MI and Aspirin

Kate, one of my students at Central Wyoming College (www.cwc.edu), asked in class about the dose of aspirin to give someone who might be experiencing a myocardial infarction (MI). Aspirin, a great drug that's been available over-the-counter since 1897, is certainly recommended when you're thinking, hey, this could be a heart attack. The "blood-thinning" properties of the drug tend to improve the outcome for the patient. Yes, the dose has changed over the years, and remains somewhat controversial, but most experts currently recommend 3-4 baby aspirin (each containing 81 mg) or one adult aspirin (with 325 mg). The aspirin gets to work a bit quicker if the tablets can be chewed before being swallowed with a swig of water. Then keep the patient physically and emotionally at rest until help can be found for an evacuation. If evacuation is delayed into additional days, each day should include more aspirin, once a day, at the same dose.

One-Ten-One

More than a foot of snow fell on Lander during the past week. It's that time of year when many beloved myths experience a rebirth. One of my favorites says something like this: If you fall into icy water, you might as well give up since hypothermia will kill you in minutes. It just ain't so. What does happen, and how you should respond, is summed up in the words "one minute--ten minutes--one hour," a slogan created by Gordon Giesbrecht, Ph.D., the guru of cold. After a plunge into very cold water, use to first minute to calm yourself and control your breathing. Those who don't are the ones who panic and drown. You then have approximately 10 minutes of useful movement. Use that time attempting to get out of the water or at least figuring out how to stabilize yourself. After 10 minutes, you should remain still to reduce heat loss. You have about one hour before you'll lose consciousness from hypothermia. If you're wearing a PFD, another hour or so will pass before your heart stops from the cold. One-ten-one. Remember it. And for more information read Hypothermia, Frostbite and Other Cold Injuires by Giesbrecht and his co-author James A. Wilkerson, M.D. (www.mountaineersbooks.org).

Air-Drying v. Wiping

Someone concerned about the germs that could be setting up housekeeping on backpacking kitchen gear asked which was better--letting washed gear air-dry or wiping it dry with a cloth. There are several variables here. Some germs may remain viable on wet gear, and wiping them off with a clean cloth gets rid of them. "Clean" is an important word. A grimy rag is less safe than air-drying. But then in areas where the air is dry, such as my home state of Wyoming, moisture on gear dries fast enough to make air-drying perfectly acceptable and probably as safe as drying with a clean cloth. In humid regions, try to keep a clean cloth available, something you can do by washing the bandanna you dried the dishes with after kitchen clean-up.

Outdoor Injuries

Those of you with no interest in numbers may choose to read no further. If you're still reading, these stats come from Wilderness and Environmental Medicine (the official publication of the Wilderness Medical Society), 19, 91-98 (2008)--and you're going to learn about the number of outdoor injuries in 2004 and 2005. During those 2 years, an estimated 212,708 injuries were sustained in outdoor activities and treated in hospitals. Sounds like a lot, yes, but the stats include just about any activity you can think of including skiing, horsepacking, skydiving, and snowmobiling. Lower limbs were involved in 27% of the injuries, upper limbs in 25%, and the head and neck in 23.3%. The most common diagnoses were fractures (27.4%) and strains or sprains (23.9%). Males were injured in 68.2% of the accidents. The most dangerous activity? Snowboarding, with a whopping 53,996 estimated annual injuries. Second was sledding, which includes sliding down snowy hillsides on tubes and disks (22,780 annual injuries), and third was hiking (13,448) which included anyone out for a walk anywhere outdoors. Short version: It's statistically much safer on ground than snow. For more info, check out www.wms.org.

Bleached Water

Someone recently asked if he could use household bleach to disinfect water on the trail. The short answer is "yes." Here's more info: Household bleach typically runs about 5% chlorine. We know that 0.1 ml to 0.2 ml of 5% chlorine bleach added to a liter of water will disinfect it, if you wait about a half hour, killing everything except Cryptosporidium (and it may take an hour or more to kill Giardia). A problem arises in measuring bleach into a water bottle. You can use a measured dropper, one that tells you how much fluid is being dropped, and that's the only way to be sure of your measurement. Others guess at the amount, using a non-measured dropper and estimating that a standard "drop" will be about 0.04 ml. Guessers often add 8 drops of bleach per liter of water in an attempt to be safe rather than sorry. The result is water tasting nastily of bleach, but it won't hurt you. Frankly, even though bleach is cheap, I'd rather use a product that guarantees safe water, such as chlorine dioxide tablets (www.rei.com/product/736898).

HAFE

The Outdoor Retailer Show in Salt Lake City was another highlight of my year, added to greatly by the presence of the awesome trio from Celtic--Kurt, Brian, and Bill. (Celtic, an advertising and public relations firm, designed and maintains this site. Check them out at www.celticinc.com). The people with problems who stopped by the first aid station were as I suspected (see the previous post), and dehydration was especially rampant, a reminder to keep your urine clear or lightly yellow in color.
Someone asked about intestinal gas at higher altitudes. High Altitude Flatus Expulsions (HAFE) is a real and discomforting, though rarely serious, problem for those arriving at upper elevations of Earth. Air in your tummy expands like air trapped in a plastic bag. The products Beano and Gas-X have been shown to help alleviate the discomfort. You and your tentmate might both appreciate the alleviation.

Outdoor Retailer

I leave in a few days for the Outdoor Retailer Show in Salt Lake City, my 34th stint in the First Aid Station. After thousands of OR patients, most of them non-serious, I know what I'll see: People forgetting some of the basics of a healthy life. They'll wear pretty shoes that rub them the wrong way, they'll dehydrate, they'll fail to get enough rest, and they'll eat way too much and/or something strange to their digestive systems. But, on the other helping hand, it's sort of like job security for me.
I'll be signing free copies of my new book (Knots You Need, totally non-medical) on Aug 8 at 4PM and Aug 9 at 5PM. If you can't drop by, you can always order (and pay for) a copy (www.globepequot.com), and if you do, I thank you.