Backpacking Health: Band-Aids & Blister Treatment -- powered by Atti's Hiking
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Showing posts with label First Aid. Show all posts
Showing posts with label First Aid. Show all posts
Wednesday, November 14, 2012
Band Aids And Blister Treatment
Backpacking Health: Band-Aids & Blister Treatment -- powered by Atti's Hiking
Monday, December 12, 2011
Hiking Safety Tips for The GSMNP
■Avoid hiking alone because the “buddy system” is safer during any type of activity. If traveling with a group, never stray from the group. If hiking alone, pick a well traveled trail.
■Tell someone where you are going and when you will return.
■Don’t forget to check in with them when you get back.
■Stay on marked trails. Making shortcuts and “bushwhacking” causes erosion and greatly increases your chance of becoming lost. As you hike, pay attention to trail blazes (paint marks on trees) and landmarks. A double blaze indicates a change in trail direction or intersection, so be sure to follow the correct trail.
■Never climb on waterfalls. A high number of injuries and deaths occur on waterfalls and slippery, wet rocks.
■Always carry quality rain gear and turn back in bad weather. If you become wet or cold, it is important to get dry and warm as quickly as possible, avoiding hypothermia.
■Dress in layers and avoid cotton. Today’s hikers can choose from numerous fabrics that wick moisture, dry quickly or conserve heat. Many experienced hikers wear a lightweight shirt that wicks moisture, while carrying a fleece pullover and waterproof jacket in a daypack.
■All hikers (especially children and older adults) should carry a whistle, which can be heard far away and takes less energy than yelling. Three short blasts is a sign of distress.
■Carry plenty of drinking water and never assume stream water is safe to drink. Frequent hikers might consider buying a water filter or water purifying tablets at an outdoor supply store.
■Don’t count on cell phones to work in the wilderness, but if they do, be able to give details about your location. Telling rescue personnel that you’re lost by a big tree won’t help as much as telling which trailhead you started from and how long you’ve been hiking.
■Don’t rely on a GPS to prevent you from getting lost. Batteries can die or the equipment can become damaged or lost.
■Invest in good hiking socks and boots such as those found at sporting goods stores. Avoid blisters by carrying “moleskin” (available at drug stores) and applying it as soon as you feel a hot spot on your feet. Available in the foot care section of drug stores, moleskin is like felt that sticks to your skin.
■Wear bright colors. Don’t dress children in camouflage.In fall or winter always dress in layers to stay warm or to strip off to cool down
Carry an Emergency Kit
Each hiker should have these items:
■Water or water filteration system
■First aid kit
■Whistle And Plastic Mirror
■Small flashlight with extra batteries( Ultimate Lithium Batteries they last 8 times longer)
■Glowsticks
■Energy food or extra food
■Brightly colored bandana
■Knife
■Rain Gear and in fall and winter fleece jacket■Emergency Bivy in case of bad weather or getting lost in the woods or off the trail
■Aluminum foil. Strips can be tied into tree limbs to reflect searchlights. It can be molded into a bowl for water.
Especially for Children
■Attach a whistle to their clothing.
■Talk to children about what to do if they become lost, no matter what the location (city or wilderness).
■Teach children that they won’t get into trouble for becoming lost.
■Reassure children that people (and possibly dogs and helicopters) will look for them if they become lost. Do not hide from searchers; answer their calls.
■Do not run. Instead, “hug a tree” and make a comfortable “nest.” This prevents wandering even further.
■Do not be afraid of animals or strange noises. If something is scary, blow the whistle.
■Come up with a password that a child will respond to if a stranger needs to pick them up. Searchers can use this password.
What to Do if You are Lost :
■Stay put.Beware of your surroundings at all times and lookout for wildlife and most of all never panic .
■Make shelter.
■Stay warm and dry.
■Be visible and heard.Use your whistle and mirror every 15 minutes someone might see you or hear you from a distance.
■If helicopters are searching overhead, seek an opening rather than thick tree cover. Lie down so you look bigger from the air.
■Tell someone where you are going and when you will return.
■Don’t forget to check in with them when you get back.
■Stay on marked trails. Making shortcuts and “bushwhacking” causes erosion and greatly increases your chance of becoming lost. As you hike, pay attention to trail blazes (paint marks on trees) and landmarks. A double blaze indicates a change in trail direction or intersection, so be sure to follow the correct trail.
■Never climb on waterfalls. A high number of injuries and deaths occur on waterfalls and slippery, wet rocks.
■Always carry quality rain gear and turn back in bad weather. If you become wet or cold, it is important to get dry and warm as quickly as possible, avoiding hypothermia.
■Dress in layers and avoid cotton. Today’s hikers can choose from numerous fabrics that wick moisture, dry quickly or conserve heat. Many experienced hikers wear a lightweight shirt that wicks moisture, while carrying a fleece pullover and waterproof jacket in a daypack.
■All hikers (especially children and older adults) should carry a whistle, which can be heard far away and takes less energy than yelling. Three short blasts is a sign of distress.
■Carry plenty of drinking water and never assume stream water is safe to drink. Frequent hikers might consider buying a water filter or water purifying tablets at an outdoor supply store.
■Don’t count on cell phones to work in the wilderness, but if they do, be able to give details about your location. Telling rescue personnel that you’re lost by a big tree won’t help as much as telling which trailhead you started from and how long you’ve been hiking.
■Don’t rely on a GPS to prevent you from getting lost. Batteries can die or the equipment can become damaged or lost.
■Invest in good hiking socks and boots such as those found at sporting goods stores. Avoid blisters by carrying “moleskin” (available at drug stores) and applying it as soon as you feel a hot spot on your feet. Available in the foot care section of drug stores, moleskin is like felt that sticks to your skin.
■Wear bright colors. Don’t dress children in camouflage.In fall or winter always dress in layers to stay warm or to strip off to cool down
Carry an Emergency Kit
Each hiker should have these items:
■Water or water filteration system
■First aid kit
■Whistle And Plastic Mirror
■Small flashlight with extra batteries( Ultimate Lithium Batteries they last 8 times longer)
■Glowsticks
■Energy food or extra food
■Brightly colored bandana
■Knife
■Rain Gear and in fall and winter fleece jacket■Emergency Bivy in case of bad weather or getting lost in the woods or off the trail
■Aluminum foil. Strips can be tied into tree limbs to reflect searchlights. It can be molded into a bowl for water.
Especially for Children
■Attach a whistle to their clothing.
■Talk to children about what to do if they become lost, no matter what the location (city or wilderness).
■Teach children that they won’t get into trouble for becoming lost.
■Reassure children that people (and possibly dogs and helicopters) will look for them if they become lost. Do not hide from searchers; answer their calls.
■Do not run. Instead, “hug a tree” and make a comfortable “nest.” This prevents wandering even further.
■Do not be afraid of animals or strange noises. If something is scary, blow the whistle.
■Come up with a password that a child will respond to if a stranger needs to pick them up. Searchers can use this password.
What to Do if You are Lost :
■Stay put.Beware of your surroundings at all times and lookout for wildlife and most of all never panic .
■Make shelter.
■Stay warm and dry.
■Be visible and heard.Use your whistle and mirror every 15 minutes someone might see you or hear you from a distance.
■If helicopters are searching overhead, seek an opening rather than thick tree cover. Lie down so you look bigger from the air.
Wednesday, November 2, 2011
Altitude Sickness
Acute mountain sickness is an illness that can affect mountain climbers, hikers, skiers, or travelers at high altitude (typically above 8,000 feet or 2,400 meters).
Causes, incidence, and risk factors
Acute mountain sickness is due to a combination of reduced air pressure and lower oxygen levels at high altitudes.
The faster you climb to a high altitude, the more likely you will get acute mountain sickness. Your symptoms will also depend on the speed of your climb and how hard you push (exert) yourself.Acute mountain sickness is due to a combination of reduced air pressure and lower oxygen levels at high altitudes.
You are at higher risk for acute mountain sickness if:
•You live at or near sea level
•You had the illness before
SymptomsSymptoms range from mild to life-threatening, and can affect the nervous system, lungs, muscles, and heart.
•Difficulty sleeping
•Dizziness or light-headedness
•Fatigue
•Headache
•Loss of appetite
•Nausea or vomiting
•Rapid pulse (heart rate)
•Shortness of breath with exertion
Symptoms generally associated with more severe acute mountain sickness include:
•Bluish discoloration of the skin (cyanosis)
•Chest tightness or congestion
•Confusion
•Cough
•Coughing up blood
•Decreased consciousness or withdrawal from social interaction
•Gray or pale complexion
•Inability to walk in a straight line, or to walk at all
•Shortness of breath at rest
Signs and tests
Listening to the chest with a stethoscope (auscultation) reveals sounds called crackles (rales) in the lung, which may be a sign of fluid in the lungs.
A chest x-ray may be performed.
Treatment
Early diagnosis is important. Acute mountain sickness is easier to treat in the early stages.
The main treatment for all forms of mountain sickness is to climb down (descend) to a lower altitude as rapidly and safely as possible. You should not continue climbing if you develop symptoms.
Extra oxygen should be given, if available.
People with severe mountain sickness may need to be admitted to a hospital.
Acetazolamide (Diamox) may be given to help improve breathing and reduce mild symptoms. This drug can cause increased urination. Make sure you drink plenty of fluids and avoid alcohol when taking this drug.
If you have fluid in your lungs (pulmonary edema), treatment may include:
•Oxygen
•A high blood pressure medicine called nifedipine
•A type of drug called a phosphodiesterase inhibitor (such as sildenafil)
•Lung inhalers beta agonists
•A breathing machine, in severe cases
Dexamethasone (Decadron) may help reduce swelling in the brain (cerebral edema).
Portable hyperbaric chambers allow hikers to simulate conditions at lower altitudes without actually moving from their location on the mountain. These devices are very helpful if bad weather or other factors make climbing down the mountain impossible.
Expectations (prognosis)
Most cases are mild, and symptoms improve promptly when you climb down the mountain to a lower altitude.
Severe cases may result in death due to lung problems or brain swelling.
In remote locations, emergency evacuation may not be possible, or treatment may be delayed. This can have a negative affect on your outcome.
Complications
•Coma
•Fluid in the lungs (pulmonary edema)
•Swelling of the brain
Calling your health care provider
Call your health care provider if you have or had symptoms of acute mountain sickness, even if you felt better when you returned to a lower altitude.
Call 911 or your local emergency number if you or another climber have any of the following symptoms:
•Severe breathing problems
•Altered level of alertness
•Coughing up blood
Climb down the mountain immediately and as safely as possible.
Prevention
Keys to preventing acute mountain sickness include:
•Climb the mountain gradually
•Stop for a day or two of rest for every 2,000 feet (600 meters) above 8,000 feet (2,400 meters)
•Sleep at a lower altitude when possible
•Learn how to recognize early symptoms of mountain sickness
If you are traveling above 9,840 feet (3,000 meters), you should carry enough oxygen for several days.
If you plan on quickly climbing to a high altitude, ask your doctor about a medication called acetazolamide (Diamox). This drug helps your body get used to higher altitudes more quickly, and reduces minor symptoms. It should be taken the day before you climb, and then for the next 1 to 2 days.
If you are at risk for anemia, ask your doctor if an iron supplement is right for you. Anemia lowers the amount of oxygen in your blood.
While climbing:
•Drink plenty of fluids
•Avoid alcohol
•Eat regular meals, high in carbohydrates
You should avoid high altitudes if you have heart or lung disease.
References
1.Hackett PH, Roach RC. High-altitude medicine. In: Auerbach PS, ed. Wilderness Medicine. 5th ed. Philadelphia, Pa: Mosby Elsevier; 2007:chap 1.
2.Schoene RB, Swenson ER. High Altitude. In: Mason RJ, Murray JF, Broaddus VC, Nadel JA, eds. Textbook of Respiratory Medicine. 4th ed. Philadelphia, Pa: Saunders Elsevier; 2005: chap 65.
3.Wright A, Brearey S, Imray C. High hopes at high altitudes: pharmacotherapy for acute mountain sickness and high-altitude cerebral and pulmonary oedema. Expert Opin Pharmacother. 2008;9(1):119-127. [PubMed: 18076343]
4.Yaron M, Honigman B. High-altitude medicine. In: Marx, JA, ed. Rosen's Emergency Medicine: Concepts and Clinical Practice. 6th ed. Philadelphia, Pa : Mosby Elsevier; 2006: chap 142.
Monday, October 24, 2011
Poison ivy, Oak and Sumac
These can be a sore subject for those of us who enjoy the outdoors. Like almost every other peril and medical emergency, a little education and understanding goes a long way to dealing with this itching scratching menace.
Poison ivy, oak, or sumac is found in every state except Alaska and Hawaii, with Nevada having some poison ivy along it’s eastern border with Utah and Idaho having poison ivy along it’s western border with Oregon. All three species and their sub species of plants are very hardy and adaptable. If there is at least eight to ten inches of rain a year, and it is below 4,000 feet, you can find poison ivy, oak or sumac. Interestingly, poison ivy is generally found in the eastern half of the United States, where poison oak is found all over the west coast.
All three of these plants emit a poisonous oil irritant called urushiol. This oil is the toxin in these plants that make you itch. In it’s pure form, the amount that you could fit on the head of a pin could make 500 people very miserable.
Because urushiol is an oil, and not a water based fluid it has some special (or would that be troublesome) qualities. Urushiol does not evaporate, so it can linger for a year. It will cover what ever it comes in contact with, clothing, tools, and even pet hair. Because it is an oil, urushiol vaporizes when it is burned, the vapor is then carried in the smoke and covers everything it comes in contact with (again contaminating it for a year or longer). Urushiol is present on the leaves, stems, and roots of the plant, and is still active even on dead plants that have dried up. It is in a phrase, really nasty stuff.
Poison ivy, oak and sumac all serve a useful purpose. Sure most people will put them on the same list of outdoor annoyances as mosquitoes and flies, but poison ivy, oak and sumac are important to the eco-systems they are present in. The small, white or bluish berries found on the ivies feed a number of birds and small animals. The tangles they form also serve as shelter, and incidentally, most animals are not effected by the irritants found in urushiol oil.
The good news is that poison ivy, oak and sumac are very easy to treat if you identified your contact with the irritating plant within a few hours of the incident. The urushiol oil chemically bonds with the proteins in your skin about 30 minutes after contact. 75% of the population is effected by contact with urushiol, although immunity to urushiol today does not assure immunity tomorrow, and vice versa. Rash symptoms can appear within a few hours but can take two to five days to appear. The rash starts as a red, annoyingly itchy area that starts to swell. The area then gets inflamed and will get covered in clusters of tiny pimples, the pimple eventually merge and turn into blisters. The fluid in the blisters turns yellow, dries up, and becomes crusty. Left completely untreated, this cycle can last as short as five days and in severe cases as long as five to six weeks.
If you come in contact with poison ivy, oak or sumac, or a animal exposed to any of these, or tools, gear, or clothing exposed to any of these, you should wash off with hot water (not so hot that it burns) and strong soap as soon as possible. If you can get washed up in the first six hours, before the first symptoms appear, you have a good chance of avoiding an out break, and an even better chance of minimizing the effects if you do have one.
If you do start to get a rash there is some bad news. There is no anti-toxin available for urushiol. There are products out there that will make you more comfortable, but no specific treatments. Washing in hot water with strong soap within the first 24 hours of exposure, and not scratching can help reduce the length and severity of a reaction.
The rash is not communicable once you get one that is you can’t pass it on to someone else through normal contact. Only the urushiol oil spreads the rash. As blisters start to form over the infected area you should never break the blisters. Breaking blisters can lead to blood poison and generally in medical circles the draining of blisters is frowned upon. You should try to let the infected area breath, if you do wrap it, keep the dressing as clean as possible, weeping blisters are a hot bed for infection.
Poison ivy, oak, or sumac is found in every state except Alaska and Hawaii, with Nevada having some poison ivy along it’s eastern border with Utah and Idaho having poison ivy along it’s western border with Oregon. All three species and their sub species of plants are very hardy and adaptable. If there is at least eight to ten inches of rain a year, and it is below 4,000 feet, you can find poison ivy, oak or sumac. Interestingly, poison ivy is generally found in the eastern half of the United States, where poison oak is found all over the west coast.
All three of these plants emit a poisonous oil irritant called urushiol. This oil is the toxin in these plants that make you itch. In it’s pure form, the amount that you could fit on the head of a pin could make 500 people very miserable.
Because urushiol is an oil, and not a water based fluid it has some special (or would that be troublesome) qualities. Urushiol does not evaporate, so it can linger for a year. It will cover what ever it comes in contact with, clothing, tools, and even pet hair. Because it is an oil, urushiol vaporizes when it is burned, the vapor is then carried in the smoke and covers everything it comes in contact with (again contaminating it for a year or longer). Urushiol is present on the leaves, stems, and roots of the plant, and is still active even on dead plants that have dried up. It is in a phrase, really nasty stuff.
Poison ivy, oak and sumac all serve a useful purpose. Sure most people will put them on the same list of outdoor annoyances as mosquitoes and flies, but poison ivy, oak and sumac are important to the eco-systems they are present in. The small, white or bluish berries found on the ivies feed a number of birds and small animals. The tangles they form also serve as shelter, and incidentally, most animals are not effected by the irritants found in urushiol oil.
The good news is that poison ivy, oak and sumac are very easy to treat if you identified your contact with the irritating plant within a few hours of the incident. The urushiol oil chemically bonds with the proteins in your skin about 30 minutes after contact. 75% of the population is effected by contact with urushiol, although immunity to urushiol today does not assure immunity tomorrow, and vice versa. Rash symptoms can appear within a few hours but can take two to five days to appear. The rash starts as a red, annoyingly itchy area that starts to swell. The area then gets inflamed and will get covered in clusters of tiny pimples, the pimple eventually merge and turn into blisters. The fluid in the blisters turns yellow, dries up, and becomes crusty. Left completely untreated, this cycle can last as short as five days and in severe cases as long as five to six weeks.
If you come in contact with poison ivy, oak or sumac, or a animal exposed to any of these, or tools, gear, or clothing exposed to any of these, you should wash off with hot water (not so hot that it burns) and strong soap as soon as possible. If you can get washed up in the first six hours, before the first symptoms appear, you have a good chance of avoiding an out break, and an even better chance of minimizing the effects if you do have one.
If you do start to get a rash there is some bad news. There is no anti-toxin available for urushiol. There are products out there that will make you more comfortable, but no specific treatments. Washing in hot water with strong soap within the first 24 hours of exposure, and not scratching can help reduce the length and severity of a reaction.
The rash is not communicable once you get one that is you can’t pass it on to someone else through normal contact. Only the urushiol oil spreads the rash. As blisters start to form over the infected area you should never break the blisters. Breaking blisters can lead to blood poison and generally in medical circles the draining of blisters is frowned upon. You should try to let the infected area breath, if you do wrap it, keep the dressing as clean as possible, weeping blisters are a hot bed for infection.
Friday, October 21, 2011
Thru-Hiker's & Long Hikers Medical Guide
FOOT CARE:
The importance of your feet can’t be overemphasized. In order to keep you feet healthy and happy here are a few basic tips: Wash feet daily. Trim toenails often. Have at least 2 pair of socks and rotate them regularly. Have a dedicated pair of sleeping socks so your feet have something dry, clean and warm to hang out in at night. Hikers with Diabetes should pay special attention to sores and infections on their feet. Would care for diabetics should probably be done under the guidance of a medical professional.
Blisters: Blisters are the result of friction. So prevention and treatment should be directed against anything causing friction inside your shoe. Most of you understand basic blister care and have your own unique methods as far as moleskin, taping or other dressings go. The addition of a dab of Neosporin over the blister will help prevent further blister formation by reducing the friction and will be much more comfortable. The Neosporin also works well for those blisters between the toes (and for preventing them).
Once a fluid filled blister has already formed they can be quite uncomfortable. Rupturing fluid filled blisters does carry a small risk of infection because it is sterile until it is ruptured. So if you decide to open the blister (or if it has already ruptured on its own) then do so with a clean knife or needle that has been sterilized with a flame. Make a hole along the bottom part of the blister then cut off the dead skin. Wash with soapy water and cover it with Neosporin and a bandage to prevent further blister formation. Be vigilant for signs of infection such as redness, warmth, severe pain and pus. Blisters that are small, not bothersome and not infected are better left alone to heal on their own.
Blood Blister Under Toenail (Subungal Hematoma):
Symptoms: Painful, purple collection of blood under the toenail, often caused by poorly fitting footwear or a heavy object squashing your toe.
Treatment: Heat up the end of a needle or safety pin (a paper clip also works) until it is red hot, then gently drill through the nail (directly over the fluid collection) until fluid starts coming out. Stop. You don’t need to go any deeper. This should not hurt at all. Put a bandaid with Neosporin over the hole. It may continue to drain on its own.
Athlete’s Foot:
This is a contagious, fungal infection. Symptoms include dry skin, scaling, itching, burning, and blisters (usually between the toes). When the blisters crack they expose raw skin, which causes burning and discomfort. The fungus thrives in the moist, warm environment inside your shoes and can infect other moist, warm areas like your groin or armpits. Its spread is usually caused by scratching, though it can be transmitted on clothing or sleeping bags.
Treatment begins with good foot care. Wash your feet with soapy water every evening, particularly between the toes. Dry well. Take your shoes and socks off during breaks and in camp to air out your feet. Pull the soles out of your shoes and put the shoes, soles, and socks in the sun to dry whenever possible. Wear dry socks to sleep. Don sandals when possible, cleaning them occasionally with rubbing alcohol or peroxide.
A variety of over-the-counter powders are available for athlete’s foot. There does not appear to be any one brand that is better than another. They need to be used for at least 2 weeks to kill the fungus. They will not work if you aren’t taking care of your feet. Tea Tree Oil may help reduce the burning caused by open sores.
There are three reasons to consult a doctor about athlete’s foot. 1) If a severe infection does not respond to the above measures after two weeks. 2) If your feet become swollen and red, or red streaking develops on your legs. 3) If you have diabetes. Severe reactions may require antibiotics due to a secondary bacterial infection.
Note: Chemical irritations from dyes, fabrics, detergents, etc in your socks or shoes can look similar to athlete’s foot. This may be the cause if symptoms commence immediately after starting new socks or shoes.
The Acutely Painful Joint
Sprains and strains occur when the ligaments and tendons in joints are overly stretched, torn, or damaged. A fracture could occur if significant amounts of force are involved. Indications of fracture include exquisite tenderness at one particular spot over the bone, and/or an inability to bear weight on the affected joint for at least 4 steps. If this is the case immobilize the joint and seek medical care for further evaluation. In the absence of a fracture, focus on stabilizing and supporting the joint, RICE (see below), and controlling the pain until symptoms improve. Healing time will vary depending on the degree of injury, how much you allow it to heal, and how much strengthening and stretching are done. For mild injuries, plan on resting for at least a couple of days. Remember that a sprain or strain will not heal if you continue hiking on it.
Prevention: 1) Good shoes (light, and comfortable). 2) Daily stretching of hams, quads, calves and back.
Management:
-RICE: Rest, Ice (20 minutes every hour), Compression, and Elevation (above your heart while lying flat). Start immediately after the injury and continue for the next 3-5 days. This will help reduce the swelling, inflammation, and pain in the early stages of the injury.
-Stabilizing or Immobilizing the Joint: If the situation requires that you continue walking on the injured joint, snugly wrap the joint with ACE bandages or whatever you have available in a figure 8 fashion around the joint. Use hiking poles or a walking stick to minimize the load on the joint. It’s OK to put as much weight on the joint as you can tolerate. If you are unable to bear weight and/or have severe pain, make a rigid splint. You will have to be creative with your available resources but the basic idea is to create firm structural supports on both sides of the joint that will completely immobilize it. Make sure the splint is well padded and does not inhibit blood flow. Sleeping pads work well for knees (think burrito). Ice axes, hiking poles, and tree limbs can work for ankles. A rigid splint will significantly reduce pain during evacuation, as will medications like Motrin or Tylenol.
Braces may be available at the local pharmacy when you get to town. If RICE and a simple brace are inadequate, you should get checked out in the ER. While you’re there you should get a plastic splint (Air-Cast). These are great splints that can be worn with a shoe on and should be worn at night as well. Stretching and rehabilitation exercises should begin within 3-5 days of the injury and should continue daily for several weeks. Look on the internet or talk with your doctor for specific exercises. I liked these sites: http://www.mckinley.uiuc.edu/Handouts/anklesprain/anklesprain.html
Knees: http://www.med.umich.edu/1libr/sma/sma_medollig_rex.htm
Basic rehab for ankles: 1) flexing the foot up and down. 2) moving the foot in circles. 3) painting the alphabet with your toe. These can be done several times a day.
Returning to activity: When you can walk down the stairs without pain or hop on the foot 4 times without pain, you are good to go.
Fractures/Dislocations:
This chapter was initially quite lengthy, bit I almost all of it out because fractures and dislocations are pretty uncommon and if you suspect such an injury you should seek medical attention. Your goals for management of such fractures in the field essentially are to straighten out the bones (when possible), splint for stability, pain control (Ice, elevation, motrin), and seeking medical attention Identifying fractures without an x-ray can be challenging, however, the ability to bear weight on the affected extremity, and move the joints back and forth with only mild to moderate pain makes a fracture unlikely. But if you are concerned or you have too much pain, seek medical attention. Fractures are generally not life threatening unless the skin is open around the fracture (which can lead to infection) or when self-supported evacuation is dangerous or impossible. If the skin is open, pour 2-3 liters of purified water through the wound and wrap it in something clean, and seek medical attention.
Numbness, Tingling and Burning (i.e. Paresthesias)
Paresthesias can feel like “pins and needles”, burning, or can be a decreased sensation like there is a layer of tape over the skin. They can occur in arms, hands, thighs, or feet. They are caused by compression or repeated direct injury to the nerves. They are disturbing but generally temporary and resolve on their own within a few weeks of correcting what is causing it. Motrin should help if it is painful.
Arms/Hands (Ulnar paresthesias): These are usually characterized by numbness or tingling in the ring and little finger. They are usually due to compression of the nerves in your armpit by your shoulder straps. So change the positioning of the straps and increase the padding.
Outside of thighs (meralgia parestheitica): Due to nerve compression by hip belt. Change position of hip belt, quit wearing it or increase the padding.
Heel/Sole of foot (Tarsal Tunnel Syndrome): Due to your shoes or boots pushing into rear aspect of your inside ankle bone and compressing a nerve that passes through there. Change the type of footwear or cut them back.
Toes (digitalgia paresthetica): Due to repeated compression of nerves on bottom of foot from walking. Stiffer shoes and less foot padding are more likely to cause this. Try running shoes or new padded insoles.
Chronic Joint/Leg/Foot Pain:
This section covers several different types of over-use injuries. The causes of these injuries can generally be boiled down to inadequate stretching and strengthening, and poor footwear. Spend some time researching footwear and choose something that will work for your foot.
www.drpribut.com/sports is a website that I used a lot for this section. It was written by a podiatrist and runner’s doc that has some excellent articles about footwear and more detailed information about injuries, stretching, etc.
Chronic Knee Pain: Runner’s knee is condition characterized by pain at or near the medial (inside) or bottom of the knee-cap. It is usually worse walking downhill or sitting with knees bent and is caused by the knee cap not tracking smoothly over the joint due an imbalance in the strengthening of the medial (inner) and lateral (outer) thigh muscles, or excessive pronation (walking on the inside of the foot) while walking. If the soles your shoes are wearing much more on the inner aspect compared to the outside, you may bee pronating excessively and could benefit from a shoe with better arch and heel stability. Also you can strengthen the inner thigh muscle by doing leg straightening exercises: lay flat with something under your knee so that the knee is at a 30 degree angle. Raise the foot until the knee is straight. Do 5 sets of ten or as many as tolerated daily. Motrin 600 mg up to 3 times a day as needed should work well for pain. And finally, consider orthotics.
Achilles Tendonitis: The Achilles tendon attaches the calve muscles to the heel. The calve is a very powerful muscle group, but the Achilles tendon has a poor blood supply so injuries are slow to heal. Tendonitis is an inflammation of the tendon caused by footwear and/or tight calve muscles. Footwear in the soles are too stiff or that have excessive heel cushion (particularly air cells) can put more stress on the tendon, causing repeated minor injury. Calve tightness can be improved with regular, gentle stretching. A ¼ inch heel lift may provide some relief. RICE (see acute joint injuries) and decreasing mileage will help as well. If the pain is limiting walking, or got suddenly worse, then rest for a few days and consider seeking medical advice.
Shin Splints:
These are thought to be due to inflammation of the lining of one of the bones (tibia) in the lower leg. Typically described as pain and tenderness in the anterior (frontal) or medial (inside) aspect of the lower leg. The pain and tenderness usually extends vertically 3-12 cm above the inner ankle bone. It may be in both legs. Patients usually can hop on the affected leg and do not have an isolated spot of tenderness in the leg. Inability to hop on the leg, pain at single point or that is horizontally oriented may suggest a stress fracture, which should be evaluated by a medical professional.
Shin splints are an over-use injury, caused or at least made worse by inadequate footwear. Excessive pronation (rolling your arch in) is usually the culprit.
Management: Motrin, rest, ice (20 min/h), stretching and strengthening. Decrease your miles or rest until the pain resolves. Consider changing your footwear.
DIARRHEA:
Prevention: WASH YOUR HANDS!!!! after every time any form of bodily fluid (feces, urine, or other) leaves your body and before you eat. Washing your hands and cleaning cooking pots and utensils with warm, soapy water is MORE likely to prevent diarrhea than water purification. This has actually been studied. That being said, PURIFY YOUR WATER consistently. Erratic water purification has similar rates of diarrheal illness as never purifying.
There are essentially 3 types of diarrhea: 1) Secretory: watery diarrhea caused by lots of different bugs but usually resolves within 3-5 days.
Treatment is replacing fluid losses, Peptobismol and Immodium. 2) Inflammatory: bloody diarrhea usually caused by specific types of bacteria. It may be associated with fevers. Treatment usually involves the above + antibiotics. If you have blood in your diarrhea, you should go see a doctor as soon as possible. 3) Chronic diarrhea: We usually blame this on Giardia. This includes persistent and recurrent diarrhea (keeps coming back). If there is no blood in it, and you don’t feel significantly dehydrated, then take tinidazole or flagyl (antibiotics) as directed by your doctor. Symptoms should improve within 24 hours.
Management: Increase fluid intake (water and//or soups). You need salt in your body to absorb the water so either eat salty foods or mix up some Oral Rehydration Cocktails: Alternate Glass 1: 8oz (250 ml) fruit juice (apple orange or lemon), ½ tsp of honey, and 1 pinch of salt. Glass 2: 8 oz of water (purified) and ¼ tsp baking soda.
Medications: Most diarrheal illness will resolve on its own in 2-3 days without medications. For nonbloody diarrhea Peptobismol is safe, cheap, readily available and may help reduce output and abdominal cramping. Immodium is not an antibiotic and I generally don’t recommend it (especially with bloody diarrhea) but will it slow down your output, which is important especially in the setting of the explosive diarrhea variety. Take 2mg after first episode of diarrhea and 1 mg after subsequent episodes for a maximum of 8mg in 24 hours.
Giardia: Symptoms can vary from large volumes of foul smelling, soft stool to explosive diarrhea, nausea, vomiting, malaise and a characteristic “rotten egg” smell to bowel movements and gas. Chronic (>2 weeks) or recurrent diarrhea can develop. Treatment: Flagyl 750 mg once a day for 5 days, or Tinidazole 2 gm once. I would go with the tinidazole since you only have to take it once. Don’t drink alcohol while taking these medications, as they will make you feel hungover.
Skin and Soft tissue:
Scrapes and Cuts:
The Basic principles are 1) get it clean, and 2) keep it clean. Lacerations (cuts) are closed with sutures primarily to reduce scar formation, and this can be delayed for 24-36 hours without untoward effects as long as you keep it clean (see below). Abrasions can simply be cleaned and covered.
Management: Hold pressure with dressing and elevate to stop the bleeding. Clean with soapy water and pour 1-2 liters of purified water through the wound. Cover the wound with antibiotic cream (e.g. bacitracin) and wet gauze. Repeat every 12 hours until you can be seen by a medical professional if you need sutures, otherwise it will heal on its own eventually. Preventing an infection by keeping the wound clean is absolutely more important than getting to the clinic a little faster. Also, trying to “Rambo” it with a fishing hook and 5 lbs line is not going to help.
Concerning features: signs of infection, and lacerations into joints or involving tendons. If you have any of these go the clinic. Most wounds do not need antibiotics (except maybe punctures).
Puncture Wounds: Whether due an animal, nail or hiking partner’s teeth, they should be cleaned the same as lacerations AND probably be seen by a medical professional due to the higher likelihood of infection.
POISON IVY, POISON OAK AND POISON SUMAC:
Eastern Poison Ivy: climbing vine with three serrated-edged pointed leaves which grow in clusters of 3.
Western Poison Ivy: similar leaves but it is a low-growing shrub.
Poison Oak: 3 leaves. Grows in sandy soil as a low shrub in the East, and a large standing shrub or climbing vine in the West.
Poison Sumac: a shrub or bush with 2 rows of 7-13 leaflets.
Characteristics: red, itchy rash, with fluid-filled vesicles. If you’ve had it before, symptoms usually develop 4-96 hours after exposure, otherwise symptoms could be delayed for a day or two.
Management: Wash all exposed skin clothing gear with copious COLD (keep the pores closed) soapy water (not alcohol based soap) immediately.
This inactivates the toxin (called urushiol) and prevents further spread to yourself and others. Be sure to clean under fingernails well.
Once the skin has been thoroughly cleaned, you are no longer contagious. The fluid in the blisters is sterile and toxin-free.
A new product, Zanfel cream, is by many accounts the most effective therapy available (the company reports that itching will go away within 30 seconds). It can be bought without a prescription at the pharmacy, although it is quite expensive at $40. For severe reactions, or debilitating reactions not responding to the above regimens, go to the clinic. For mild reactions, just clean the wound, and take benadryl (25 mg every 12 hours as needed) for the itch. Calamine lotion, cortisone 1% cream, or aveeno oatmeal baths may help with the symptoms.
Prevention: Long pants, long-sleeve shirts, and identification/avoidance of noxious plants. Creams to prevent exposure (e.g. Ivy Block) are safe and will prevent reactions most of the time, but they must be re-applied every 4 hours.
Jock Itch/Yeast Infections:
MEN: It is essentially athlete’s foot in your groin. It usually does not involve the scrotum or penis. Clean the affected areas with soapy water. Avoid tight fitting underwear. The antifungal powders could be helpful. Be sure to use them as directed and for at least 2 weeks. Wear clean, dry boxers to sleep in. This is contagious so avoid sharing shorts or sexual activity until resolved.
WOMEN: Generally don’t get Jock Itch. If you have burning in the vaginal area then it is likely one of two things: a yeast infection or vaginitis (a bacterial infection). Neither is life threatening. Yeast infections are usually associated with a white, cottage cheese-ish discharge. Vaginitis is usually associated with a brown or grey fish smelling discharge.
Vaginitis can be transmitted sexually or it can just be a bacterial overgrowth (it is not caused by gonorrhea or Chlamydia). Treatment is Flagyl 2 gm one time. Consult a doctor before treating.
Yeast Infections can occur after taking any antibiotics, and from bodily stress or hormonal changes. Prevention: If you are taking antibiotics you should also eat yogurt with live cultures, and/or take lactobacillus (nonprescription pills with bacteria in them). Keep genital area clean and dry. Avoid perfumes, feminine hygiene sprays and douches. Treatment: Prescription: Diflucan 150 mg (tablet) once. Nonprescription: Monostat vaginal suppositories (use as directed). Please make sure you are not pregnant before taking any of these medications.
Reasons to see a doctor: 1) You need a prescription. 2) You develop severe abdominal pain, bleeding from your vagina, or fevers. 3) Infection not responding to the above measures. 4) If you are pregnant.
Sunburns: For simple sunburns, keep your skin covered and clean. Apply cool soaks and aloe vera for comfort.
Blistering Sunburns: Cool the affected area with cold packs and cool, clean water. Remove loose skin and debris. Drain and cut back blisters larger than a quarter or if they look like they are going to burst. Apply antibiotic cream (e.g. Bacitracin) and a clean dressing. Sunburns generally do not need to be seen by a medical professional unless they are getting worse or infected (worsening redness, pain or pussiness) .
Burns: Burns can be very serious as they have a tendency to get infected. All burns other that dime-size superficial burns should be evaluated by a physician.
Boils/Abscesses:
Boils (abscesses) are walled off infections under the skin, like acne but bigger. They are painful and feel like tight water balloons. They generally occur in armpits, buttock creases, and other hairy places, but can occur anywhere.
If it looks red and angry, go to the doctor. If it doesn’t try putting rags soaked in hot water and Epsom salts on the abscess, which may induce it to open on its own. Once it is draining, the pain will go away, and the abscess may resolve. They do commonly recur and you should continue the warm compresses for a couple of days until you are sure it has resolved. If that doesn’t work, go to the ER and have someone open it. Don’t try cutting into it unless you have been trained to do so.
Treatment is drainage. Antibiotics ae generally neither necessary or helpful, unless there is a surrounding skin infection.
Bees, Wasps:
If the person starts having difficulty breathing, swallowing, hoarse voice, hives covering their body, or other signs of anaphylaxis, USE THE EPI-PEN. Do not delay. Then evacuate.
Otherwise, just remove the stinger, apply ice, and clean the wound.
Snake Bites: Pit vipers (rattlesnakes, water moccasins, etc) and coral snakes are the only poisonous snakes in North America. Pit vipers have triangular heads, and cat-like pupils. Coral snakes have to chew on you to envenomate, so don’t let them.
The Sawyer Extractor might work if used within 2-3 minutes. Remove jewelry as swelling will likely occur. Do not try to capture the snake (a simple description will do). Begin evacuating to the closest road immediately.
DO NOT: immobilize the limb (will just slow you down), shock the would with a car battery, put ice on it (may worsen tissue necrosis), the “cut and suck” thing (doesn’t work), apply a torniquet (not effective at limiting spread of toxin, and will guarantee loss of the limb).
Anyone who has been bit by a snake that they are not absolutely sure was not a pit viper or coral snake, should seek medical attention.
Spider Bites: The only spiders in North America that are dangerous to humans are: Black Widow, Brown Recluse and Hobo Spiders. The symptoms are not specific but generally occur within 36 hours and could include: local tissue destruction, muscle cramps, fevers/chills, nausea and vomiting. If you know that you were bitten by one of these spiders or you develop these symptoms then go to the clinic or at least stay close by. Keep the wound clean and covered.
Ticks: Lyme Disease (classically a Northeast disease that has quickly worked its way South and across the Mississippi, although I am not aware of any reports along the PCT) and other tick-borne illnesses such as Rocky Mountain Spotted Fever, and Ehrlichiosis are a concern along the trails.
Prevention: Permetherin-soaked clothes, and DEET are very effective at keeping the ticks off. If you can’t handle that, then be vigilant with “tick checks”. Removing ticks within 48 hours has been reported to prevent infection. If the head is stuck then pick it out with a needle. Do not burn the tick, cover it in gasoline, twist it or smother it in alcohol. Just pull straight back. Then clean the wound with soapy, warm water.
Signs of Lyme Disease: fever, headache, unexplainable joint pain, and/or classic rash that is red, round and clear in the middle, resembling a “target sign”.
If you develop these symptoms go to a clinic, even if symptoms resolve. Lyme can be difficult to distinguish from the flu. Depending on the situation, they may do blood tests or just go ahead and treat you.
Treatment: for mild/moderate infection is doxycycline 100 mg twice a day for 6 weeks. Infections can become severe, or chronic if not treated correctly. Please do so under the supervision of a doctor.
Eyes:
Bugs, dirt, etc in your eye: typically the eye is red, watery and it feels like someone is dragging a rake across your eye every time it moves.
Management: Remove contacts (and do NOT replace for several days until redness has completely resolved) Pour copious amounts of purified water directly into the eye until the raking sensation is gone. If you can see the object (flip the lid up) then an assistant could try gently removing it with a moistened Q-tip. Pain should be resolved by the next morning. If you develop worsening pain, worsening vision or other problems go to the ER promptly.
Snowblindness:
Solar radiation particularly on snowfields can lead to a sun burn on the cornea (skin) of your eye if you don’t wear sunglasses. The pain does not generally develop until later in the afternoon or evening, however, it is particularly intense and will result in severe discomfort for at least the next 1-2 days.
Treatment is symptomatic and is primarily pain control (usually requires narcotics). Eye drops to paralyze the eyes may be prescribed and will provide some relief. Artificial tears or contact solution can be bought at the store and will provide some relief as well. Medical evaluation is helpful to ensure there is not debris in the eye and no ulcers have formed. Contacts should be removed and not replaced until symptoms are gone.
Urinary Tract Infections:
They are characterized by burning with urination or increased frequency of urination. Generally they are uncommon in men. However, the presence of symptoms warrants medical evaluation. For women, since UTI’s are so common, they may elect to carry antibiotics to take should symptoms develop. It is important to do this under the guidance of a medical professional. Ensure that you are not pregnant with a home pregnancy test prior to taking antibiotics, as some of them are not safe in pregnancy.
The development of fevers, vomiting or pain in your back could signify that the infection has spread to the kidneys. Kidney infections can be serious, so go to the ER if flank pain or fevers develop.
Treatment: Bactrim DS 80/160 twice a day (3 days for bladder/urethral infections, 10 days for kidney infections). Pyridium (aka Azo) 100 mg twice a day for 3 days will help with the pain of urination but is not an antibiotic.
Drink plenty of fluids, particularly cranberry juice which may help fight the infection.
Menstruation:
Changes in womens’ menstrual cycles are very common among long-distance hikers (about 50%) and are likely due to decreased body fat and other nutritional factors. The long-term affects of this are unclear, however, cycles generally normalize when an adequate diet resumes. That being said, a “home pregnancy test” should be performed whenever there is a change in menstruation.
BEFORE YOU GO…
The vast majority of hikers are going to have a relatively uneventful trip from a medical standpoint, but there are a few things you can do prior to leaving that could make a big difference. 1) obtain at least some sort of catastrophe medical insurance. It’s cheap and could be useful. 2) go visit with your doctor (or PA/NP or college health clinic). Having a few prescription medications available and someone to call when you get sick will help you get well sooner and save you a significant amount of money by possibly preventing a long and expensive trip to the local ER. They will likely be really excited about your trip and enjoy being the “expedition doc” even if it’s via telephone or email, so don’t be shy. 3) Put together a first aid kit yourself that way you know what is in there and why. 4) consider taking a Wilderness first Responder or First Aid course.
First Aide Kit:
There are a myriad of ready-made first aid kits available in the market for backpacking, however, I feel that we can go lighter and smaller without missing much. Your first aid kit should allow you to deal with minor injuries and have a few other select medications and tools to treat or temporize other issues until you can make it to town, AND it should fit in a small Ziploc bag. The following list is what I take with me. It does change depending on what is wrong with me. Your kit should reflect any previous medical problems you’ve had and current issues. Extra supplies can be shipped along in your “bounce box” or bought in the local store. Just because you may need a splint or bandages on your way through Washington, doesn’t mean you have to carry them through the desert. Buy things as you need them. Adapt.
My Basic Kit:
1) Band-aides (enough to last a week, not the whole box)
2) Bandages (2 4x4’s should be fine)
3) Antibiotic ointment (Neosporin or bacitracin)
4) Safety Pins (for securing, popping, drilling)
5) Mole Foam/Second Skin or other Blister stuff
Note: having scissors on your pocket knife will make it immensely easier to cut up the blister stuff.
6) Uncle Ben’s tweezers
7) Sunscreen
8) Small bar of soap (fragment of Bronner’s in bar form)
9) DEET (for when you can’t take it any longer)
10) Lip balm
11) Emergency Fire Starting Kit
Non-Prescription Medications:
12) Gold Bond Medicated Powder (for chaffing)
13) Motrin or Tylenol for pain
14) Peptobismol chewable tabs (8 should get you to town)
15) Zanfel (poison ivy dope)
16) Oral Reydration Packets (2-3)
Prescription medications:
-Antibiotics:
-Flagyl OR Tinidazole for chronic diarrhea (Giardia)
-(Tinidazole is only one time dosing, so I prefer it)
-Bactrim 80/160 can be used for skin infections, pneumonias, and urinary infections
-Pain Medications
-19) Ketorolac (an NSAID, not a narcotic, similar to motrin but stronger. Avoid motrin (ibuprofen), Aleve (naprosyn) while taking it)
**If you’ve ever had an anaphylactic reaction, or if you just want to be prepared, carry an Epi-Pen. It is one of the few “weird” drugs I carry because you can actually save someone’s life with it [think: bee sting, puffy face, can’t breathe (talk with your doctor, and read the instructions before you go)]. You’ll need a prescription.
Visit your doctor prior to leaving. I think a reasonable plan is to get prescriptions and fill them while you are home. Carry these medications in your first aid kit and then you can call your doctor when you get ill and they can make recommendations about what to take and how often. Do not take them without the supervision of a medical professional. If the actual prescription paper is from out-of-state or is out-dated, it may not be honored by the local pharmacist, so try to “fill” the prescriptions prior to leaving home. Most other bandages, splints and such can be improvised from things already in your pack. Be creative. And get to town when you have a significant injury.
Wilderness Medicine Resources:
1) Fred Darvill, Jr. MD Mountaineering Medicine and Backcountry Medical Guide
2) William Forgey, MD Wilderness Medical Society: Guidelines for Wilderness Emergency Care
3) Advanced Wilderness Life Support (Syllabus) this is an excellent course accredited through the Wilderness Medical Society. Edited by David Della-Giustina, MD and Richard Ingebretson, MD
4) Paul Auerbach, MD Wilderness Emergency Medicine
By:
Stewart Anderson, MD
The importance of your feet can’t be overemphasized. In order to keep you feet healthy and happy here are a few basic tips: Wash feet daily. Trim toenails often. Have at least 2 pair of socks and rotate them regularly. Have a dedicated pair of sleeping socks so your feet have something dry, clean and warm to hang out in at night. Hikers with Diabetes should pay special attention to sores and infections on their feet. Would care for diabetics should probably be done under the guidance of a medical professional.
Blisters: Blisters are the result of friction. So prevention and treatment should be directed against anything causing friction inside your shoe. Most of you understand basic blister care and have your own unique methods as far as moleskin, taping or other dressings go. The addition of a dab of Neosporin over the blister will help prevent further blister formation by reducing the friction and will be much more comfortable. The Neosporin also works well for those blisters between the toes (and for preventing them).
Once a fluid filled blister has already formed they can be quite uncomfortable. Rupturing fluid filled blisters does carry a small risk of infection because it is sterile until it is ruptured. So if you decide to open the blister (or if it has already ruptured on its own) then do so with a clean knife or needle that has been sterilized with a flame. Make a hole along the bottom part of the blister then cut off the dead skin. Wash with soapy water and cover it with Neosporin and a bandage to prevent further blister formation. Be vigilant for signs of infection such as redness, warmth, severe pain and pus. Blisters that are small, not bothersome and not infected are better left alone to heal on their own.
Blood Blister Under Toenail (Subungal Hematoma):
Symptoms: Painful, purple collection of blood under the toenail, often caused by poorly fitting footwear or a heavy object squashing your toe.
Treatment: Heat up the end of a needle or safety pin (a paper clip also works) until it is red hot, then gently drill through the nail (directly over the fluid collection) until fluid starts coming out. Stop. You don’t need to go any deeper. This should not hurt at all. Put a bandaid with Neosporin over the hole. It may continue to drain on its own.
Athlete’s Foot:
This is a contagious, fungal infection. Symptoms include dry skin, scaling, itching, burning, and blisters (usually between the toes). When the blisters crack they expose raw skin, which causes burning and discomfort. The fungus thrives in the moist, warm environment inside your shoes and can infect other moist, warm areas like your groin or armpits. Its spread is usually caused by scratching, though it can be transmitted on clothing or sleeping bags.
Treatment begins with good foot care. Wash your feet with soapy water every evening, particularly between the toes. Dry well. Take your shoes and socks off during breaks and in camp to air out your feet. Pull the soles out of your shoes and put the shoes, soles, and socks in the sun to dry whenever possible. Wear dry socks to sleep. Don sandals when possible, cleaning them occasionally with rubbing alcohol or peroxide.
A variety of over-the-counter powders are available for athlete’s foot. There does not appear to be any one brand that is better than another. They need to be used for at least 2 weeks to kill the fungus. They will not work if you aren’t taking care of your feet. Tea Tree Oil may help reduce the burning caused by open sores.
There are three reasons to consult a doctor about athlete’s foot. 1) If a severe infection does not respond to the above measures after two weeks. 2) If your feet become swollen and red, or red streaking develops on your legs. 3) If you have diabetes. Severe reactions may require antibiotics due to a secondary bacterial infection.
Note: Chemical irritations from dyes, fabrics, detergents, etc in your socks or shoes can look similar to athlete’s foot. This may be the cause if symptoms commence immediately after starting new socks or shoes.
The Acutely Painful Joint
Sprains and strains occur when the ligaments and tendons in joints are overly stretched, torn, or damaged. A fracture could occur if significant amounts of force are involved. Indications of fracture include exquisite tenderness at one particular spot over the bone, and/or an inability to bear weight on the affected joint for at least 4 steps. If this is the case immobilize the joint and seek medical care for further evaluation. In the absence of a fracture, focus on stabilizing and supporting the joint, RICE (see below), and controlling the pain until symptoms improve. Healing time will vary depending on the degree of injury, how much you allow it to heal, and how much strengthening and stretching are done. For mild injuries, plan on resting for at least a couple of days. Remember that a sprain or strain will not heal if you continue hiking on it.
Prevention: 1) Good shoes (light, and comfortable). 2) Daily stretching of hams, quads, calves and back.
Management:
-RICE: Rest, Ice (20 minutes every hour), Compression, and Elevation (above your heart while lying flat). Start immediately after the injury and continue for the next 3-5 days. This will help reduce the swelling, inflammation, and pain in the early stages of the injury.
-Stabilizing or Immobilizing the Joint: If the situation requires that you continue walking on the injured joint, snugly wrap the joint with ACE bandages or whatever you have available in a figure 8 fashion around the joint. Use hiking poles or a walking stick to minimize the load on the joint. It’s OK to put as much weight on the joint as you can tolerate. If you are unable to bear weight and/or have severe pain, make a rigid splint. You will have to be creative with your available resources but the basic idea is to create firm structural supports on both sides of the joint that will completely immobilize it. Make sure the splint is well padded and does not inhibit blood flow. Sleeping pads work well for knees (think burrito). Ice axes, hiking poles, and tree limbs can work for ankles. A rigid splint will significantly reduce pain during evacuation, as will medications like Motrin or Tylenol.
Braces may be available at the local pharmacy when you get to town. If RICE and a simple brace are inadequate, you should get checked out in the ER. While you’re there you should get a plastic splint (Air-Cast). These are great splints that can be worn with a shoe on and should be worn at night as well. Stretching and rehabilitation exercises should begin within 3-5 days of the injury and should continue daily for several weeks. Look on the internet or talk with your doctor for specific exercises. I liked these sites: http://www.mckinley.uiuc.edu/Handouts/anklesprain/anklesprain.html
Knees: http://www.med.umich.edu/1libr/sma/sma_medollig_rex.htm
Basic rehab for ankles: 1) flexing the foot up and down. 2) moving the foot in circles. 3) painting the alphabet with your toe. These can be done several times a day.
Returning to activity: When you can walk down the stairs without pain or hop on the foot 4 times without pain, you are good to go.
Fractures/Dislocations:
This chapter was initially quite lengthy, bit I almost all of it out because fractures and dislocations are pretty uncommon and if you suspect such an injury you should seek medical attention. Your goals for management of such fractures in the field essentially are to straighten out the bones (when possible), splint for stability, pain control (Ice, elevation, motrin), and seeking medical attention Identifying fractures without an x-ray can be challenging, however, the ability to bear weight on the affected extremity, and move the joints back and forth with only mild to moderate pain makes a fracture unlikely. But if you are concerned or you have too much pain, seek medical attention. Fractures are generally not life threatening unless the skin is open around the fracture (which can lead to infection) or when self-supported evacuation is dangerous or impossible. If the skin is open, pour 2-3 liters of purified water through the wound and wrap it in something clean, and seek medical attention.
Numbness, Tingling and Burning (i.e. Paresthesias)
Paresthesias can feel like “pins and needles”, burning, or can be a decreased sensation like there is a layer of tape over the skin. They can occur in arms, hands, thighs, or feet. They are caused by compression or repeated direct injury to the nerves. They are disturbing but generally temporary and resolve on their own within a few weeks of correcting what is causing it. Motrin should help if it is painful.
Arms/Hands (Ulnar paresthesias): These are usually characterized by numbness or tingling in the ring and little finger. They are usually due to compression of the nerves in your armpit by your shoulder straps. So change the positioning of the straps and increase the padding.
Outside of thighs (meralgia parestheitica): Due to nerve compression by hip belt. Change position of hip belt, quit wearing it or increase the padding.
Heel/Sole of foot (Tarsal Tunnel Syndrome): Due to your shoes or boots pushing into rear aspect of your inside ankle bone and compressing a nerve that passes through there. Change the type of footwear or cut them back.
Toes (digitalgia paresthetica): Due to repeated compression of nerves on bottom of foot from walking. Stiffer shoes and less foot padding are more likely to cause this. Try running shoes or new padded insoles.
Chronic Joint/Leg/Foot Pain:
This section covers several different types of over-use injuries. The causes of these injuries can generally be boiled down to inadequate stretching and strengthening, and poor footwear. Spend some time researching footwear and choose something that will work for your foot.
www.drpribut.com/sports is a website that I used a lot for this section. It was written by a podiatrist and runner’s doc that has some excellent articles about footwear and more detailed information about injuries, stretching, etc.
Chronic Knee Pain: Runner’s knee is condition characterized by pain at or near the medial (inside) or bottom of the knee-cap. It is usually worse walking downhill or sitting with knees bent and is caused by the knee cap not tracking smoothly over the joint due an imbalance in the strengthening of the medial (inner) and lateral (outer) thigh muscles, or excessive pronation (walking on the inside of the foot) while walking. If the soles your shoes are wearing much more on the inner aspect compared to the outside, you may bee pronating excessively and could benefit from a shoe with better arch and heel stability. Also you can strengthen the inner thigh muscle by doing leg straightening exercises: lay flat with something under your knee so that the knee is at a 30 degree angle. Raise the foot until the knee is straight. Do 5 sets of ten or as many as tolerated daily. Motrin 600 mg up to 3 times a day as needed should work well for pain. And finally, consider orthotics.
Achilles Tendonitis: The Achilles tendon attaches the calve muscles to the heel. The calve is a very powerful muscle group, but the Achilles tendon has a poor blood supply so injuries are slow to heal. Tendonitis is an inflammation of the tendon caused by footwear and/or tight calve muscles. Footwear in the soles are too stiff or that have excessive heel cushion (particularly air cells) can put more stress on the tendon, causing repeated minor injury. Calve tightness can be improved with regular, gentle stretching. A ¼ inch heel lift may provide some relief. RICE (see acute joint injuries) and decreasing mileage will help as well. If the pain is limiting walking, or got suddenly worse, then rest for a few days and consider seeking medical advice.
Shin Splints:
These are thought to be due to inflammation of the lining of one of the bones (tibia) in the lower leg. Typically described as pain and tenderness in the anterior (frontal) or medial (inside) aspect of the lower leg. The pain and tenderness usually extends vertically 3-12 cm above the inner ankle bone. It may be in both legs. Patients usually can hop on the affected leg and do not have an isolated spot of tenderness in the leg. Inability to hop on the leg, pain at single point or that is horizontally oriented may suggest a stress fracture, which should be evaluated by a medical professional.
Shin splints are an over-use injury, caused or at least made worse by inadequate footwear. Excessive pronation (rolling your arch in) is usually the culprit.
Management: Motrin, rest, ice (20 min/h), stretching and strengthening. Decrease your miles or rest until the pain resolves. Consider changing your footwear.
DIARRHEA:
Prevention: WASH YOUR HANDS!!!! after every time any form of bodily fluid (feces, urine, or other) leaves your body and before you eat. Washing your hands and cleaning cooking pots and utensils with warm, soapy water is MORE likely to prevent diarrhea than water purification. This has actually been studied. That being said, PURIFY YOUR WATER consistently. Erratic water purification has similar rates of diarrheal illness as never purifying.
There are essentially 3 types of diarrhea: 1) Secretory: watery diarrhea caused by lots of different bugs but usually resolves within 3-5 days.
Treatment is replacing fluid losses, Peptobismol and Immodium. 2) Inflammatory: bloody diarrhea usually caused by specific types of bacteria. It may be associated with fevers. Treatment usually involves the above + antibiotics. If you have blood in your diarrhea, you should go see a doctor as soon as possible. 3) Chronic diarrhea: We usually blame this on Giardia. This includes persistent and recurrent diarrhea (keeps coming back). If there is no blood in it, and you don’t feel significantly dehydrated, then take tinidazole or flagyl (antibiotics) as directed by your doctor. Symptoms should improve within 24 hours.
Management: Increase fluid intake (water and//or soups). You need salt in your body to absorb the water so either eat salty foods or mix up some Oral Rehydration Cocktails: Alternate Glass 1: 8oz (250 ml) fruit juice (apple orange or lemon), ½ tsp of honey, and 1 pinch of salt. Glass 2: 8 oz of water (purified) and ¼ tsp baking soda.
Medications: Most diarrheal illness will resolve on its own in 2-3 days without medications. For nonbloody diarrhea Peptobismol is safe, cheap, readily available and may help reduce output and abdominal cramping. Immodium is not an antibiotic and I generally don’t recommend it (especially with bloody diarrhea) but will it slow down your output, which is important especially in the setting of the explosive diarrhea variety. Take 2mg after first episode of diarrhea and 1 mg after subsequent episodes for a maximum of 8mg in 24 hours.
Giardia: Symptoms can vary from large volumes of foul smelling, soft stool to explosive diarrhea, nausea, vomiting, malaise and a characteristic “rotten egg” smell to bowel movements and gas. Chronic (>2 weeks) or recurrent diarrhea can develop. Treatment: Flagyl 750 mg once a day for 5 days, or Tinidazole 2 gm once. I would go with the tinidazole since you only have to take it once. Don’t drink alcohol while taking these medications, as they will make you feel hungover.
Skin and Soft tissue:
Scrapes and Cuts:
The Basic principles are 1) get it clean, and 2) keep it clean. Lacerations (cuts) are closed with sutures primarily to reduce scar formation, and this can be delayed for 24-36 hours without untoward effects as long as you keep it clean (see below). Abrasions can simply be cleaned and covered.
Management: Hold pressure with dressing and elevate to stop the bleeding. Clean with soapy water and pour 1-2 liters of purified water through the wound. Cover the wound with antibiotic cream (e.g. bacitracin) and wet gauze. Repeat every 12 hours until you can be seen by a medical professional if you need sutures, otherwise it will heal on its own eventually. Preventing an infection by keeping the wound clean is absolutely more important than getting to the clinic a little faster. Also, trying to “Rambo” it with a fishing hook and 5 lbs line is not going to help.
Concerning features: signs of infection, and lacerations into joints or involving tendons. If you have any of these go the clinic. Most wounds do not need antibiotics (except maybe punctures).
Puncture Wounds: Whether due an animal, nail or hiking partner’s teeth, they should be cleaned the same as lacerations AND probably be seen by a medical professional due to the higher likelihood of infection.
POISON IVY, POISON OAK AND POISON SUMAC:
Eastern Poison Ivy: climbing vine with three serrated-edged pointed leaves which grow in clusters of 3.
Western Poison Ivy: similar leaves but it is a low-growing shrub.
Poison Oak: 3 leaves. Grows in sandy soil as a low shrub in the East, and a large standing shrub or climbing vine in the West.
Poison Sumac: a shrub or bush with 2 rows of 7-13 leaflets.
Characteristics: red, itchy rash, with fluid-filled vesicles. If you’ve had it before, symptoms usually develop 4-96 hours after exposure, otherwise symptoms could be delayed for a day or two.
Management: Wash all exposed skin clothing gear with copious COLD (keep the pores closed) soapy water (not alcohol based soap) immediately.
This inactivates the toxin (called urushiol) and prevents further spread to yourself and others. Be sure to clean under fingernails well.
Once the skin has been thoroughly cleaned, you are no longer contagious. The fluid in the blisters is sterile and toxin-free.
A new product, Zanfel cream, is by many accounts the most effective therapy available (the company reports that itching will go away within 30 seconds). It can be bought without a prescription at the pharmacy, although it is quite expensive at $40. For severe reactions, or debilitating reactions not responding to the above regimens, go to the clinic. For mild reactions, just clean the wound, and take benadryl (25 mg every 12 hours as needed) for the itch. Calamine lotion, cortisone 1% cream, or aveeno oatmeal baths may help with the symptoms.
Prevention: Long pants, long-sleeve shirts, and identification/avoidance of noxious plants. Creams to prevent exposure (e.g. Ivy Block) are safe and will prevent reactions most of the time, but they must be re-applied every 4 hours.
Jock Itch/Yeast Infections:
MEN: It is essentially athlete’s foot in your groin. It usually does not involve the scrotum or penis. Clean the affected areas with soapy water. Avoid tight fitting underwear. The antifungal powders could be helpful. Be sure to use them as directed and for at least 2 weeks. Wear clean, dry boxers to sleep in. This is contagious so avoid sharing shorts or sexual activity until resolved.
WOMEN: Generally don’t get Jock Itch. If you have burning in the vaginal area then it is likely one of two things: a yeast infection or vaginitis (a bacterial infection). Neither is life threatening. Yeast infections are usually associated with a white, cottage cheese-ish discharge. Vaginitis is usually associated with a brown or grey fish smelling discharge.
Vaginitis can be transmitted sexually or it can just be a bacterial overgrowth (it is not caused by gonorrhea or Chlamydia). Treatment is Flagyl 2 gm one time. Consult a doctor before treating.
Yeast Infections can occur after taking any antibiotics, and from bodily stress or hormonal changes. Prevention: If you are taking antibiotics you should also eat yogurt with live cultures, and/or take lactobacillus (nonprescription pills with bacteria in them). Keep genital area clean and dry. Avoid perfumes, feminine hygiene sprays and douches. Treatment: Prescription: Diflucan 150 mg (tablet) once. Nonprescription: Monostat vaginal suppositories (use as directed). Please make sure you are not pregnant before taking any of these medications.
Reasons to see a doctor: 1) You need a prescription. 2) You develop severe abdominal pain, bleeding from your vagina, or fevers. 3) Infection not responding to the above measures. 4) If you are pregnant.
Sunburns: For simple sunburns, keep your skin covered and clean. Apply cool soaks and aloe vera for comfort.
Blistering Sunburns: Cool the affected area with cold packs and cool, clean water. Remove loose skin and debris. Drain and cut back blisters larger than a quarter or if they look like they are going to burst. Apply antibiotic cream (e.g. Bacitracin) and a clean dressing. Sunburns generally do not need to be seen by a medical professional unless they are getting worse or infected (worsening redness, pain or pussiness) .
Burns: Burns can be very serious as they have a tendency to get infected. All burns other that dime-size superficial burns should be evaluated by a physician.
Boils/Abscesses:
Boils (abscesses) are walled off infections under the skin, like acne but bigger. They are painful and feel like tight water balloons. They generally occur in armpits, buttock creases, and other hairy places, but can occur anywhere.
If it looks red and angry, go to the doctor. If it doesn’t try putting rags soaked in hot water and Epsom salts on the abscess, which may induce it to open on its own. Once it is draining, the pain will go away, and the abscess may resolve. They do commonly recur and you should continue the warm compresses for a couple of days until you are sure it has resolved. If that doesn’t work, go to the ER and have someone open it. Don’t try cutting into it unless you have been trained to do so.
Treatment is drainage. Antibiotics ae generally neither necessary or helpful, unless there is a surrounding skin infection.
Bees, Wasps:
If the person starts having difficulty breathing, swallowing, hoarse voice, hives covering their body, or other signs of anaphylaxis, USE THE EPI-PEN. Do not delay. Then evacuate.
Otherwise, just remove the stinger, apply ice, and clean the wound.
Snake Bites: Pit vipers (rattlesnakes, water moccasins, etc) and coral snakes are the only poisonous snakes in North America. Pit vipers have triangular heads, and cat-like pupils. Coral snakes have to chew on you to envenomate, so don’t let them.
The Sawyer Extractor might work if used within 2-3 minutes. Remove jewelry as swelling will likely occur. Do not try to capture the snake (a simple description will do). Begin evacuating to the closest road immediately.
DO NOT: immobilize the limb (will just slow you down), shock the would with a car battery, put ice on it (may worsen tissue necrosis), the “cut and suck” thing (doesn’t work), apply a torniquet (not effective at limiting spread of toxin, and will guarantee loss of the limb).
Anyone who has been bit by a snake that they are not absolutely sure was not a pit viper or coral snake, should seek medical attention.
Spider Bites: The only spiders in North America that are dangerous to humans are: Black Widow, Brown Recluse and Hobo Spiders. The symptoms are not specific but generally occur within 36 hours and could include: local tissue destruction, muscle cramps, fevers/chills, nausea and vomiting. If you know that you were bitten by one of these spiders or you develop these symptoms then go to the clinic or at least stay close by. Keep the wound clean and covered.
Ticks: Lyme Disease (classically a Northeast disease that has quickly worked its way South and across the Mississippi, although I am not aware of any reports along the PCT) and other tick-borne illnesses such as Rocky Mountain Spotted Fever, and Ehrlichiosis are a concern along the trails.
Prevention: Permetherin-soaked clothes, and DEET are very effective at keeping the ticks off. If you can’t handle that, then be vigilant with “tick checks”. Removing ticks within 48 hours has been reported to prevent infection. If the head is stuck then pick it out with a needle. Do not burn the tick, cover it in gasoline, twist it or smother it in alcohol. Just pull straight back. Then clean the wound with soapy, warm water.
Signs of Lyme Disease: fever, headache, unexplainable joint pain, and/or classic rash that is red, round and clear in the middle, resembling a “target sign”.
If you develop these symptoms go to a clinic, even if symptoms resolve. Lyme can be difficult to distinguish from the flu. Depending on the situation, they may do blood tests or just go ahead and treat you.
Treatment: for mild/moderate infection is doxycycline 100 mg twice a day for 6 weeks. Infections can become severe, or chronic if not treated correctly. Please do so under the supervision of a doctor.
Eyes:
Bugs, dirt, etc in your eye: typically the eye is red, watery and it feels like someone is dragging a rake across your eye every time it moves.
Management: Remove contacts (and do NOT replace for several days until redness has completely resolved) Pour copious amounts of purified water directly into the eye until the raking sensation is gone. If you can see the object (flip the lid up) then an assistant could try gently removing it with a moistened Q-tip. Pain should be resolved by the next morning. If you develop worsening pain, worsening vision or other problems go to the ER promptly.
Snowblindness:
Solar radiation particularly on snowfields can lead to a sun burn on the cornea (skin) of your eye if you don’t wear sunglasses. The pain does not generally develop until later in the afternoon or evening, however, it is particularly intense and will result in severe discomfort for at least the next 1-2 days.
Treatment is symptomatic and is primarily pain control (usually requires narcotics). Eye drops to paralyze the eyes may be prescribed and will provide some relief. Artificial tears or contact solution can be bought at the store and will provide some relief as well. Medical evaluation is helpful to ensure there is not debris in the eye and no ulcers have formed. Contacts should be removed and not replaced until symptoms are gone.
Urinary Tract Infections:
They are characterized by burning with urination or increased frequency of urination. Generally they are uncommon in men. However, the presence of symptoms warrants medical evaluation. For women, since UTI’s are so common, they may elect to carry antibiotics to take should symptoms develop. It is important to do this under the guidance of a medical professional. Ensure that you are not pregnant with a home pregnancy test prior to taking antibiotics, as some of them are not safe in pregnancy.
The development of fevers, vomiting or pain in your back could signify that the infection has spread to the kidneys. Kidney infections can be serious, so go to the ER if flank pain or fevers develop.
Treatment: Bactrim DS 80/160 twice a day (3 days for bladder/urethral infections, 10 days for kidney infections). Pyridium (aka Azo) 100 mg twice a day for 3 days will help with the pain of urination but is not an antibiotic.
Drink plenty of fluids, particularly cranberry juice which may help fight the infection.
Menstruation:
Changes in womens’ menstrual cycles are very common among long-distance hikers (about 50%) and are likely due to decreased body fat and other nutritional factors. The long-term affects of this are unclear, however, cycles generally normalize when an adequate diet resumes. That being said, a “home pregnancy test” should be performed whenever there is a change in menstruation.
BEFORE YOU GO…
The vast majority of hikers are going to have a relatively uneventful trip from a medical standpoint, but there are a few things you can do prior to leaving that could make a big difference. 1) obtain at least some sort of catastrophe medical insurance. It’s cheap and could be useful. 2) go visit with your doctor (or PA/NP or college health clinic). Having a few prescription medications available and someone to call when you get sick will help you get well sooner and save you a significant amount of money by possibly preventing a long and expensive trip to the local ER. They will likely be really excited about your trip and enjoy being the “expedition doc” even if it’s via telephone or email, so don’t be shy. 3) Put together a first aid kit yourself that way you know what is in there and why. 4) consider taking a Wilderness first Responder or First Aid course.
First Aide Kit:
There are a myriad of ready-made first aid kits available in the market for backpacking, however, I feel that we can go lighter and smaller without missing much. Your first aid kit should allow you to deal with minor injuries and have a few other select medications and tools to treat or temporize other issues until you can make it to town, AND it should fit in a small Ziploc bag. The following list is what I take with me. It does change depending on what is wrong with me. Your kit should reflect any previous medical problems you’ve had and current issues. Extra supplies can be shipped along in your “bounce box” or bought in the local store. Just because you may need a splint or bandages on your way through Washington, doesn’t mean you have to carry them through the desert. Buy things as you need them. Adapt.
My Basic Kit:
1) Band-aides (enough to last a week, not the whole box)
2) Bandages (2 4x4’s should be fine)
3) Antibiotic ointment (Neosporin or bacitracin)
4) Safety Pins (for securing, popping, drilling)
5) Mole Foam/Second Skin or other Blister stuff
Note: having scissors on your pocket knife will make it immensely easier to cut up the blister stuff.
6) Uncle Ben’s tweezers
7) Sunscreen
8) Small bar of soap (fragment of Bronner’s in bar form)
9) DEET (for when you can’t take it any longer)
10) Lip balm
11) Emergency Fire Starting Kit
Non-Prescription Medications:
12) Gold Bond Medicated Powder (for chaffing)
13) Motrin or Tylenol for pain
14) Peptobismol chewable tabs (8 should get you to town)
15) Zanfel (poison ivy dope)
16) Oral Reydration Packets (2-3)
Prescription medications:
-Antibiotics:
-Flagyl OR Tinidazole for chronic diarrhea (Giardia)
-(Tinidazole is only one time dosing, so I prefer it)
-Bactrim 80/160 can be used for skin infections, pneumonias, and urinary infections
-Pain Medications
-19) Ketorolac (an NSAID, not a narcotic, similar to motrin but stronger. Avoid motrin (ibuprofen), Aleve (naprosyn) while taking it)
**If you’ve ever had an anaphylactic reaction, or if you just want to be prepared, carry an Epi-Pen. It is one of the few “weird” drugs I carry because you can actually save someone’s life with it [think: bee sting, puffy face, can’t breathe (talk with your doctor, and read the instructions before you go)]. You’ll need a prescription.
Visit your doctor prior to leaving. I think a reasonable plan is to get prescriptions and fill them while you are home. Carry these medications in your first aid kit and then you can call your doctor when you get ill and they can make recommendations about what to take and how often. Do not take them without the supervision of a medical professional. If the actual prescription paper is from out-of-state or is out-dated, it may not be honored by the local pharmacist, so try to “fill” the prescriptions prior to leaving home. Most other bandages, splints and such can be improvised from things already in your pack. Be creative. And get to town when you have a significant injury.
Wilderness Medicine Resources:
1) Fred Darvill, Jr. MD Mountaineering Medicine and Backcountry Medical Guide
2) William Forgey, MD Wilderness Medical Society: Guidelines for Wilderness Emergency Care
3) Advanced Wilderness Life Support (Syllabus) this is an excellent course accredited through the Wilderness Medical Society. Edited by David Della-Giustina, MD and Richard Ingebretson, MD
4) Paul Auerbach, MD Wilderness Emergency Medicine
By:
Stewart Anderson, MD
Thursday, October 20, 2011
Lightning Safety While Backpacking And Hiking
How Lightning Develops Between The Cloud And The Ground
A moving thunderstorm gathers another pool of positively charged particles along the ground that travel with the storm. As the differences in charges continue to increase, positively charged particles rise up taller objects such as trees, houses, and telephone poles. Have you ever been under a storm and had your hair stand up? Yes, the particles also can move up you! This is one of nature's warning signs that says you are in the wrong place, and you may be a lightning target!
The negatively charged area in the storm will send out a charge toward the ground called a stepped leader. It is invisible to the human eye, and moves in steps in less than a second toward the ground. When it gets close to the ground, it is attracted by all these positively charged objects, and a channel develops. You see the electrical transfer in this channel as lightning. There may be several return strokes of electricity within the established channel that you will see as flickering lightning.
http://www.lightningsafety.noaa.gov/science.htm
COMMON MISCONCEPTIONS AND MYTHS
1. Lightning never strikes twice… it strikes the Empire State Building in NYC some 22-25 times per year!
2. Rubber tires or a foam pad will insulate me from lightning… it takes about 10,000 volts to create a one inch spark. Lightning has millions of volts and easily can jump 10-20 feet!
3. Lightning rods will protect my ropes course…lightning rods are "preferential attachment points" for lightning. You do not want to "draw" lightning to any area with people nearby.
4. We should get off the water when boating, canoeing or sailing…tall trees and rocky outcrops along shore and on nearby land may be a more dangerous place.
5. A cave is a safe place in a thunderstorm…if it is shallow cave, or an old mine with metallics nearby, it can be a deadly location during lightning.
2.0 Atmospheric Physics 101. At any one time around the planet, there are 2000 thunderstorms and 100 lightning strikes to earth per second. The frequency of lightning increases in the lower latitudes (closer to the equator), and in the higher altitudes (mountainous terrain). In the USA, central Florida experiences some 10-15 lightning strikes per sq. km./yr. The Rocky Mountain west has about two thirds this activity. Central Africa, parts of Southeast Asia, and the Latin American mountain regions can experience two to three times as much lightning as central Florida.
Lightning leaders from thunderclouds proceed in steps of tens of meters, electrifying ground-based objects as they approach the earth. Ground-based objects may launch lightning streamers to meet these leaders. Streamers may be heard (some say they "sound like bacon frying") and seen (we may notice our hair standing on end). A connecting leader-streamer results in a closed circuit cloud-to-ground lightning flash. Thunder accompanying it is the acoustic shock wave from the electrical discharge. Thus, thunder and lightning are associated with one another.
3.0 Flash/Bang. We all possess a first-class lightning detection device, built into our heads as standard equipment. By referencing the time in seconds from seeing the lightning (the FLASH, or "F" ) to hearing the accompanying thunder (the BANG, or "B"), we can range lightning's distance. A "1,001 to 1,005" of five seconds equals lightning distance being one mile away. A "1,001 to 1,010" of ten = two miles; a "1,001 to 1,020" of twenty = four miles; a "1,001 to 1,030" of thirty = six miles; etc.
New information shows successive, sequential lightning strikes (distances from Strike 1 to Strike 2 to Strike 3) can be some 6-8 miles apart. Taking immediate defensive actions is recommended when lightning is indicated within 6-8 miles. The next strike could be close enough to be an immediate and severe threat.
Lightning is a capricious and random event. It cannot be predicted with any accuracy. It cannot be prevented. Advanced planning in the form of a risk management program is the best defense for maximum safety.
4.0 Standard lightning defenses. The eco-tourism environment is different from situations where substantial buildings or fully enclosed metal vehicles are the recommended shelters. Lightning in remote terrain creates dangerous conditions. Follow these guidelines:
LIGHTNING SAFETY TIPS
AVOID: Avoid water. Avoid all metallic objects. Avoid the high ground. Avoid solitary tall trees. Avoid close contact with others - spread out 15-20 ft. apart. Avoid contact with dissimilar objects (water & land; boat & land; rock & ground; tree & ground). Avoid open spaces.
SEEK:Seek clumps of shrubs or trees of uniform height. Seek ditches, trenches or the low ground. Seek a low, crouching position with feet together with hands on ears to minimize acoujstic shock from thunder.
KEEP: Keep a high level of safety awareness for thirty minutes after the last observed lightning or thunder.
5.0 Medical treatment and symptoms. Treat the apparently dead first. Immediately administer CPR to restore breathing. Eighty percent of lightning strike victims survive the shock. Lightning strike victims do not retain an electric charge and are safe to handle. Common lightning aftereffects include impaired eyesight and loss of hearing. Electrical burns should be treated as other burns.
Treat lightning like a snake: if you see it or hear it, take evasive measures.
A moving thunderstorm gathers another pool of positively charged particles along the ground that travel with the storm. As the differences in charges continue to increase, positively charged particles rise up taller objects such as trees, houses, and telephone poles. Have you ever been under a storm and had your hair stand up? Yes, the particles also can move up you! This is one of nature's warning signs that says you are in the wrong place, and you may be a lightning target!
The negatively charged area in the storm will send out a charge toward the ground called a stepped leader. It is invisible to the human eye, and moves in steps in less than a second toward the ground. When it gets close to the ground, it is attracted by all these positively charged objects, and a channel develops. You see the electrical transfer in this channel as lightning. There may be several return strokes of electricity within the established channel that you will see as flickering lightning.
http://www.lightningsafety.noaa.gov/science.htm
COMMON MISCONCEPTIONS AND MYTHS
1. Lightning never strikes twice… it strikes the Empire State Building in NYC some 22-25 times per year!
2. Rubber tires or a foam pad will insulate me from lightning… it takes about 10,000 volts to create a one inch spark. Lightning has millions of volts and easily can jump 10-20 feet!
3. Lightning rods will protect my ropes course…lightning rods are "preferential attachment points" for lightning. You do not want to "draw" lightning to any area with people nearby.
4. We should get off the water when boating, canoeing or sailing…tall trees and rocky outcrops along shore and on nearby land may be a more dangerous place.
5. A cave is a safe place in a thunderstorm…if it is shallow cave, or an old mine with metallics nearby, it can be a deadly location during lightning.
2.0 Atmospheric Physics 101. At any one time around the planet, there are 2000 thunderstorms and 100 lightning strikes to earth per second. The frequency of lightning increases in the lower latitudes (closer to the equator), and in the higher altitudes (mountainous terrain). In the USA, central Florida experiences some 10-15 lightning strikes per sq. km./yr. The Rocky Mountain west has about two thirds this activity. Central Africa, parts of Southeast Asia, and the Latin American mountain regions can experience two to three times as much lightning as central Florida.
Lightning leaders from thunderclouds proceed in steps of tens of meters, electrifying ground-based objects as they approach the earth. Ground-based objects may launch lightning streamers to meet these leaders. Streamers may be heard (some say they "sound like bacon frying") and seen (we may notice our hair standing on end). A connecting leader-streamer results in a closed circuit cloud-to-ground lightning flash. Thunder accompanying it is the acoustic shock wave from the electrical discharge. Thus, thunder and lightning are associated with one another.
3.0 Flash/Bang. We all possess a first-class lightning detection device, built into our heads as standard equipment. By referencing the time in seconds from seeing the lightning (the FLASH, or "F" ) to hearing the accompanying thunder (the BANG, or "B"), we can range lightning's distance. A "1,001 to 1,005" of five seconds equals lightning distance being one mile away. A "1,001 to 1,010" of ten = two miles; a "1,001 to 1,020" of twenty = four miles; a "1,001 to 1,030" of thirty = six miles; etc.
New information shows successive, sequential lightning strikes (distances from Strike 1 to Strike 2 to Strike 3) can be some 6-8 miles apart. Taking immediate defensive actions is recommended when lightning is indicated within 6-8 miles. The next strike could be close enough to be an immediate and severe threat.
Lightning is a capricious and random event. It cannot be predicted with any accuracy. It cannot be prevented. Advanced planning in the form of a risk management program is the best defense for maximum safety.
4.0 Standard lightning defenses. The eco-tourism environment is different from situations where substantial buildings or fully enclosed metal vehicles are the recommended shelters. Lightning in remote terrain creates dangerous conditions. Follow these guidelines:
LIGHTNING SAFETY TIPS
AVOID: Avoid water. Avoid all metallic objects. Avoid the high ground. Avoid solitary tall trees. Avoid close contact with others - spread out 15-20 ft. apart. Avoid contact with dissimilar objects (water & land; boat & land; rock & ground; tree & ground). Avoid open spaces.
SEEK:Seek clumps of shrubs or trees of uniform height. Seek ditches, trenches or the low ground. Seek a low, crouching position with feet together with hands on ears to minimize acoujstic shock from thunder.
KEEP: Keep a high level of safety awareness for thirty minutes after the last observed lightning or thunder.
5.0 Medical treatment and symptoms. Treat the apparently dead first. Immediately administer CPR to restore breathing. Eighty percent of lightning strike victims survive the shock. Lightning strike victims do not retain an electric charge and are safe to handle. Common lightning aftereffects include impaired eyesight and loss of hearing. Electrical burns should be treated as other burns.
Treat lightning like a snake: if you see it or hear it, take evasive measures.
Wednesday, October 19, 2011
Hydration and Dehydration Be Aware While Hiking !
What is dehydration?
Basically Dehydration is a condition in which the body or certain body tissues suffer from lack of water. In serious enough cases, this can rapidly lead to death.
What causes dehydration?
Dehydration is a condition that occurs when a person loses more fluids than he or she takes in. Under normal conditions, we all lose body water daily through sweat, tears, urine & stool. In a healthy person, this water is replaced by drinking fluids & eating foods that contain water. When a person becomes so sick with fever, diarrhea, or vomiting or if an individual is overexposed to the sun, or has limited access to water, dehydration occurs. This is caused when the body loses water content & essential body salts such as sodium, potassium, calcium bicarbonate & phosphate.
Occasionally, dehydration can be caused by drugs, such as diuretics*, which deplete body fluids & electrolytes. Whatever the cause, dehydration should be treated as soon as possible.
For us hikers it can easily be caused by not drinking enough water often enough. When someone gets dehydrated, it means the amount of water in his or her body has dropped below its adequate level (our bodies are about 2/3 water). Small decreases don't cause problems, & in most cases, they go completely unnoticed. But losing larger amounts of water can sometimes make a person feel quite sick.
* Some sample diuretics: Soda / Pop (with caffeine), coffee, tea, alcohol (yes, even beer, sorry!), many medications especially those for heart patients (Lasix is commonly called a “water pill” it’s function is to eliminate water from the body and it does so VERY WELL.) Some who regularly drink caffeine report no additional loss of fluid, however I suggest: Why take a chance? Also, try to drink more water to "compensate".
What are the signs/symptoms of dehydration?
The following are the most common symptoms of dehydration, although each individual may experience symptoms differently. Symptoms may include:
•Thirst (late sign/symptom) one of the most obvious, so pay close attention to it.
•Less-frequent urination
•Dark urine (early sign/symptom, be aware!)
•Dry skin (late sign/symptom)
•Fatigue
•Light-headedness
•Dizziness
•Confusion
•Dry mouth & mucous membranes
•Increased heart rate & breathing (possibly with associated chest pains)
Please note that thirst is a late sign/symptom; do NOT rely on thirst as an indicator of need for water. As Andrew “Iceman” Priestley states:
“It takes a while for that water to work through your system. You can be drinking & still be dehydrated. By the time you feel thirsty, you are over a quart low. If you never make up that quart, you'll still feel thirsty.
I drink almost constantly while hiking. I keep 2 liters on me if at all possible & drink A LOT. Frequent pee breaks become a valuable method of judging your level of hydration. Toss a packet of sport's drink concentrate in once a day as well; the extra electrolytes & such are good for you when your water throughput is high. During hot summer months I probably drink upward of 1.5 to 2 gallons of water a day when hiking. But then I sweat a lot.”
I can hear you say: “Two Gallons? That is way too much!” Yes, the (old) recommendation from the medical community was to "drink Six to Eight Quarts a day". A quart is ¼ of a gallon, so yes 8 quarts = 2 gallons. Almost no one drinks that much & most people are chronically dehydrated, and then they go hiking. The 6 to 8 Quart recommendation is for “strenuous activity” and may very well be way outdated. The point is still drink a lot of water. I do believe that hiking in the mountains carrying a backpack would qualify as strenuous activity, don’t you. Also, please note that in severe cases of dehydration, it takes anywhere from 48 to 72 hours to completely replenish water to normal levels.
Hints / tips:
Drink at least a quart of water first thing in the morning before even starting out; it won't keep you from getting thirsty, but by putting a quart in right away, it postpones the thirst by flooding the system before you even start hiking.
Also take a big drink every time you get to a decent water source & this is also a good time to check the water bottle levels at every source to make sure your not running too low; this is CRITICALLY important if you're using a hydration system/suck tube.
Get in the habit of checking your supply or sooner or later, you'll run out several miles from the next water. Many also keep a full quart by His/Her head at night so if they wake up several times during the night, they can take several short drinks; this keeps one from "drying out" during the night.
And lastly, don't forget to drink water when you're in town, many folks drink nothing but beer or soda in town. The easiest way to do this in town is to ask for ice water with your meals, & drink this instead of or in addition to an alternate beverage. But the key thing is to drink a lot of water & drink it often. Dehydration weakens muscles & tendons, & leaves you chronically fatigued. Most of the time when hikers complain of feeling poorly, feeling exhausted, all achy & irritable, these are all symptoms of chronic dehydration, & this is easily avoidable. Drink water BEFORE you get thirsty, & drink even when you're NOT thirsty, & however much you're drinking, drink more. Nothing like that good Mountain Spring Water, girls & guys.
So, now you are dehydrated, what to do?
To counter dehydration, you need to restore the proper balance of water in your body. On the trail this means drinking copious amounts of water, as a start. If you find a decent water source, set up camp then & there. No, you do not continue hiking, remember it can take: “anywhere from 48 to 72 hours to completely replenish water to normal levels.” So you need to STOP and get re-hydrated NOW! The trail will still be there, & the hike will be much more fun if you are properly hydrated. Added salt is still controversial, some say yes, some say no, & still others say in limited amounts. I lean toward no or very limited additional salt, especially if you are eating mostly pre-packaged things (Ramen flavor packets are mostly salt) you are getting ample salt, and besides the problem is too little water not too little salt. “But my sweat is salty, so I must be loosing salt”. Not necessarily, much of that “salt taste” is excess salt your body is getting rid of. Anyway: take a full day off, drink the above 2 gallons of water as a start then drink more. Probably, when you are peeing clear the majority of the crisis is over, you may then continue with your hike, but please take it slow and continue to drink and drink and drink.
An example: I got dehydrated at work, my partner started a 1-liter IV on me, and at the hospital I was diagnosed with moderate dehydration. After 2 liters of IV fluid and about 2 liters of oral water I was released from the hospital, I didn’t feel 100% for over 48 hrs. I had “endless thirsts” for about another 24 hours after that.
Survival Situation
Dehydration & heat exhaustion & stroke can be very dangerous. In the outdoors, it cannot be stressed enough: If you cannot get to a clean water supply, GO AHEAD & DRINK THE WATER. It is best to re-hydrate yourself, whether it is from creek, stream or lake. Your survival might depend on it. When you are then found & get back to a location where you can be treated, the health-care professionals can treat your symptoms at that point in time. For example, Guardia Labia, which is the very common organism that causes diarrhea, the incubation for Guardia is approximately 3 weeks. You will be found most likely in less time than that, & you are not going to suffer any symptoms until you get back. So, hydration is key. Please drink the water if you are in a situation that warrants that.
Basically Dehydration is a condition in which the body or certain body tissues suffer from lack of water. In serious enough cases, this can rapidly lead to death.
What causes dehydration?
Dehydration is a condition that occurs when a person loses more fluids than he or she takes in. Under normal conditions, we all lose body water daily through sweat, tears, urine & stool. In a healthy person, this water is replaced by drinking fluids & eating foods that contain water. When a person becomes so sick with fever, diarrhea, or vomiting or if an individual is overexposed to the sun, or has limited access to water, dehydration occurs. This is caused when the body loses water content & essential body salts such as sodium, potassium, calcium bicarbonate & phosphate.
Occasionally, dehydration can be caused by drugs, such as diuretics*, which deplete body fluids & electrolytes. Whatever the cause, dehydration should be treated as soon as possible.
For us hikers it can easily be caused by not drinking enough water often enough. When someone gets dehydrated, it means the amount of water in his or her body has dropped below its adequate level (our bodies are about 2/3 water). Small decreases don't cause problems, & in most cases, they go completely unnoticed. But losing larger amounts of water can sometimes make a person feel quite sick.
* Some sample diuretics: Soda / Pop (with caffeine), coffee, tea, alcohol (yes, even beer, sorry!), many medications especially those for heart patients (Lasix is commonly called a “water pill” it’s function is to eliminate water from the body and it does so VERY WELL.) Some who regularly drink caffeine report no additional loss of fluid, however I suggest: Why take a chance? Also, try to drink more water to "compensate".
What are the signs/symptoms of dehydration?
The following are the most common symptoms of dehydration, although each individual may experience symptoms differently. Symptoms may include:
•Thirst (late sign/symptom) one of the most obvious, so pay close attention to it.
•Less-frequent urination
•Dark urine (early sign/symptom, be aware!)
•Dry skin (late sign/symptom)
•Fatigue
•Light-headedness
•Dizziness
•Confusion
•Dry mouth & mucous membranes
•Increased heart rate & breathing (possibly with associated chest pains)
Please note that thirst is a late sign/symptom; do NOT rely on thirst as an indicator of need for water. As Andrew “Iceman” Priestley states:
“It takes a while for that water to work through your system. You can be drinking & still be dehydrated. By the time you feel thirsty, you are over a quart low. If you never make up that quart, you'll still feel thirsty.
I drink almost constantly while hiking. I keep 2 liters on me if at all possible & drink A LOT. Frequent pee breaks become a valuable method of judging your level of hydration. Toss a packet of sport's drink concentrate in once a day as well; the extra electrolytes & such are good for you when your water throughput is high. During hot summer months I probably drink upward of 1.5 to 2 gallons of water a day when hiking. But then I sweat a lot.”
I can hear you say: “Two Gallons? That is way too much!” Yes, the (old) recommendation from the medical community was to "drink Six to Eight Quarts a day". A quart is ¼ of a gallon, so yes 8 quarts = 2 gallons. Almost no one drinks that much & most people are chronically dehydrated, and then they go hiking. The 6 to 8 Quart recommendation is for “strenuous activity” and may very well be way outdated. The point is still drink a lot of water. I do believe that hiking in the mountains carrying a backpack would qualify as strenuous activity, don’t you. Also, please note that in severe cases of dehydration, it takes anywhere from 48 to 72 hours to completely replenish water to normal levels.
Hints / tips:
Drink at least a quart of water first thing in the morning before even starting out; it won't keep you from getting thirsty, but by putting a quart in right away, it postpones the thirst by flooding the system before you even start hiking.
Also take a big drink every time you get to a decent water source & this is also a good time to check the water bottle levels at every source to make sure your not running too low; this is CRITICALLY important if you're using a hydration system/suck tube.
Get in the habit of checking your supply or sooner or later, you'll run out several miles from the next water. Many also keep a full quart by His/Her head at night so if they wake up several times during the night, they can take several short drinks; this keeps one from "drying out" during the night.
And lastly, don't forget to drink water when you're in town, many folks drink nothing but beer or soda in town. The easiest way to do this in town is to ask for ice water with your meals, & drink this instead of or in addition to an alternate beverage. But the key thing is to drink a lot of water & drink it often. Dehydration weakens muscles & tendons, & leaves you chronically fatigued. Most of the time when hikers complain of feeling poorly, feeling exhausted, all achy & irritable, these are all symptoms of chronic dehydration, & this is easily avoidable. Drink water BEFORE you get thirsty, & drink even when you're NOT thirsty, & however much you're drinking, drink more. Nothing like that good Mountain Spring Water, girls & guys.
So, now you are dehydrated, what to do?
To counter dehydration, you need to restore the proper balance of water in your body. On the trail this means drinking copious amounts of water, as a start. If you find a decent water source, set up camp then & there. No, you do not continue hiking, remember it can take: “anywhere from 48 to 72 hours to completely replenish water to normal levels.” So you need to STOP and get re-hydrated NOW! The trail will still be there, & the hike will be much more fun if you are properly hydrated. Added salt is still controversial, some say yes, some say no, & still others say in limited amounts. I lean toward no or very limited additional salt, especially if you are eating mostly pre-packaged things (Ramen flavor packets are mostly salt) you are getting ample salt, and besides the problem is too little water not too little salt. “But my sweat is salty, so I must be loosing salt”. Not necessarily, much of that “salt taste” is excess salt your body is getting rid of. Anyway: take a full day off, drink the above 2 gallons of water as a start then drink more. Probably, when you are peeing clear the majority of the crisis is over, you may then continue with your hike, but please take it slow and continue to drink and drink and drink.
An example: I got dehydrated at work, my partner started a 1-liter IV on me, and at the hospital I was diagnosed with moderate dehydration. After 2 liters of IV fluid and about 2 liters of oral water I was released from the hospital, I didn’t feel 100% for over 48 hrs. I had “endless thirsts” for about another 24 hours after that.
Survival Situation
Dehydration & heat exhaustion & stroke can be very dangerous. In the outdoors, it cannot be stressed enough: If you cannot get to a clean water supply, GO AHEAD & DRINK THE WATER. It is best to re-hydrate yourself, whether it is from creek, stream or lake. Your survival might depend on it. When you are then found & get back to a location where you can be treated, the health-care professionals can treat your symptoms at that point in time. For example, Guardia Labia, which is the very common organism that causes diarrhea, the incubation for Guardia is approximately 3 weeks. You will be found most likely in less time than that, & you are not going to suffer any symptoms until you get back. So, hydration is key. Please drink the water if you are in a situation that warrants that.
Tuesday, October 18, 2011
HYPOTHERMIA Prevention And Description
HYPOTHERMIA
1) DEFINITION AND DESCRIPTION
Hypothermia: From “Hypo” meaning: Low, lowered, lowering or below. And “Thermia” meaning temperature, so: Lowered (body ) Temperature.
Hypothermia Is a state of low body temperature, specifically low body core temperature. When the core temperature of the body drops below 97º (36º C) an individual is considered to be in a hypothermic state. Hypothermia can be attributed to either: a decrease in heat production (perhaps due to illness or injury, dehydration, or lack of food); or an increase in heat loss (perhaps due to; lack of adequate clothing for the temperature, wet, windy conditions.); or a combination of both.
2) HYPOTHERMIA vs FROSTBITE
Years ago you heard of people dying of “exposure.” What we used to call exposure is hypothermia. This is different from frostbite, which can only occur below freezing. Frostbite is freezing of an exposed part of the body. With frostbite the cells in the affected area freeze and the cell walls burst actually killing the tissue in that area, like nerves, skin, muscle, and capillaries. This is why you see severe frostbite areas turning black from the dead tissue. Serious frostbite can be extremely painful and require months of recovery with possible loss of fingers, limbs, etc.. Contrary to popular old wife’s tales an area of frostbite should not be rubbed as this will just cause more damage. The treatment of frostbite is similar to that of burns. With hypothermia there is no tissue damage.
It is amazing how misunderstood hypothermia is. Basically, the human body functions over a very narrow internal temperature range. The loss of core temperature, or losing heat faster than it can be generated by the body, results in hypothermia. The body’s normal temperature is 98.6°F and a drop of under 2°F will start this process. Note that hypothermia is caused only by loss of core temperature and you could have frostbite on your hands and still not be hypothermic. Hypothermia also doesn’t require near freezing temperatures, in fact, a person with low body fat and a low metabolic rate could easily get hypothermic sitting in a swimming pool or bath at 75°F. Your body’s ability to generate heat depends on health, level of fitness, proper hydration, food, etc. Alcohol consumption will make you FEEL warm, when in reality the alcohol, in addition to clouding your judgment further (see “97°F” above), dilates the blood vessels in your skin thereby increasing heat loss (& causing that flushed feeling/look). Coffee and some other drinks are also diuretics and can cause dilation of blood vessels in the extremities and accelerate heat loss. Most cases of hypothermia associated with hiking occur in the summer months when the temperature is 40°F-50°F and you have wet, windy conditions.
Hypothermia victims can be divided into three main categories According to Core Body temperature range: mild, moderate & severe:
A core temperature between 94º and 97º F (34 – 36 C) is considered mild hypothermia.
A core temperature between 86º and 94º (30 – 34 C) is Moderate Hypothermia.
A core temperature less than 86º F (30 C) is Severe Hypothermia.
So let’s see what happens as you lose core temperature:
98.6°F- your brain functions normally
97°F - judgment starts to go; as temperature decreases so does mental ability
96°F - you begin shivering, there is loss of fine motor skills like tying shoes
94°F - coordination is failing, you start stumbling; shivering increases
92°F - shivering is severe; you will be unable to walk
90°F - shivering is convulsive; you are unable to talk; you assume the fetal position
88°F - shivering stops because the body is giving up on that method of re-warming itself
86°F and below -you are in what is referred to as a “metabolic icebox” where you may appear dead. You are unconscious, ashen gray, no perceivable pulse or breathing.
3) SYMPTIONS -WHAT TO LOOK FOR
Although the “umbles” (grumble, mumble, stumble, tumble) have been mentioned as telltale symptoms of hypothermia, keep in mind that these aren’t necessarily obvious or occur in exact order. Also, these symptoms are generally not obvious to the person who is getting hypothermic because of their depressed brain function. Almost always it will be a fellow hiker that recognizes the symptoms.
Grumble The grumbling occurs when we get irritable, but some people start out that way. What you should be looking for in your fellow hikers is a change from what is normal for them. A lot of people who grumble aren’t hypothermic, that’s just normal for them. However, if it is cold and wet and someone starts to grumble, try to figure out the cause. If it is the onset of hypothermia, take corrective measures.
Fumble As your hands get cold, there is loss of fine motor skills like those required to tie shoes. This may also be caused by localized cooling and not hypothermia.
Mumble Contrary to popular belief, this doesn’t have a lot to do with the brain. There are facial muscles that move the jaw and when they get cold and stiffen up we have trouble forming words. If you start talking nonsense then it probably is the brain that is involved.
Stumble Again, the brain is not the only thing that could cause this problem. If your legs get really cold there are two big nerve bundles in your legs that control things like foot drop, etc. If you’ve ever watched a drunk, you can recognize this staggering, flatfooted foot slapping on the floor type of gait. The inability to send and receive nerve messages from the feet are one thing that causes this problem. This could occur alone or in combination with the brain having problems because of hypothermia.
Tumble This one is pretty obvious and almost always comes after some combination of the previous three “umbles”. This is when you are getting into a really serious stage of hypothermia.
Some of the other symptoms that you may notice are the hypothermic person becoming combative, or even taking off clothing. Even well prepared hikers suffering from hypothermia have died despite having everything they needed to survive right in their pack. Don’t expect rational thought processes from someone who is hypothermic.
4) TREATMENT –HOW DO I TREAT SOMEONE WHO IS HYPOTHERMIC?
The first thing to do is to recognize a person who is hypothermic, remove the cause, and take corrective measures. The only true way is to measure core temperature is with a special low-reading rectal hypothermia thermometer. A friend of mine who trains EMTs and is an expert in cold weather related injuries claims if you are willing to let him take your rectal temperature, you ARE truly hypothermic.
If the hypothermia is mild and the person can still walk, the best course of action is to remove the cause. If the clothes are wet, strip the person and put on dry warm clothes. If they haven’t been eating or drinking, feed them. And, most important, keep them moving. It is easier to keep them producing their own heat than for you to try to warm them by other means. This works only if the hypothermia is mild and the person can still walk. Always ambulate before carry if possible because any backcountry litter carry involves a large group of rescuers and many hours.
If the hypothermia is more moderate, keep this one thought in mind: never strip them and put them in a sleeping bag with a functioning warm person. Almost always you will succeed in creating two hypothermic people. This is a very bad idea. What you need to do is to remove the cause of the hypothermia, like their wet clothes, and put them in a hypothermia wrap or sleeping bag (see link for details). You should try to warm the core and not the extremities. Warming the arms and legs can “fool” the body into thinking it is warmer and flushing the warmer blood from the core to the extremities, further cooling the core. The last reference below shows how to create this “human burrito,” as it is sometimes called, to re-warm a hypothermic person.
If a hypothermic person is conscious and is capable of drinking (after removing the cause of the heat loss and protecting them), be very careful that the drinks you give them aren’t too hot. Because the sensation of touch and warmth is so depressed it is very easy for a hypothermic person to be burned by steaming hot liquids that a normal person could not drink. Any drinks should be tested or measured by thermometer to be no more than 105°F. Never try to give drinks or food to an unconscious person.
One last thing. Never assume that if there are no visible signs of life in a severly hypothermic person that it is too late. The experts in this field of medicine say they aren’t dead until they are warm and dead. Respiration can be near zero and the pulse rate could be 6 per minute. Because the blood supply to the extremities is basically shut down, you will get no distal pulse. The muscles stiffen up with the cold and the heart is a muscle. A severe hypothermic person who appears to be dead may just be in this “metabolic icebox.” The severely hypothermic person's heart is extremely susceptible to ventricular fibrillation, which even the slightest jolt can cause. A severely hypothermic person should never be re-warmed in the field. They must be protected from further heat loss and carefully transported to a hospital as soon as possible.
5) PREVENTION –FUEL FOR THE BODY
I know some of you are saying: “Hey, that doesn’t sound like any fun, how to I prevent it?” Well, to prevent it you have to know a little bit about thermodynamics, fortunately, very little. You have to understand how the body generates heat and distributes it through the body as well as how the body loses heat. Metabolism, level of conditioning, illness, drugs, alcohol, and fatigue also can play a big role in hypothermia.
First of all, the body can be thought of as a furnace, burning the fuel (food) that you feed it. The blood forms an important part of this system sending the processed fuel to the cells. Anything that compromises this flow (even restrictive clothing) will cause problems. As you get dehydrated the blood becomes more viscose, or thicker, and its ability to transport oxygen and fuel to the cells decreases. The sensation of thirst isn’t a good indication of when to drink. When you “feel” thirsty, you are already down a quart or so. The sensation of thirst is also depressed by the cold affecting the brain. This is why it is so important pay attention to staying hydrated.
Not all foods are created equal and not all fluids are either. Sugars give you a quick shot of energy but pastas, potatoes, and fats are slower burning and are best to eat before bedtime to help keep your furnace going through the night, but they require more water to digest as well. The problem with fruit juices and some energy drinks is they are too concentrated and are absorbed by the body slowly. Juices diluted about 2 to 1 are absorbed faster. Alcohol, coffee and some other drinks should be avoided. Coffee is a diuretic and can cause dilation of blood vessels allowing the extremities to radiate more heat. The effects of drinking coffee could be thought of like taking off an insulation layer.
6) PREVENTION –CLOTHING AND THERMOREGULATION
There are several ways the body can lose heat. The main ways are:
Conduction One way is by direct contact like lying on the ground. If you and your clothing are wet the loss of heat is up to 25 times greater than if you are dry.
Convection is heat loss due to a breeze and is known as “wind chill.” Again, if you are in damp or wet clothing, the problem is much worse. Although fleece is a good insulation layer, it is very porous and is next to useless in a wind. One way to improve fleece is to add a wind block layer. Another way is to wear a thin wind shirt over the fleece. A tent, or an enclosed hammock, would be warmer than an open-faced shelter by blocking wind and adding some insulation.
Respiration A lot of heat is lost during respiration as a combination of conduction and evaporation. Inhaled cold air is warmed by contact with the upper airway & lungs and the warm exhaled air has moisture from evaporation in the lungs if the inhaled air is dry. The drier the air, the more respiration also contributes to dehydration. Higher altitude, colder and drier air, and rapid breathing all contribute to higher heat loss and dehydration.
Radiation The rate of radiation increases as the difference in temperature between you and the air increases. Like convection, this form of heat loss can be lessened considerably by adding a layer of insulation.
Evaporation Sweating is the body’s natural way of trying to regulate our temperature when we get too hot. The amount of sweat produced by a body at rest could be about 100ml per day. With heavy exercise this could climb to 5000ml or 5 liters per day. If this moisture can’t pass through your clothing to the outside, you will get soaked.
The materials used for your clothing layers are important. Remember cotton absorbs water, loses its insulation ability, gets heavy, and should not be used as a layer. The phrase "cotton kills" says it all. The base layers should be hydrophobic, i.e., not absorb or attract water, the synthetic base layer should freely pass sweat to the outer layers and keep your body as dry as possible. Any of the layers you use should not be constrictive as this will restrict blood flow and make you feel colder. Always think of your layers as part of a “system” that has to fit together properly. When you buy your outer rainproof layer, make sure it is large enough to fit over all the other layers you could be wearing underneath it. Added features like full front zippers and "pit-zips" in jackets and full-length side zippers in rain/wind pants can make them much more versatile and easy to put on or take off. Check the references on layering for a more complete description of material options and layering.
Putting on or taking off layers of clothing allows you to bring your body’s temperature back closer to the normal range under widely varying conditions which could include wind, sun, rain, snow, or your differing levels of exertion. If you do not have the proper clothing for the conditions you are in, you are at risk of hypothermia. A popular belief is that the body tries to “protect” the core organs by shunting blood flow away from the extremities. While this is the effect, the reason is simply to prevent heat loss from the extremities. Not as much heat is radiated from the head as is commonly believed but a hat is an important part of a clothing system. Gloves are also important to prevent your hands from getting wet and cold, which could lead to loss of coordination.
Trying to prevent having to go pee in the middle of a cold night by not drinking (hydrating) properly before bed isn’t wise and can cause you to sleep colder. The old wife’s tale about it taking energy to keep the water in your bladder warm defies logic and science. One practical suggestion to add warmth is to fill a water bottle with hot water and take that to bed with you. This should be done with care because if the water leaks, then you are in trouble. My personal feeling is that you should be carrying enough clothing and a warm enough sleeping bag so this isn’t necessary for warmth.
Also, the air in the sleeping bag doesn’t hold some mystical property that make you sleep warmer when naked. The bottom line is more insulation equals more warmth. If you put on a layer of dry clothing, you will sleep warmer. One footnote should be that an equal sized volume filled with down (or any other type of sleeping bag insulation) is warmer than an equal sized volume filled with air. The reason is convection currents in the larger air areas allows heat flow. The down actually doesn’t have any insulation properties itself, it does, however, break up the possibly convection current heat losses by creating many micro pockets of air, and it is very light and compressible. Keep in mind that if down gets wet, it is useless as an insulator, and is very heavy. Synthetic insulation (like Primaloft) is much better in this regard.
7) Summation:
-Hypothermia is sneaky and can kill. The hypothermic victim is generally not the person who notices their problem.
-Hypothermia (lowered core temperature) should not be confused with frostbite (localized freezing of tissue). These are two different things. Both are serious and require immediate attention.
-If you are hypothermic, or find someone who is hypothermic, remove the cause and prevent further heat loss. Take corrective measures as described above depending on the severity and level of consciousness of the person.
-Alcohol and any diuretics are to be avoided; they will cause the blood vessels to dilate, especially in the skin, causing you to feel warm but in fact accelerating the heat loss.
-Cotton clothing is totally inappropriate for hiking: The saying “Cotton Kills” may seem over used, but cotton & cold, wet weather do not mix. Always carry extra appropriate clothing, raingear, and shelter. Be prepared.
1) DEFINITION AND DESCRIPTION
Hypothermia: From “Hypo” meaning: Low, lowered, lowering or below. And “Thermia” meaning temperature, so: Lowered (body ) Temperature.
Hypothermia Is a state of low body temperature, specifically low body core temperature. When the core temperature of the body drops below 97º (36º C) an individual is considered to be in a hypothermic state. Hypothermia can be attributed to either: a decrease in heat production (perhaps due to illness or injury, dehydration, or lack of food); or an increase in heat loss (perhaps due to; lack of adequate clothing for the temperature, wet, windy conditions.); or a combination of both.
2) HYPOTHERMIA vs FROSTBITE
Years ago you heard of people dying of “exposure.” What we used to call exposure is hypothermia. This is different from frostbite, which can only occur below freezing. Frostbite is freezing of an exposed part of the body. With frostbite the cells in the affected area freeze and the cell walls burst actually killing the tissue in that area, like nerves, skin, muscle, and capillaries. This is why you see severe frostbite areas turning black from the dead tissue. Serious frostbite can be extremely painful and require months of recovery with possible loss of fingers, limbs, etc.. Contrary to popular old wife’s tales an area of frostbite should not be rubbed as this will just cause more damage. The treatment of frostbite is similar to that of burns. With hypothermia there is no tissue damage.
It is amazing how misunderstood hypothermia is. Basically, the human body functions over a very narrow internal temperature range. The loss of core temperature, or losing heat faster than it can be generated by the body, results in hypothermia. The body’s normal temperature is 98.6°F and a drop of under 2°F will start this process. Note that hypothermia is caused only by loss of core temperature and you could have frostbite on your hands and still not be hypothermic. Hypothermia also doesn’t require near freezing temperatures, in fact, a person with low body fat and a low metabolic rate could easily get hypothermic sitting in a swimming pool or bath at 75°F. Your body’s ability to generate heat depends on health, level of fitness, proper hydration, food, etc. Alcohol consumption will make you FEEL warm, when in reality the alcohol, in addition to clouding your judgment further (see “97°F” above), dilates the blood vessels in your skin thereby increasing heat loss (& causing that flushed feeling/look). Coffee and some other drinks are also diuretics and can cause dilation of blood vessels in the extremities and accelerate heat loss. Most cases of hypothermia associated with hiking occur in the summer months when the temperature is 40°F-50°F and you have wet, windy conditions.
Hypothermia victims can be divided into three main categories According to Core Body temperature range: mild, moderate & severe:
A core temperature between 94º and 97º F (34 – 36 C) is considered mild hypothermia.
A core temperature between 86º and 94º (30 – 34 C) is Moderate Hypothermia.
A core temperature less than 86º F (30 C) is Severe Hypothermia.
So let’s see what happens as you lose core temperature:
98.6°F- your brain functions normally
97°F - judgment starts to go; as temperature decreases so does mental ability
96°F - you begin shivering, there is loss of fine motor skills like tying shoes
94°F - coordination is failing, you start stumbling; shivering increases
92°F - shivering is severe; you will be unable to walk
90°F - shivering is convulsive; you are unable to talk; you assume the fetal position
88°F - shivering stops because the body is giving up on that method of re-warming itself
86°F and below -you are in what is referred to as a “metabolic icebox” where you may appear dead. You are unconscious, ashen gray, no perceivable pulse or breathing.
3) SYMPTIONS -WHAT TO LOOK FOR
Although the “umbles” (grumble, mumble, stumble, tumble) have been mentioned as telltale symptoms of hypothermia, keep in mind that these aren’t necessarily obvious or occur in exact order. Also, these symptoms are generally not obvious to the person who is getting hypothermic because of their depressed brain function. Almost always it will be a fellow hiker that recognizes the symptoms.
Grumble The grumbling occurs when we get irritable, but some people start out that way. What you should be looking for in your fellow hikers is a change from what is normal for them. A lot of people who grumble aren’t hypothermic, that’s just normal for them. However, if it is cold and wet and someone starts to grumble, try to figure out the cause. If it is the onset of hypothermia, take corrective measures.
Fumble As your hands get cold, there is loss of fine motor skills like those required to tie shoes. This may also be caused by localized cooling and not hypothermia.
Mumble Contrary to popular belief, this doesn’t have a lot to do with the brain. There are facial muscles that move the jaw and when they get cold and stiffen up we have trouble forming words. If you start talking nonsense then it probably is the brain that is involved.
Stumble Again, the brain is not the only thing that could cause this problem. If your legs get really cold there are two big nerve bundles in your legs that control things like foot drop, etc. If you’ve ever watched a drunk, you can recognize this staggering, flatfooted foot slapping on the floor type of gait. The inability to send and receive nerve messages from the feet are one thing that causes this problem. This could occur alone or in combination with the brain having problems because of hypothermia.
Tumble This one is pretty obvious and almost always comes after some combination of the previous three “umbles”. This is when you are getting into a really serious stage of hypothermia.
Some of the other symptoms that you may notice are the hypothermic person becoming combative, or even taking off clothing. Even well prepared hikers suffering from hypothermia have died despite having everything they needed to survive right in their pack. Don’t expect rational thought processes from someone who is hypothermic.
4) TREATMENT –HOW DO I TREAT SOMEONE WHO IS HYPOTHERMIC?
The first thing to do is to recognize a person who is hypothermic, remove the cause, and take corrective measures. The only true way is to measure core temperature is with a special low-reading rectal hypothermia thermometer. A friend of mine who trains EMTs and is an expert in cold weather related injuries claims if you are willing to let him take your rectal temperature, you ARE truly hypothermic.
If the hypothermia is mild and the person can still walk, the best course of action is to remove the cause. If the clothes are wet, strip the person and put on dry warm clothes. If they haven’t been eating or drinking, feed them. And, most important, keep them moving. It is easier to keep them producing their own heat than for you to try to warm them by other means. This works only if the hypothermia is mild and the person can still walk. Always ambulate before carry if possible because any backcountry litter carry involves a large group of rescuers and many hours.
If the hypothermia is more moderate, keep this one thought in mind: never strip them and put them in a sleeping bag with a functioning warm person. Almost always you will succeed in creating two hypothermic people. This is a very bad idea. What you need to do is to remove the cause of the hypothermia, like their wet clothes, and put them in a hypothermia wrap or sleeping bag (see link for details). You should try to warm the core and not the extremities. Warming the arms and legs can “fool” the body into thinking it is warmer and flushing the warmer blood from the core to the extremities, further cooling the core. The last reference below shows how to create this “human burrito,” as it is sometimes called, to re-warm a hypothermic person.
If a hypothermic person is conscious and is capable of drinking (after removing the cause of the heat loss and protecting them), be very careful that the drinks you give them aren’t too hot. Because the sensation of touch and warmth is so depressed it is very easy for a hypothermic person to be burned by steaming hot liquids that a normal person could not drink. Any drinks should be tested or measured by thermometer to be no more than 105°F. Never try to give drinks or food to an unconscious person.
One last thing. Never assume that if there are no visible signs of life in a severly hypothermic person that it is too late. The experts in this field of medicine say they aren’t dead until they are warm and dead. Respiration can be near zero and the pulse rate could be 6 per minute. Because the blood supply to the extremities is basically shut down, you will get no distal pulse. The muscles stiffen up with the cold and the heart is a muscle. A severe hypothermic person who appears to be dead may just be in this “metabolic icebox.” The severely hypothermic person's heart is extremely susceptible to ventricular fibrillation, which even the slightest jolt can cause. A severely hypothermic person should never be re-warmed in the field. They must be protected from further heat loss and carefully transported to a hospital as soon as possible.
5) PREVENTION –FUEL FOR THE BODY
I know some of you are saying: “Hey, that doesn’t sound like any fun, how to I prevent it?” Well, to prevent it you have to know a little bit about thermodynamics, fortunately, very little. You have to understand how the body generates heat and distributes it through the body as well as how the body loses heat. Metabolism, level of conditioning, illness, drugs, alcohol, and fatigue also can play a big role in hypothermia.
First of all, the body can be thought of as a furnace, burning the fuel (food) that you feed it. The blood forms an important part of this system sending the processed fuel to the cells. Anything that compromises this flow (even restrictive clothing) will cause problems. As you get dehydrated the blood becomes more viscose, or thicker, and its ability to transport oxygen and fuel to the cells decreases. The sensation of thirst isn’t a good indication of when to drink. When you “feel” thirsty, you are already down a quart or so. The sensation of thirst is also depressed by the cold affecting the brain. This is why it is so important pay attention to staying hydrated.
Not all foods are created equal and not all fluids are either. Sugars give you a quick shot of energy but pastas, potatoes, and fats are slower burning and are best to eat before bedtime to help keep your furnace going through the night, but they require more water to digest as well. The problem with fruit juices and some energy drinks is they are too concentrated and are absorbed by the body slowly. Juices diluted about 2 to 1 are absorbed faster. Alcohol, coffee and some other drinks should be avoided. Coffee is a diuretic and can cause dilation of blood vessels allowing the extremities to radiate more heat. The effects of drinking coffee could be thought of like taking off an insulation layer.
6) PREVENTION –CLOTHING AND THERMOREGULATION
There are several ways the body can lose heat. The main ways are:
Conduction One way is by direct contact like lying on the ground. If you and your clothing are wet the loss of heat is up to 25 times greater than if you are dry.
Convection is heat loss due to a breeze and is known as “wind chill.” Again, if you are in damp or wet clothing, the problem is much worse. Although fleece is a good insulation layer, it is very porous and is next to useless in a wind. One way to improve fleece is to add a wind block layer. Another way is to wear a thin wind shirt over the fleece. A tent, or an enclosed hammock, would be warmer than an open-faced shelter by blocking wind and adding some insulation.
Respiration A lot of heat is lost during respiration as a combination of conduction and evaporation. Inhaled cold air is warmed by contact with the upper airway & lungs and the warm exhaled air has moisture from evaporation in the lungs if the inhaled air is dry. The drier the air, the more respiration also contributes to dehydration. Higher altitude, colder and drier air, and rapid breathing all contribute to higher heat loss and dehydration.
Radiation The rate of radiation increases as the difference in temperature between you and the air increases. Like convection, this form of heat loss can be lessened considerably by adding a layer of insulation.
Evaporation Sweating is the body’s natural way of trying to regulate our temperature when we get too hot. The amount of sweat produced by a body at rest could be about 100ml per day. With heavy exercise this could climb to 5000ml or 5 liters per day. If this moisture can’t pass through your clothing to the outside, you will get soaked.
The materials used for your clothing layers are important. Remember cotton absorbs water, loses its insulation ability, gets heavy, and should not be used as a layer. The phrase "cotton kills" says it all. The base layers should be hydrophobic, i.e., not absorb or attract water, the synthetic base layer should freely pass sweat to the outer layers and keep your body as dry as possible. Any of the layers you use should not be constrictive as this will restrict blood flow and make you feel colder. Always think of your layers as part of a “system” that has to fit together properly. When you buy your outer rainproof layer, make sure it is large enough to fit over all the other layers you could be wearing underneath it. Added features like full front zippers and "pit-zips" in jackets and full-length side zippers in rain/wind pants can make them much more versatile and easy to put on or take off. Check the references on layering for a more complete description of material options and layering.
Putting on or taking off layers of clothing allows you to bring your body’s temperature back closer to the normal range under widely varying conditions which could include wind, sun, rain, snow, or your differing levels of exertion. If you do not have the proper clothing for the conditions you are in, you are at risk of hypothermia. A popular belief is that the body tries to “protect” the core organs by shunting blood flow away from the extremities. While this is the effect, the reason is simply to prevent heat loss from the extremities. Not as much heat is radiated from the head as is commonly believed but a hat is an important part of a clothing system. Gloves are also important to prevent your hands from getting wet and cold, which could lead to loss of coordination.
Trying to prevent having to go pee in the middle of a cold night by not drinking (hydrating) properly before bed isn’t wise and can cause you to sleep colder. The old wife’s tale about it taking energy to keep the water in your bladder warm defies logic and science. One practical suggestion to add warmth is to fill a water bottle with hot water and take that to bed with you. This should be done with care because if the water leaks, then you are in trouble. My personal feeling is that you should be carrying enough clothing and a warm enough sleeping bag so this isn’t necessary for warmth.
Also, the air in the sleeping bag doesn’t hold some mystical property that make you sleep warmer when naked. The bottom line is more insulation equals more warmth. If you put on a layer of dry clothing, you will sleep warmer. One footnote should be that an equal sized volume filled with down (or any other type of sleeping bag insulation) is warmer than an equal sized volume filled with air. The reason is convection currents in the larger air areas allows heat flow. The down actually doesn’t have any insulation properties itself, it does, however, break up the possibly convection current heat losses by creating many micro pockets of air, and it is very light and compressible. Keep in mind that if down gets wet, it is useless as an insulator, and is very heavy. Synthetic insulation (like Primaloft) is much better in this regard.
7) Summation:
-Hypothermia is sneaky and can kill. The hypothermic victim is generally not the person who notices their problem.
-Hypothermia (lowered core temperature) should not be confused with frostbite (localized freezing of tissue). These are two different things. Both are serious and require immediate attention.
-If you are hypothermic, or find someone who is hypothermic, remove the cause and prevent further heat loss. Take corrective measures as described above depending on the severity and level of consciousness of the person.
-Alcohol and any diuretics are to be avoided; they will cause the blood vessels to dilate, especially in the skin, causing you to feel warm but in fact accelerating the heat loss.
-Cotton clothing is totally inappropriate for hiking: The saying “Cotton Kills” may seem over used, but cotton & cold, wet weather do not mix. Always carry extra appropriate clothing, raingear, and shelter. Be prepared.
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