Ibu to the Rescue

A recent study reported in the Annals of Emergency Medicine 2009:54 revealed that children aged 4-18 years who had suffered fractured arms and who were treated with ibuprofen experienced less side-effects (not surprising) and less pain (very surprising) than children--same ages, same injuries--who were treated with acetaminophen and codeine. Who wudda thunk it? The dose of ibuprofen, by the way, was 10 millgrams per kilogram (2.2 pounds) of body weight. It's a bold extrapolation, yes, to say anyone in pain treated with ibu (over-the-counter) will suffer less than if treated with acetaminophen and codeine (prescription)--but it certainly seems worth a try. And out there in the wilds ibuprofen is often our only choice. I will certainly use it with even more confidence than in the past. You can read more about the study and Paul Auerbach's thoughts on it at www.healthline.com/blogs/outdoor_health.

Neck and Neck

An argument heard at least now and then at gatherings of those who at least think themselves savvy in the ways of wilderness medicine concerns the effectiveness of improvising a cervical collar with a SAM Splint (http://sammedical.com). Whether you are pro or con, take a look at Wilderness and Environmental Medicine (Volume 20, Number 2, 2009). You'll be able to read a report on a study done by McGrath and Murphy comparing a Philadelphia cervical collar (used on ambulances) with a collar improvised with a SAM Splint. The results, briefly stated, suggest the SAM Splint, used according to the directions that come with the device, are, once again at least, as effective as the Philadelphia collar. The study, in case you're interested, tested motion of the neck in extension and side to side. Personally, I have been teaching use of the SAM Splint as an improvised cervical collar for just about 25 years. I will continue to do so--but with renewed confidence.

Back At It

No blog since November 10? In case someone was wondering if I had died, the answer is no, but I felt, now and then, sort of like I was. My lumbar spine, slowing giving out over the past decade or so, gave up completely. The first signal was pain in the posterior region of my acetabulum, the back of my right hip. Gradually the pain moved down the outside of my thigh, under my knee, and down my shin to the top of my right foot. "Classic presentation," said the spine surgeon in Billings, Montana. I said the pain, classic or not, was keeping me pretty much off my feet. So he operated, removing bits of my lower two vertebrae and a smidge of my sacrum to make room for the nerves to emerge freely. I am quite happy to report I feel like a new man--or at least a man with a new lower spine.

WFA in the News

A meeting of the minds of the largest providers of wild med training, an effort spearheaded by Tod Schimelpfenig of the Wilderness Medicine Institute and David Johnson of Wilderness Medical Associates, produced a first draft of minimum requirements and scope of practice for wilderness first aid. Several attempts to produce such a document in the past failed despite the fact that, as Tod says, in his opinion, ". . . the content of the major providers is very consistent." Tod continued: "Conversations with David Johnson, MD, of WMA over the past year, and the actions of the BSA WFA curriculum project led us to sense we are at a tipping point and should move forward on these questions of standard content." Perhaps at last the time has come for a national standard. I have certainly witnessed a few near misses. If you're interested in taking a look at the document, send me a comment with the email address you wish it sent to. And you can read more at www.wildmed.com/blog/is-there-a-standard-in-wilderness-medicine-training/.

H1N1

It may be impossible to avoid contact with H1N1 (the piggy flu) or with at least some flu virus this year. But you can avoid allowing the virus to proliferate enough to cause disease. Keep in mind the pathways for the germs to enter your body are the nose and mouth, and keep in mind these six preventative outdoor and/or indoor steps:
1. Wash your hands often (and if you haven't gotten that message, you are from off-world).
2. Keep your hands off your face unless you are eating or bathing (and wash your hands before eating).
3. Gargle twice a day to rinse out germs that might have entered your mouth. Listerine works fine, but so does warm, salty water.
4. Blow your nose at least once a day. A quick swabbing with salt-water-soaked cotton would be even better.
5. Get enough vitamin C via fresh fruits and veggies and/or supplements.
6. Drink plenty of warm fluids, such as coffee and tea, every day. It's sort of like gargling in reverse. Flu germs in your mouth are flushed into your tummy where they cannot survive.

Bagged Arms Go Numb

A question that comes across my desk semi-often is this: why do my arms go numb from the elbow to the hand after a night in my sleeping bag? The numbness usually can be explained by the fact that people sleep differently in their bags. With less room, they curl their arms at the elbows and often at the wrists as well, especially if they snooze with their hands tucked under their chins. This position, if prolonged, will irritate the median and/or ulnar nerves, and the result is numbness. On the positive side, nothing serious is happening, and soon after the arms are straightened, the numbness goes harmlessly away. If folks had rather avoid the problem, they can try a bigger and/or more insulated bag. Bigger, of course, means more room and less need for elbow flexion. More insulated could mean sleeping warmer with less need to curl up to hold in body heat.

Charlie Houston

On September 27 Charles Houston, MD, slipped away peacefully in his Vermont home at the age of 96. As a pioneering mountaineer, he had few equals. First ascents of Foraker and Nanda Devi were his, and numerous other climbs in Alaska and the Himalayas. A fine writer, Houston's book, K2: The Savage Mountain, chronicling his second expedition to the world's second highest mountain, is a true classic in mountaineering literature. But Charlie Houston contributed most profoundly to the world through his unprecedented research into high altitude medicine. He is indeed credited with the first identification of high altitude pulmonary edema. Houston established and for ten years directed altitude medicine research on Mount Logan in Canada. Much of what we know today and depend upon when we acclimatize to high altitude or treat those who have not acclimatized can be traced to roots on Logan. A classic in wilderness medicine literature, Going Higher: Oxygen, Man, and Mountains, was written by Houston. I remember him best as a kind man who generously answered all my questions when I was young in the field of wild med. I will miss him.