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Conference 5/28/2020

Week ten of Virtual Conference is upon us. Thanks to last weeks’ lecturers for a great job, including our guest lecturers!  This week traditionally has been MEDWars in the pre-Covid times. Although we cannot participate in the great outdoor games, we can certainly discuss some wilderness medicine and disaster preparedness. Additionally we will have an entertaining joint-venture with the UTSW EM Residency crew. What exactly? tune in 5/28 for more details.

But first

A somber Memorial Day 5/25. In these times this is certainly amplified. Thank you to those who have made the ultimate sacrifice. Thank you to all military service members, families, and loved ones. We support and salute you.

Also

As Ramadan ends, Happy Eid Mubarak, which began 5/23 and ended 5/24.

Next up

To cement the sports and orthopedics knowledge from the recent guest lecturer, I recommend reading this EMDOCS (TM) article regarding fracture terminology and how to describe the fracture.

This week we also discuss some wilderness medicine topics including Ski Medicine, Mountain and Diving Medicine, pathways to training and certification as well as Search and Rescue (SAR) terminology and techniques. Wilderness medicine is difficult to teach without in field demonstrations, but I will attempt to discuss some principles in virtual conference including splinting, field carrying and envenomations. In the mean time check out the links below.

Wilderness Tips

Certain things will kill victims fast, so you address these issues first:

  • Massive hemorrhage. Bleeding from the femoral artery, carotid artery, temporal artery, or brachial artery can all kill within minutes. Put some pressure on that. Use a pad and an ACE wrap to approximate a pressure bandage so you can keep your hands free.
  • Airway.
  • Respiration.
  • Circulation.
  • Hypo/hyperthermia. Address and adjust.
  • “H” also stands for hike/helicopter and in a way – transport — you have to decide how the patient is getting back home. (1)
  • Spine assessment + Limb assessment
  • Simple dislocation + Fracture reduction
  • Manage wounds and remove impaled objects


Read more Wilderness Tips here: https://www.aafp.org/news/blogs/freshperspectives/entry/20180605fp-wilderness.html

Avalanche Fatalities

A study in 2016 in Wilderness Emergency Medicine looked at avalanche related fatalities. There were 925 recorded avalanche fatalities in the United States between 1951 and 2013. The mean (+/- SD) age was 29 ± 6.6 years (range, 6-67 years), and 86% were men. Snowmobilers are now the largest group among fatalities and accounted for 23% of deaths (n = 213). (4) Overall it appears that avalanche related deaths are increasing from recreational usage of backcountry terrain. (4)

Avalance Survival Tips

  1. Expand chest immediately once buried –> Reduced snow compression of thorax
  2. Hot breath – clear air pocket in front of mouth –>Extends survival to >90 mins
  3. Exhaled gases – 5% CO2, 16% O2.
  4. >90 mins = hypothermia
  5. You can purchase an Avalung device to use while skiing –> the difficult part is that you have to get the mouthpiece in before you are immersed in snow.

Wilderness Envenomations

Here is a great article from the Wilderness Medical Society (WMS) regarding US Pitviper envenomations. https://www.wemjournal.org/article/S1080-6032(15)00220-3/fulltext

Additionally, here is a great article also regarding Lyme disease and what a wilderness provider needs to know in the field. https://www.wemjournal.org/article/S1080-6032(15)00205-7/fulltext

Thats all for now, see you in conference 5/28

References

  1. https://www.aafp.org/news/blogs/freshperspectives/entry/20180605fp-wilderness.html
  2. https://blog.nols.edu/2019/08/10/scene-size-up-5-steps
  3. https://pubmed.ncbi.nlm.nih.gov/10560307/
  4. https://www.wemjournal.org/article/S1080-6032(07)70258-2/fulltext
  5. https://www.wemjournal.org/article/S1080-6032(15)00220-3/fulltext


Image Credits
Unsplash/@Will_Turner https://unsplash.com/@turner_imagery

Stefan Meyering DO, FAAEM, FACEP

Dad, Academic EM Attending Physician, Fish Nerd & Backyard Mechanic | APD @ Ft Worth EM | Interests: Graduate Medical Education, Risk Management and Legal Medicine, POCUS, Free Open Access Medical Education (FOAMed), Physician Wellness

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