Thursday, January 29, 2009

HAPE Country News

High Altitude Pulmonary Edema (HAPE), a non-cardiogenic form of pulmonary edema, remains a threat to people who ascend quickly to elevations above 2500 m (8250 ft). In a recent report in Wilderness & Environmental Medicine, Vol 19, No 4, 2008, the journal of the Wilderness Medical Society (www.wms.org), Drs. Stream and Grissom briefly reviewed a study showing inhaled salmeterol reduces the risk of HAPE in HAPE-prone individuals by 50 percent. (You' ll have to chat with a doc about a 'script for salmeterol.) But, more importantly, it was reported that there is nothing new in the preferred treatment for the problem: patients who descend 500-1000 m (1650-3300 ft) and/or who are treated with supplemental oxygen at a rate high enough to keep their oxygen saturation at 90 percent or more, get better--given adequate time. Those patients on O2 should avoid strenuous activity as well.

Wednesday, January 21, 2009

An Abrasive Thought

New evidence suggests a long-held belief might not be as worthy of being held onto as we have thought. I just returned from a short trip to Dallas (actually Irving, TX) where a group met to discuss wilderness first aid (and I hope to report more on that later). One topic was abrasions, a wound typically causing the patient pain--sometimes more than a little--when it is scrubbed clean. According to Dr. William Forgey, an application of an antibiotic ointment applied liberally within 10-15 minutes of the injury and you do not need to scrub. The ointment penetrates the skin, promoting the resistance of infection while protecting the site--and patient's so treated may actually develop an infection less often than when scrubbed. Doc Forgey did recommend removing large particles contaminating the wound prior to applying the ointment. You can brush those particles out with sterile gauze. And he further noted that we need to be ready to scrub if the wound is older than the 15 minutes (or so) time limit.

Monday, January 5, 2009

Two People and One Bag

The temp dropped to zero again in Lander, and that might help explain the return of an annual winter question: are two people in one sleeping bag effective when one person is hypothermic? Despite the popularity of this proposal, snuggling is not a great warming method. The warm person adds very little heat, certainly not enough to reverse significant hypothermia quickly--and there are possible negative results. Two people seldom fit into one bag, and if you can't close the bag, heat retention is lost. If the heat donor wants out, much of the heat that has been retained is lost when the bag is opened. The warm person might be more useful making hot water bottles for the cold person, building a fire, or carrying out a message asking for help. It is not necessarily "wrong" to put two people in one bag, but neither is it the "standard of care," and there are usually better things to do.