.srv.cis.pitt.edu via qmail ID ; Sun, 21 Nov 1999 23:22:39 -0500 (EST) Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.1) ID ; Sun, 21 Nov 1999 23:21:36 -0500 (EST) Received: from spamgaad.compuserve.com (as-img-4.compuserve.com [149.174.217.147]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.1) ID for ; Sun, 21 Nov 1999 23:21:28 -0500 (EST) Received: (from mailgate@localhost) by spamgaad.compuserve.com (8.9.3/8.9.3/SUN-1.7) id XAA20806 for wilderness-emergency-medicine@list.pitt.edu; Sun, 21 Nov 1999 23:20:57 -0500 (EST) Date: Sun, 21 Nov 1999 23:20:12 -0500 From: Darren Walter Subject: Re: W-EMED Last minute comments on Wilderness Medical Kits To: "INTERNET:wilderness-emergency-medicine@list.pitt.edu" Message-ID: <199911212320_MC2-8E12-3F6D@compuserve.com> MIME-Version: 1.0 Content-Type: text/plain; charset=ISO-8859-1 Content-Disposition: inline Content-Transfer-Encoding: 8bit X-MIME-Autoconverted: from quoted-printable to 8bit by list.srv.cis.pitt.edu id XAA16325 Sender: owner-wilderness-emergency-medicine@list.pitt.edu Precedence: bulk Reply-To: wilderness-emergency-medicine@list.pitt.edu X-PMFLAGS: 524416 0 1 P39A80.CNM >The papers showing uptake are measuring the amount absorbed into the cells in a test tube - minute amounts. The one against shows that insufficient glucose is absorbed through the mouth mucosa to increase the blood glucose by a measurable amount in a person. Once the patient is not able to swallow intravenous glucose is the only way to go. ( I have no experience with techniques such as via a stomach tube, into the marrow cavity of the tibia, or rectal, all of which should work well).< How much glucose is required to improve a level of consciousness sufficient to be able to take orally? Can it be referenced? There is no doubt that glucose in the stomach is better than glucose adjacent to the oral mucosa (demonstrated by Gunning in JAMA 1978). The question, I thought, was regarding the ability of glucose introduced into the mouth to help in the management of a hypoglycaemic and semi-conscious patient. I agree entirely that intravenous glucose is the standard, glucagon is a next step, but what if you are not licenced to use these. In the UK there are legal restrictions to the use of prescription only medicines (POMs) by non-medical practitioners. In considering how these carers can help, less than optimal treatments need to be considered. The British Diabetic Association provides oral glucose gel and supports its use by parents and teachers (when they are not trained in the use of glucagon) on the advice of its diabetologists. I've never really questioned it before. :-( Some things you take from specialists as read. I would hope that intraosseous glucose would be a paramedical procedure. Apart from being toxic, through its hyperosmolar state, to the bone marrow, it is access to the circulation and so will work. Gastric tubes don't always end up in the stomach, 50% dextrose in the pulmonary tree would be a disaster. Can't endorse this. If dextrose is absorbed through the rectal mucosa, why not through the oral mucosa :-) Best wishes, Darren Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- X-NAV-TimeoutProtection0: X X-NAV-TimeoutProtection1: X X-NAV-TimeoutProtection2: X X-NAV-TimeoutProtection3: X X-NAV-TimeoutProtection4: X X-NAV-TimeoutProtection5: X X-NAV-TimeoutProtection6: X Received: from post-ofc06.srv.cis.pitt.edu (root@post-ofc06.srv.cis.pitt.edu [136.142.185.43]) by pop.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cispop-7.2.2.1) ID ; Mon, 22 Nov 1999 02:07:37 -0500 (EST) Received: from localhost (root@localhost) by post-ofc06.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.3) ID ; Mon, 22 Nov 1999 02:07:06 -0500 (EST) Received: via switchmail; Mon, 22 Nov 1999 02:07:05 -0500 (EST) Received: from list.srv.cis.pitt.edu via qmail ID ; Mon, 22 Nov 1999 02:05:33 -0500 (EST) Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.1) ID ; Mon, 22 Nov 1999 02:05:10 -0500 (EST) Received: from imo19.mx.aol.com (imo19.mx.aol.com [198.81.17.9]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.1) ID for ; Mon, 22 Nov 1999 02:05:07 -0500 (EST) From: Jaymullen@aol.com Received: from Jaymullen@aol.com by imo19.mx.aol.com (mail_out_v24.4.) id h.0.b3030062 (4155) for ; Mon, 22 Nov 1999 02:04:30 -0500 (EST) Message-ID: <0.b3030062.256a44fe@aol.com> Date: Mon, 22 Nov 1999 02:04:30 EST Subject: Re: W-EMED Stupid Anaphylaxis Trick # 1 (was "rapid sulingual absorption) To: wilderness-emergency-medicine@list.pitt.edu MIME-Version: 1.0 Content-Type: text/plain; charset="us-ascii" Content-Transfer-Encoding: 7bit X-Mailer: Windows AOL sub 45 Sender: owner-wilderness-emergency-medicine@list.pitt.edu Precedence: bulk Reply-To: wilderness-emergency-medicine@list.pitt.edu X-PMFLAGS: 524416 0 1 P41730.CNM Ron-- I think you are defining anesthetic too narrowly. Mosby defines it as "a drug or agent that is capable of producing a complete or partial loss of feeling (aneshesia)." Based on that definition, ice and Benadryl, and for that matter, intradermal saline are all anesthetics. --Jay Mullen MD Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- X-NAV-TimeoutProtection0: X X-NAV-TimeoutProtection1: X X-NAV-TimeoutProtection2: X X-NAV-TimeoutProtection3: X X-NAV-TimeoutProtection4: X X-NAV-TimeoutProtection5: X X-NAV-TimeoutProtection6: X Received: from post-ofc01.srv.cis.pitt.edu (root@post-ofc01.srv.cis.pitt.edu [136.142.185.25]) by pop.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cispop-7.2.2.1) ID ; Mon, 22 Nov 1999 23:49:44 -0500 (EST) Received: from localhost (root@localhost) by post-ofc01.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.3) ID ; Mon, 22 Nov 1999 23:49:11 -0500 (EST) Received: via switchmail; Mon, 22 Nov 1999 23:49:11 -0500 (EST) Received: from list.srv.cis.pitt.edu via qmail ID ; Mon, 22 Nov 1999 23:45:12 -0500 (EST) Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.1) ID ; Mon, 22 Nov 1999 23:43:54 -0500 (EST) Received: from smtp6.mindspring.com (smtp6.mindspring.com [207.69.200.110]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.1) ID for ; Mon, 22 Nov 1999 23:43:44 -0500 (EST) Received: from LOCALNAME (user-38lcjm2.dialup.mindspring.com [209.86.78.194]) by smtp6.mindspring.com (8.9.3/8.8.5) with SMTP id XAA15966 for ; Mon, 22 Nov 1999 23:43:42 -0500 (EST) Message-Id: <3.0.1.16.19991122003540.2d47ee8c@pop.mindspring.com> X-Sender: pmturner@pop.mindspring.com X-Mailer: Windows Eudora Light Version 3.0.1 (16) Date: Mon, 22 Nov 1999 00:35:40 To: wilderness-emergency-medicine@list.pitt.edu From: Patton Turner Subject: Re: W-EMED The Benedryl trick In-Reply-To: <001f01bf33dd$307c3a60$214122cf@lana-s-computer> Mime-Version: 1.0 Content-Type: text/plain; charset="us-ascii" Sender: owner-wilderness-emergency-medicine@list.pitt.edu Precedence: bulk Reply-To: wilderness-emergency-medicine@list.pitt.edu X-PMFLAGS: 524416 0 1 P1E250.CNM Lana, Ana-Kit's come with 4 doses of chewable chlorpheniramine. I have wondered why it wasn't diphenhydramine (Benadryl), which is claimed to be faster acting. Prehaps it is the numbness problem. The USFS insect sting module in their first aid kits also contains chewable chlorpheniramine in addition to the Epi inhailer. As to the firefighter who felt this wasn't on topic, my only first hand experience with an alergic reaction came when strip firing behind a tractor-plow. The plow opened up a yellow jacket nest and they had about 60 seconds to get their act together before I walked right into them. The fact that the USFS puts a insect sting kit in every one of their first aid kits implies this isn't an uncommon event. Pat At 09:59 PM 11/20/99 -0700, you wrote: >HI folks, > > >>We use this often in patients who have mouth >>ulcers after recieving chemotherapy. Per the patients, the mix without >>the lidocaine is almost as effective in numbing their mouth as that with >>the lidocaine. >> >>Given this, I can certainly understand how this numbing of the tongue >>could be disconcerting to the patient who is having the allergic >>reaction. > > > >I find this an interesting line of discussion. I work at a Kid's camp where >those kids who have serious allergies OFTEN carry both epi-pen/ana-kit AND >Benedryl with them. > > Since lots of kids have a difficult time swollowing pills (especially when >having an allergic rxn) they often carry either tiny bottles of Benedryl >syrup (single or double dose sizes) >>OR<< Children's Chewable benedryl >tablets. > > The benedryl tablets are chewable, comparativley pleasently flavoured >(kinda grapey).. and don't seem to cause the tongue numbing thing (I tried >one). > Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- X-NAV-TimeoutProtection0: X X-NAV-TimeoutProtection1: X X-NAV-TimeoutProtection2: X X-NAV-TimeoutProtection3: X X-NAV-TimeoutProtection4: X X-NAV-TimeoutProtection5: X X-NAV-TimeoutProtection6: X X-NAV-TimeoutProtection7: X X-NAV-TimeoutProtection8: X Received: from post-ofc02.srv.cis.pitt.edu (root@post-ofc02.srv.cis.pitt.edu [136.142.185.24]) by pop.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cispop-7.2.2.1) ID ; Sun, 21 Nov 1999 19:08:15 -0500 (EST) Received: from localhost (root@localhost) by post-ofc02.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Sun, 21 Nov 1999 19:07:43 -0500 (EST) Received: via switchmail; Sun, 21 Nov 1999 19:07:42 -0500 (EST) Received: from list.srv.cis.pitt.edu via qmail ID ; Sun, 21 Nov 1999 19:05:46 -0500 (EST) Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.1) ID ; Sun, 21 Nov 1999 19:05:05 -0500 (EST) Received: from hotmail.com (oe24.law7.hotmail.com [216.33.236.244]) by list.srv.cis.pitt.edu with SMTP (8.8.8/8.8.8/cisls-7.2.2.1) ID for ; Sun, 21 Nov 1999 19:05:01 -0500 (EST) Received: (qmail 37744 invoked by uid 65534); 22 Nov 1999 00:04:30 -0000 Message-ID: <19991122000430.37743.qmail@hotmail.com> X-Originating-IP: [193.237.196.184] From: "Medilet" To: Subject: W-EMED Traumatic brain injury Date: Mon, 22 Nov 1999 00:00:23 -0000 MIME-Version: 1.0 Content-Type: multipart/alternative; boundary="----=_NextPart_000_0044_01BF347C.92F1C350" X-Priority: 3 X-MSMail-Priority: Normal X-Mailer: Microsoft Outlook Express 5.00.2314.1300 X-MimeOLE: Produced By Microsoft MimeOLE V5.00.2014.211 Sender: owner-wilderness-emergency-medicine@list.pitt.edu Precedence: bulk Reply-To: wilderness-emergency-medicine@list.pitt.edu X-PMFLAGS: 537395584 0 1 P69D60.CNM This is a multi-part message in MIME format. ------=_NextPart_000_0044_01BF347C.92F1C350 Content-Type: text/plain; charset="iso-8859-1" Content-Transfer-Encoding: quoted-printable As a medical student, I have completed some research into traumatic = brain injury. I thought that members of the list might find this of = interest and of help. It is available to download free at : = http://www.iqport.com/cgi-bin/asset?10567 James Dawson Medical Student ------=_NextPart_000_0044_01BF347C.92F1C350 Content-Type: text/html; charset="iso-8859-1" Content-Transfer-Encoding: quoted-printable
As a medical student, I have completed = some=20 research into traumatic brain injury. I thought that members of the list = might=20 find this of interest and of help.
 
It is available to download free at : = http://www.iqport.com/= cgi-bin/asset?10567

James=20 Dawson
Medical=20 Student
------=_NextPart_000_0044_01BF347C.92F1C350-- Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- X-NAV-TimeoutProtection0: X X-NAV-TimeoutProtection1: X X-NAV-TimeoutProtection2: X X-NAV-TimeoutProtection3: X X-NAV-TimeoutProtection4: X X-NAV-TimeoutProtection5: X X-NAV-TimeoutProtection6: X Received: from post-ofc07.srv.cis.pitt.edu (root@post-ofc07.srv.cis.pitt.edu [136.142.185.73]) by pop.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cispop-7.2.2.1) ID ; Sun, 21 Nov 1999 13:10:37 -0500 (EST) Received: from localhost (root@localhost) by post-ofc07.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.3) ID ; Sun, 21 Nov 1999 13:10:05 -0500 (EST) Received: via switchmail; Sun, 21 Nov 1999 13:10:04 -0500 (EST) Received: from list.srv.cis.pitt.edu via qmail ID ; Sun, 21 Nov 1999 13:09:51 -0500 (EST) Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.1) ID ; Sun, 21 Nov 1999 13:09:39 -0500 (EST) Received: from vop.nucleus.com (vop.nucleus.com [207.34.93.23]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.1) ID for ; Sun, 21 Nov 1999 13:09:36 -0500 (EST) Received: from lana-s-computer (unverified [207.34.65.29]) by vop.nucleus.com (Vircom SMTPRS 4.1.180) with SMTP id for ; Sun, 21 Nov 1999 11:09:35 -0700 Message-ID: <001201bf344b$7b0240c0$1d4122cf@lana-s-computer> From: "Lana Berrington" To: Subject: Re: W-EMED The Benedryl trick Date: Sun, 21 Nov 1999 11:08:56 -0700 MIME-Version: 1.0 Content-Type: text/plain; charset="iso-8859-1" Content-Transfer-Encoding: 7bit X-Priority: 3 X-MSMail-Priority: Normal X-Mailer: Microsoft Outlook Express 4.72.3110.1 X-MimeOLE: Produced By Microsoft MimeOLE V4.72.3110.3 Sender: owner-wilderness-emergency-medicine@list.pitt.edu Precedence: bulk Reply-To: wilderness-emergency-medicine@list.pitt.edu X-PMFLAGS: 524416 0 1 P77F00.CNM >tube" of each of my epi-pens... I carry two at all times. I often wondered >why they did not make a little compartment in the tube itself, since almost >everyone I know who carries an epi-pen also carries benedryl. >Do not reproduce without author's express permission. Hey! you could get rich with an idea like that. You could make little plastic cases with a compartment for an epi-pen, a compartment for benedryl.. and maybe a built in cellphone with '911' pre-dialed... maybe make it into a fanny-pack.. I can see it now Lana Berrington, EMT-A Calgary, Canada Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- X-NAV-TimeoutProtection0: X X-NAV-TimeoutProtection1: X X-NAV-TimeoutProtection2: X X-NAV-TimeoutProtection3: X X-NAV-TimeoutProtection4: X X-NAV-TimeoutProtection5: X X-NAV-TimeoutProtection6: X Received: from post-ofc07.srv.cis.pitt.edu (root@post-ofc07.srv.cis.pitt.edu [136.142.185.73]) by pop.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cispop-7.2.2.1) ID ; Sun, 21 Nov 1999 12:27:19 -0500 (EST) Received: from localhost (root@localhost) by post-ofc07.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.3) ID ; Sun, 21 Nov 1999 12:26:47 -0500 (EST) Received: via switchmail; Sun, 21 Nov 1999 12:26:47 -0500 (EST) Received: from list.srv.cis.pitt.edu via qmail ID ; Sun, 21 Nov 1999 12:25:59 -0500 (EST) Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.1) ID ; Sun, 21 Nov 1999 12:25:40 -0500 (EST) Received: from post-ofc06.srv.cis.pitt.edu (root@post-ofc06.srv.cis.pitt.edu [136.142.185.43]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.1) ID for ; Sun, 21 Nov 1999 12:25:37 -0500 (EST) Received: from micron (ehdup-t-63.rmt.net.pitt.edu [136.142.23.73]) by post-ofc06.srv.cis.pitt.edu with SMTP (8.8.8/8.8.8/cispo-7.2.2.3) ID ; Sun, 21 Nov 1999 12:25:33 -0500 (EST) Message-Id: <199911211725.MAA04550@post-ofc06.srv.cis.pitt.edu> From: "Keith Conover, M.D., FACEP" To: Bensquire@aol.com Date: Sun, 21 Nov 1999 12:25:29 -0500 MIME-Version: 1.0 Content-type: text/plain; charset=US-ASCII Content-transfer-encoding: 7BIT Subject: W-EMED Re: Pain Relief in the backcountry. CC: wilderness-emergency-medicine@list.pitt.edu In-reply-to: <0.70029b24.2568f867@aol.com> X-mailer: Pegasus Mail for Win32 (v3.11) Sender: owner-wilderness-emergency-medicine@list.pitt.edu Precedence: bulk Reply-To: wilderness-emergency-medicine@list.pitt.edu X-PMFLAGS: 524416 0 1 P72340.CNM The spasm of the ureters is mediated by prostacyclin -- and NSAIDs specifically target this, as well as decreasing GFR (glomerular filtration rate) in the kidney, as well as affecting pain in the spinal cord. So NSAIDs not only cover up the pain of a kidney stone, they decrease the underlying problem. I've seen a vomiting kidney stone patient (a large man, to be true) get minimal relief from a total of 150 mg of Demerol (e.g., meperidine, Pethidine) but get good relief with 30 mg IV Toradol (ketorolac). Lest more people sign off because this isn't relevant to wilderness situations , let me point out that this shows that a NSAID (any NSAID, including OTC drugs like ibuprofen = Advil, Nuprin, Peidaprofen, Brufen, or naproxen = Aleve) is ideal for anyone in the wilderness with a kidney stone. If vomiting, crush the pill and mix with a litle chocolate and make an improvised rectal suppostory. Dosage of ibuprofen for this indication would be 800 mg up to 4x/day (same oral and rectal dosage) -- MUCH higher than the dosage used for pain. Indeed, I am religious about teaching my residents NOT to prescribe big prescription doses for musculoskeletal pain. The OTC dosage (200 mg tabs, 1-2 every 4 hours as needed for pain, or usually about 1400 mg/day max) works just as well as the usual prescription strengh used for things like rheumatoid arthritis (800 TID=3x/day, or 600 QID=4x/day, total of 2400mg/day). But the bigger dose, even when used appropriately for rheumatoid arthritis, has a lot more likelihood of causing complications: GI upset, gastric ulcers or gastritis with GI bleeding, or, if the person gets dehydrated or has diabetes or both, renal failure. Moral: carry ibuprofen (OTC type). Use as it says on the bottle UNLESS the patient has kidney stones. Take care. On 21 Nov 99, at 2:25, Bensquire@aol.com wrote: > In a message dated 11/20/1999 4:08:43 PM Pacific Standard Time, > kconover+@pitt.edu writes: > > << In the past, I've used Toradol IM or IV during rescues, but due to the > following study (one done by a group of colleagues at our hospital), I > reserve Toradol solely for those with renal colic and vomiting. >> > > I've seen Toradol given in the hospital for kidney stones. Why is it > effective for this specific type of pain? > > Ben > --Keith Conover, M.D., FACEP http://www.pitt.edu/~kconover Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- X-NAV-TimeoutProtection0: X X-NAV-TimeoutProtection1: X X-NAV-TimeoutProtection2: X X-NAV-TimeoutProtection3: X X-NAV-TimeoutProtection4: X X-NAV-TimeoutProtection5: X X-NAV-TimeoutProtection6: X Received: from post-ofc02.srv.cis.pitt.edu (root@post-ofc02.srv.cis.pitt.edu [136.142.185.24]) by pop.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cispop-7.2.2.1) ID ; Sun, 21 Nov 1999 10:28:35 -0500 (EST) Received: from localhost (root@localhost) by post-ofc02.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Sun, 21 Nov 1999 10:28:01 -0500 (EST) Received: via switchmail; Sun, 21 Nov 1999 10:28:01 -0500 (EST) Received: from list.srv.cis.pitt.edu via qmail ID ; Sun, 21 Nov 1999 10:26:03 -0500 (EST) Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.1) ID ; Sun, 21 Nov 1999 10:25:31 -0500 (EST) Received: from imo19.mx.aol.com (imo19.mx.aol.com [198.81.17.9]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.1) ID for ; Sun, 21 Nov 1999 10:25:27 -0500 (EST) From: Bighoss19@aol.com Received: from Bighoss19@aol.com by imo19.mx.aol.com (mail_out_v24.4.) id h.0.170f82d3 (4247) for ; Sun, 21 Nov 1999 10:24:50 -0500 (EST) Message-ID: <0.170f82d3.256968c2@aol.com> Date: Sun, 21 Nov 1999 10:24:50 EST Subject: Re: W-EMED anyone actually been out the woods lately - c-ya To: wilderness-emergency-medicine@list.pitt.edu MIME-Version: 1.0 Content-Type: text/plain; charset="us-ascii" Content-Transfer-Encoding: 7bit X-Mailer: Windows AOL sub 45 Sender: owner-wilderness-emergency-medicine@list.pitt.edu Precedence: bulk Reply-To: wilderness-emergency-medicine@list.pitt.edu X-PMFLAGS: 524416 0 1 P3E4D0.CNM At first the discussion about Stupid Anaphylaxis Tricks seem interesting but I think it is getting off topic so I am signing off the list -- someone let me know when the Wilderness part of this list returns! Ed Harvey Firefighter/EMT New Marlborough, MA http://www.fire-ems.net/firedept/view/SouthfiledMA/ The possibilities are endless! Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- X-NAV-TimeoutProtection0: X X-NAV-TimeoutProtection1: X X-NAV-TimeoutProtection2: X X-NAV-TimeoutProtection3: X X-NAV-TimeoutProtection4: X X-NAV-TimeoutProtection5: X X-NAV-TimeoutProtection6: X Received: from post-ofc06.srv.cis.pitt.edu (root@post-ofc06.srv.cis.pitt.edu [136.142.185.43]) by pop.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cispop-7.2.2.1) ID ; Sun, 21 Nov 1999 03:50:49 -0500 (EST) Received: from localhost (root@localhost) by post-ofc06.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.3) ID ; Sun, 21 Nov 1999 03:50:16 -0500 (EST) Received: via switchmail; Sun, 21 Nov 1999 03:50:16 -0500 (EST) Received: from list.srv.cis.pitt.edu via qmail ID ; Sun, 21 Nov 1999 03:50:14 -0500 (EST) Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.1) ID ; Sun, 21 Nov 1999 03:49:59 -0500 (EST) Received: from mail-01.cdsnet.net (mail-01.cdsnet.net [206.107.16.35]) by list.srv.cis.pitt.edu with SMTP (8.8.8/8.8.8/cisls-7.2.2.1) ID for ; Sun, 21 Nov 1999 03:49:55 -0500 (EST) Received: (qmail 13133 invoked from network); 21 Nov 1999 08:49:53 -0000 Received: from d01a88a8.dip.cdsnet.net (HELO internetcds.com) (208.26.136.168) by mail.cdsnet.net with SMTP; 21 Nov 1999 08:49:53 -0000 Message-ID: <3837B208.3CACDCB9@internetcds.com> Date: Sun, 21 Nov 1999 00:49:12 -0800 From: Ron Shenker X-Mailer: Mozilla 4.05 [en]C-CDSN3_98 (Win95; I) MIME-Version: 1.0 To: wilderness-emergency-medicine@list.pitt.edu Subject: Re: W-EMED Stupid Anaphylaxis Trick # 1 (was "rapid sulingual absorption) References: <0.5fabe5e1.2565f5d1@aol.com> <3834D7E2.5EA3623D@main-net.com> <3835FB91.AD21B663@internetcds.com> <3835A222.31649EA2@icon.co.za> Content-Type: text/plain; charset=us-ascii Content-Transfer-Encoding: 7bit Sender: owner-wilderness-emergency-medicine@list.pitt.edu Precedence: bulk Reply-To: wilderness-emergency-medicine@list.pitt.edu X-PMFLAGS: 524416 0 1 P23B90.CNM Arthur, I was responding to a post that called Benadryl an amide local anesthetic, which it is not. Of course we all know that many drugs have anesthetic type side effects including H 1 blockers And I surely agree with you, don't believe all of what drug companies try to tell us. Ron Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- X-NAV-TimeoutProtection0: X X-NAV-TimeoutProtection1: X X-NAV-TimeoutProtection2: X X-NAV-TimeoutProtection3: X X-NAV-TimeoutProtection4: X X-NAV-TimeoutProtection5: X X-NAV-TimeoutProtection6: X Received: from post-ofc06.srv.cis.pitt.edu (root@post-ofc06.srv.cis.pitt.edu [136.142.185.43]) by pop.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cispop-7.2.2.1) ID ; Sun, 21 Nov 1999 03:07:40 -0500 (EST) Received: from localhost (root@localhost) by post-ofc06.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.3) ID ; Sun, 21 Nov 1999 03:07:07 -0500 (EST) Received: via switchmail; Sun, 21 Nov 1999 03:07:07 -0500 (EST) Received: from list.srv.cis.pitt.edu via qmail ID ; Sun, 21 Nov 1999 03:06:53 -0500 (EST) Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.1) ID ; Sun, 21 Nov 1999 03:06:39 -0500 (EST) Received: from mail-01.cdsnet.net (mail-01.cdsnet.net [206.107.16.35]) by list.srv.cis.pitt.edu with SMTP (8.8.8/8.8.8/cisls-7.2.2.1) ID for ; Sun, 21 Nov 1999 03:06:35 -0500 (EST) Received: (qmail 26680 invoked from network); 21 Nov 1999 08:06:34 -0000 Received: from d01a88a8.dip.cdsnet.net (HELO internetcds.com) (208.26.136.168) by mail.cdsnet.net with SMTP; 21 Nov 1999 08:06:34 -0000 Message-ID: <3837A7E0.E21173C1@internetcds.com> Date: Sun, 21 Nov 1999 00:05:52 -0800 From: Ron Shenker X-Mailer: Mozilla 4.05 [en]C-CDSN3_98 (Win95; I) MIME-Version: 1.0 To: wilderness-emergency-medicine@list.pitt.edu Subject: Re: W-EMED Stupid Anaphylaxis Trick # 1 (was "rapid sulingual absorption) References: <0.5fabe5e1.2565f5d1@aol.com> <3834D7E2.5EA3623D@main-net.com> <3835FB91.AD21B663@internetcds.com> <3837110C.5B466F0A@sprynet.com> Content-Type: text/plain; charset=us-ascii Content-Transfer-Encoding: 7bit Sender: owner-wilderness-emergency-medicine@list.pitt.edu Precedence: bulk Reply-To: wilderness-emergency-medicine@list.pitt.edu X-PMFLAGS: 524416 0 1 P52DA0.CNM Try injecting saline "anesthetic" and no problem with tissue necrosis. Many chemicals injected into tissue can have "anesthetic like", numbing, results. H1 blockers do possess some local anesthetic action and Promethazine [Phenergan] is one that is specifically mentioned as being especially active. I wouldn't use it. In 30 yrs of administering anesthesia I have yet to come across a true Lidocaine allergic pt. I'm not saying that such a pt does not exist just that it has to be extremely rare. The claims of allergy to Lido most of the time are not documented, may be due to the preservatives in the local anes. confused with procaine or the most common hx is... "I received Lidocaine at the DENTIST and I had a terrible reaction. Right after injection my heart started beating so fast that I thought I was going to die. I almost passed out They had to give me Oxygen. The dentist said I had a bad reaction to Lidocaine". Sound familiar? And then some well meaning doc writes on the pts history, "Allergy to Lidocaine". Try skin testing these people. We are doing them a big favor by finding out that Amide locals are OK for them. They might really have a need for a regional anesthetic some time, not just a laceration sutured. I hope these lacerations you close using Benadryl are fairly small. I am imagining some pt getting 250-500 mg of drug. Then we could also give Benadyl credit for being a general anesthetic. I won't belabor this any more. Sorry getting into it this far. Ron Shenker CRNA Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- X-NAV-TimeoutProtection0: X X-NAV-TimeoutProtection1: X X-NAV-TimeoutProtection2: X X-NAV-TimeoutProtection3: X X-NAV-TimeoutProtection4: X X-NAV-TimeoutProtection5: X X-NAV-TimeoutProtection6: X Received: from post-ofc04.srv.cis.pitt.edu (root@post-ofc04.srv.cis.pitt.edu [136.142.185.11]) by pop.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cispop-7.2.2.1) ID ; Sat, 20 Nov 1999 22:24:18 -0500 (EST) Received: from localhost (root@localhost) by post-ofc04.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Sat, 20 Nov 1999 22:23:44 -0500 (EST) Received: via switchmail; Sat, 20 Nov 1999 22:23:44 -0500 (EST) Received: from list.srv.cis.pitt.edu via qmail ID ; Sat, 20 Nov 1999 22:23:01 -0500 (EST) Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.1) ID ; Sat, 20 Nov 1999 22:22:02 -0500 (EST) Received: from pol.net (sigma.po.com [204.178.220.39]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.1) ID for ; Sat, 20 Nov 1999 22:21:59 -0500 (EST) Received: from LOCALNAME (1Cust142.tnt4.morgantown.wv.da.uu.net [63.15.80.142]) by pol.net (8.9.3/8.8.8) with SMTP id WAA19431 for ; Sat, 20 Nov 1999 22:20:07 -0500 (EST) Message-ID: <383797D6.336@pol.net> Date: Sat, 20 Nov 1999 22:57:26 -0800 From: Charles Werntz Organization: West Virginia University - Internal Medicine X-Mailer: Mozilla 3.0C-POLNET134 (Win16; U) MIME-Version: 1.0 To: wilderness-emergency-medicine@list.pitt.edu Subject: W-EMED Re: Stupid Anaphylaxis Trick # 1 References: <0.5fabe5e1.2565f5d1@aol.com> <3834D7E2.5EA3623D@main-net.com> <3835FB91.AD21B663@internetcds.com> <3837110C.5B466F0A@sprynet.com> Content-Type: text/plain; charset=us-ascii Content-Transfer-Encoding: 7bit Sender: owner-wilderness-emergency-medicine@list.pitt.edu Precedence: bulk Reply-To: wilderness-emergency-medicine@list.pitt.edu X-PMFLAGS: 524416 0 1 P4BDE0.CNM FWIW, diphenhydramine does have some topical analgesic effects, at least on mucosal surfaces. We often use it as a component of the "magic swizzle" concoction for patients with mouth ulcers. (This concoction of maalox, diphenhydramine, and occasionally lidocaine has different names in different regions). We use this often in patients who have mouth ulcers after recieving chemotherapy. Per the patients, the mix without the lidocaine is almost as effective in numbing their mouth as that with the lidocaine. Given this, I can certainly understand how this numbing of the tongue could be disconcerting to the patient who is having the allergic reaction. Carl Werntz, D.O. Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- X-NAV-TimeoutProtection0: X X-NAV-TimeoutProtection1: X X-NAV-TimeoutProtection2: X X-NAV-TimeoutProtection3: X X-NAV-TimeoutProtection4: X X-NAV-TimeoutProtection5: X X-NAV-TimeoutProtection6: X Received: from post-ofc04.srv.cis.pitt.edu (root@post-ofc04.srv.cis.pitt.edu [136.142.185.11]) by pop.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cispop-7.2.2.1) ID ; Sun, 21 Nov 1999 01:55:29 -0500 (EST) Received: from localhost (root@localhost) by post-ofc04.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Sun, 21 Nov 1999 01:54:58 -0500 (EST) Received: via switchmail; Sun, 21 Nov 1999 01:54:58 -0500 (EST) Received: from list.srv.cis.pitt.edu via qmail ID ; Sun, 21 Nov 1999 01:54:52 -0500 (EST) Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.1) ID ; Sun, 21 Nov 1999 01:54:38 -0500 (EST) Received: from mail-01.cdsnet.net (mail-01.cdsnet.net [206.107.16.35]) by list.srv.cis.pitt.edu with SMTP (8.8.8/8.8.8/cisls-7.2.2.1) ID for ; Sun, 21 Nov 1999 01:54:35 -0500 (EST) Received: (qmail 24311 invoked from network); 21 Nov 1999 06:54:33 -0000 Received: from d01a88a8.dip.cdsnet.net (HELO internetcds.com) (208.26.136.168) by mail.cdsnet.net with SMTP; 21 Nov 1999 06:54:33 -0000 Message-ID: <383796FF.A1D59DD9@internetcds.com> Date: Sat, 20 Nov 1999 22:53:52 -0800 From: Ron Shenker X-Mailer: Mozilla 4.05 [en]C-CDSN3_98 (Win95; I) MIME-Version: 1.0 To: wilderness-emergency-medicine@list.pitt.edu Subject: Re: W-EMED Stupid Anaphylaxis Trick # 1 (was "rapid sulingual absorption) References: Content-Type: text/plain; charset=us-ascii Content-Transfer-Encoding: 7bit Sender: owner-wilderness-emergency-medicine@list.pitt.edu Precedence: bulk Reply-To: wilderness-emergency-medicine@list.pitt.edu X-PMFLAGS: 524416 0 1 P65FE0.CNM Purely theoretical, Russ. It's just not used. Intradermal saline has an anesthetic action and is used frequently for inserting IVs but its not an anesthetic. Neither is ice. Ron Shenker CRNA Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- X-NAV-TimeoutProtection0: X X-NAV-TimeoutProtection1: X X-NAV-TimeoutProtection2: X X-NAV-TimeoutProtection3: X X-NAV-TimeoutProtection4: X X-NAV-TimeoutProtection5: X X-NAV-TimeoutProtection6: X Received: from post-ofc04.srv.cis.pitt.edu (root@post-ofc04.srv.cis.pitt.edu [136.142.185.11]) by pop.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cispop-7.2.2.1) ID ; Sun, 21 Nov 1999 00:02:26 -0500 (EST) Received: from localhost (root@localhost) by post-ofc04.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Sun, 21 Nov 1999 00:01:54 -0500 (EST) Received: via switchmail; Sun, 21 Nov 1999 00:01:54 -0500 (EST) Received: from list.srv.cis.pitt.edu via qmail ID ; Sun, 21 Nov 1999 00:00:53 -0500 (EST) Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.1) ID ; Sun, 21 Nov 1999 00:00:22 -0500 (EST) Received: from vop.nucleus.com (vop.nucleus.com [207.34.93.23]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.1) ID for ; Sun, 21 Nov 1999 00:00:16 -0500 (EST) Received: from lana-s-computer (unverified [207.34.65.33]) by vop.nucleus.com (Vircom SMTPRS 4.1.180) with SMTP id for ; Sat, 20 Nov 1999 22:00:05 -0700 Message-ID: <001f01bf33dd$307c3a60$214122cf@lana-s-computer> From: "Lana Berrington" To: Subject: W-EMED The Benedryl trick Date: Sat, 20 Nov 1999 21:59:27 -0700 MIME-Version: 1.0 Content-Type: text/plain; charset="iso-8859-1" Content-Transfer-Encoding: 7bit X-Priority: 3 X-MSMail-Priority: Normal X-Mailer: Microsoft Outlook Express 4.72.3110.1 X-MimeOLE: Produced By Microsoft MimeOLE V4.72.3110.3 Sender: owner-wilderness-emergency-medicine@list.pitt.edu Precedence: bulk Reply-To: wilderness-emergency-medicine@list.pitt.edu X-PMFLAGS: 524416 0 1 P5B660.CNM HI folks, >We use this often in patients who have mouth >ulcers after recieving chemotherapy. Per the patients, the mix without >the lidocaine is almost as effective in numbing their mouth as that with >the lidocaine. > >Given this, I can certainly understand how this numbing of the tongue >could be disconcerting to the patient who is having the allergic >reaction. I find this an interesting line of discussion. I work at a Kid's camp where those kids who have serious allergies OFTEN carry both epi-pen/ana-kit AND Benedryl with them. Since lots of kids have a difficult time swollowing pills (especially when having an allergic rxn) they often carry either tiny bottles of Benedryl syrup (single or double dose sizes) >>OR<< Children's Chewable benedryl tablets. The benedryl tablets are chewable, comparativley pleasently flavoured (kinda grapey).. and don't seem to cause the tongue numbing thing (I tried one). I was wondering if one couldn't use the 'chew the benedryl' trick just with a scaled-up dose of childrens chewables. - of course you'd have to take more than the kid's dose.. (not sure how much.. probably 4 or 5 to equal 2 adult caplets).. but It likely wouldn't make you want to VOMIT like chewing the little pink numbers do. Just a thought Lana Berrington, EMT-A Calgary, Canada Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- X-NAV-TimeoutProtection0: X X-NAV-TimeoutProtection1: X X-NAV-TimeoutProtection2: X X-NAV-TimeoutProtection3: X X-NAV-TimeoutProtection4: X X-NAV-TimeoutProtection5: X X-NAV-TimeoutProtection6: X Received: from post-ofc09.srv.cis.pitt.edu (root@post-ofc09.srv.cis.pitt.edu [136.142.185.57]) by pop.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cispop-7.2.2.1) ID for ; Sun, 21 Nov 1999 02:26:01 -0500 (EST) From: Bensquire@aol.com Received: from localhost (root@localhost) by post-ofc09.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.3) ID for kconover@pop.pitt.edu; Sun, 21 Nov 1999 02:26:00 -0500 (EST) Received: via switchmail for kconover+@pitt.edu; Sun, 21 Nov 1999 02:26:00 -0500 (EST) Received: from imo-d09.mx.aol.com (imo-d09.mx.aol.com [205.188.157.41]) by post-ofc09.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cispo-7.2.2.3) ID for ; Sun, 21 Nov 1999 02:26:00 -0500 (EST) Received: from Bensquire@aol.com by imo-d09.mx.aol.com (mail_out_v24.4.) id h.0.70029b24 (4207) for ; Sun, 21 Nov 1999 02:25:27 -0500 (EST) Message-ID: <0.70029b24.2568f867@aol.com> Date: Sun, 21 Nov 1999 02:25:27 EST Subject: Re: Pain Relief in the backcountry. To: kconover+@pitt.edu MIME-Version: 1.0 Content-Type: text/plain; charset="us-ascii" Content-Transfer-Encoding: 7bit X-Mailer: Windows AOL sub 44 X-PMFLAGS: 1572992 0 1 P49C20.CNM In a message dated 11/20/1999 4:08:43 PM Pacific Standard Time, kconover+@pitt.edu writes: << In the past, I've used Toradol IM or IV during rescues, but due to the following study (one done by a group of colleagues at our hospital), I reserve Toradol solely for those with renal colic and vomiting. >> I've seen Toradol given in the hospital for kidney stones. Why is it effective for this specific type of pain? Ben -- End -- X-NAV-TimeoutProtection0: X X-NAV-TimeoutProtection1: X X-NAV-TimeoutProtection2: X X-NAV-TimeoutProtection3: X X-NAV-TimeoutProtection4: X X-NAV-TimeoutProtection5: X X-NAV-TimeoutProtection6: X Received: from post-ofc01.srv.cis.pitt.edu (root@post-ofc01.srv.cis.pitt.edu [136.142.185.25]) by pop.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cispop-7.2.2.1) ID ; Sun, 21 Nov 1999 02:27:22 -0500 (EST) Received: from localhost (root@localhost) by post-ofc01.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.3) ID ; Sun, 21 Nov 1999 02:26:51 -0500 (EST) Received: via switchmail; Sun, 21 Nov 1999 02:26:51 -0500 (EST) Received: from list.srv.cis.pitt.edu via qmail ID ; Sun, 21 Nov 1999 01:29:44 -0500 (EST) Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.1) ID ; Sun, 21 Nov 1999 01:29:25 -0500 (EST) Received: from imo28.mx.aol.com (imo28.mx.aol.com [152.163.225.72]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.1) ID for ; Sun, 21 Nov 1999 01:29:23 -0500 (EST) From: KE4WKR@aol.com Received: from KE4WKR@aol.com by imo28.mx.aol.com (mail_out_v24.4.) id h.0.d21ff098 (4389) for ; Sun, 21 Nov 1999 01:28:39 -0500 (EST) Message-ID: <0.d21ff098.2568eb17@aol.com> Date: Sun, 21 Nov 1999 01:28:39 EST Subject: Re: W-EMED The Benedryl trick To: wilderness-emergency-medicine@list.pitt.edu MIME-Version: 1.0 Content-Type: text/plain; charset="us-ascii" Content-Transfer-Encoding: 7bit X-Mailer: AOL 4.0 for Windows 95 sub 228 Sender: owner-wilderness-emergency-medicine@list.pitt.edu Precedence: bulk Reply-To: wilderness-emergency-medicine@list.pitt.edu X-PMFLAGS: 524416 0 1 P52DC0.CNM In a message dated 11/21/1999 12:23:00 AM Eastern Standard Time, lana@nucleus.com writes: > I was wondering if one couldn't use the 'chew the benedryl' trick just > with a scaled-up dose of children's chewables. - of course you'd have to > take more than the kid's dose.. (not sure how much.. probably 4 or 5 to > equal 2 adult caplets).. but It likely wouldn't make you want to VOMIT > like chewing the little pink numbers do. > Hm...interesting idea...next time I go to the drug store, I will look and see how many. would equal 50 mg. I personally have never gotten to the point where I could not swallow benedryl caps though, and it is quite convenient to slip 2 tablets of benedryl in their bubble wrappings into the yellow "carry tube" of each of my epi-pens... I carry two at all times. I often wondered why they did not make a little compartment in the tube itself, since almost everyone I know who carries an epi-pen also carries benedryl. Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- X-NAV-TimeoutProtection0: X X-NAV-TimeoutProtection1: X X-NAV-TimeoutProtection2: X X-NAV-TimeoutProtection3: X X-NAV-TimeoutProtection4: X X-NAV-TimeoutProtection5: X X-NAV-TimeoutProtection6: X Received: from post-ofc07.srv.cis.pitt.edu (root@post-ofc07.srv.cis.pitt.edu [136.142.185.73]) by pop.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cispop-7.2.2.1) ID ; Sat, 20 Nov 1999 16:23:43 -0500 (EST) Received: from localhost (root@localhost) by post-ofc07.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.3) ID ; Sat, 20 Nov 1999 16:23:10 -0500 (EST) Received: via switchmail; Sat, 20 Nov 1999 16:23:10 -0500 (EST) Received: from list.srv.cis.pitt.edu via qmail ID ; Sat, 20 Nov 1999 16:21:59 -0500 (EST) Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.1) ID ; Sat, 20 Nov 1999 16:21:26 -0500 (EST) Received: from smtp6.mindspring.com (smtp6.mindspring.com [207.69.200.110]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.1) ID for ; Sat, 20 Nov 1999 16:21:23 -0500 (EST) Received: from sprynet.com (pool-207-205-182-99.phnx.grid.net [207.205.182.99]) by smtp6.mindspring.com (8.8.5/8.8.5) with ESMTP id QAA10934 for ; Sat, 20 Nov 1999 16:21:16 -0500 (EST) Message-ID: <3837110C.5B466F0A@sprynet.com> Date: Sat, 20 Nov 1999 14:22:20 -0700 From: "Ron Brace MD, FACEP" X-Mailer: Mozilla 4.7 [en] (Win98; U) X-Accept-Language: en MIME-Version: 1.0 To: wilderness-emergency-medicine@list.pitt.edu Subject: Re: W-EMED Stupid Anaphylaxis Trick # 1 (was "rapid sulingual absorption) References: <0.5fabe5e1.2565f5d1@aol.com> <3834D7E2.5EA3623D@main-net.com> <3835FB91.AD21B663@internetcds.com> Content-Type: text/plain; charset=us-ascii Content-Transfer-Encoding: 7bit Sender: owner-wilderness-emergency-medicine@list.pitt.edu Precedence: bulk Reply-To: wilderness-emergency-medicine@list.pitt.edu X-PMFLAGS: 524416 0 1 P35AE0.CNM Sorry to say so, but benadryl is a local anesthetic. I also have used diphenhydramine as a local anesthetic in those individuals with documented allergy to lidocaine. It is almost always effective but there is a slight risk of tissue necrosis that I have seen only once. My Residency program actually was involved in a study of diphenhydramine as a local anesthetic many years ago, but I do not know if it was published. In "Wounds and Lacerations, Emergency Care and Closure" by Alexander Trott, MD, 1991, diphenhydramine is a recommended alternative in cases of allergy. Ron Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- X-NAV-TimeoutProtection0: X X-NAV-TimeoutProtection1: X X-NAV-TimeoutProtection2: X X-NAV-TimeoutProtection3: X X-NAV-TimeoutProtection4: X X-NAV-TimeoutProtection5: X X-NAV-TimeoutProtection6: X Received: from post-ofc06.srv.cis.pitt.edu (root@post-ofc06.srv.cis.pitt.edu [136.142.185.43]) by pop.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cispop-7.2.2.1) ID ; Sun, 21 Nov 1999 14:22:00 -0500 (EST) Received: from localhost (root@localhost) by post-ofc06.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.3) ID ; Sun, 21 Nov 1999 14:21:26 -0500 (EST) Received: via switchmail; Sun, 21 Nov 1999 14:21:26 -0500 (EST) Received: from list.srv.cis.pitt.edu via qmail ID ; Sun, 21 Nov 1999 14:20:38 -0500 (EST) Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.1) ID ; Sun, 21 Nov 1999 14:20:15 -0500 (EST) Received: from cgi.icon.co.za (cgi.icon.co.za [196.35.95.41]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.1) ID for ; Sun, 21 Nov 1999 14:20:06 -0500 (EST) Received: from mail450.icon.co.za (smtp.icon.co.za [196.35.95.40]) by cgi.icon.co.za (Postfix) with ESMTP id 1E86E465AB for ; Sun, 21 Nov 1999 21:25:13 +0200 (SAST) Received: from icon.co.za (a1-jhb-63.dial-up.net [196.26.223.63]) by mail450.icon.co.za (8.9.3/8.9.3) with ESMTP id VAA24042 for ; Sun, 21 Nov 1999 21:19:50 +0200 (GMT) Message-ID: <3836FF89.3EB75BAF@icon.co.za> Date: Sat, 20 Nov 1999 22:07:37 +0200 From: Arthur Morgan X-Mailer: Mozilla 4.7 [en] (Win95; I) X-Accept-Language: en-GB,en,en-US,af,pl MIME-Version: 1.0 To: wilderness-emergency-medicine@list.pitt.edu Subject: Re: W-EMED Last minute comments on Wilderness Medical Kits References: <199911210021_MC2-8DF7-F919@compuserve.com> Content-Type: text/plain; charset=us-ascii Content-Transfer-Encoding: 7bit Sender: owner-wilderness-emergency-medicine@list.pitt.edu Precedence: bulk Reply-To: wilderness-emergency-medicine@list.pitt.edu X-PMFLAGS: 524416 0 1 P5BA60.CNM Darren, The papers showing uptake are measuring the amount absorbed into the cells in a test tube - minute amounts. The one against shows that insufficient glucose is absorbed through the mouth mucosa to increase the blood glucose by a measurable amount in a person. Once the patient is not able to swallow intravenous glucose is the only way to go. ( I have no experience with techniques such as via a stomach tube, into the marrow cavity of the tibia, or rectal, all of which should work well). Arthur Darren Walter wrote: > > >If someone wil do a search, I think you will find there was an exquisit > research project using labelled glucose, that proved (consistent with the > physiology of the buccal mucosa)that the sugar was NOT absorbed there!< > > Since I posted in favour of oral absorption of dextrose, both from teaching > and personal experience I felt obliged to back my position. A search of > Medline revealed 2 for and 1 against. The titles have already been listed > by Russell McMullen, but I enclose the abstracts as well. > Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- X-NAV-TimeoutProtection0: X X-NAV-TimeoutProtection1: X X-NAV-TimeoutProtection2: X X-NAV-TimeoutProtection3: X X-NAV-TimeoutProtection4: X X-NAV-TimeoutProtection5: X X-NAV-TimeoutProtection6: X Received: from post-ofc05.srv.cis.pitt.edu (root@post-ofc05.srv.cis.pitt.edu [136.142.185.10]) by pop.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cispop-7.2.2.1) ID ; Fri, 19 Nov 1999 22:46:17 -0500 (EST) Received: from localhost (root@localhost) by post-ofc05.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Fri, 19 Nov 1999 22:45:41 -0500 (EST) Received: via switchmail; Fri, 19 Nov 1999 22:45:37 -0500 (EST) Received: from list.srv.cis.pitt.edu via qmail ID ; Fri, 19 Nov 1999 22:43:42 -0500 (EST) Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.1) ID ; Fri, 19 Nov 1999 22:43:14 -0500 (EST) Received: from jason02.u.washington.edu (root@jason02.u.washington.edu [140.142.76.8]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.1) ID for ; Fri, 19 Nov 1999 22:43:11 -0500 (EST) Received: from aagaard02.u.washington.edu (mcmullen@aagaard02.u.washington.edu [140.142.14.4]) by jason02.u.washington.edu (8.9.3+UW99.09/8.9.3+UW99.09) with ESMTP id TAA30308 for ; Fri, 19 Nov 1999 19:43:10 -0800 Received: from localhost (mcmullen@localhost) by aagaard02.u.washington.edu (8.9.3+UW99.09/8.9.3+UW99.09) with ESMTP id TAA234178 for ; Fri, 19 Nov 1999 19:43:09 -0800 Date: Fri, 19 Nov 1999 19:43:09 -0800 (PST) From: Russell McMullen To: wilderness-emergency-medicine@list.pitt.edu Subject: Re: W-EMED Stupid Anaphylaxis Trick # 1 (was "rapid sulingual absorption) In-Reply-To: <3835FB91.AD21B663@internetcds.com> Message-ID: MIME-Version: 1.0 Content-Type: TEXT/PLAIN; charset=US-ASCII Sender: owner-wilderness-emergency-medicine@list.pitt.edu Precedence: bulk Reply-To: wilderness-emergency-medicine@list.pitt.edu X-PMFLAGS: 524416 0 1 P0EAF0.CNM Diphenhydramine [Benedryl] has anesthetic properties and has been recommended as an alternative for local infiltration in those rare individuals who are truly allergic to other local anesthetics. Onset is slower and duration shorter. Norris has a brief discussion about this, citing references, in the Emergency Medicine Clinics of North America [Norris RL, Jr. Local Anesthetics. Emerg Med Clin North Amer 1992 volume 10, Number 4, p.713]. Russell McMullen, M.D. Seattle, WA On Fri, 19 Nov 1999, Ron Shenker wrote: > Eric, > You are very wrong. Benadryl[diphenylhydramamine] is NOT an > anesthetic,amide, ester or any other kind and its not used for local > anes. It is an antihistamine. > Ester anesthetics are rarely used for local infilltration. Lidocaine is > the most frequently used local anes. and it is an amide. > Better dig out your pharm. texts and review before posting misleading > info on this list. > Ron Shenker CRNA > Grants Pass Oregon > Do not reproduce without author's express permission. > To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" > as the body of a message (no subject) To: Majordomo@list.pitt.edu > Submissions To: wilderness-emergency-medicine@list.pitt.edu > Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- X-NAV-TimeoutProtection0: X X-NAV-TimeoutProtection1: X X-NAV-TimeoutProtection2: X X-NAV-TimeoutProtection3: X X-NAV-TimeoutProtection4: X X-NAV-TimeoutProtection5: X X-NAV-TimeoutProtection6: X Received: from post-ofc07.srv.cis.pitt.edu (root@post-ofc07.srv.cis.pitt.edu [136.142.185.73]) by pop.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cispop-7.2.2.1) ID ; Fri, 19 Nov 1999 20:41:23 -0500 (EST) Received: from localhost (root@localhost) by post-ofc07.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.3) ID ; Fri, 19 Nov 1999 20:40:52 -0500 (EST) Received: via switchmail; Fri, 19 Nov 1999 20:40:51 -0500 (EST) Received: from list.srv.cis.pitt.edu via qmail ID ; Fri, 19 Nov 1999 20:40:06 -0500 (EST) Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.1) ID ; Fri, 19 Nov 1999 20:39:29 -0500 (EST) Received: from mail-01.cdsnet.net (mail-01.cdsnet.net [206.107.16.35]) by list.srv.cis.pitt.edu with SMTP (8.8.8/8.8.8/cisls-7.2.2.1) ID for ; Fri, 19 Nov 1999 20:39:24 -0500 (EST) Received: (qmail 13923 invoked from network); 20 Nov 1999 01:39:17 -0000 Received: from d01a8807.dip.cdsnet.net (HELO internetcds.com) (208.26.136.7) by mail.cdsnet.net with SMTP; 20 Nov 1999 01:39:17 -0000 Message-ID: <3835FB91.AD21B663@internetcds.com> Date: Fri, 19 Nov 1999 17:38:25 -0800 From: Ron Shenker X-Mailer: Mozilla 4.05 [en]C-CDSN3_98 (Win95; I) MIME-Version: 1.0 To: wilderness-emergency-medicine@list.pitt.edu Subject: Re: W-EMED Stupid Anaphylaxis Trick # 1 (was "rapid sulingual absorption) References: <0.5fabe5e1.2565f5d1@aol.com> <3834D7E2.5EA3623D@main-net.com> Content-Type: text/plain; charset=us-ascii Content-Transfer-Encoding: 7bit Sender: owner-wilderness-emergency-medicine@list.pitt.edu Precedence: bulk Reply-To: wilderness-emergency-medicine@list.pitt.edu X-PMFLAGS: 524416 0 1 P3D680.CNM Eric, You are very wrong. Benadryl[diphenylhydramamine] is NOT an anesthetic,amide, ester or any other kind and its not used for local anes. It is an antihistamine. Ester anesthetics are rarely used for local infilltration. Lidocaine is the most frequently used local anes. and it is an amide. Better dig out your pharm. texts and review before posting misleading info on this list. Ron Shenker CRNA Grants Pass Oregon Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- X-NAV-TimeoutProtection0: X X-NAV-TimeoutProtection1: X X-NAV-TimeoutProtection2: X X-NAV-TimeoutProtection3: X X-NAV-TimeoutProtection4: X X-NAV-TimeoutProtection5: X X-NAV-TimeoutProtection6: X Received: from post-ofc04.srv.cis.pitt.edu (root@post-ofc04.srv.cis.pitt.edu [136.142.185.11]) by pop.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cispop-7.2.2.1) ID ; Sat, 20 Nov 1999 02:19:58 -0500 (EST) Received: from localhost (root@localhost) by post-ofc04.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Sat, 20 Nov 1999 02:19:26 -0500 (EST) Received: via switchmail; Sat, 20 Nov 1999 02:19:26 -0500 (EST) Received: from list.srv.cis.pitt.edu via qmail ID ; Sat, 20 Nov 1999 02:17:57 -0500 (EST) Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.1) ID ; Sat, 20 Nov 1999 02:15:58 -0500 (EST) Received: from cgi.icon.co.za (cgi.icon.co.za [196.35.95.41]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.1) ID for ; Sat, 20 Nov 1999 02:15:53 -0500 (EST) Received: from mail450.icon.co.za (smtp.icon.co.za [196.35.95.40]) by cgi.icon.co.za (Postfix) with ESMTP id 83DB346558 for ; Sat, 20 Nov 1999 09:20:52 +0200 (SAST) Received: from icon.co.za (a2-jhb-16.dial-up.net [196.26.223.144]) by mail450.icon.co.za (8.9.3/8.9.3) with ESMTP id JAA14233 for ; Sat, 20 Nov 1999 09:15:38 +0200 (GMT) Message-ID: <3835A222.31649EA2@icon.co.za> Date: Fri, 19 Nov 1999 21:16:50 +0200 From: Arthur Morgan X-Mailer: Mozilla 4.7 [en] (Win95; I) X-Accept-Language: en-GB,en,en-US,af,pl MIME-Version: 1.0 To: wilderness-emergency-medicine@list.pitt.edu Subject: Re: W-EMED Stupid Anaphylaxis Trick # 1 (was "rapid sulingual absorption) References: <0.5fabe5e1.2565f5d1@aol.com> <3834D7E2.5EA3623D@main-net.com> <3835FB91.AD21B663@internetcds.com> Content-Type: text/plain; charset=us-ascii Content-Transfer-Encoding: 7bit Sender: owner-wilderness-emergency-medicine@list.pitt.edu Precedence: bulk Reply-To: wilderness-emergency-medicine@list.pitt.edu X-PMFLAGS: 524416 0 1 P1D770.CNM Ron, Diphenhydramine (Benadryl) is a local anaesthetic. It is usually used for its antihistamine (anti - H1 ) actions, but it, like most drugs, has other actions ( called side effects and adverse effects or similar terms depending upon the dangers of the effects ). I know of no drug with a pure action despite what the drug companies try to say. Arthur Ron Shenker wrote: > > Eric, > You are very wrong. Benadryl[diphenylhydramamine] is NOT an > anesthetic,amide, ester or any other kind and its not used for local > anes. It is an antihistamine. Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- X-NAV-TimeoutProtection0: X X-NAV-TimeoutProtection1: X X-NAV-TimeoutProtection2: X X-NAV-TimeoutProtection3: X X-NAV-TimeoutProtection4: X X-NAV-TimeoutProtection5: X X-NAV-TimeoutProtection6: X Received: from post-ofc01.srv.cis.pitt.edu (root@post-ofc01.srv.cis.pitt.edu [136.142.185.25]) by pop.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cispop-7.2.2.1) ID ; Thu, 18 Nov 1999 21:02:05 -0500 (EST) Received: from localhost (root@localhost) by post-ofc01.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.3) ID ; Thu, 18 Nov 1999 21:01:33 -0500 (EST) Received: via switchmail; Thu, 18 Nov 1999 21:01:33 -0500 (EST) Received: from list.srv.cis.pitt.edu via qmail ID ; Thu, 18 Nov 1999 20:57:43 -0500 (EST) Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.1) ID ; Thu, 18 Nov 1999 20:55:59 -0500 (EST) Received: from ra.mgmainnet.com (ra.main-net.com [206.152.250.3]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.1) ID for ; Thu, 18 Nov 1999 20:55:56 -0500 (EST) Received: from main-net.com (f0-07.dupa.main-net.com [208.163.86.73]) by ra.mgmainnet.com (8.8.8/8.8.6) with ESMTP id UAA11860 for ; Thu, 18 Nov 1999 20:57:30 -0500 (EST) Message-ID: <3834D7E2.5EA3623D@main-net.com> Date: Thu, 18 Nov 1999 20:53:55 -0800 From: Erik Scheiderer X-Mailer: Mozilla 4.04 [en] (Win95; U) MIME-Version: 1.0 To: wilderness-emergency-medicine@list.pitt.edu Subject: Re: W-EMED Stupid Anaphylaxis Trick # 1 (was "rapid sulingual absorption) References: <0.5fabe5e1.2565f5d1@aol.com> Content-Type: text/plain; charset=us-ascii Content-Transfer-Encoding: 7bit Sender: owner-wilderness-emergency-medicine@list.pitt.edu Precedence: bulk Reply-To: wilderness-emergency-medicine@list.pitt.edu X-PMFLAGS: 524416 0 1 P27520.CNM Folks, Forgive me if this was mentioned already. I was sitting here reading Jay's posting and realized something about Benadryl. It is an amide anesthetic, used alternatively in cases where patients are allergic to esther anesthetics, used to infiltrate lacerations for suture repair. Hence the mouth numbing experience that was posted previously. I didn't want to contribute fluff to the discussion, just thought I could help some of you good folks out. Erik Scheiderer, RN, CEN, EMT-P JadedMedic@aol.com wrote: > Hi WMED, > > Jay here, posting from a different email address. Here's a copy of the first > "Stupid Anaphylaxis Trick" essay that I posted to the "First Aid" list. I > hope you find it useful. (As I mentioned before, you can learn more about > the First Aid list by going over to www.merginet.com) > > Regards, > > Jay > > XXXXXXXXXXXXXXXXXXXXXXXXXX > > Hi (again) folks, > > On the subject of using diphenhydramine (aka Benadryl, Sominex, Nytol, many > other brand names) in the treatment of anaphylaxis... > > Epi can be great in the treatment of anaphylaxis (it's what frequently saves > the patient's life), however it treats only the symptoms of the reaction, not > the reaction itself. An antihistamine, such as diphenhydramine, goes more > directly to the cause of the problem. > > For what the Red Cross calls "Citizen Responders" (I'm increasingly coming to > prefer the British term "First Aiders") there's good news and there's bad > news in this regard. > > The good news is that diphenhydramine can be bought over the counter. Among > other things, it's the active ingredient in about half of the > over-the-counter sleeping pills such as Nytol or Sominex. > > The bad news is that medication given by mouth usually takes longer to take > effect than medication given by injection. Thus, diphenhydramine tablets, > even the sleeping-pill-type "quick dissolving" tablets, may not be all that > much help in the treatment of a really rapid, severe reaction. > > However, we do have the option of diphenhydramine syrup -- another > available-over-the-counter medication. > > I have this spiffy video on anaphylaxis and epinephrine that I got from the > Epipen people. In the video, the allergy specialist makes the point that > diphenhydramine syrup is absorbed (and takes effect) significantly faster > than the tablets do. > > [Warning: Anecdotal evidence ahead] > > Early this year, I had occasion to discuss the "civilian treatment" of > anaphylaxis with a man whose son has very bad allergies. He confirmed that, > in his experience, the syrup did indeed take effect significantly more > quickly than the tablets did. He also had two additional comments: > > 1. In addition to it's systemic effects, he had repeatedly noticed that the > syrup seemed to have a local effect on the tissues of his son's throat as > well, appearing to act directly to noticeably decrease the laryngeal > swelling. (This is a credible statement. Diphenhydramine is used in many > anti-allergy topical products.) > > 2. He also mentioned that the syrup was much easier to administer, even in > the throes of a severe reaction, than the tablets were. I still remember his > comment: "I can get that syrup down a throat that I could never get the > pills down." > > So, while I'm not prepared to draw truly major conclusions from one person's > experience, it appears that diphenhydramine syrup just may have the following > properties... > > 1. It takes effect relatively quickly -- as in within about ten to twenty > minutes. In any event, it takes effect significantly more quickly than the > tablets do. > > 2. It may act to directly decrease laryngeal swelling (whereas tablets do > not). > > 3. It can often be administered orally to patients who are unable to take > tablets by mouth. > > There are a few drawbacks. > > 1. The syrup is noticeably more expensive than the tablets are. I can buy > several dozen diphenhydramine tablets for the cost of a bottle containing > about a dozen doses of the syrup. > > 2. The syrup is not nearly as portable. For example, I have a touch of > arthritis, so I always have my pill bottle on me, and down in the bottom of > that pill bottle sit four 25 mg. Nytol tablets. (The usual therapeutic dose > for an adult is 50 mg., so I have two doses available if necesary.) However > the bottle of syrup is far too bulky for "carry everywhere" use. The bottle > does sit very nicely, however, in a first aid kit. > > Regards to all, > > Jay Wiseman > FA/CPR Instructor at large > Do not reproduce without author's express permission. > To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" > as the body of a message (no subject) To: Majordomo@list.pitt.edu > Submissions To: wilderness-emergency-medicine@list.pitt.edu Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- X-NAV-TimeoutProtection0: X X-NAV-TimeoutProtection1: X X-NAV-TimeoutProtection2: X X-NAV-TimeoutProtection3: X X-NAV-TimeoutProtection4: X X-NAV-TimeoutProtection5: X X-NAV-TimeoutProtection6: X Received: from post-ofc04.srv.cis.pitt.edu (root@post-ofc04.srv.cis.pitt.edu [136.142.185.11]) by pop.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cispop-7.2.2.1) ID ; Thu, 18 Nov 1999 17:25:58 -0500 (EST) Received: from localhost (root@localhost) by post-ofc04.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Thu, 18 Nov 1999 17:25:24 -0500 (EST) Received: via switchmail; Thu, 18 Nov 1999 17:25:23 -0500 (EST) Received: from list.srv.cis.pitt.edu via qmail ID ; Thu, 18 Nov 1999 15:51:47 -0500 (EST) Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.1) ID ; Thu, 18 Nov 1999 15:30:31 -0500 (EST) Received: from web501.yahoomail.com (web501.mail.yahoo.com [128.11.68.68]) by list.srv.cis.pitt.edu with SMTP (8.8.8/8.8.8/cisls-7.2.2.1) ID for ; Thu, 18 Nov 1999 15:30:25 -0500 (EST) Message-ID: <19991118203024.24902.rocketmail@web501.yahoomail.com> Received: from [142.110.131.194] by web501.mail.yahoo.com; Thu, 18 Nov 1999 12:30:24 PST Date: Thu, 18 Nov 1999 12:30:24 -0800 (PST) From: Lana Berrington Subject: Re: W-EMED Rapid sublingual absorption of diphenhydramine? To: wilderness-emergency-medicine@list.pitt.edu MIME-Version: 1.0 Content-Type: text/plain; charset=us-ascii Sender: owner-wilderness-emergency-medicine@list.pitt.edu Precedence: bulk Reply-To: wilderness-emergency-medicine@list.pitt.edu X-PMFLAGS: 524416 0 1 P66D10.CNM > HOWEVER... for me at least the taste is such that > one must fight > the urge to vomit, so I chew, let it sit for a SHORT > time, then > swallow, then follow with two more unchewed > tablets/capsules. Intersting.. the numb tongue thing.. along with the taste that makes one feel like they want to vomit.. I was wondering. I work at a childrens camp.. There.. the children with severe allergies usuall carry both benedryl and their epi-pen/ana-kit with them. The younger children almost ALWAYS carry Children's Chewable Benedryl with them. It has a plesent taste and none of the tongue-numbing effect that people here have written about . I wonder .. could one not take the dosage equivalent in children's chewable benedryl (probably - although I don't know off hand - like 5 tablets or something) Just a thought Lana Berrington, EMT-A Calgary, Canada __________________________________________________ Do You Yahoo!? Bid and sell for free at http://auctions.yahoo.com Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- X-NAV-TimeoutProtection0: X X-NAV-TimeoutProtection1: X X-NAV-TimeoutProtection2: X X-NAV-TimeoutProtection3: X X-NAV-TimeoutProtection4: X X-NAV-TimeoutProtection5: X X-NAV-TimeoutProtection6: X Received: from post-ofc02.srv.cis.pitt.edu (root@post-ofc02.srv.cis.pitt.edu [136.142.185.24]) by pop.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cispop-7.2.2.1) ID ; Thu, 18 Nov 1999 19:42:03 -0500 (EST) Received: from localhost (root@localhost) by post-ofc02.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Thu, 18 Nov 1999 19:41:30 -0500 (EST) Received: via switchmail; Thu, 18 Nov 1999 19:41:30 -0500 (EST) Received: from list.srv.cis.pitt.edu via qmail ID ; Thu, 18 Nov 1999 19:40:27 -0500 (EST) Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.1) ID ; Thu, 18 Nov 1999 19:38:24 -0500 (EST) Received: from imo23.mx.aol.com (imo23.mx.aol.com [152.163.225.67]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.1) ID for ; Thu, 18 Nov 1999 19:38:18 -0500 (EST) From: JadedMedic@aol.com Received: from JadedMedic@aol.com by imo23.mx.aol.com (mail_out_v24.4.) id h.0.5fabe5e1 (4541) for ; Thu, 18 Nov 1999 19:37:38 -0500 (EST) Message-ID: <0.5fabe5e1.2565f5d1@aol.com> Date: Thu, 18 Nov 1999 19:37:37 EST Subject: W-EMED Stupid Anaphylaxis Trick # 1 (was "rapid sulingual absorption) To: wilderness-emergency-medicine@list.pitt.edu MIME-Version: 1.0 Content-Type: text/plain; charset="us-ascii" Content-Transfer-Encoding: 7bit X-Mailer: Windows AOL sub 45 Sender: owner-wilderness-emergency-medicine@list.pitt.edu Precedence: bulk Reply-To: wilderness-emergency-medicine@list.pitt.edu X-PMFLAGS: 524416 0 1 P1B3E0.CNM Hi WMED, Jay here, posting from a different email address. Here's a copy of the first "Stupid Anaphylaxis Trick" essay that I posted to the "First Aid" list. I hope you find it useful. (As I mentioned before, you can learn more about the First Aid list by going over to www.merginet.com) Regards, Jay XXXXXXXXXXXXXXXXXXXXXXXXXX Hi (again) folks, On the subject of using diphenhydramine (aka Benadryl, Sominex, Nytol, many other brand names) in the treatment of anaphylaxis... Epi can be great in the treatment of anaphylaxis (it's what frequently saves the patient's life), however it treats only the symptoms of the reaction, not the reaction itself. An antihistamine, such as diphenhydramine, goes more directly to the cause of the problem. For what the Red Cross calls "Citizen Responders" (I'm increasingly coming to prefer the British term "First Aiders") there's good news and there's bad news in this regard. The good news is that diphenhydramine can be bought over the counter. Among other things, it's the active ingredient in about half of the over-the-counter sleeping pills such as Nytol or Sominex. The bad news is that medication given by mouth usually takes longer to take effect than medication given by injection. Thus, diphenhydramine tablets, even the sleeping-pill-type "quick dissolving" tablets, may not be all that much help in the treatment of a really rapid, severe reaction. However, we do have the option of diphenhydramine syrup -- another available-over-the-counter medication. I have this spiffy video on anaphylaxis and epinephrine that I got from the Epipen people. In the video, the allergy specialist makes the point that diphenhydramine syrup is absorbed (and takes effect) significantly faster than the tablets do. [Warning: Anecdotal evidence ahead] Early this year, I had occasion to discuss the "civilian treatment" of anaphylaxis with a man whose son has very bad allergies. He confirmed that, in his experience, the syrup did indeed take effect significantly more quickly than the tablets did. He also had two additional comments: 1. In addition to it's systemic effects, he had repeatedly noticed that the syrup seemed to have a local effect on the tissues of his son's throat as well, appearing to act directly to noticeably decrease the laryngeal swelling. (This is a credible statement. Diphenhydramine is used in many anti-allergy topical products.) 2. He also mentioned that the syrup was much easier to administer, even in the throes of a severe reaction, than the tablets were. I still remember his comment: "I can get that syrup down a throat that I could never get the pills down." So, while I'm not prepared to draw truly major conclusions from one person's experience, it appears that diphenhydramine syrup just may have the following properties... 1. It takes effect relatively quickly -- as in within about ten to twenty minutes. In any event, it takes effect significantly more quickly than the tablets do. 2. It may act to directly decrease laryngeal swelling (whereas tablets do not). 3. It can often be administered orally to patients who are unable to take tablets by mouth. There are a few drawbacks. 1. The syrup is noticeably more expensive than the tablets are. I can buy several dozen diphenhydramine tablets for the cost of a bottle containing about a dozen doses of the syrup. 2. The syrup is not nearly as portable. For example, I have a touch of arthritis, so I always have my pill bottle on me, and down in the bottom of that pill bottle sit four 25 mg. Nytol tablets. (The usual therapeutic dose for an adult is 50 mg., so I have two doses available if necesary.) However the bottle of syrup is far too bulky for "carry everywhere" use. The bottle does sit very nicely, however, in a first aid kit. Regards to all, Jay Wiseman FA/CPR Instructor at large Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- X-NAV-TimeoutProtection0: X X-NAV-TimeoutProtection1: X X-NAV-TimeoutProtection2: X X-NAV-TimeoutProtection3: X X-NAV-TimeoutProtection4: X X-NAV-TimeoutProtection5: X X-NAV-TimeoutProtection6: X Received: from post-ofc01.srv.cis.pitt.edu (root@post-ofc01.srv.cis.pitt.edu [136.142.185.25]) by pop.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cispop-7.2.2.1) ID ; Thu, 18 Nov 1999 10:28:27 -0500 (EST) Received: from localhost (root@localhost) by post-ofc01.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.3) ID ; Thu, 18 Nov 1999 10:27:54 -0500 (EST) Received: via switchmail; Thu, 18 Nov 1999 10:27:54 -0500 (EST) Received: from list.srv.cis.pitt.edu via qmail ID ; Thu, 18 Nov 1999 10:05:36 -0500 (EST) Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.1) ID ; Thu, 18 Nov 1999 10:02:34 -0500 (EST) Received: from imo-d09.mx.aol.com (imo-d09.mx.aol.com [205.188.157.41]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.1) ID for ; Thu, 18 Nov 1999 10:02:21 -0500 (EST) From: KE4WKR@aol.com Received: from KE4WKR@aol.com by imo-d09.mx.aol.com (mail_out_v24.4.) id h.0.b09e8671 (3934) for ; Thu, 18 Nov 1999 10:01:48 -0500 (EST) Message-ID: <0.b09e8671.25656edc@aol.com> Date: Thu, 18 Nov 1999 10:01:48 EST Subject: Re: W-EMED Rapid sublingual absorption of diphenhydramine? To: wilderness-emergency-medicine@list.pitt.edu MIME-Version: 1.0 Content-Type: text/plain; charset="us-ascii" Content-Transfer-Encoding: 7bit X-Mailer: AOL 4.0 for Windows 95 sub 228 Sender: owner-wilderness-emergency-medicine@list.pitt.edu Precedence: bulk Reply-To: wilderness-emergency-medicine@list.pitt.edu X-PMFLAGS: 1572992 0 1 P571D0.CNM I too am one of those lucky individuals who has had the experience of multiple and varying degrees of anaphylaxis...and carry at all times, the appropriate medications/treatments to care for myself when faced with anything from a swelling lip and slight wheeze to truly frightening respiratory distress, massive swelling, and/or GI involvement. I too was introduced to the idea of chewing benedryl. Having done so. I would like to strongly agree with D. Carp, the author of the prior posting regarding the effects and dangers of chewing benedryl. One of the major gauges I have personally of how "bad" I am is how my lips/ tongue feel. The few times I have chewed the benedryl, the feeling of "numbness" so mimicked the feeling of a swelling tongue, it caused me to become truly anxious. Every episode of developing anaphylaxis is different, (And in no way will I attempt to re-produce an event for experimental purposes), so I could not gauge weather this method of administration was more or less effective. Swallowing 50-100 MG of benedryl has been, and probably will continue to be my practice. By the way, due to a large amount of "spam" I am changing my e-mail address, but would still like to get this list. I cannot remember for the life of me how I first started receiving it...can somebody e-mail me and tell me how so I can get my new address on the list? Thanks. Omi Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- X-NAV-TimeoutProtection0: X X-NAV-TimeoutProtection1: X X-NAV-TimeoutProtection2: X X-NAV-TimeoutProtection3: X X-NAV-TimeoutProtection4: X X-NAV-TimeoutProtection5: X X-NAV-TimeoutProtection6: X Received: from post-ofc07.srv.cis.pitt.edu (root@post-ofc07.srv.cis.pitt.edu [136.142.185.73]) by pop.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cispop-7.2.2.1) ID ; Thu, 18 Nov 1999 04:50:46 -0500 (EST) Received: from localhost (root@localhost) by post-ofc07.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.3) ID ; Thu, 18 Nov 1999 04:50:14 -0500 (EST) Received: via switchmail; Thu, 18 Nov 1999 04:50:14 -0500 (EST) Received: from list.srv.cis.pitt.edu via qmail ID ; Thu, 18 Nov 1999 04:49:18 -0500 (EST) Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.1) ID ; Thu, 18 Nov 1999 04:47:23 -0500 (EST) Received: from mtiwmhc06.worldnet.att.net (mtiwmhc06.worldnet.att.net [204.127.131.41]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.1) ID for ; Thu, 18 Nov 1999 04:47:20 -0500 (EST) Received: from yumwind ([12.74.22.42]) by mtiwmhc06.worldnet.att.net (InterMail v03.02.07.07 118-134) with ESMTP id <19991118094648.DRKG3446@yumwind> for ; Thu, 18 Nov 1999 09:46:48 +0000 From: "D. Carp" To: wilderness-emergency-medicine@list.pitt.edu Date: Thu, 18 Nov 1999 03:44:11 -0600 Subject: Re: W-EMED Rapid sublingual absorption of diphenhydramine? In-reply-to: <19991117.082149.4078.1.JayWiseman@juno.com> X-mailer: Pegasus Mail for Win32 (v3.12a) Message-Id: <19991118094648.DRKG3446@yumwind> Sender: owner-wilderness-emergency-medicine@list.pitt.edu Precedence: bulk Reply-To: wilderness-emergency-medicine@list.pitt.edu X-PMFLAGS: 128 0 1 P1D7F0.CNM I am an EMT-B/WEMT, and am also a severe asthmatic with very severe allergies [some of them resulting in anaphylaxis] to many things, as well as many less severe allergies. > consistently good and fairly rapid results from, in essence, chewing a > diphenhydramine tablet and letting the crushed tablet melt under her This was first suggested to me several years ago by a fellow asthmatic/anaphylactic, when one day she had me chew the first Benadryl tablet while I was having an anaphylactic reaction to a charming antibiotic -- chew the first Beandryl, then swallow two others [in addition to the Bricanyl Turbuhaler which had already failed to help the bronchoconstriction, and the 2 doses of Ventolin via nebulizer which were subsequently taken before we even got to the ER]. My MD has since said that chewing the Benadryl is probably a helpful tactic, as presumably it helps it get absorbed faster, just as the original poster suggsted, though he said he didn't know of any studies that would demonstrate this... But he figured that it wouldn't hurt [except for the problem discussed below], and might help, and it is only a part of taking 75-100mg of Benadryl anyway... HOWEVER... for me at least the taste is such that one must fight the urge to vomit, so I chew, let it sit for a SHORT time, then swallow, then follow with two more unchewed tablets/capsules. Also, chewed Benadryl has a problematic side effect for everyone that I know who has done it... it makes your tongue go numb. Which makes it hard for the patient to tell if their tongue is swelling or not [highly relevant if the patient is actually aware of the progression of the allergic reaction, and especially so if they are so aware AND alone at the time... been there, done that, do not recommend it]. Having been the patient many times, and more often than not alone when the reaction starts... I WANT to be able to tell how the reaction is progressing... a numb or strange-feeling tongue makes this somewhat more difficult, as it is hard to judge if one's tongue is swelling beyond what it was before you took the meds or not. *For me* usually the tip of my tongue and the front sides will swell [along with my lips] before I am able to get the Benadryl into me --. that initial swelling part of the reaction is often the first sign that I have that something is going wrong. If I have chewed the Benadryl, then one guage of how severe the continuuing reaction is and exactly how it is progressing is 'lost'... Does that stop me from chewing the Benadryl? Only if the reaction seems relatively 'mild' [yes, there are gradations of anaphylaxis] at the point of taking the Benadryl. Of course, my 'mild' is relative to my experience of having been through varying levels of anaphylaxis many many times... I don't know if chewing the Benadryl actually helps in terms of speed of drug onset [or any other factor] or not, but I am also not about to experiment on myself to see if it does :) I usually reserve my chewing of it for the more serious reactions [scaled I guess in terms of how subjectively bad the reaction is by the time I am taking the Benadryl combined with a 'time to get to that point' factor], and those are the ones where experimenting isn't exactly the wisest thing to do, IMO. > injection, if memory serves. Given that anaphylaxis is a "big scary" > situation, and that diphenhydramine is available over the counter, I > think this option should be given a closer look. Especially for use by patients... I certainly would like to find out if the chew it option is valid or not... Day to day, at almost all times, I carry with me: an Epi-pen, MANY [>6] Benadryl 25mg tablets, and a Bricanyl [terbutaline] Trubuhaler. Depending on what I am doing and where I am going, I may also carry any of: a mini-Wright peak flow meter, more Benadryl, extra Epi-pens, Ventolin nebulizer solution, and a portable nebulizer. More often than not, when I start into a systemic allergic reaction, I am alone, and have to start treating it alone, which for even the mildest of such reactions will mean taking at least 50mg of Benadryl plus using the Bricanyl. The epi-pen may or may not get used [a discussion of which anaphylaxis protocol to use is beyond the pervue of this post, I think], and the nebulizer may or may not be used. Having options beyond simply "swallow two to four Benadryl, use your bronchodilator, maybe use the epi-pen, and call for help" is beneficial, especially since I am acutely aware of exactly what is happening and what may or may not happen in the short-term future; and calling for help is not always an option [or appropriate?]. Anaphylaxsis is... disconcerting at least... scary sometimes... and for most people I guess it is a 'big scary' most of the time... I've been through various degrees of it so many times that I don't really get scared by it very much anymore, unless the reaction is really unusual/severe/the meds are not working... And even then... it is more... hmmm... annoying/frustrating... The people around me tend to get much more scared on my behalf than I do... DC. Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- X-NAV-TimeoutProtection0: X X-NAV-TimeoutProtection1: X X-NAV-TimeoutProtection2: X X-NAV-TimeoutProtection3: X X-NAV-TimeoutProtection4: X X-NAV-TimeoutProtection5: X X-NAV-TimeoutProtection6: X Received: from post-ofc02.srv.cis.pitt.edu (root@post-ofc02.srv.cis.pitt.edu [136.142.185.24]) by pop.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cispop-7.2.2.1) ID ; Sun, 31 Oct 1999 22:57:39 -0500 (EST) Received: from localhost (root@localhost) by post-ofc02.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.3) ID ; Sun, 31 Oct 1999 22:23:20 -0500 (EST) Received: via switchmail; Sun, 31 Oct 1999 22:23:20 -0500 (EST) Received: from list.srv.cis.pitt.edu via qmail ID ; Sun, 31 Oct 1999 22:21:28 -0500 (EST) Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.1) ID ; Sun, 31 Oct 1999 22:20:18 -0500 (EST) Received: from imo12.mx.aol.com (imo12.mx.aol.com [198.81.17.2]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.1) ID for ; Sun, 31 Oct 1999 22:20:12 -0500 (EST) From: REBURR@aol.com Received: from REBURR@aol.com by imo12.mx.aol.com (mail_out_v23.6.) id hEJAa09316 (3977) for ; Sun, 31 Oct 1999 22:22:41 -0500 (EST) Message-ID: <0.8f910383.254e6181@aol.com> Date: Sun, 31 Oct 1999 22:22:41 EST Subject: Re: W-EMED Baxter hypothermia device To: wilderness-emergency-medicine@list.pitt.edu MIME-Version: 1.0 Content-Type: text/plain; charset="us-ascii" Content-Transfer-Encoding: 7bit X-Mailer: AOL 4.0 for Windows 95 sub 26 Sender: owner-wilderness-emergency-medicine@list.pitt.edu Precedence: bulk Reply-To: wilderness-emergency-medicine@list.pitt.edu X-PMFLAGS: 524416 0 1 P027B0.CNM The use of distal extremity warming for mild-moderate hypothermia has been used for a long time (at least the 70's) by the Danish Navy based on work by VanGaard and others. I understand that immersion of the hands, forearms and feet in warm water is the current SOP for rewarming aboard ship. I have been told that the technique is useful and safe. I have not used it myself. There should be an article soon in Aviation, Space and Environmental Medicine reporting more recent work with mildly hypothermic human volunteers rewarmed by various technique including distal rewarming. This should advance the debate, but the rewarming technique did not use local heat packs, so did not address this controversy directly. Heat packs have always seemed to be troublesome and despite the enthusiasm of their promoters are frequently associated with burn and CO hazards. This technique appears to share that characteristic with its predecessors. Bob Burr Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- X-NAV-TimeoutProtection0: X X-NAV-TimeoutProtection1: X X-NAV-TimeoutProtection2: X X-NAV-TimeoutProtection3: X X-NAV-TimeoutProtection4: X X-NAV-TimeoutProtection5: X X-NAV-TimeoutProtection6: X Received: from post-ofc05.srv.cis.pitt.edu (root@post-ofc05.srv.cis.pitt.edu [136.142.185.10]) by pop.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cispop-7.2.2.1) ID ; Sun, 31 Oct 1999 13:21:37 -0500 (EST) Received: from localhost (root@localhost) by post-ofc05.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.3) ID ; Sun, 31 Oct 1999 13:21:03 -0500 (EST) Received: via switchmail; Sun, 31 Oct 1999 13:21:03 -0500 (EST) Received: from list.srv.cis.pitt.edu via qmail ID ; Sun, 31 Oct 1999 13:20:33 -0500 (EST) Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.1) ID ; Sun, 31 Oct 1999 13:18:54 -0500 (EST) Received: from lh2.rdc1.bc.home.com (ioracle@ha2.rdc1.bc.wave.home.com [24.2.10.67]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.1) ID for ; Sun, 31 Oct 1999 13:18:51 -0500 (EST) Received: from vip.net ([24.66.178.28]) by lh2.rdc1.bc.home.com (InterMail v4.01.01.00 201-229-111) with ESMTP id <19991031182208.YQKB22817.lh2.rdc1.bc.home.com@vip.net> for ; Sun, 31 Oct 1999 10:22:08 -0800 Message-ID: <381C894C.F60BE9C3@vip.net> Date: Sun, 31 Oct 1999 10:24:12 -0800 From: John Hood Organization: Hood Thermo-Pad Canada Ltd. X-Mailer: Mozilla 4.61 [en]C-AtHome0407 (Win98; U) X-Accept-Language: en MIME-Version: 1.0 To: wilderness-emergency-medicine@list.pitt.edu Subject: W-EMED Baxter hypothermia device References: <0.21821209.254cf608@aol.com> Content-Type: text/plain; charset=us-ascii Content-Transfer-Encoding: 7bit Sender: owner-wilderness-emergency-medicine@list.pitt.edu Precedence: bulk Reply-To: wilderness-emergency-medicine@list.pitt.edu X-PMFLAGS: 524416 0 1 P6AFD0.CNM http://www.stanford.edu/dept/news/relaged/981201thermostat.html More info at this site. If this actually works it would be a dramatic change in the treatment of hypothermia. John -- THERMO-PAD - THE HEATING PAD WITH A HUNDRED USES John Hood | Ph. 250 494 5002 - Fax 250 494 5003 Hood Thermo-Pad Canada Ltd. | Toll Free Canada 800 665 9555 C. 20, S. 61A, RR 2 | Email jhood@vip.net Summerland, BC V0H 1Z0 | URL http://Thermo-Pad.com Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- X-NAV-TimeoutProtection0: X X-NAV-TimeoutProtection1: X X-NAV-TimeoutProtection2: X X-NAV-TimeoutProtection3: X X-NAV-TimeoutProtection4: X X-NAV-TimeoutProtection5: X X-NAV-TimeoutProtection6: X Received: from post-ofc04.srv.cis.pitt.edu (root@post-ofc04.srv.cis.pitt.edu [136.142.185.11]) by pop.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cispop-7.2.2.1) ID ; Sun, 31 Oct 1999 10:43:08 -0500 (EST) Received: from localhost (root@localhost) by post-ofc04.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.3) ID ; Sun, 31 Oct 1999 10:42:36 -0500 (EST) Received: via switchmail; Sun, 31 Oct 1999 10:42:35 -0500 (EST) Received: from list.srv.cis.pitt.edu via qmail ID ; Sun, 31 Oct 1999 10:41:03 -0500 (EST) Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.1) ID ; Sun, 31 Oct 1999 10:39:07 -0500 (EST) Received: from post-ofc06.srv.cis.pitt.edu (root@post-ofc06.srv.cis.pitt.edu [136.142.185.43]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.1) ID for ; Sun, 31 Oct 1999 10:39:05 -0500 (EST) Received: from homesys (mod5.ft22.upmc.edu [128.147.22.120]) by post-ofc06.srv.cis.pitt.edu with SMTP (8.8.8/8.8.8/cispo-7.2.2.3) ID for ; Sun, 31 Oct 1999 10:39:02 -0500 (EST) From: "Jack T. Grandey" To: Subject: RE: W-EMED Baxter hypothermia device Date: Sun, 31 Oct 1999 10:42:10 -0500 Message-ID: <000901bf23b6$7f24c740$a03e9380@1upmcpuh> MIME-Version: 1.0 Content-Type: text/plain; charset="iso-8859-1" Content-Transfer-Encoding: 7bit X-Priority: 3 (Normal) X-MSMail-Priority: Normal X-Mailer: Microsoft Outlook 8.5, Build 4.71.2173.0 In-Reply-To: <199910302042.QAA06895@list.srv.cis.pitt.edu> Importance: Normal X-MimeOLE: Produced By Microsoft MimeOLE V5.00.2615.200 Sender: owner-wilderness-emergency-medicine@list.pitt.edu Precedence: bulk Reply-To: wilderness-emergency-medicine@list.pitt.edu X-PMFLAGS: 524416 0 1 P69010.CNM I was invited out to the company that developed this device to act as a pre-production consultant. I met with the researcher from Stanford who did some of the preliminary testing as well as some international leaders in hypothermia research. The developer (Aquarius) has had some early success in using them in the PACU environment. Baxter is the exclusive distributor there. The company dearly wanted to develop a prehospital market for the device. The concept of the device is interesting, based upon what little we know and more that is surmised about the function of Aterio-Venous Anestomosies and how they may be activated to shunt warmth directly to the central circulation. At the conclusion of our one meeting, there were still questions about the re-producible efficacy of the device as well as some disagreement as to how (if) it actually worked and the value of the vacuum. Not to mention, how much surface area needed to be in contact with the heat packs (1 hand or 2 & just the dorsal surface or the entire forearm.). The company went forward to do some testing with swimmers & felt that they had good results (though I've not been able to obtain them). Even if the device worked as well as advertised, I saw significant form factor problems, trying to use it pre-hospital (not to mention, wilderness). The other item that I could not get the company to document was (even if it works) whether it was really superior to other methods already at our disposal. Other researchers have not been able to pre-produce the results of those involved in the development & marketing of the device. I have not heard from the company in over six months regarding the feedback provided and questions raised, although I have heard that they have been promoting the device at various conferences. At this point, I remain interested, though un-convinced. JTG -----Original Message----- From: owner-wilderness-emergency-medicine@list.pitt.edu [mailto:owner-wilderness-emergency-medicine@list.pitt.edu]On Behalf Of Douglas F. Kupas Sent: Saturday, October 30, 1999 16:46 To: wilderness-emergency-medicine@list.pitt.edu Subject: W-EMED Baxter hypothermia device At the ACEP meeting in Las Vegas, I came upon an exhibit that was of some interest. Baxter is marketing a device for hypothermia. The rep was not able to answer all of my questions, and I wondered if anyone on the list had experience with (or had further investigated) the device. The device is a plastic shell that fits around one hand. It contains a fancy version of a chemical heat pack. It's advantages seem to be a relatively small size and weight and it only costs about $25 per use. The idea is that the local heating of the hand causes vasodilation (Hunting reflex) and warms blood which is transported to the core. The rep quoted evidence that it is effective in elevating core temperature. My questions were: how effective is it in raising core temperature in moderate to severe hypothermia? what about after drop ( for those that believe that this is a legitimate concern)? Can anyone provide me with more insight? Doug Douglas F. Kupas, MD, FACEP Director, EMS Programs Director, Emergency Medicine Residency Program Geisinger Medical Center Penn State Geisinger Health System Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- X-NAV-TimeoutProtection0: X X-NAV-TimeoutProtection1: X X-NAV-TimeoutProtection2: X X-NAV-TimeoutProtection3: X X-NAV-TimeoutProtection4: X X-NAV-TimeoutProtection5: X X-NAV-TimeoutProtection6: X Received: from post-ofc06.srv.cis.pitt.edu (root@post-ofc06.srv.cis.pitt.edu [136.142.185.43]) by pop.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cispop-7.2.2.1) ID ; Sat, 30 Oct 1999 23:22:48 -0400 (EDT) Received: from localhost (root@localhost) by post-ofc06.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.3) ID ; Sat, 30 Oct 1999 23:22:14 -0400 (EDT) Received: via switchmail; Sat, 30 Oct 1999 23:22:14 -0400 (EDT) Received: from list.srv.cis.pitt.edu via qmail ID ; Sat, 30 Oct 1999 23:20:35 -0400 (EDT) Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.1) ID ; Sat, 30 Oct 1999 23:18:42 -0400 (EDT) Received: from smtp1.gateway.net (relay6.gateway.net [208.230.117.245]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.1) ID for ; Sat, 30 Oct 1999 23:18:31 -0400 (EDT) Received: from default (1Cust23.tnt1.pittsburgh.pa.da.uu.net [63.10.61.23]) by smtp1.gateway.net (8.9.3/8.9.3) with SMTP id XAA23438 for ; Sat, 30 Oct 1999 23:21:43 -0400 (EDT) From: "Matthew F. Russell, M.D." To: Subject: RE: W-EMED Baxter hypothermia device Date: Sat, 30 Oct 1999 23:22:54 -0400 Message-ID: MIME-Version: 1.0 Content-Type: text/plain; charset="iso-8859-1" Content-Transfer-Encoding: 7bit X-Priority: 3 (Normal) X-MSMail-Priority: Normal X-Mailer: Microsoft Outlook IMO, Build 9.0.2416 (9.0.2910.0) X-MimeOLE: Produced By Microsoft MimeOLE V5.00.2314.1300 In-reply-to: <199910302042.QAA06895@list.srv.cis.pitt.edu> Importance: Normal Sender: owner-wilderness-emergency-medicine@list.pitt.edu Precedence: bulk Reply-To: wilderness-emergency-medicine@list.pitt.edu X-PMFLAGS: 524416 0 1 P089E0.CNM There was a seminar about the device at this year's World Congress on Wilderness Medicine. The conclusions: 1. It has not been shown to be effective at rewarming core temperature outside the initial testing phase - especially in anyone who is volume depleted (like most hypothermic patients) 2. A few people suffered BURNS from the device 3. The overall consensus was that it was ineffective MFR -----Original Message----- From: owner-wilderness-emergency-medicine@list.pitt.edu [mailto:owner-wilderness-emergency-medicine@list.pitt.edu]On Behalf Of Douglas F. Kupas Sent: Saturday, October 30, 1999 4:46 PM To: wilderness-emergency-medicine@list.pitt.edu Subject: W-EMED Baxter hypothermia device At the ACEP meeting in Las Vegas, I came upon an exhibit that was of some interest. Baxter is marketing a device for hypothermia. The rep was not able to answer all of my questions, and I wondered if anyone on the list had experience with (or had further investigated) the device. The device is a plastic shell that fits around one hand. It contains a fancy version of a chemical heat pack. It's advantages seem to be a relatively small size and weight and it only costs about $25 per use. The idea is that the local heating of the hand causes vasodilation (Hunting reflex) and warms blood which is transported to the core. The rep quoted evidence that it is effective in elevating core temperature. My questions were: how effective is it in raising core temperature in moderate to severe hypothermia? what about after drop ( for those that believe that this is a legitimate concern)? Can anyone provide me with more insight? Doug Douglas F. Kupas, MD, FACEP Director, EMS Programs Director, Emergency Medicine Residency Program Geisinger Medical Center Penn State Geisinger Health System Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- X-NAV-TimeoutProtection0: X X-NAV-TimeoutProtection1: X X-NAV-TimeoutProtection2: X X-NAV-TimeoutProtection3: X X-NAV-TimeoutProtection4: X X-NAV-TimeoutProtection5: X X-NAV-TimeoutProtection6: X Received: from post-ofc05.srv.cis.pitt.edu (root@post-ofc05.srv.cis.pitt.edu [136.142.185.10]) by pop.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cispop-7.2.2.1) ID ; Sat, 30 Oct 1999 21:33:46 -0400 (EDT) Received: from localhost (root@localhost) by post-ofc05.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.3) ID ; Sat, 30 Oct 1999 21:33:14 -0400 (EDT) Received: via switchmail; Sat, 30 Oct 1999 21:33:13 -0400 (EDT) Received: from list.srv.cis.pitt.edu via qmail ID ; Sat, 30 Oct 1999 21:32:25 -0400 (EDT) Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.1) ID ; Sat, 30 Oct 1999 21:30:50 -0400 (EDT) Received: from imo-d07.mx.aol.com (imo-d07.mx.aol.com [205.188.157.39]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.1) ID for ; Sat, 30 Oct 1999 21:30:47 -0400 (EDT) From: Jaymullen@aol.com Received: from Jaymullen@aol.com by imo-d07.mx.aol.com (mail_out_v23.6.) id hGWG062X.Z (4189) for ; Sat, 30 Oct 1999 21:33:28 -0400 (EDT) Message-ID: <0.7a63ad40.254cf667@aol.com> Date: Sat, 30 Oct 1999 21:33:27 EDT Subject: W-EMED (no subject) To: wilderness-emergency-medicine@list.pitt.edu MIME-Version: 1.0 Content-Type: text/plain; charset="us-ascii" Content-Transfer-Encoding: 7bit X-Mailer: AOL 4.0 for Windows 95 sub 216 Sender: owner-wilderness-emergency-medicine@list.pitt.edu Precedence: bulk Reply-To: wilderness-emergency-medicine@list.pitt.edu X-PMFLAGS: 524416 0 1 P5F230.CNM That's what I thought, but they claim that the peripheral vasoconstriction that happens so quickly as hypothermia progresses is overcome by the vacuum device. I wait with bated breath... Jay Jay Mullen MD Adventure Medicine Consultants www.AdventureDocs.com Tucson, Arizona Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- X-NAV-TimeoutProtection0: X X-NAV-TimeoutProtection1: X X-NAV-TimeoutProtection2: X X-NAV-TimeoutProtection3: X X-NAV-TimeoutProtection4: X X-NAV-TimeoutProtection5: X X-NAV-TimeoutProtection6: X Received: from post-ofc06.srv.cis.pitt.edu (root@post-ofc06.srv.cis.pitt.edu [136.142.185.43]) by pop.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cispop-7.2.2.1) ID ; Sat, 30 Oct 1999 21:32:48 -0400 (EDT) Received: from localhost (root@localhost) by post-ofc06.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.3) ID ; Sat, 30 Oct 1999 21:32:15 -0400 (EDT) Received: via switchmail; Sat, 30 Oct 1999 21:32:15 -0400 (EDT) Received: from list.srv.cis.pitt.edu via qmail ID ; Sat, 30 Oct 1999 21:30:55 -0400 (EDT) Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.1) ID ; Sat, 30 Oct 1999 21:29:12 -0400 (EDT) Received: from imo11.mx.aol.com (imo11.mx.aol.com [198.81.17.1]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.1) ID for ; Sat, 30 Oct 1999 21:29:09 -0400 (EDT) From: Jaymullen@aol.com Received: from Jaymullen@aol.com by imo11.mx.aol.com (mail_out_v23.6.) id hXBNa05338 (4189) for ; Sat, 30 Oct 1999 21:31:52 -0400 (EDT) Message-ID: <0.21821209.254cf608@aol.com> Date: Sat, 30 Oct 1999 21:31:52 EDT Subject: Fwd: W-EMED Baxter hypothermia device To: wilderness-emergency-medicine@list.pitt.edu MIME-Version: 1.0 Content-Type: multipart/mixed; boundary="part1_0.21821209.254cf608_boundary" X-Mailer: AOL 4.0 for Windows 95 sub 216 Sender: owner-wilderness-emergency-medicine@list.pitt.edu Precedence: bulk Reply-To: wilderness-emergency-medicine@list.pitt.edu X-PMFLAGS: 537395328 0 1 P1FD70.CNM --part1_0.21821209.254cf608_boundary Content-Type: text/plain; charset="us-ascii" Content-Transfer-Encoding: 7bit --part1_0.21821209.254cf608_boundary Content-Type: message/rfc822 Content-Disposition: inline Return-Path: Received: from rly-yd03.mx.aol.com (rly-yd03.mail.aol.com [172.18.150.3]) by air-yd02.mail.aol.com (v62.10) with ESMTP; Sat, 30 Oct 1999 20:49:13 -0400 Received: from midsouth.net (mail.midsouth.net [207.65.92.3]) by rly-yd03.mx.aol.com (v62.10) with ESMTP; Sat, 30 Oct 1999 20:49:05 -0400 Received: (qmail 3947 invoked from network); 31 Oct 1999 00:50:00 -0000 Received: from du2-09.midsouth.net (HELO kitt) (207.65.92.158) by mail.midsouth.net with SMTP; 31 Oct 1999 00:50:00 -0000 From: "Ralph A Brigham KG4CSQ" Organization: ER-NCRC, OTR Medstaph To: "Douglas F. Kupas" Date: Sun, 31 Oct 1999 00:49:05 UTC MIME-Version: 1.0 Content-type: text/enriched; charset=US-ASCII Content-transfer-encoding: 7BIT Subject: Re: W-EMED Baxter hypothermia device Reply-to: rabrigham@midsouth.net CC: Jaymullen@aol.com Priority: urgent In-reply-to: <199910302042.QAA06895@list.srv.cis.pitt.edu> X-mailer: Pegasus Mail for Win32 (v3.11) Message-ID: <199910302049.TFMa08634@rly-yd03.mx.aol.com> 0100,0100,0100Bookman Old StyleDoug and Jay; >From my LIMITED experience with hypothermia; I would hazard a guess that this unit would be of minimal value in a situation where the patient is already hypothermic and the peripheral extremities are vasoconstricted to conserve the core temperature. Now if the patient is experiencing just moderate cooling of the extremities - this device MIGHT serve to reverse the cooling of the hands. My background is CAVE RESCUE, but I feel that this would apply to a wilderness and even snow ski situation. Take Care - - Ralph B. BTW, if you want - you may forward this response to the full group. Book Antiqua ************* Ralph A Brigham NSS 22048RL KG4CSQ 931-906-9277 939 S Riverside Dr., Apt H-61 Grid: EM66HM Clarksville TN 37040-3158 Middle TN Skywarn ID: 125-074 TEMA - RACES member --part1_0.21821209.254cf608_boundary-- Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- X-NAV-TimeoutProtection0: X X-NAV-TimeoutProtection1: X X-NAV-TimeoutProtection2: X X-NAV-TimeoutProtection3: X X-NAV-TimeoutProtection4: X X-NAV-TimeoutProtection5: X X-NAV-TimeoutProtection6: X Received: from post-ofc07.srv.cis.pitt.edu (root@post-ofc07.srv.cis.pitt.edu [136.142.185.73]) by pop.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cispop-7.2.2.1) ID ; Sat, 30 Oct 1999 16:46:01 -0400 (EDT) Received: from localhost (root@localhost) by post-ofc07.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.3) ID ; Sat, 30 Oct 1999 16:45:30 -0400 (EDT) Received: via switchmail; Sat, 30 Oct 1999 16:45:30 -0400 (EDT) Received: from list.srv.cis.pitt.edu via qmail ID ; Sat, 30 Oct 1999 16:45:05 -0400 (EDT) Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.1) ID ; Sat, 30 Oct 1999 16:42:27 -0400 (EDT) Received: from mail.ptd.net (mail1.ha-net.ptd.net [207.44.96.65]) by list.srv.cis.pitt.edu with SMTP (8.8.8/8.8.8/cisls-7.2.2.1) ID for ; Sat, 30 Oct 1999 16:42:24 -0400 (EDT) Message-Id: <199910302042.QAA06895@list.srv.cis.pitt.edu> Received: (qmail 14652 invoked from network); 30 Oct 1999 20:45:12 -0000 Received: from du13145.blo.ptd.net (HELO dkupas.ptdprolog.net) (204.186.13.145) by mail.ptd.net with SMTP; 30 Oct 1999 20:45:12 -0000 From: "Douglas F. Kupas" To: Subject: W-EMED Baxter hypothermia device Date: Sat, 30 Oct 1999 16:46:04 -0400 X-MSMail-Priority: Normal X-Priority: 3 X-Mailer: Microsoft Internet Mail 4.70.1155 MIME-Version: 1.0 Content-Type: text/plain; charset=ISO-8859-1 Content-Transfer-Encoding: 7bit Sender: owner-wilderness-emergency-medicine@list.pitt.edu Precedence: bulk Reply-To: wilderness-emergency-medicine@list.pitt.edu X-PMFLAGS: 524416 0 1 P47850.CNM At the ACEP meeting in Las Vegas, I came upon an exhibit that was of some interest. Baxter is marketing a device for hypothermia. The rep was not able to answer all of my questions, and I wondered if anyone on the list had experience with (or had further investigated) the device. The device is a plastic shell that fits around one hand. It contains a fancy version of a chemical heat pack. It's advantages seem to be a relatively small size and weight and it only costs about $25 per use. The idea is that the local heating of the hand causes vasodilation (Hunting reflex) and warms blood which is transported to the core. The rep quoted evidence that it is effective in elevating core temperature. My questions were: how effective is it in raising core temperature in moderate to severe hypothermia? what about after drop ( for those that believe that this is a legitimate concern)? Can anyone provide me with more insight? Doug Douglas F. Kupas, MD, FACEP Director, EMS Programs Director, Emergency Medicine Residency Program Geisinger Medical Center Penn State Geisinger Health System Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- X-NAV-TimeoutProtection0: X X-NAV-TimeoutProtection1: X X-NAV-TimeoutProtection2: X X-NAV-TimeoutProtection3: X X-NAV-TimeoutProtection4: X X-NAV-TimeoutProtection5: X X-NAV-TimeoutProtection6: X Received: from post-ofc03.srv.cis.pitt.edu (root@post-ofc03.srv.cis.pitt.edu [136.142.185.39]) by pop.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cispop-7.2.2.1) ID ; Sat, 30 Oct 1999 20:13:25 -0400 (EDT) Received: from localhost (root@localhost) by post-ofc03.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.3) ID ; Sat, 30 Oct 1999 20:12:50 -0400 (EDT) Received: via switchmail; Sat, 30 Oct 1999 20:12:50 -0400 (EDT) Received: from list.srv.cis.pitt.edu via qmail ID ; Sat, 30 Oct 1999 20:11:25 -0400 (EDT) Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.1) ID ; Sat, 30 Oct 1999 20:09:17 -0400 (EDT) Received: from imo-d05.mx.aol.com (imo-d05.mx.aol.com [205.188.157.37]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.1) ID for ; Sat, 30 Oct 1999 20:09:14 -0400 (EDT) From: Jaymullen@aol.com Received: from Jaymullen@aol.com by imo-d05.mx.aol.com (mail_out_v23.6.) id hQBL0_l2io (4462) for ; Sat, 30 Oct 1999 20:11:58 -0400 (EDT) Message-ID: <0.a3fc993e.254ce34e@aol.com> Date: Sat, 30 Oct 1999 20:11:58 EDT Subject: Re: W-EMED Baxter hypothermia device To: wilderness-emergency-medicine@list.pitt.edu MIME-Version: 1.0 Content-Type: text/plain; charset="us-ascii" Content-Transfer-Encoding: 7bit X-Mailer: AOL 4.0 for Windows 95 sub 216 Sender: owner-wilderness-emergency-medicine@list.pitt.edu Precedence: bulk Reply-To: wilderness-emergency-medicine@list.pitt.edu X-PMFLAGS: 524416 0 1 P4D480.CNM I spoke to someone recently about the device, and they added three additional pieces of information. First, they stated that there was a vacuum device which helped draw blood to the warming extremity. Second, they claim to have little or no after drop since there is only warming of one extremity at a time. Lastly, they claim to have very rapid returns to normal temperatures. Anyone with any experience using it? Sounds almost too good to be true. --Jay Jay Mullen MD Adventure Medicine Consultants www.AdventureDocs.com Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- X-NAV-TimeoutProtection0: X X-NAV-TimeoutProtection1: X X-NAV-TimeoutProtection2: X X-NAV-TimeoutProtection3: X X-NAV-TimeoutProtection4: X X-NAV-TimeoutProtection5: X X-NAV-TimeoutProtection6: X Received: from post-ofc04.srv.cis.pitt.edu (root@post-ofc04.srv.cis.pitt.edu [136.142.185.11]) by pop.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cispop-7.2.2.1) ID ; Tue, 26 Oct 1999 19:16:03 -0400 (EDT) Received: from localhost (root@localhost) by post-ofc04.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Tue, 26 Oct 1999 19:15:30 -0400 (EDT) Received: via switchmail; Tue, 26 Oct 1999 19:15:30 -0400 (EDT) Received: from list.srv.cis.pitt.edu via qmail ID ; Tue, 26 Oct 1999 19:14:06 -0400 (EDT) Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.1) ID ; Tue, 26 Oct 1999 19:10:09 -0400 (EDT) Received: from post-ofc05.srv.cis.pitt.edu (root@post-ofc05.srv.cis.pitt.edu [136.142.185.10]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.1) ID for ; Tue, 26 Oct 1999 19:10:05 -0400 (EDT) Received: from micron (ehdup-e1-12.rmt.net.pitt.edu [136.142.21.22]) by post-ofc05.srv.cis.pitt.edu with SMTP (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Tue, 26 Oct 1999 19:09:19 -0400 (EDT) Message-Id: <199910262309.TAA20026@post-ofc05.srv.cis.pitt.edu> From: "Keith Conover, M.D., FACEP" To: Hal Lillywhite , wilderness-emergency-medicine@list.pitt.edu, sar-l@listserv.islandnet.com Date: Tue, 26 Oct 1999 19:12:28 -0400 MIME-Version: 1.0 Content-type: text/plain; charset=US-ASCII Content-transfer-encoding: 7BIT Subject: Re: W-EMED Suspension trauma and stretchers (long) In-reply-to: <199910112134.OAA25146@macs.mxim.com> X-mailer: Pegasus Mail for Win32 (v3.11) Sender: owner-wilderness-emergency-medicine@list.pitt.edu Precedence: bulk Reply-To: wilderness-emergency-medicine@list.pitt.edu On 11 Oct 99, at 14:34, Hal Lillywhite wrote: > So my question: Are there circumstances in which it might be > advisable to save time and have the patient vertical? Maybe > something like a leg or arm injury without shock? I suspect we will > have to abandon the idea of a vertical litter entirely but would > like to know if there is any hope. This is a SAR and not a medical question, primarily -- the question from the medical side is "what is the risk of a vertical position for someone with an isolated extremity injury"? The SAR part is "what are the risks of waiting for a horizontal position evac?" and that depends on water levels, weather, rockfall and avalanche risk, fatigue, number of personnel available and their energy level and equipment. The main answer is in two parts. 1. if the patient is hypothermic or dehydrated, the risk of orthostatic hypotension in the vertical position is high, and should be avoided unless the situation requires drastic speed ("extreme measures" in NCRC terms). 2. if the patient can do the old "parade-ground twitch" and keep alternately tensing and releasing tension on the calf and thigh muscles -- and is not hypothermic or dehydrated -- then the risk is much lower. However, this requires non-fractured legs, and the ability to stay awake and keep doing the exercises during the evac. hope this helps. --Keith Conover, M.D., FACEP http://www.pitt.edu/~kconover Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- X-NAV-TimeoutProtection0: X X-NAV-TimeoutProtection1: X X-NAV-TimeoutProtection2: X X-NAV-TimeoutProtection3: X X-NAV-TimeoutProtection4: X X-NAV-TimeoutProtection5: X X-NAV-TimeoutProtection6: X Received: from post-ofc06.srv.cis.pitt.edu (root@post-ofc06.srv.cis.pitt.edu [136.142.185.43]) by pop.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cispop-7.2.2.1) ID ; Tue, 26 Oct 1999 22:57:05 -0400 (EDT) Received: from localhost (root@localhost) by post-ofc06.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Tue, 26 Oct 1999 22:57:16 -0400 (EDT) Received: via switchmail; Tue, 26 Oct 1999 22:57:15 -0400 (EDT) Received: from list.srv.cis.pitt.edu via qmail ID ; Tue, 26 Oct 1999 22:54:51 -0400 (EDT) Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.1) ID ; Tue, 26 Oct 1999 22:54:29 -0400 (EDT) Received: from imo-d09.mx.aol.com (imo-d09.mx.aol.com [205.188.157.41]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.1) ID for ; Tue, 26 Oct 1999 22:54:26 -0400 (EDT) From: Mobile9@aol.com Received: from Mobile9@aol.com by imo-d09.mx.aol.com (mail_out_v23.6.) id hIZFS_DxS_ (3897) for ; Tue, 26 Oct 1999 22:56:57 -0400 (EDT) Message-ID: <0.ba974354.2547c3f8@aol.com> Date: Tue, 26 Oct 1999 22:56:56 EDT Subject: Re: W-EMED Suspension trauma and stretchers (long) To: wilderness-emergency-medicine@list.pitt.edu MIME-Version: 1.0 Content-Type: text/plain; charset="us-ascii" Content-Transfer-Encoding: 7bit X-Mailer: Windows AOL sub 41 Sender: owner-wilderness-emergency-medicine@list.pitt.edu Precedence: bulk Reply-To: wilderness-emergency-medicine@list.pitt.edu X-PMFLAGS: 524416 0 1 P2B730.CNM I'm coming into this in mid-conversation, so i hope I'm not off base. I'd favor a sitting position for SAR, particularly is you are planning a helo extraction via hoist. Many helos carry both a Stryker frame as well as a sitting basket. The basket is attractive in many situations especially where the patient to be transported has IVs that are going into the transition as well. I'm more used to marine extraction, but we have done a number of helo rescues inland as well. In the San francisco Bay area we have gone as far inland as Tahoe to do mountain rescues since not many helos have a hoist capability along with all weather instrumentation. Ted Dunbar DSO-CM 11th District, Northern Region. Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- X-cs: R From: Keith Conover, M.D., FACEP X-RS-ID: X-RS-Flags: 0,0,1,1,0,0,0 X-RS-Header: In-reply-to: <199910112134.OAA25146@macs.mxim.com> X-RS-Sigset: 2 To: Hal Lillywhite ,wilderness-emergency-medicine@list.pitt.edu, sar-l@listserv.islandnet.com Subject: Re: W-EMED Suspension trauma and stretchers (long) Reply-to: kconover+@pitt.edu MIME-Version: 1.0 Content-type: text/plain; charset=ISO-8859-1 Content-transfer-encoding: 8BIT Date: Tue, 26 Oct 1999 18:44:57 -0400 On 11 Oct 99, at 14:34, Hal Lillywhite wrote: > So my question: Are there circumstances in which it might be > advisable to save time and have the patient vertical? Maybe > something like a leg or arm injury without shock? I suspect we will > have to abandon the idea of a vertical litter entirely but would > like to know if there is any hope. This is a SAR and not a medical question, primarily -- the question from the medical side is "what is the risk of a vertical position for someone with an isolated extremity injury"? The SAR part is "what are the risks of waiting for a horizontal position evac?" and that depends on water levels, weather, rockfall and avalanche risk, fatigue, number of personnel available and their energy level and equipment. The main answer is in two parts. 1. if the patient is hypothermic or dehydrated, the risk of orthostatic hypotension in the vertical position is high, and should be avoided unless the situation requires drastic speed ("extreme measures" in NCRC terms). 2. if the patient can do the old "parade-ground twitch" and keep alternately tensing and releasing tension on the calf and thigh muscles -- and is not hypothermic or dehydrated -- then the risk is much lower. However, this requires non-fractured legs, and the ability to stay awake and keep doing the exercises during the evac. hope this helps. -- End -- X-NAV-TimeoutProtection0: X X-NAV-TimeoutProtection1: X X-NAV-TimeoutProtection2: X X-NAV-TimeoutProtection3: X X-NAV-TimeoutProtection4: X X-NAV-TimeoutProtection5: X X-NAV-TimeoutProtection6: X Received: from post-ofc06.srv.cis.pitt.edu (root@post-ofc06.srv.cis.pitt.edu [136.142.185.43]) by pop.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cispop-7.2.2.1) ID ; Sat, 23 Oct 1999 21:34:14 -0400 (EDT) Received: from localhost (root@localhost) by post-ofc06.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Sat, 23 Oct 1999 21:33:40 -0400 (EDT) Received: via switchmail; Sat, 23 Oct 1999 21:33:39 -0400 (EDT) Received: from list.srv.cis.pitt.edu via qmail ID ; Sat, 23 Oct 1999 21:31:37 -0400 (EDT) Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.1) ID ; Sat, 23 Oct 1999 21:29:27 -0400 (EDT) Received: from post-ofc06.srv.cis.pitt.edu (root@post-ofc06.srv.cis.pitt.edu [136.142.185.43]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.1) ID for ; Sat, 23 Oct 1999 21:29:24 -0400 (EDT) Received: from micron (ehdup-o-14.rmt.net.pitt.edu [136.142.22.64]) by post-ofc06.srv.cis.pitt.edu with SMTP (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Sat, 23 Oct 1999 21:29:20 -0400 (EDT) Message-Id: <199910240129.VAA25752@post-ofc06.srv.cis.pitt.edu> From: "Keith Conover, M.D., FACEP" To: postmaster@att.net, abuse@att.net, wilderness-emergency-medicine@list.pitt.edu Date: Sat, 23 Oct 1999 21:32:20 -0400 MIME-Version: 1.0 Content-type: text/plain; charset=US-ASCII Content-transfer-encoding: 7BIT Subject: Re: W-EMED We need Home Workers! In-reply-to: <737.643391.591816@ns.bigbear.com> X-mailer: Pegasus Mail for Win32 (v3.11) Sender: owner-wilderness-emergency-medicine@list.pitt.edu Precedence: bulk Reply-To: wilderness-emergency-medicine@list.pitt.edu Dear ATT postmaster, please do what you can to prevent future spam like this to our list. Drawing and quartering preferred, but termination of email privileges and a ban on future email subscriptions would be adequate. Legal action against the following company, if indeed this spam is from them, would also be nice. > MOHW Co > PMB > 11054 Ventura Blvd #126 > Studio City, CA 91604 Thank you. --wilderness-emergency-medicine listowner On 23 Oct 99, at 2:17, mohwo@att.net wrote: > Dear Future Associate, > > You Can Work At Home & Set Your Own Hours. Start earning Big > Money in a short time > [snip] --Keith Conover, M.D., FACEP http://www.pitt.edu/~kconover Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- X-NAV-TimeoutProtection0: X X-NAV-TimeoutProtection1: X X-NAV-TimeoutProtection2: X X-NAV-TimeoutProtection3: X X-NAV-TimeoutProtection4: X X-NAV-TimeoutProtection5: X X-NAV-TimeoutProtection6: X Received: from post-ofc03.srv.cis.pitt.edu (root@post-ofc03.srv.cis.pitt.edu [136.142.185.39]) by pop.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cispop-7.2.2.1) ID ; Sat, 23 Oct 1999 08:54:21 -0400 (EDT) Received: from localhost (root@localhost) by post-ofc03.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Sat, 23 Oct 1999 08:53:49 -0400 (EDT) Received: via switchmail; Sat, 23 Oct 1999 08:53:48 -0400 (EDT) Received: from list.srv.cis.pitt.edu via qmail ID ; Sat, 23 Oct 1999 08:53:21 -0400 (EDT) Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.1) ID ; Sat, 23 Oct 1999 08:49:42 -0400 (EDT) Received: from ns.bigbear.com (p37.amax1.dialup.lax1.flash.net [209.30.74.37]) by list.srv.cis.pitt.edu with SMTP (8.8.8/8.8.8/cisls-7.2.2.1) ID ; Sat, 23 Oct 1999 08:49:22 -0400 (EDT) From: mohwo@att.net Subject: W-EMED We need Home Workers! Date: Sat, 23 Oct 1999 02:17:17 Message-Id: <737.643391.591816@ns.bigbear.com> To: undisclosed-recipients:; Sender: owner-wilderness-emergency-medicine@list.pitt.edu Precedence: bulk Reply-To: wilderness-emergency-medicine@list.pitt.edu X-PMFLAGS: 3145856 0 1 P04E70.CNM Dear Future Associate, You Can Work At Home & Set Your Own Hours. Start earning Big Money in a short time NO Newspaper Advertising! Your job will be to stuff and mail envelopes for our company. You will receive $.25 for each and every envelope you stuff and mail out. Just follow our simple instructions and you will be making money as easy as 1… 2… 3 For example stuff and mail 200 envelopes and you will receive $50.00. Stuff and mail 1000 and you will receive $250.00. Stuff and mail 2000 and you will receive $500.00 and more Never before has there been an easier way to make money from home! Our Company's Home Mailing Program is designed for people with little or no experience and provides simple, step by step instructions. There is no prior experience or special skills necessary on your part, Just stuffing envelopes. We need the help of honest and reliable home workers like you. Because we are overloaded with work and have more than our staff can handle. We have now expanded our mailing program and are expecting to reach millions more with our offers throughout the US and Canada. Our system of stuffing and mailing envelopes is very simple and easy to do! You will not be required to buy envelopes or postage stamps. We will gladly furnish all circulars at no cost to you. We assure you that as a participant in our program you will never have to mail anything objective or offensive. There are no quotas to meet, and there no contracts to sign. You can work as much, or as little as you want. Payment for each envelope you send out is Guaranteed! Here is what you will receive when you get your first Package. Inside you will find 100 envelopes, 100 labels and 100 sales letters ready to stuff and mail As soon as you are done with stuffing and mailing these first letters, your payment will arrive shortly, thereafter. All you have to do is to order more free supplies and stuff and mail more envelopes to make more money. Our sales literature which you will be stuffing and mailing will contain information outlining our highly informative manuals that we are advertising nationwide. As a free gift you will receive a special manual valued at $24.95, absolutely free, just for joining our Home Mailers Program. Plus you will get your own special code number, so that we will know how much you are to get paid. And to make re-ordering of more envelopes, that our company supplies very simple for you. We are giving you this free bonus because we want you to be confident in our company and to ensure that we will be doing business with you for a long time. Benefits Of This Job: 1. You do not have to quit your present job, to earn more money at home 2. You can make between $2,500 to $4,500 a month depending on the amount of time you are willing to spend stuffing and mailing envelopes 3. This is a great opportunity for the students, mothers, disabled persons or those who are home bodies. To secure your position and to show us that you are serious about earning extra income at home we require a one-time registration fee of $35.00. This fee covers the cost of your initial start up package, which includes 100 envelopes, 100 labels and 100 sales letters and a manual, your registration fee will be refunded back to you shortly thereafter. Money Back Guarantee! We guarantee that as soon as you stuff and mail your first 300 envelopes You will be paid $75.00 and your registration fee will be refunded. Many of you wonder why it is necessary to pay a deposit to get a job. It is because we are looking for people that seriously want to work from home. * If 3.000 people told us they wanted to start working from home and we sent out 3.000 packages free to every one. And then half of the people decided not to work, this would be a potential loss of more than $60,000 in supply's and shipping that we have sent out to people that don't want to work We have instituted this policy to make sure that you really want to work and at least finish your first package. To Get Started Today Please Enclose Your Registration Fee of $35 Check, Or Money Order and fill out the application below and mail to: MOHW Co PMB 11054 Ventura Blvd #126 Studio City, CA 91604 Name_____________________________________________________ Address___________________________________________________ City____________________________________ State______________ Zip Code________________ Telephone Number(s)_________________________________________ E-mail Address______________________________________________ For all orders, please allow seven (7) days for delivery and up to 10 days. Money Orders will result in faster shipping of your package. Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- X-NAV-TimeoutProtection0: X X-NAV-TimeoutProtection1: X X-NAV-TimeoutProtection2: X X-NAV-TimeoutProtection3: X X-NAV-TimeoutProtection4: X X-NAV-TimeoutProtection5: X X-NAV-TimeoutProtection6: X Received: from post-ofc05.srv.cis.pitt.edu (root@post-ofc05.srv.cis.pitt.edu [136.142.185.10]) by pop.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cispop-7.2.2.1) ID ; Wed, 20 Oct 1999 14:52:02 -0400 (EDT) Received: from localhost (root@localhost) by post-ofc05.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Wed, 20 Oct 1999 14:51:23 -0400 (EDT) Received: via switchmail; Wed, 20 Oct 1999 14:51:23 -0400 (EDT) Received: from list.srv.cis.pitt.edu via qmail ID ; Wed, 20 Oct 1999 14:51:03 -0400 (EDT) Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.1) ID ; Wed, 20 Oct 1999 14:49:54 -0400 (EDT) Received: from post-ofc06.srv.cis.pitt.edu (root@post-ofc06.srv.cis.pitt.edu [136.142.185.43]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.1) ID for ; Wed, 20 Oct 1999 14:49:52 -0400 (EDT) Received: from micron (ehdup-r3-2.rmt.net.pitt.edu [136.142.22.152]) by post-ofc06.srv.cis.pitt.edu with SMTP (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Wed, 20 Oct 1999 14:49:13 -0400 (EDT) Message-Id: <199910201849.OAA01765@post-ofc06.srv.cis.pitt.edu> From: "Keith Conover, M.D., FACEP" To: Timothy.E.Burdick@Dartmouth.EDU (Timothy E. Burdick), wilderness-emergency-medicine@list.pitt.edu Date: Wed, 20 Oct 1999 14:51:56 -0400 MIME-Version: 1.0 Content-type: text/plain; charset=US-ASCII Content-transfer-encoding: 7BIT Subject: Re: W-EMED wilderness/family medicine CC: bpoirier@nexicom.net In-reply-to: <28441817@donner.Dartmouth.EDU> X-mailer: Pegasus Mail for Win32 (v3.11) Sender: owner-wilderness-emergency-medicine@list.pitt.edu Precedence: bulk Reply-To: wilderness-emergency-medicine@list.pitt.edu X-PMFLAGS: 524416 0 1 P1ABE0.CNM On 20 Oct 99, at 7:50, Timothy E. Burdick wrote: > Dr. John Walden, MD, presented a paper about the Wilderness > Medicine Track in Family Practice. The abstract is published on > page 28 of the Wilderness Medical Society Annual Scientific > Assembly conference proceedings (Lake Placid, 1988). The > program is at Marshall University School of Medicine (WV I > believe). The program culminates in a 4-6 week wilderness > medicine field experience during the PG3 year. Yes, Marshall is in WV. And, for many years, Jim Blackman has offered a wilderness medicine "track" in the family practice residency in Boise, Idaho. But let's make sure we are all on the same "track" when we're talking about "specializing" in wilderness medicine. For those that don't understand medical specialties, let me explain as best I can. Anyone who meets the minimum state licensure requirements for MDs or DOs, usually two years of postgraduate training in any kind of residency, can hang out a shingle and practice medicine. And anyone who is licensed to practice medicine can put on that shingle "cardiologist" or "neurosurgeon." However, persuading a hospital to allow you to do cardiac caths or evacuate subdural hematomas may be a bit more difficult -- you'll need to show that you have the training and experience required to perform these procedures safely. The easiest way to show this is to complete a residency -- a specified course of postgraduate training in a program supervised by an organization that keeps tabs on the training the residents get -- and occasionally requires residencies to change their curriculum to maintain their accreditation (the RRC). Residencies range from 3-7 years depending on the program and the specialty. Those who complete a residency generally go on to take an exam and become Board Certified in the specialty. There are organizations for each specialty that offer these exams -- they generally require that you have successfully completed a residency to take the exam. However, when some specialties were newly recognized the boards offered a "grandfather clause" or "practice track" so that people who had been practicing the specialty but hadn't done a residency could sit for the boards. As far as I know, all such practice tracks are closed for all recognized specialties. [Things are a little more complicated than this, as both MDs and DOs have separate organizations and separate board exams, although there is some crossover in some specialties, and there is one small rival to the American Board of Medical Specialties and the equivalent DO organization -- but as Bacon once said "we are more likely to reach the truth through error than through confusion" so ignore this for now. Some board certifications are "permanent" -- as in my own ABIM Internal Medicine board certification -- although most, such as my ABEM Emergency Medicine board certification have to be renewed by retesting every 10 years. Many boards are switching to the 10-year retesting -- for instance, new ABIM diplomates have to recertify every 10 years.] It so happens that it is considered unlawful for hospital medical staffs to require board certification as a condition for giving hospital privileges -- hospital medical staffs are required to perform an overall assessment of the candidate. Nonetheless, residency training and "board eligibility" (somoone who has met all requirements to sit for the exam, even if he or she hasn't actually taken the board exam yet) is effectively the major criterion for joining a hospital medical staff and getting privileges. There are also "subspecialties" -- for instance, Pediatric Emergency Medicine is a subspecialty of both Emergency Medicine and Pediatrics. Someone who has completed either an Emergency Medicine or Pediatrics residency can get into a Pediatric Emergency Medicine Fellowship and then sit for an exam jointly administered by both the emergency medicine and pediatric board people. It's basically another merit badge. [Another sideline, ignore if it's confusing. There are some other subspecialties that have their own boards -- hand surgery, under both plastic surgery and orthopedics, and toxicology, under both emergency medicine and internal medicine, come to mind, as do the medical subspecialties such as Infectious Diseases, Pulmonary Medicine, Cardiology, and Gastroenterology, and some surgical subspecialties under General Surgery -- but Neurology (medical) and Neurosurgery (surgical) and ENT and ophthalmology and anesthesiology have their own residencies, even though they often require a year or two of training in a generic internship (first year residency) or surgical residency before entering the field- specific residency. But for the subspecialties, you need to train in the related primary specialty to then qualify for fellowship in the subspecialty.] Back to the point. There are no "wilderness medicine" boards, nor is there a recognized residency curriculum for wilderness medicine, nor are there any hospitals that expect training in "wilderness medicine" and offer privileges in such. So, calling something a "joint" family practice/wilderness medicine residency doesn't make a lot of sense in terms of what you can do afterwards. It's like taking an EMT course with extra training in giving immunizations tacked on -- nobody recognizes the tacked-on training as giving you any special privilege to give immunizations, but it might make it easier for you to get a job where they have you giving immunizations under a doctor's supervision. (Then again it might not.) Same thing with wilderness medicine -- there's really very little money in "doing" wilderness medicine, and therefore I doubt there will ever be a RRC-recognized "residency" in wilderness medicine, nor a wilderness medicine board exam. Not enough demand given the cost of doing such a training program and board exam. This shouldn't divert anyone from choosing a family practice residency like Boise or Marshall University that features a good, strong wilderness medicine program as part of the residency -- or doing an emergency medicine residency at a place with a strong interest in wilderness medicine among the faculty (our University of Pittsburgh residency is one), and if you're interested in wilderness EMS (working with cave/mountain rescue team medics), doing the WEMSI Wilderness EMS elective that we offer (information at www.wemsi.org). Keith Conover, M.D., FACEP (NSS 12893, WD4PSY) http://www.pitt.edu/~kconover - 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.wemsi.org; for a WEMSI-sponsored list, send "subscribe wilderness-emergency-medicine" to Majordomo@list.pitt.edu) - Eastern Region, Natl. Cave Rescue Comm./Appalachian SAR Conf. Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- X-cs: R From: Keith Conover, M.D., FACEP X-RS-ID: X-RS-Flags: 0,0,1,1,0,0,0 X-RS-Header: In-reply-to: <28441817@donner.Dartmouth.EDU> X-RS-Sigset: 0 To: Timothy.E.Burdick@Dartmouth.EDU (Timothy E. Burdick),wilderness-emergency-medicine@list.pitt.edu Subject: Re: W-EMED wilderness/family medicine Cc: bpoirier@nexicom.net Reply-to: kconover+@pitt.edu MIME-Version: 1.0 Content-type: text/plain; charset=ISO-8859-1 Content-transfer-encoding: 8BIT Date: Wed, 20 Oct 1999 14:03:41 -0400 On 20 Oct 99, at 7:50, Timothy E. Burdick wrote: > Dr. John Walden, MD, presented a paper about the Wilderness > Medicine Track in Family Practice. The abstract is published on > page 28 of the Wilderness Medical Society Annual Scientific > Assembly conference proceedings (Lake Placid, 1988). The > program is at Marshall University School of Medicine (WV I > believe). The program culminates in a 4-6 week wilderness > medicine field experience during the PG3 year. Yes, Marshall is in WV. And, for many years, Jim Blackman has offered a wilderness medicine "track" in the family practice residency in Boise, Idaho. But let's make sure we are all on the same "track" when we're talking about "specializing" in wilderness medicine. For those that don't understand medical specialties, let me explain as best I can. Anyone who meets the minimum state licensure requirements for MDs or DOs, usually two years of postgraduate training in any kind of residency, can hang out a shingle and practice medicine. And anyone who is licensed to practice medicine can put on that shingle "cardiologist" or "neurosurgeon." However, persuading a hospital to allow you to do cardiac caths or evacuate subdural hematomas may be a bit more difficult -- you'll need to show that you have the training and experience required to perform these procedures safely. The easiest way to show this is to complete a residency -- a specified course of postgraduate training in a program supervised by an organization that keeps tabs on the training the residents get -- and occasionally requires residencies to change their curriculum to maintain their accreditation (the RRC). Residencies range from 3-7 years depending on the program and the specialty. Those who complete a residency generally go on to take an exam and become Board Certified in the specialty. There are organizations for each specialty that offer these exams -- they generally require that you have successfully completed a residency to take the exam. However, when some specialties were newly recognized the boards offered a "grandfather clause" or "practice track" so that people who had been practicing the specialty but hadn't done a residency could sit for the boards. As far as I know, all such practice tracks are closed for all recognized specialties. [Things are a little more complicated than this, as both MDs and DOs have separate organizations and separate board exams, although there is some crossover in some specialties, and there is one small rival to the American Board of Medical Specialties and the equivalent DO organization -- but as Bacon once said "we are more likely to reach the truth through error than through confusion" so ignore this for now. Some board certifications are "permanent" -- as in my own ABIM Internal Medicine board certification -- although most, such as my ABEM Emergency Medicine board certification have to be renewed by retesting every 10 years. Many boards are switching to the 10-year retesting -- for instance, new ABIM diplomates have to recertify every 10 years.] It so happens that it is considered unlawful for hospital medical staffs to require board certification as a condition for giving hospital privileges -- hospital medical staffs are required to perform an overall assessment of the candidate. Nonetheless, residency training and "board eligibility" (somoone who has met all requirements to sit for the exam, even if he or she hasn't actually taken the board exam yet) is effectively the major criterion for joining a hospital medical staff and getting privileges. There are also "subspecialties" -- for instance, Pediatric Emergency Medicine is a subspecialty of both Emergency Medicine and Pediatrics. Someone who has completed either an Emergency Medicine or Pediatrics residency can get into a Pediatric Emergency Medicine Fellowship and then sit for an exam jointly administered by both the emergency medicine and pediatric board people. It's basically another merit badge. [Another sideline, ignore if it's confusing. There are some other subspecialties that have their own boards -- hand surgery, under both plastic surgery and orthopedics, and toxicology, under both emergency medicine and internal medicine, come to mind, as do the medical subspecialties such as Infectious Diseases, Pulmonary Medicine, Cardiology, and Gastroenterology, and some surgical subspecialties under General Surgery -- but Neurology (medical) and Neurosurgery (surgical) and ENT and ophthalmology and anesthesiology have their own residencies, even though they often require a year or two of training in a generic internship (first year residency) or surgical residency before entering the field- specific residency. But for the subspecialties, you need to train in the related primary specialty to then qualify for fellowship in the subspecialty.] Back to the point. There are no "wilderness medicine" boards, nor is there a recognized residency curriculum for wilderness medicine, nor are there any hospitals that expect training in "wilderness medicine" and offer privileges in such. So, calling something a "joint" family practice/wilderness medicine residency doesn't make a lot of sense in terms of what you can do afterwards. It's like taking an EMT course with extra training in giving immunizations tacked on -- nobody recognizes the tacked-on training as giving you any special privilege to give immunizations, but it might make it easier for you to get a job where they have you giving immunizations under a doctor's supervision. (Then again it might not.) Same thing with wilderness medicine -- there's really very little money in "doing" wilderness medicine, and therefore I doubt there will ever be a RRC-recognized "residency" in wilderness medicine, nor a wilderness medicine board exam. Not enough demand given the cost of doing such a training program and board exam. This shouldn't divert anyone from choosing a family practice residency like Boise or Marshall University that features a good, strong wilderness medicine program as part of the residency -- or doing an emergency medicine residency at a place with a strong interest in wilderness medicine among the faculty (our University of Pittsburgh residency is one), and if you're interested in wilderness EMS (working with cave/mountain rescue team medics), doing the WEMSI Wilderness EMS elective that we offer (information at www.wemsi.org). -- End -- X-NAV-TimeoutProtection0: X X-NAV-TimeoutProtection1: X X-NAV-TimeoutProtection2: X X-NAV-TimeoutProtection3: X X-NAV-TimeoutProtection4: X X-NAV-TimeoutProtection5: X X-NAV-TimeoutProtection6: X Received: from post-ofc01.srv.cis.pitt.edu (root@post-ofc01.srv.cis.pitt.edu [136.142.185.25]) by pop.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cispop-7.2.2.1) ID ; Wed, 20 Oct 1999 19:58:45 -0400 (EDT) Received: from localhost (root@localhost) by post-ofc01.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Wed, 20 Oct 1999 10:26:56 -0400 (EDT) Received: via switchmail; Wed, 20 Oct 1999 10:26:54 -0400 (EDT) Received: from list.srv.cis.pitt.edu via qmail ID ; Wed, 20 Oct 1999 10:19:57 -0400 (EDT) Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.1) ID ; Wed, 20 Oct 1999 10:19:02 -0400 (EDT) Received: from zonetail.med.unc.edu (zonetail.med.unc.edu [152.19.4.12]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.1) ID for ; Wed, 20 Oct 1999 10:18:58 -0400 (EDT) Received: from med.unc.edu (beernut.fammed.unc.edu [152.19.27.127]) by zonetail.med.unc.edu (8.8.6/8.8.6) with ESMTP id KAA28315; Wed, 20 Oct 1999 10:21:56 -0400 (EDT) Message-ID: <380DD031.4F1E7BB7@med.unc.edu> Date: Wed, 20 Oct 1999 10:22:41 -0400 From: Tom Bush X-Mailer: Mozilla 4.61 [en]C-CCK-MCD {UNC-CH Family Medicine} (Win95; I) X-Accept-Language: en MIME-Version: 1.0 To: wilderness-emergency-medicine@list.pitt.edu Subject: Re: W-EMED wilderness/family medicine References: <28441817@donner.Dartmouth.EDU> Content-Type: text/plain; charset=us-ascii Content-Transfer-Encoding: 7bit Sender: owner-wilderness-emergency-medicine@list.pitt.edu Precedence: bulk Reply-To: wilderness-emergency-medicine@list.pitt.edu X-PMFLAGS: 524416 0 1 P25A60.CNM Here is a reference to the program in a journal published by the WMS. Wilderness & Environmental Medicine; volume 9,#4 (1998) page 248. Hope this helps. -- Tom Bush,MSN,FNP Family Nurse Practitioner Department of Family Medicine University of North Carolina Tom_Bush@med.unc.edu "Timothy E. Burdick" wrote: > > Dr. John Walden, MD, presented a paper about the Wilderness Medicine Track in Family Practice. The abstract is published on page 28 of the Wilderness Medical Society Annual Scientific Assembly conference proceedings (Lake Placid, 1988). The program is at Marshall University School of Medicine (WV I believe). The program culminates in a 4-6 week wilderness medicine field experience during the PG3 year. > > (I got this info from the WMS conference and have no further information about the program.) > > Tim Burdick > Mountain Aid Training International Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- X-NAV-TimeoutProtection0: X X-NAV-TimeoutProtection1: X X-NAV-TimeoutProtection2: X X-NAV-TimeoutProtection3: X X-NAV-TimeoutProtection4: X X-NAV-TimeoutProtection5: X X-NAV-TimeoutProtection6: X Received: from post-ofc02.srv.cis.pitt.edu (root@post-ofc02.srv.cis.pitt.edu [136.142.185.24]) by pop.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cispop-7.2.2.1) ID ; Thu, 21 Oct 1999 01:59:04 -0400 (EDT) Received: from localhost (root@localhost) by post-ofc02.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Wed, 20 Oct 1999 08:43:19 -0400 (EDT) Received: via switchmail; Wed, 20 Oct 1999 08:43:14 -0400 (EDT) Received: from list.srv.cis.pitt.edu via qmail ID ; Wed, 20 Oct 1999 08:41:16 -0400 (EDT) Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.1) ID ; Wed, 20 Oct 1999 08:41:06 -0400 (EDT) Received: from redtail.med.unc.edu (redtail.med.unc.edu [152.19.4.7]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.1) ID for ; Wed, 20 Oct 1999 08:41:03 -0400 (EDT) Received: from med.unc.edu (beernut.fammed.unc.edu [152.19.27.127]) by redtail.med.unc.edu (8.8.6/8.8.6) with ESMTP id IAA20492; Wed, 20 Oct 1999 08:44:00 -0400 (EDT) Message-ID: <380DB93C.78D91DCA@med.unc.edu> Date: Wed, 20 Oct 1999 08:44:44 -0400 From: Tom Bush X-Mailer: Mozilla 4.61 [en]C-CCK-MCD {UNC-CH Family Medicine} (Win95; I) X-Accept-Language: en MIME-Version: 1.0 To: wilderness-emergency-medicine@list.pitt.edu Subject: Re: W-EMED wilderness/family medicine References: <28441817@donner.Dartmouth.EDU> Content-Type: text/plain; charset=us-ascii Content-Transfer-Encoding: 7bit Sender: owner-wilderness-emergency-medicine@list.pitt.edu Precedence: bulk Reply-To: wilderness-emergency-medicine@list.pitt.edu X-PMFLAGS: 524416 0 1 P67950.CNM The program is in Hunting ton West Virginia. There is a reference to it in the Journal of Wilderness Medicine. (some time last year, don't remember the date or issue). -- Tom Bush,MSN,FNP Family Nurse Practitioner Department of Family Medicine University of North Carolina Tom_Bush@med.unc.edu "Timothy E. Burdick" wrote: > > Dr. John Walden, MD, presented a paper about the Wilderness Medicine Track in Family Practice. The abstract is published on page 28 of the Wilderness Medical Society Annual Scientific Assembly conference proceedings (Lake Placid, 1988). The program is at Marshall University School of Medicine (WV I believe). The program culminates in a 4-6 week wilderness medicine field experience during the PG3 year. > > (I got this info from the WMS conference and have no further information about the program.) > > Tim Burdick > Mountain Aid Training International Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- X-NAV-TimeoutProtection0: X X-NAV-TimeoutProtection1: X X-NAV-TimeoutProtection2: X X-NAV-TimeoutProtection3: X X-NAV-TimeoutProtection4: X X-NAV-TimeoutProtection5: X X-NAV-TimeoutProtection6: X Received: from post-ofc01.srv.cis.pitt.edu (root@post-ofc01.srv.cis.pitt.edu [136.142.185.25]) by pop.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cispop-7.2.2.1) ID ; Wed, 20 Oct 1999 19:58:48 -0400 (EDT) Received: from localhost (root@localhost) by post-ofc01.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Wed, 20 Oct 1999 11:21:36 -0400 (EDT) Received: via switchmail; Wed, 20 Oct 1999 11:21:34 -0400 (EDT) Received: from list.srv.cis.pitt.edu via qmail ID ; Wed, 20 Oct 1999 11:21:19 -0400 (EDT) Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.1) ID ; Wed, 20 Oct 1999 11:20:57 -0400 (EDT) Received: from mailhub.dartmouth.edu (mailhub.dartmouth.edu [129.170.16.6]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.1) ID for ; Wed, 20 Oct 1999 11:20:52 -0400 (EDT) Received: from donner.Dartmouth.EDU (donner.dartmouth.edu [129.170.208.3]) by mailhub.dartmouth.edu (8.9.3+DND/8.9.3) with ESMTP id LAA28989 for ; Wed, 20 Oct 1999 11:23:50 -0400 (EDT) Message-id: <28451808@donner.Dartmouth.EDU> Date: 20 Oct 1999 11:23:50 EDT From: Timothy.E.Burdick@Dartmouth.EDU (Timothy E. Burdick) Subject: W-EMED wildernes med schools To: wilderness-emergency-medicine@list.pitt.edu MIME-Version: 1.0 Content-Type: text/plain; charset=iso-8859-1 Content-Disposition: inline Content-Transfer-Encoding: 8bit X-MIME-Autoconverted: from quoted-printable to 8bit by list.srv.cis.pitt.edu id LAA12102 Sender: owner-wilderness-emergency-medicine@list.pitt.edu Precedence: bulk Reply-To: wilderness-emergency-medicine@list.pitt.edu X-PMFLAGS: 524416 0 1 P49C00.CNM --- You wrote: As a result of this goal, I've been searching > (largely in vain) for any leads on medical schools (in the U.S., > Canada, and abroad) that offer wilderness medicine as an area of > specialization/residency. --- end of quote --- Dartmouth Medical School (NH) does several wilderness-related activities, including a student/community run SAR team (www.dartmouth.edu/~jade/sar/index.html), a wilderness medicine student interest group (supported by the Wilderness Medical Society), and a short wilderness medicine elective (year 1 or 2). We also help teach wilderness medicine classes through Mountain Aid Training International (www.mati-online.org). There is also a chance that a 4th year, 1 month elective will be offered in the future. Several other med schools have offered wilderness medicine electives in the past: U Nevada Reno: www.med.unr.edu/homepage/ome/bioint.html U Washington: www.washington.edu/students/crscat/famed.html (Also UMass I think?) If anybody would like more information, please feel free to email me outside the listserv. cheers! Tim ------------- Tim Burdick, Dartmouth Medical School Year 2 Medical Officer, Upper Valley Wilderness Response Team Instructor, Mountain Aid Training International (MATI) http://www.mati-online.org/ ---------- Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- X-NAV-TimeoutProtection0: X X-NAV-TimeoutProtection1: X X-NAV-TimeoutProtection2: X X-NAV-TimeoutProtection3: X X-NAV-TimeoutProtection4: X X-NAV-TimeoutProtection5: X X-NAV-TimeoutProtection6: X Received: from post-ofc03.srv.cis.pitt.edu (root@post-ofc03.srv.cis.pitt.edu [136.142.185.39]) by pop.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cispop-7.2.2.1) ID ; Wed, 20 Oct 1999 07:49:21 -0400 (EDT) Received: from localhost (root@localhost) by post-ofc03.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Wed, 20 Oct 1999 07:48:43 -0400 (EDT) Received: via switchmail; Wed, 20 Oct 1999 07:48:40 -0400 (EDT) Received: from list.srv.cis.pitt.edu via qmail ID ; Wed, 20 Oct 1999 07:48:14 -0400 (EDT) Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.1) ID ; Wed, 20 Oct 1999 07:47:47 -0400 (EDT) Received: from mailhub.dartmouth.edu (mailhub.dartmouth.edu [129.170.16.6]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.1) ID for ; Wed, 20 Oct 1999 07:47:44 -0400 (EDT) Received: from donner.Dartmouth.EDU (donner.dartmouth.edu [129.170.208.3]) by mailhub.dartmouth.edu (8.9.3+DND/8.9.3) with ESMTP id HAA22281 for ; Wed, 20 Oct 1999 07:50:43 -0400 (EDT) Message-id: <28441817@donner.Dartmouth.EDU> Date: 20 Oct 1999 07:50:43 EDT From: Timothy.E.Burdick@Dartmouth.EDU (Timothy E. Burdick) Subject: W-EMED wilderness/family medicine To: wilderness-emergency-medicine@list.pitt.edu MIME-Version: 1.0 Content-Type: text/enriched Content-Disposition: inline Sender: owner-wilderness-emergency-medicine@list.pitt.edu Precedence: bulk Reply-To: wilderness-emergency-medicine@list.pitt.edu X-PMFLAGS: 1074266240 0 1 P0B820.CNM Dr. John Walden, MD, presented a paper about the Wilderness Medicine Track in Family Practice. The abstract is published on page 28 of the Wilderness Medical Society Annual Scientific Assembly conference proceedings (Lake Placid, 1988). The program is at Marshall University School of Medicine (WV I believe). The program culminates in a 4-6 week wilderness medicine field experience during the PG3 year. (I got this info from the WMS conference and have no further information about the program.) Tim Burdick Mountain Aid Training International Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- X-NAV-TimeoutProtection0: X X-NAV-TimeoutProtection1: X X-NAV-TimeoutProtection2: X X-NAV-TimeoutProtection3: X X-NAV-TimeoutProtection4: X X-NAV-TimeoutProtection5: X X-NAV-TimeoutProtection6: X Received: from post-ofc05.srv.cis.pitt.edu (root@post-ofc05.srv.cis.pitt.edu [136.142.185.10]) by pop.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cispop-7.2.2.1) ID ; Wed, 20 Oct 1999 06:47:17 -0400 (EDT) Received: from localhost (root@localhost) by post-ofc05.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Wed, 20 Oct 1999 06:46:44 -0400 (EDT) Received: via switchmail; Wed, 20 Oct 1999 06:46:44 -0400 (EDT) Received: from list.srv.cis.pitt.edu via qmail ID ; Wed, 20 Oct 1999 06:46:24 -0400 (EDT) Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.1) ID ; Wed, 20 Oct 1999 06:45:54 -0400 (EDT) Received: from hotmail.com (f152.law4.hotmail.com [216.33.149.152]) by list.srv.cis.pitt.edu with SMTP (8.8.8/8.8.8/cisls-7.2.2.1) ID for ; Wed, 20 Oct 1999 06:45:51 -0400 (EDT) Received: (qmail 65468 invoked by uid 0); 20 Oct 1999 10:48:19 -0000 Message-ID: <19991020104819.65467.qmail@hotmail.com> Received: from 198.250.223.115 by www.hotmail.com with HTTP; Wed, 20 Oct 1999 03:48:18 PDT X-Originating-IP: [198.250.223.115] From: "Chris Adams DO" To: wilderness-emergency-medicine@list.pitt.edu Subject: Re: W-EMED Re: Fwd: wilderness medicine degrees Date: Wed, 20 Oct 1999 03:48:18 PDT Mime-Version: 1.0 Content-Type: text/plain; format=flowed Sender: owner-wilderness-emergency-medicine@list.pitt.edu Precedence: bulk Reply-To: wilderness-emergency-medicine@list.pitt.edu X-PMFLAGS: 524416 0 1 P789F0.CNM There is a Residency Program at Marshall University in WV that offers a "dual" Family Practice/Wilderness Medicine Residency. I have looked into it and it looks like a good program that I may also end up pursuing after my commitment is up with the US military. Very Respectfully, Chris >From: "Seth Hawkins" >Reply-To: wilderness-emergency-medicine@list.pitt.edu >To: wilderness-emergency-medicine@list.pitt.edu >CC: bpoirier@nexicom.net >Subject: Re: W-EMED Re: Fwd: wilderness medicine degrees >Date: Tue, 19 Oct 1999 17:57:55 -0400 >From owner-wilderness-emergency-medicine@list.pitt.edu Tue Oct 19 15:56:16 >1999 >Received: from [136.142.185.20] by hotmail.com (3.2) with ESMTP id >MHotMailB9D63AD60070D82197BE888EB9149ABD0; Tue Oct 19 15:26:54 1999 >Received: from localhost (majordom@localhost) by >list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.1) ID >; Tue, 19 Oct 1999 17:55:01 -0400 >(EDT) >Received: from grayhawk.med.unc.edu (grayhawk.med.unc.edu [152.2.119.120]) > by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.1) > ID for >; Tue, 19 Oct 1999 >17:54:58 -0400 (EDT) >Received: from webmail ([152.19.4.30]) by grayhawk.med.unc.edu >(Netscape Messaging Server 3.01) with SMTP id AAA25890; Tue, 19 >Oct 1999 17:57:55 -0400 >X-Mailer: Netscape Messenger Express 3.5 [Mozilla/4.0 (compatible; MSIE >5.0; Windows 95; DigExt)] >Message-ID: <19991019215755.AAA25890@webmail> >Sender: owner-wilderness-emergency-medicine@list.pitt.edu >Precedence: bulk > >There is a family medicine residency -- I believe in West >Virginia, or somewhere in the southeast -- that bills itself as >a wilderness medicine/family medicine "joint" residency. I >don't know more details because I decided not to go the family >medicine route, but I will see if I can get more information for >you. Or does anyone else know about this program? The flyer I >saw made it sound as though it was very new. > >seth > >[Providence, RI] >----------------------------------- >Seth Collings Hawkins, MSIV >Carolina Wilderness Medicine >UNC @ Chapel Hill School of Medicine >207A Purefoy Rd, C.H., NC 27514-4857 >www.members.tripod.com/hawk_s/h.html >------------------------------------ > >On 18 Oct 99, at 11:16, Lfrizzsolo@aol.com wrote: > > > > > >> Delivered-To: serious-solo@serioussports.com > >> From: "poirier" > >> To: > >> Subject: wilderness medicine degrees > >> Date: Sun, 10 Oct 1999 17:57:06 -0400 > >> X-Mailer: Microsoft Outlook Express 4.72.3110.1 > >> > >> Hello! > >>  My name is Bryan Poirier. I'm currently an Outdoor and > >> Experiential Education (BEd.) student at Queen's University >in > >> Kingston, Ontario. My personal focus in this program is to >further > >> devolop my skills and understanding of wilderness medicine >and > >> wilderness first aid. In the near future, I hope to pursue a >career > >> in medicine.  As a result of this goal, I've been >searching > >> (largely in vain) for any leads on medical schools (in the >U.S., > >> Canada, and abroad) that offer wilderness medicine as an area >of > >> specialization/residency. Might you have any information >regarding > >> such programs? Any suggestions or ideas that you might have >would be > >> GREATLY appreciated!  > > > >Bryan, I'm afraid that there is no such thing as a residency in > > >wilderness medicine -- primarily because there is no market for > > >fulltime wilderness medicine physicians. If you are >independently > >wealthy, you could pay your way through medical school, then do > > >two years of any residency, and then set up a practice as a > >wilderness medcicine physician -- but don't expect to make any > > >money doing it. > > > >There are some doctors, often ID specialists (an internal >medicine > >subspecialty, take a residency in IM and then do an ID >fellowship) > >and some sports medicine docs (ortho, family practice, etc. who > > >are generally board certified in their primary specialties and >then do > >some additional training in sports medicine) who offer "travel > > >medicine" services but this is generally a sideline. > > > >Many emergency physicians (3-4 year residencies available) do > >wilderness medicine as part of their practice, and even get >support > >from their practices for this, like me. There is also a >wilderness > >_EMS_ elective (3-4 weeks) for R-2/R-3 emergency medicine > >residents here in Pittsburgh, available on a limited basis. > >Information is posted at http://www.wemsi.org > > > >I am not aware of any other wilderness-medicine specific >training > >opportunities (wilderness EMS is my specific, but the >Wilderness > >Medical Society (http://www.wms.org) often has information >about > >medical student opportunties in wilderness medicine. > > > >Thanks for your interest. > >--Keith Conover, M.D., FACEP > > http://www.pitt.edu/~kconover > >Do not reproduce without author's express permission. > >To unsubscribe, send the text "unsubscribe >wilderness-emergency-medicine" > >as the body of a message (no subject) To: >Majordomo@list.pitt.edu > >Submissions To: wilderness-emergency-medicine@list.pitt.edu > > > > >Do not reproduce without author's express permission. >To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" >as the body of a message (no subject) To: Majordomo@list.pitt.edu >Submissions To: wilderness-emergency-medicine@list.pitt.edu ______________________________________________________ Get Your Private, Free Email at http://www.hotmail.com Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- X-NAV-TimeoutProtection0: X X-NAV-TimeoutProtection1: X X-NAV-TimeoutProtection2: X X-NAV-TimeoutProtection3: X X-NAV-TimeoutProtection4: X X-NAV-TimeoutProtection5: X X-NAV-TimeoutProtection6: X Received: from post-ofc02.srv.cis.pitt.edu (root@post-ofc02.srv.cis.pitt.edu [136.142.185.24]) by pop.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cispop-7.2.2.1) ID ; Wed, 20 Oct 1999 02:00:01 -0400 (EDT) Received: from localhost (root@localhost) by post-ofc02.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Tue, 19 Oct 1999 17:59:07 -0400 (EDT) Received: via switchmail; Tue, 19 Oct 1999 17:59:05 -0400 (EDT) Received: from list.srv.cis.pitt.edu via qmail ID ; Tue, 19 Oct 1999 17:56:56 -0400 (EDT) Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.1) ID ; Tue, 19 Oct 1999 17:55:01 -0400 (EDT) Received: from grayhawk.med.unc.edu (grayhawk.med.unc.edu [152.2.119.120]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.1) ID for ; Tue, 19 Oct 1999 17:54:58 -0400 (EDT) Received: from webmail ([152.19.4.30]) by grayhawk.med.unc.edu (Netscape Messaging Server 3.01) with SMTP id AAA25890; Tue, 19 Oct 1999 17:57:55 -0400 From: "Seth Hawkins" To: wilderness-emergency-medicine@list.pitt.edu Cc: bpoirier@nexicom.net Subject: Re: W-EMED Re: Fwd: wilderness medicine degrees X-Mailer: Netscape Messenger Express 3.5 [Mozilla/4.0 (compatible; MSIE 5.0; Windows 95; DigExt)] Date: Tue, 19 Oct 1999 17:57:55 -0400 Message-ID: <19991019215755.AAA25890@webmail> Sender: owner-wilderness-emergency-medicine@list.pitt.edu Precedence: bulk Reply-To: wilderness-emergency-medicine@list.pitt.edu X-PMFLAGS: 128 0 1 P57F60.CNM There is a family medicine residency -- I believe in West Virginia, or somewhere in the southeast -- that bills itself as a wilderness medicine/family medicine "joint" residency. I don't know more details because I decided not to go the family medicine route, but I will see if I can get more information for you. Or does anyone else know about this program? The flyer I saw made it sound as though it was very new. seth [Providence, RI] ----------------------------------- Seth Collings Hawkins, MSIV Carolina Wilderness Medicine UNC @ Chapel Hill School of Medicine 207A Purefoy Rd, C.H., NC 27514-4857 www.members.tripod.com/hawk_s/h.html ------------------------------------ >On 18 Oct 99, at 11:16, Lfrizzsolo@aol.com wrote: > > >> Delivered-To: serious-solo@serioussports.com >> From: "poirier" >> To: >> Subject: wilderness medicine degrees >> Date: Sun, 10 Oct 1999 17:57:06 -0400 >> X-Mailer: Microsoft Outlook Express 4.72.3110.1 >> >> Hello! >>  My name is Bryan Poirier. I'm currently an Outdoor and >> Experiential Education (BEd.) student at Queen's University in >> Kingston, Ontario. My personal focus in this program is to further >> devolop my skills and understanding of wilderness medicine and >> wilderness first aid. In the near future, I hope to pursue a career >> in medicine.  As a result of this goal, I've been searching >> (largely in vain) for any leads on medical schools (in the U.S., >> Canada, and abroad) that offer wilderness medicine as an area of >> specialization/residency. Might you have any information regarding >> such programs? Any suggestions or ideas that you might have would be >> GREATLY appreciated!  > >Bryan, I'm afraid that there is no such thing as a residency in >wilderness medicine -- primarily because there is no market for >fulltime wilderness medicine physicians. If you are independently >wealthy, you could pay your way through medical school, then do >two years of any residency, and then set up a practice as a >wilderness medcicine physician -- but don't expect to make any >money doing it. > >There are some doctors, often ID specialists (an internal medicine >subspecialty, take a residency in IM and then do an ID fellowship) >and some sports medicine docs (ortho, family practice, etc. who >are generally board certified in their primary specialties and then do >some additional training in sports medicine) who offer "travel >medicine" services but this is generally a sideline. > >Many emergency physicians (3-4 year residencies available) do >wilderness medicine as part of their practice, and even get support >from their practices for this, like me. There is also a wilderness >_EMS_ elective (3-4 weeks) for R-2/R-3 emergency medicine >residents here in Pittsburgh, available on a limited basis. >Information is posted at http://www.wemsi.org > >I am not aware of any other wilderness-medicine specific training >opportunities (wilderness EMS is my specific, but the Wilderness >Medical Society (http://www.wms.org) often has information about >medical student opportunties in wilderness medicine. > >Thanks for your interest. >--Keith Conover, M.D., FACEP > http://www.pitt.edu/~kconover >Do not reproduce without author's express permission. >To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" >as the body of a message (no subject) To: Majordomo@list.pitt.edu >Submissions To: wilderness-emergency-medicine@list.pitt.edu > Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- X-NAV-TimeoutProtection0: X X-NAV-TimeoutProtection1: X X-NAV-TimeoutProtection2: X X-NAV-TimeoutProtection3: X X-NAV-TimeoutProtection4: X X-NAV-TimeoutProtection5: X X-NAV-TimeoutProtection6: X Received: from post-ofc07.srv.cis.pitt.edu (root@post-ofc07.srv.cis.pitt.edu [136.142.185.73]) by pop.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cispop-7.2.2.1) ID ; Tue, 19 Oct 1999 13:33:48 -0400 (EDT) Received: from localhost (root@localhost) by post-ofc07.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Tue, 19 Oct 1999 13:33:14 -0400 (EDT) Received: via switchmail; Tue, 19 Oct 1999 13:33:14 -0400 (EDT) Received: from list.srv.cis.pitt.edu via qmail ID ; Tue, 19 Oct 1999 13:31:43 -0400 (EDT) Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.1) ID ; Tue, 19 Oct 1999 13:29:17 -0400 (EDT) Received: from post-ofc06.srv.cis.pitt.edu (root@post-ofc06.srv.cis.pitt.edu [136.142.185.43]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.1) ID for ; Tue, 19 Oct 1999 13:29:07 -0400 (EDT) Received: from klaptop (ehdup-t-74.rmt.net.pitt.edu [136.142.23.84]) by post-ofc06.srv.cis.pitt.edu with SMTP (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Tue, 19 Oct 1999 13:28:39 -0400 (EDT) Message-Id: <199910191728.NAA23616@post-ofc06.srv.cis.pitt.edu> From: "Keith Conover, M.D., FACEP" To: Lfrizzsolo@aol.com Date: Tue, 19 Oct 1999 13:31:20 -0400 MIME-Version: 1.0 Content-type: text/plain; charset=US-ASCII Content-transfer-encoding: 7BIT Subject: W-EMED Re: Fwd: wilderness medicine degrees CC: "poirier" , wilderness-emergency-medicine@list.pitt.edu In-reply-to: <0.50fabfb7.253c93e1@aol.com> X-mailer: Pegasus Mail for Win32 (v3.11) Sender: owner-wilderness-emergency-medicine@list.pitt.edu Precedence: bulk Reply-To: wilderness-emergency-medicine@list.pitt.edu X-PMFLAGS: 524416 0 1 P01ED0.CNM On 18 Oct 99, at 11:16, Lfrizzsolo@aol.com wrote: > Delivered-To: serious-solo@serioussports.com > From: "poirier" > To: > Subject: wilderness medicine degrees > Date: Sun, 10 Oct 1999 17:57:06 -0400 > X-Mailer: Microsoft Outlook Express 4.72.3110.1 > > Hello! >  My name is Bryan Poirier. I'm currently an Outdoor and > Experiential Education (BEd.) student at Queen's University in > Kingston, Ontario. My personal focus in this program is to further > devolop my skills and understanding of wilderness medicine and > wilderness first aid. In the near future, I hope to pursue a career > in medicine.  As a result of this goal, I've been searching > (largely in vain) for any leads on medical schools (in the U.S., > Canada, and abroad) that offer wilderness medicine as an area of > specialization/residency. Might you have any information regarding > such programs? Any suggestions or ideas that you might have would be > GREATLY appreciated!  Bryan, I'm afraid that there is no such thing as a residency in wilderness medicine -- primarily because there is no market for fulltime wilderness medicine physicians. If you are independently wealthy, you could pay your way through medical school, then do two years of any residency, and then set up a practice as a wilderness medcicine physician -- but don't expect to make any money doing it. There are some doctors, often ID specialists (an internal medicine subspecialty, take a residency in IM and then do an ID fellowship) and some sports medicine docs (ortho, family practice, etc. who are generally board certified in their primary specialties and then do some additional training in sports medicine) who offer "travel medicine" services but this is generally a sideline. Many emergency physicians (3-4 year residencies available) do wilderness medicine as part of their practice, and even get support from their practices for this, like me. There is also a wilderness _EMS_ elective (3-4 weeks) for R-2/R-3 emergency medicine residents here in Pittsburgh, available on a limited basis. Information is posted at http://www.wemsi.org I am not aware of any other wilderness-medicine specific training opportunities (wilderness EMS is my specific, but the Wilderness Medical Society (http://www.wms.org) often has information about medical student opportunties in wilderness medicine. Thanks for your interest. --Keith Conover, M.D., FACEP http://www.pitt.edu/~kconover Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- X-NAV-TimeoutProtection0: X X-NAV-TimeoutProtection1: X X-NAV-TimeoutProtection2: X X-NAV-TimeoutProtection3: X X-NAV-TimeoutProtection4: X X-NAV-TimeoutProtection5: X X-NAV-TimeoutProtection6: X Received: from post-ofc03.srv.cis.pitt.edu (root@post-ofc03.srv.cis.pitt.edu [136.142.185.39]) by pop.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cispop-7.2.2.1) ID ; Sat, 16 Oct 1999 15:33:05 -0400 (EDT) Received: from localhost (root@localhost) by post-ofc03.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Sat, 16 Oct 1999 15:32:31 -0400 (EDT) Received: via switchmail; Sat, 16 Oct 1999 15:32:31 -0400 (EDT) Received: from list.srv.cis.pitt.edu via qmail ID ; Sat, 16 Oct 1999 15:31:11 -0400 (EDT) Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.1) ID ; Sat, 16 Oct 1999 15:27:37 -0400 (EDT) Received: from imo11.mx.aol.com (imo11.mx.aol.com [198.81.17.1]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.1) ID for ; Sat, 16 Oct 1999 15:27:34 -0400 (EDT) From: Jaymullen@aol.com Received: from Jaymullen@aol.com by imo11.mx.aol.com (mail_out_v23.6.) id hTZKa05338 (4116) for ; Sat, 16 Oct 1999 15:29:52 -0400 (EDT) Message-ID: <0.460f9192.253a2c30@aol.com> Date: Sat, 16 Oct 1999 15:29:52 EDT Subject: W-EMED Adventure Race at Lake Powell To: wilderness-emergency-medicine@list.pitt.edu MIME-Version: 1.0 Content-Type: text/plain; charset="us-ascii" Content-Transfer-Encoding: 7bit X-Mailer: AOL 4.0 for Windows 95 sub 216 Sender: owner-wilderness-emergency-medicine@list.pitt.edu Precedence: bulk Reply-To: wilderness-emergency-medicine@list.pitt.edu X-PMFLAGS: 524416 0 1 P065E0.CNM Hey Everybody-- Interested in helping to provide medical support at a major adventure race? We're gearing up to cover the medical aspects of another large adventure race. This race is on and around Lake Powell in Northern Arizona, and runs for 40 hours straight on November 6th and 7th. This race is going to be fun for us -- deep steep canyons, cold, big cold water where swells can jump to more than 6 to 10 feet, nasty mountain biking and more. They expect about 150 racers. This is a great opportunity to see beautiful country, and get out in the field and treat wilderness associated injuries/illnesses. If you are thinking about helping out, let me know as soon as possible. Anyone who would like to help out should respond to me at Jay@AdventureDocs.com. Please do not respond to the list as a whole. You can check the Four Winds web site (www.4windsadventure.com) for more info. Or contact me. Thanks-- Jay Jay Mullen MD Adventure Medicine Consultants www.AdventureDocs.com Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- X-NAV-TimeoutProtection0: X X-NAV-TimeoutProtection1: X X-NAV-TimeoutProtection2: X X-NAV-TimeoutProtection3: X X-NAV-TimeoutProtection4: X X-NAV-TimeoutProtection5: X X-NAV-TimeoutProtection6: X Received: from post-ofc07.srv.cis.pitt.edu (root@post-ofc07.srv.cis.pitt.edu [136.142.185.73]) by pop.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cispop-7.2.2.1) ID ; Mon, 11 Oct 1999 14:18:05 -0400 (EDT) Received: from localhost (root@localhost) by post-ofc07.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Mon, 11 Oct 1999 14:17:22 -0400 (EDT) Received: via switchmail; Mon, 11 Oct 1999 14:17:21 -0400 (EDT) Received: from list.srv.cis.pitt.edu via qmail ID ; Mon, 11 Oct 1999 14:16:02 -0400 (EDT) Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.1) ID ; Mon, 11 Oct 1999 14:13:18 -0400 (EDT) Received: from m9.boston.juno.com (m9.boston.juno.com [205.231.100.195]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.1) ID for ; Mon, 11 Oct 1999 14:13:14 -0400 (EDT) Received: (from jaywiseman@juno.com) by m9.boston.juno.com (queuemail) id ENNV4N9M; Mon, 11 Oct 1999 14:14:56 EDT To: wilderness-emergency-medicine@list.pitt.edu Date: Mon, 11 Oct 1999 11:08:50 -0700 Subject: W-EMED Do upraised arms really increase the risk of fainting? Message-ID: <19991011.111758.12782.2.JayWiseman@juno.com> References: <199910110326.XAA02587@post-ofc05.srv.cis.pitt.edu> X-Mailer: Juno 1.49 X-Juno-Line-Breaks: 0-2,12-17 From: Jay J Wiseman Sender: owner-wilderness-emergency-medicine@list.pitt.edu Precedence: bulk Reply-To: wilderness-emergency-medicine@list.pitt.edu X-PMFLAGS: 128 0 1 P5F490.CNM Hi folks, Jay here, with a question. There is a belief "out there" that having your arms raised high over your head, especially if you are standing still, increases your risk of fainting. Now, I certainly know that simply standing still can increase your risk of fainting, due to lack of muscle contractions in the legs and thus decreased venous return to the heart, but I have never seen or heard of any credible evidence to support the idea that holding your hands overhead increases the severity of this condition. Indeed, it seems to me that raising your arms might actually increase venous return to the heart a bit, and thus maybe help make the problem a bit less severe. Has anybody got any info on this? Regards, Jay ___________________________________________________________________ Get the Internet just the way you want it. Free software, free e-mail, and free Internet access for a month! Try Juno Web: http://dl.www.juno.com/dynoget/tagj. Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- X-NAV-TimeoutProtection0: X X-NAV-TimeoutProtection1: X X-NAV-TimeoutProtection2: X X-NAV-TimeoutProtection3: X X-NAV-TimeoutProtection4: X X-NAV-TimeoutProtection5: X X-NAV-TimeoutProtection6: X Received: from post-ofc06.srv.cis.pitt.edu (root@post-ofc06.srv.cis.pitt.edu [136.142.185.43]) by pop.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cispop-7.2.2.1) ID ; Mon, 11 Oct 1999 17:46:13 -0400 (EDT) Received: from localhost (root@localhost) by post-ofc06.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Mon, 11 Oct 1999 17:45:34 -0400 (EDT) Received: via switchmail; Mon, 11 Oct 1999 17:45:33 -0400 (EDT) Received: from list.srv.cis.pitt.edu via qmail ID ; Mon, 11 Oct 1999 17:44:01 -0400 (EDT) Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.1) ID ; Mon, 11 Oct 1999 17:43:35 -0400 (EDT) Received: from macs.mxim.com (macs.mxim.com [204.17.143.130]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.1) ID for ; Mon, 11 Oct 1999 17:43:31 -0400 (EDT) Received: from localhost (localhost [127.0.0.1]) by macs.mxim.com (8.7/8.6.9) with SMTP id OAA25146; Mon, 11 Oct 1999 14:34:16 -0700 (PDT) Message-Id: <199910112134.OAA25146@macs.mxim.com> X-Mailer: exmh version 2.0.1 12/23/97 To: kconover+@pitt.edu cc: wilderness-emergency-medicine@list.pitt.edu, sar-l@listserv.islandnet.com Subject: Re: W-EMED Suspension trauma and stretchers (long) Mime-Version: 1.0 Content-Type: text/plain; charset=us-ascii Date: Mon, 11 Oct 1999 14:34:16 PDT From: Hal Lillywhite Sender: owner-wilderness-emergency-medicine@list.pitt.edu Precedence: bulk Reply-To: wilderness-emergency-medicine@list.pitt.edu Keith Conover, M.D., FACEP writes: >A standard first-year medical school physiology experiment is to >place a student on a "tilt-table" and tilt the student head-up >without letting him or her stand. The other students check the blood >pressure and pulse and are very surprised when the student on the >table gets, essentially, shocky. So the physiology is a no-brainer. ... >One of the first medical reports on hypothermia (and BTW a >wonderful description of how not to run a backcountry run/walk), >this paper describes one patient who was hypothermic and >probably dehydrated -- and as soon as tilted head-up in the litter, >seized and died. Timely information from my point of view. Our group was looking into going mainly to a vertical position raise or lowering for injured subjects. The idea was that we can do this so much faster than when the patient is horizontal that we thought a short time vertical would beat a much longer time horizontal while getting the patient to a place where we can provide better care. This obviously throws doubt on the wisdom of that theory. We have done some experiments, a couple with live but uninjured test subjects and more with only a weighted litter. We use either a basket litter or a SKED and backboard. It works extremely well as far as a quick raising or lowering. The litter is not likely to hang up on anything and if rigged correctly you almost never even need an edge person. However that is no help if the patient seizes and dies as soon as we get him moving. Of course, if the subject is uninjured he isn't going to be in a litter anyway so anybody we put in a litter (except for practice) will be injured. So my question: Are there circumstances in which it might be advisable to save time and have the patient vertical? Maybe something like a leg or arm injury without shock? I suspect we will have to abandon the idea of a vertical litter entirely but would like to know if there is any hope. Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- X-NAV-TimeoutProtection0: X X-NAV-TimeoutProtection1: X X-NAV-TimeoutProtection2: X X-NAV-TimeoutProtection3: X X-NAV-TimeoutProtection4: X X-NAV-TimeoutProtection5: X X-NAV-TimeoutProtection6: X Received: from post-ofc01.srv.cis.pitt.edu (root@post-ofc01.srv.cis.pitt.edu [136.142.185.25]) by pop.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cispop-7.2.2.1) ID ; Sun, 10 Oct 1999 23:28:10 -0400 (EDT) Received: from localhost (root@localhost) by post-ofc01.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Sun, 10 Oct 1999 23:27:36 -0400 (EDT) Received: via switchmail; Sun, 10 Oct 1999 23:27:35 -0400 (EDT) Received: from list.srv.cis.pitt.edu via qmail ID ; Sun, 10 Oct 1999 23:27:27 -0400 (EDT) Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.1) ID ; Sun, 10 Oct 1999 23:26:28 -0400 (EDT) Received: from post-ofc05.srv.cis.pitt.edu (root@post-ofc05.srv.cis.pitt.edu [136.142.185.10]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.1) ID for ; Sun, 10 Oct 1999 23:26:23 -0400 (EDT) Received: from micron (ehdup-d3-2.rmt.net.pitt.edu [136.142.20.232]) by post-ofc05.srv.cis.pitt.edu with SMTP (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Sun, 10 Oct 1999 23:26:02 -0400 (EDT) Message-Id: <199910110326.XAA02587@post-ofc05.srv.cis.pitt.edu> From: "Keith Conover, M.D., FACEP" To: "Rob Thomas" , wilderness-emergency-medicine@list.pitt.edu, sar-l@listserv.islandnet.com, wilderness-emergency-medicine@list.pitt.edu Date: Sun, 10 Oct 1999 23:28:28 -0400 MIME-Version: 1.0 Content-type: text/plain; charset=US-ASCII Content-transfer-encoding: 7BIT Subject: Re: W-EMED Suspension trauma and stretchers (long) In-reply-to: <349CAF25BBF@medinfo.iplan.co.za> X-mailer: Pegasus Mail for Win32 (v3.11) Sender: owner-wilderness-emergency-medicine@list.pitt.edu Precedence: bulk Reply-To: wilderness-emergency-medicine@list.pitt.edu 0100,0100,0100On 27 Sep 99, at 9:15, Rob Thomas wrote: 0000,0000,0000> A short while ago someone pointed me to a couple of web-pages > relating to suspension trauma, also known as harness induced > pathology. What I've written here is a paraphrasing of a couple of > articles, some of which are grammatically interesting translations > from French. Hi, Rob. Your post and subsequent posts are indeed a nice summary of the problem and the "literature" such as it is. A standard first-year medical school physiology experiment is to place a student on a "tilt-table" and tilt the student head-up without letting him or her stand. The other students check the blood pressure and pulse and are very surprised when the student on the table gets, essentially, shocky. So the physiology is a no-brainer. A harness may indeed make the situation worse by constricting the bloodflow some more. A padded harness may make this a bit less of a problem, but you're right, the main problem is the lack of muscular pumping action pushing venous blood back up the legs. (It might be worth noting the anatomy: every inch or few along the larger veins in the legs are oneway valves. With muscular contractions alternately compressing different segments of the vein, this works like a wonderful pump to return venous blood to the torso-- but it depends on strong and continuously changing muscular contractions squeezing the sections of vein between the valves. However, we know that people who are tired tend to be dehydrated, too. And, we also know that cold stress, even without true hypothermia, causes significant dehydration ("cold diuresis"). So, take someone who is really cold, really tired and dehydrated, and put him or her vertically on a rope with something tied around the proximal thighs (a venous tourniquet, AKA a seat harness) you have a recipe for disaster. And, given the observation about medical-student tilt-table experiments, it's certainly true this is a problem for litter patients, too. I will make an observation about a great article: Pugh 0100,0100,0100LGCE. Hypothermia in walkers, climbers, and campers: report to the medical commission on accident prevention. Br Med J 1966; 123-129 One of the first medical reports on hypothermia (and BTW a wonderful description of how not to run a backcountry run/walk), this paper describes one patient who was hypothermic and probably dehydrated -- and as soon as tilted head-up in the litter, seized and died. In the WEMSI Wilderness EMT course we teach that dehydrated/hypothermic patients shouldn't be tilted in the headup position if at all possible -- and if you have to tilt such a patient, i.e. to get up a narrow pit in a cave -- rehydrate first, and consider putting the MAST garment on the patient, inflation prior to the vertical lift, and deflating after the vertical portion's done. BTW, I do know that there is an international society for fall prevention, dealing with workers on scaffolds and window washers and the like, and suspect that there is more information about "harness hang" out there but haven't had the time to dig further and see if there's any information there. Take care. --Keith Conover, M.D., FACEP http://www.pitt.edu/~kconover Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- X-cs: R From: Keith Conover, M.D., FACEP X-RS-ID: X-RS-Flags: 0,0,1,1,0,0,0 X-RS-Header: In-reply-to: <349CAF25BBF@medinfo.iplan.co.za> X-RS-Sigset: 2 To: "Rob Thomas" ,wilderness-emergency-medicine@list.pitt.edu,sar-l@listserv.islandnet.com, wilderness-emergency-medicine@list.pitt.edu Subject: Re: W-EMED Suspension trauma and stretchers (long) Reply-to: kconover+@pitt.edu MIME-Version: 1.0 Content-type: text/enriched; charset=ISO-8859-1 Content-transfer-encoding: 8BIT Date: Sun, 10 Oct 1999 13:53:26 -0400 0100,0100,0100On 27 Sep 99, at 9:15, Rob Thomas wrote: 0000,0000,0000> A short while ago someone pointed me to a couple of web-pages > relating to suspension trauma, also known as harness induced > pathology. What I've written here is a paraphrasing of a couple of > articles, some of which are grammatically interesting translations > from French. Hi, Rob. Your post and subsequent posts are indeed a nice summary of the problem and the "literature" such as it is. A standard first-year medical school physiology experiment is to place a student on a "tilt-table" and tilt the student head-up without letting him or her stand. The other students check the blood pressure and pulse and are very surprised when the student on the table gets, essentially, shocky. So the physiology is a no-brainer. A harness may indeed make the situation worse by constricting the bloodflow some more. A padded harness may make this a bit less of a problem, but you're right, the main problem is the lack of muscular pumping action pushing venous blood back up the legs. (It might be worth noting the anatomy: every inch or few along the larger veins in the legs are oneway valves. With muscular contractions alternately compressing different segments of the vein, this works like a wonderful pump to return venous blood to the torso-- but it depends on strong and continuously changing muscular contractions squeezing the sections of vein between the valves. However, we know that people who are tired tend to be dehydrated, too. And, we also know that cold stress, even without true hypothermia, causes significant dehydration ("cold diuresis"). So, take someone who is really cold, really tired and dehydrated, and put him or her vertically on a rope with something tied around the proximal thighs (a venous tourniquet, AKA a seat harness) you have a recipe for disaster. And, given the observation about medical-student tilt-table experiments, it's certainly true this is a problem for litter patients, too. I will make an observation about a great article: Pugh 0100,0100,0100LGCE. Hypothermia in walkers, climbers, and campers: report to the medical commission on accident prevention. Br Med J 1966; 123-129 One of the first medical reports on hypothermia (and BTW a wonderful description of how not to run a backcountry run/walk), this paper describes one patient who was hypothermic and probably dehydrated -- and as soon as tilted head-up in the litter, seized and died. In the WEMSI Wilderness EMT course we teach that dehydrated/hypothermic patients shouldn't be tilted in the headup position if at all possible -- and if you have to tilt such a patient, i.e. to get up a narrow pit in a cave -- rehydrate first, and consider putting the MAST garment on the patient, inflation prior to the vertical lift, and deflating after the vertical portion's done. BTW, I do know that there is an international society for fall prevention, dealing with workers on scaffolds and window washers and the like, and suspect that there is more information about "harness hang" out there but haven't had the time to dig further and see if there's any information there. Take care. -- End -- X-NAV-TimeoutProtection0: X X-NAV-TimeoutProtection1: X X-NAV-TimeoutProtection2: X X-NAV-TimeoutProtection3: X X-NAV-TimeoutProtection4: X X-NAV-TimeoutProtection5: X X-NAV-TimeoutProtection6: X Received: from post-ofc04.srv.cis.pitt.edu (root@post-ofc04.srv.cis.pitt.edu [136.142.185.11]) by pop.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cispop-7.2.2.1) ID ; Tue, 5 Oct 1999 03:49:03 -0400 (EDT) Received: from localhost (root@localhost) by post-ofc04.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Tue, 5 Oct 1999 03:15:48 -0400 (EDT) Received: via switchmail; Tue, 5 Oct 1999 03:15:48 -0400 (EDT) Received: from list.srv.cis.pitt.edu via qmail ID ; Tue, 5 Oct 1999 03:15:06 -0400 (EDT) Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.1) ID ; Tue, 5 Oct 1999 03:14:31 -0400 (EDT) Received: from uucp.iafrica.com (uucp.iafrica.com [196.7.0.177]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.1) ID for ; Tue, 5 Oct 1999 03:14:26 -0400 (EDT) Received: by uucp.iafrica.com via sendmail with UUCP id for wilderness-emergency-medicine@list.pitt.edu; Tue, 5 Oct 1999 09:16:50 +0200 (SAST) (Smail-3.2 1996-Jul-4 #1 built 1997-Jan-21) Received: from medinfo.iplan.co.za (medinfo.iplan.co.za [196.16.129.16]) by cthru.sita.co.za (8.9.3/8.9.3) with ESMTP id IAA15700; Tue, 5 Oct 1999 08:25:40 +0200 Received: from MEDINFO/SpoolDir by medinfo.iplan.co.za (Mercury 1.44); 5 Oct 99 08:13:23 +0200 Received: from SpoolDir by MEDINFO (Mercury 1.44); 5 Oct 99 08:13:02 +0200 From: "Rob Thomas" X-Real-Sender: ROBT Organization: State I.T. Agency, S.A. To: wilderness-emergency-medicine@list.pitt.edu, sar-l@listserv.islandnet.com Date: Tue, 5 Oct 1999 08:12:53 +0200 Subject: W-EMED Re: Suspension trauma - a reply X-mailer: Pegasus Mail v3.31 Message-ID: <408C60B5855@medinfo.iplan.co.za> Sender: owner-wilderness-emergency-medicine@list.pitt.edu Precedence: bulk Reply-To: wilderness-emergency-medicine@list.pitt.edu Hi all Below is a reply I received relating to the above topic, with my own reply interspersed. Forwarded to the list with the permission of the person who replied to me. On 1 Oct 99 at 11:41, MONGO12@aol.com wrote: > My name is James P. Roach, Iam the Team Leader for the High > Incident Rescue Team Inc. out of Massachusetts. I reveived your > e mail from a collegue of mine who read it from Search & Rescue web > site. Nice to see people passing on items of interest to other parties. > I think we havent had these problems here due to the fact that most > of our rescue teams are using fully padded class 2 and class 3 > harnesses, this help greatly reduce the effects of blood pooling > into the lower extremities. All so remember that its not the blood > pooling into the lower extremities but the fact that it CAN NOT > RETURN through the venous system due to the compression of the > webbing acting like a toruniquet on the thighs and femerols. While I agree that a better harness may mitigate the problem to a very small extent, I'm not sure that I agree that the harness design and construction would play as significant a part as you suggest. The reason I say this is two-fold: (1) In the original tests they concluded that the problem would persist regardless of harness and that further research on harness construction would be money wasted, and (2) My analogy of the soldier passing out on parade shows that this happens even when there is no harness involved. I do agree that the problem isn't caused by the flow of blood to the legs but by the inability of the blood to return. However, in their research they state that despite the heart's output the blood return to the heart still relies to some extent on muscular contraction / movement to assist with venous return. Consequently, a person who is wearing no harness but is totally motionless would suffer the same effects as a result of no muscular activity and hence reduced bloodflow. > As far as vertical lift extrication with stretchers.......when > properly secured into a stokes liter the body is free to slightly > move the limbs to facilitate circulation, also the body is not > compressed due to straps/webbing like the harness so all the > weight is on the feet and along the back. On use of a SKED > exctrication device we have used these for sewer and cavern > rescues since they hit the market......we have had up to 45 mins > of hang time for the victim and no problem with > hypotentioning.......again like the stokes the body should have no > constriction to any of the thighs or waist, so flexation should be > available for the victims. Again, I agree that it isn't necessarily the stretcher design that causes the problem, although the way in which the immobilisation is done probably does play a part. I suspect it's the combined effect of a person who is *totally* motionless and that they're unable to fall over which leads to the ultimate problem. We, too, have had people in the stretcher for very long periods with no apparent ill effects but most of these have been conscious and moving freely or in an altered state of consciousness and somewhat combative. In both cases there is muscular activity. Ultimately, I think the mechanism is the combination of the lack of muscular activity and the vertical positioning which causes the problem. Constriction as a result of poor harness fit or enthusiastic immobilisation will merely hasten the process. However, most patients we encounter are moving spontaneously from time to time and will therefore not encounter the problem. I think the ones we need to look out for are those who are immobile (unconscious or para-/quadriplegic), are aleady somewhat fragile (lowered BP / lung injury / heart-rate / head injury) and are faced with an extended extraction in a vertical configuration. > If you have any futher commments or information please contact me > direct at MONGO12@aol.com ...and back to you. Keep well and thanks for a considered reply. Regards Rob -- Rob Thomas +27-12 450-2957 07h30-16h30 GMT+0200 +27-82-652-2540 all hours (try to be reasonable) Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- X-NAV-TimeoutProtection0: X X-NAV-TimeoutProtection1: X X-NAV-TimeoutProtection2: X X-NAV-TimeoutProtection3: X X-NAV-TimeoutProtection4: X X-NAV-TimeoutProtection5: X X-NAV-TimeoutProtection6: X Received: from post-ofc07.srv.cis.pitt.edu (root@post-ofc07.srv.cis.pitt.edu [136.142.185.73]) by pop.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cispop-7.2.2.1) ID ; Mon, 4 Oct 1999 10:54:05 -0400 (EDT) Received: from localhost (root@localhost) by post-ofc07.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Mon, 4 Oct 1999 10:53:32 -0400 (EDT) Received: via switchmail; Mon, 4 Oct 1999 10:53:32 -0400 (EDT) Received: from list.srv.cis.pitt.edu via qmail ID ; Mon, 4 Oct 1999 10:51:24 -0400 (EDT) Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.1) ID ; Mon, 4 Oct 1999 10:49:00 -0400 (EDT) Received: from fs1.tlsinc.com (host-208-170-96-33.tlsinc.com [208.170.96.33] (may be forged)) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.1) ID for ; Mon, 4 Oct 1999 10:48:55 -0400 (EDT) Received: by FS1 with Internet Mail Service (5.5.2448.0) id <4GJV0AY6>; Mon, 4 Oct 1999 09:55:58 -0500 Message-ID: <71CC974D48FCD111825300A0C990B705047D44@FS1> From: Ed To: wilderness-emergency-medicine@list.pitt.edu Subject: W-EMED Vacume full body splints Date: Mon, 4 Oct 1999 09:55:56 -0500 MIME-Version: 1.0 X-Mailer: Internet Mail Service (5.5.2448.0) Content-Type: text/plain; charset="iso-8859-1" Sender: owner-wilderness-emergency-medicine@list.pitt.edu Precedence: bulk Reply-To: wilderness-emergency-medicine@list.pitt.edu X-PMFLAGS: 524416 0 1 P66E20.CNM Thanks for all the info and replies. We hope to add a couple of these this year to the cache. Thanks Again Ed Nicholas, EMT-D Huntsville cave rescue Unit, Inc HEMSI High Angle Rough Terrain Team Huntsville, Alabama Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- X-NAV-TimeoutProtection0: X X-NAV-TimeoutProtection1: X X-NAV-TimeoutProtection2: X X-NAV-TimeoutProtection3: X X-NAV-TimeoutProtection4: X X-NAV-TimeoutProtection5: X X-NAV-TimeoutProtection6: X Received: from post-ofc04.srv.cis.pitt.edu (root@post-ofc04.srv.cis.pitt.edu [136.142.185.11]) by pop.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cispop-7.2.2.1) ID ; Fri, 1 Oct 1999 17:20:13 -0400 (EDT) Received: from localhost (root@localhost) by post-ofc04.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Fri, 1 Oct 1999 16:49:21 -0400 (EDT) Received: via switchmail; Fri, 1 Oct 1999 16:49:20 -0400 (EDT) Received: from list.srv.cis.pitt.edu via qmail ID ; Fri, 1 Oct 1999 16:48:26 -0400 (EDT) Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.1) ID ; Fri, 1 Oct 1999 16:47:54 -0400 (EDT) Received: from post-ofc06.srv.cis.pitt.edu (root@post-ofc06.srv.cis.pitt.edu [136.142.185.43]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.1) ID for ; Fri, 1 Oct 1999 16:47:50 -0400 (EDT) Received: from micron (ehdup-t-96.rmt.net.pitt.edu [136.142.23.106]) by post-ofc06.srv.cis.pitt.edu with SMTP (8.8.8/8.8.8/cispo-7.2.2.2) ID for ; Fri, 1 Oct 1999 16:47:42 -0400 (EDT) Message-Id: <199910012047.QAA22133@post-ofc06.srv.cis.pitt.edu> From: "Keith Conover, M.D., FACEP" To: wilderness-emergency-medicine@list.pitt.edu Date: Fri, 1 Oct 1999 16:50:01 -0400 MIME-Version: 1.0 Content-type: text/plain; charset=US-ASCII Content-transfer-encoding: 7BIT Subject: Re: W-EMED SAR Team Med equipment list... In-reply-to: <19991001164906.87458.qmail@hotmail.com> X-mailer: Pegasus Mail for Win32 (v3.11) Sender: owner-wilderness-emergency-medicine@list.pitt.edu Precedence: bulk Reply-To: wilderness-emergency-medicine@list.pitt.edu X-PMFLAGS: 524416 0 1 P4BE00.CNM On 1 Oct 99, at 9:49, Gurkan Ozel wrote: > The recent email I got > from them asking me to send them a list of medical equipment that can be > used not only in wilderness SAR but also in urban rescue. Gurkan, please check the "team medical kit list" at http://www.wemsi.org It includes a generic US-type ALS (advanced life support) kit as well as other wilderness-specific items. Note that each state in the US has a different ALS kit on ambulances, and the one in the WEMSI list is sort of a consensus. Your team may also be interested in the Wilderness EMT training course posted on the above web site -- it's something you could probably set up in Turkey for your own team, with a little help. The emergency medicine residents and faculty from the emergency medicine residency in Izmir, for which our EM group here in Pittsburgh has provided visiting faculty, could probably help, too. --Keith Conover, M.D., FACEP http://www.pitt.edu/~kconover Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- X-NAV-TimeoutProtection0: X X-NAV-TimeoutProtection1: X X-NAV-TimeoutProtection2: X X-NAV-TimeoutProtection3: X X-NAV-TimeoutProtection4: X X-NAV-TimeoutProtection5: X X-NAV-TimeoutProtection6: X Received: from post-ofc04.srv.cis.pitt.edu (root@post-ofc04.srv.cis.pitt.edu [136.142.185.11]) by pop.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cispop-7.2.2.1) ID ; Fri, 1 Oct 1999 12:52:38 -0400 (EDT) Received: from localhost (root@localhost) by post-ofc04.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Fri, 1 Oct 1999 12:52:00 -0400 (EDT) Received: via switchmail; Fri, 1 Oct 1999 12:52:00 -0400 (EDT) Received: from list.srv.cis.pitt.edu via qmail ID ; Fri, 1 Oct 1999 12:50:11 -0400 (EDT) Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.1) ID ; Fri, 1 Oct 1999 12:47:23 -0400 (EDT) Received: from hotmail.com (f33.law3.hotmail.com [209.185.241.33]) by list.srv.cis.pitt.edu with SMTP (8.8.8/8.8.8/cisls-7.2.2.1) ID for ; Fri, 1 Oct 1999 12:47:12 -0400 (EDT) Received: (qmail 87459 invoked by uid 0); 1 Oct 1999 16:49:06 -0000 Message-ID: <19991001164906.87458.qmail@hotmail.com> Received: from 205.169.197.108 by www.hotmail.com with HTTP; Fri, 01 Oct 1999 09:49:06 PDT X-Originating-IP: [205.169.197.108] From: "Gurkan Ozel" To: wilderness-emergency-medicine@list.pitt.edu Subject: W-EMED SAR Team Med equipment list... Date: Fri, 01 Oct 1999 09:49:06 PDT Mime-Version: 1.0 Content-Type: text/plain; format=flowed Sender: owner-wilderness-emergency-medicine@list.pitt.edu Precedence: bulk Reply-To: wilderness-emergency-medicine@list.pitt.edu X-PMFLAGS: 1572992 0 1 P04DA0.CNM Hello all, This is Gurkan, the Turkish guy again. The EMT-B training is going pretty good up in Crested Butte,CO. My fellow SAR Team members in Turkey are working hard on re-establishing the things again. The recent email I got from them asking me to send them a list of medical equipment that can be used not only in wilderness SAR but also in urban rescue. They will have a budget up to $10,000 for this. Can you help me out to make a list of equipment that can be enough to help 2-3 causalties at the same time, strechers, vacuum splints, other splinting material, & whole bunch of other medical equipment that you think should be carried by a rescue team on the field. I'd be glad if you can provide the info about the suppliers as well. Many thanks in advance. Cheers :) Gurkan Ozel ********************* 615 W. San Juan Ave. Gunnison, CO 81230 (970) 641 2082 ********************* ______________________________________________________ Get Your Private, Free Email at http://www.hotmail.com Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End --