In this “Medical Minute” segment AMK’s wilderness medical consultant and AMK Co-founder, Eric A. Weiss, MD, debunks some commonly held myths about the most effective methods for stopping problem bleeding. While there are some great new hemostatic products ( Quikclot ) on the market to stop a severe bleed – like an arterial bleed,  - the tried and true method of applying direct pressure will work 99% of the time. Watch this video to see how.

One of the co-founders of Adventure Medical Kits, Dr. Weiss is also the author of A Comprehensive Guide to Wilderness & Travel Medicine. Currently, he is the Associate Director of Trauma at the Stanford University Medical Center.

Everyone has had a toothache at some point in their lives, but what do you do when you are in a remote area, traveling in a developing country, or on a back-country expedition?  Below are some tips from AMK’s Founder, Dr. Eric A. Weiss about what to do when you find yourself with a dental emergency far from the nearest dentist…..

Excerpt from A Comprehensive Guide to Wilderness & Travel Medicine, by Dr. Eric A. Weiss.

DENTAL EMERGENCIES

TOOTHACHE

The common toothache is caused by inflammation of the dental pulp and is often associated with a cavity. The pain may be severe and intermittent and is made worse by hot or cold foods or liquids.

Treatment

1) If the offending cavity can be localized, a piece of cotton soaked with a topical anti-inflammatory agent such as eugenol (oil of cloves) can first be applied.

2) Place a temporary filling material, such as Cavit® or zinc-oxide and eugenol cement, into the cavity or lost filling site to protect the nerve.

ʻWEISS ADVICEʼ [IMPROVISED TECHNIQUE]

Quick relief of dental pain and bleeding.  Bleeding and pain from the mouth can often be relieved by placing a moistened tea bag onto the bleeding site or into the socket that is bleeding.

(more…)

Excerpt from A Comprehensive Guide to Wilderness and Travel Medicine, by Dr. Eric A. Weiss.

ALTITUDE ILLNESS  (Mountain Sickness)
It is rare to experience altitude sickness below 6,000 feet.  Moderate altitude is between 8,000 and 12,000 feet (2,400 and 3,600 meters), High altitude is between 12,000 and 18,000 feet (3,600 and 5,400 meters), and extreme altitude is over 18,000 feet (5,400 meters).  High altitude illness is a direct result of reduces barometric pressure and concentration of oxygen in the air at high elevations.  Lower pressure make the air less dense, so your body gets fewer oxygen
molecules with every breath.
Prevention
Graded ascent is the best and safest method of preventing altitude illness.  Avoid abrupt ascent to sleeping altitudes greater than 10,000 feet (3,000 meters), and average no more than 1,000 feet (300 meters) of elevation gain per day above 10,000 feet.  Day trips to a higher altitude, with a return to lower altitudes for sleep, will aid acclimatization.  Eat foods that are high in carbohydrates and low in fat, and stay well hydrated.

When to Worry

Descend Quickly When…

Progression of one’s symptoms despite rest at the same altitude, or the loss of coordination, mandate immediate descent to a lower altitude (2,000 to 3,000 feet lower).  Do not wait for morning to begin descent.  An individual who might have been able to walk down under his own power with aid of a headlamp can easily become a litter case in just 12 hours. The single most useful sign in recognizing the progression of altitude illness from mild to severe is loss of coordination.  The victim tends to stagger, has trouble with balance, and is unable to walk a straight line heel to tow, as if he were drunk.

Never allow a victim to descend alone.  Always have a healthy person accompany the individual.

Treatment
1.)    When mild symptoms develop, one should not go any higher in altitude until the symptoms have completely resolved.  Watch the victim closely for progression of illness to more severe forms.  Usually, within one or two days, the victim will feel better and can then travel to higher altitudes with caution.  Symptoms will improve more rapidly simply by going down a few thousand feet.
2.)    Administer acetaminophen (Tylenol®) 650 to 1000 mg or ibuprofen (Motrin®) 400-600 mg for headache.
3.)    Consider administering acetazolamide (Diamox®) at a treatment dose of 250 mg twice a day.
4.)    Minimize exertion.
5.)    Avoid sleeping pills.

SEVERE ALTITUDE ILLNESS
High Altitude Cerebral Edema (HACE)

Signs and Symptoms
A victim may have one or more of the following:

1.)    Severe headache unrelieved by Tylenol® or Motrin®;
2.)    Vomiting:
3.)    Loss of coordination;
4.)    Severe lassitude;
5.)    Confusion, inappropriate behavior, hallucinations, stupor or coma;
6.)    Transient blindness, partial paralysis or loss of sensation on one side of the body may occur;
7.)    Seizures.

Treatment
1.)    IMMEDIATE DESCENT of at least 3,000 feet (1,000 meters), or until the victim shows signs of considerable improvement, is the most important treatment.  Do not wait to see if the victim gets worse or improves.  Waiting could prove to be fatal.
2.)    Administer acetazolamide (Diamox®) 250 mg twice a day.
3.)    Administer dexamethasone (Decadron®) 8 mg followed by 4 mg every six hours if available.
4.)    Administer oxygen, if available.
5.)    When descent is not immediately possible, placing the victim in a portable hyperbaric chamber (Gamow Bag) may be helpful in mitigating the effects of HACE or HAPE.  When zippered shut with the victim inside, this nylon bag is pressurized with a foot pump, resulting in a decrease in altitude for the victim.  The bag takes approximately two minutes to inflate and is labor intensive; it requires 10 to 15 pumps per minute to maintain pressure and to flush out carbon dioxide.  The Gamow Bag should not be used as a substitute for descent;  it should be used when descent is not possible due to darkness, injury or lack of manpower to carry a victim to lower altitude.

The Golden Rules of Altitude Sickness
1.)    Above 8,000 feet, headache, nausea, shortness of breath, and vomiting should be considered to be altitude illness until proven otherwise.
2.)    No one with mild symptoms of altitude illness should ascend any higher until symptoms have resolved.
3.)    Anyone with worsening symptoms or severe symptoms of altitude illness should descend immediately to a lower altitude.

HIGH ALTITUDE PULMONARY EDEMA (HAPE)
HAPE usually begins within the first two to four days of ascent to higher altitudes, most commonly on the second night.

Signs and Symptoms
A victim may have one or more of the following:

1.)    Initially, the victim will notice marked breathlessness with minor exertion and develop a dry, hacking cough.
2.)    As fluid collects in the lungs, the victim develops increasing shortness of breath, even while resting, and a cough that may produce frothy sputum.
3.)    The victim looks anxious, is restless, and has a rapid bounding pulse.

4.)    Cyanosis (a bluish color of the lips and nails indicating poor oxygenation of the blood) may be present.

Treatment
1.)    IMMEDIATE DESCENT of at least 3,000 feet (1,000 meters), or until the victim shows signs of considerable improvement, is the most important treatment.  Do not wait.  Waiting could prove to be fatal.
2.)    Administer oxygen, four to six liters per minute, if available.
3.)    The prescription drug, nifedipine (Procardia®) may be helpful for HAPE.  The dose is 10 to 20 mg every eight hours.
4.)    The use of the Gamow Bag, as described above, may be beneficial when the victim cannot be immediately evacuated to a lower altitude.

by Eric A. Weiss, M.D. (excerpt from his book,
A Comprehensive Guide to Wilderness & Travel Medicine)

VENOMOUS SNAKE BITES

There are two classes of poisonous snakes in the United States:

• Pit Vipers (rattlesnakes, cottonmouths [water moccasins], and copperheads) have a characteristic triangular head, a deep pit (heat receptor organ) between the eye and nostril, and a catlike, elliptical pupil.

• Elapids (coral snakes) are characterized by their color pattern with red, black, and yellow or white bands encircling the body. The fangs are short — these snakes bite by chewing rather than by striking.

All states except Maine, Hawaii, and Alaska have at least one species of venomous snake. The states with the highest incidence of snakebites are North Carolina, Arkansas, Texas, Mississippi, Louisiana, Arizona, and New Mexico. About 90 percent of snake bites occur between April and October, because snakes are more active in warm months of the year. Your chance of dying from a venomous snakebite in the wilderness is extremely remote — about one in 12 million.

Snakes can strike up to one-half their body length and may bite and not inject venom (dry bite). No poisoning occurs in about 20 to 30 percent of rattlesnake bites, and fewer than 40 percent of coral snake bites result in envenomation.

Pit Vipers

Signs and Symptoms of Envenomation

• One or more fang marks (rattlesnake bites may leave one, two, or even three fang marks).

• Local, burning pain immediately after the bite.

• Swelling at the site of the bite, usually beginning within five to 20 minutes and spreading slowly over a period of six to 12 hours. The faster the swelling progresses up the arm or leg, the worse the degree of envenomation.

• Bruising (black and blue discoloration) and blister formation at the bite site.

• Numbness and tingling of the lips and face, usually 10 to 60 minutes after the bite.

• Twitching of the muscles around the eyes and mouth.

• Rubbery or metallic taste in the mouth.

• After six to 12 hours, bleeding from the gums and nose may develop and denote a serious envenomation.

• Weakness, sweating, nausea, vomiting and faintness may occur.

Treatment

The definitive treatment for snake venom poisoning is the administration of antivenin. The most important aspect of therapy is to get the victim to a medical facility as quickly as possible.

First Aid

1) Rinse the area around the bite site with water to remove any venom that might remain on the skin.

2) Clean the wound and cover with a sterile dressing.

3) Remove any rings or jewelry.

4) Immobilize the injured part as you would for a fracture, but splint it just below the level of the heart.

5) Transport the victim to the nearest hospital as soon as possible. If you pass by a telephone, stop and notify the hospital that you are bringing in a snakebite victim so they can begin to locate and procure antivenin.

6) It is not necessary to kill the snake and transport it with the victim for identification. If the snake is killed, it should not be directly handled, but should be transported in a closed container. Decapitated snake heads can still produce envenomation

7) Extractor pumps designed to provide suction over a snakebite wound are sold in many camping stores and endorsed by some as a first aid treatment for snakebites. Based on recent scientific evidence, these devices are no longer recommended. A study published in the Annals of Emergency Medicine in 2004 showed that these devices remove an insignificant amount of venom, and may also be harmful to the victim. The best first aid for snakebite is a cell phone (call the hospital that you are going to so that they can procure antivenin) and a car or helicopter to get the victim there as quickly as possible.

Other First-Aid Treatments That May Be Beneficial

Immediately wrapping the entire bitten extremity with a broad elastic bandage (the “Australian Compression and Immobilization Technique”) has proven effective in the treatment of elapid and sea snake envenomations only. It is only recommended when the victim appears to have suffered a severe envenomation and is several hours from medical care.

The wrap is started over the bite site and continued upward toward the torso in an even fashion about as tight as one would wrap a sprained ankle (Fig. 60). Monitor the color, pulse and temperature of the hand or foot to make sure that there is adequate circulation. If circulation appears compromised, loosen the wrap. Otherwise the bandage should not be released until after the victim has been brought to a medical facility. The limb should then be immobilized with a well-padded splint.

Things Not To Do

1) Do not make any incisions in the skin or apply suction with your mouth.

2) Do not apply ice or a tourniquet.

3) Do not shock the victim with a stun gun or electrical current.

Coral Snake

Signs and Symptoms of Envenomation

• Burning pain at the site of the bite.

• Numbness and/or weakness of a bitten arm or leg develops within 90 minutes.

• Twitching, nervousness, drowsiness, increased salivation, and drooling develop within one to three hours.

• Within five to ten hours, the victim develops slurred speech, double vision, difficulty talking and swallowing, and difficulty breathing. The venom may cause total paralysis.

Symptoms may sometimes be delayed by up to 13 hours after the bite.

First Aid

Treatment is the same as for a pit viper bite. Early use of the pressure immobilization technique is highly recommended because it is both effective and safe (coral snake venom does not produce any local tissue destruction).

Download Printable PDF:

adventure-medical-kits-snake-bites

Best Way to Handle Mountain Bike Road Rash

Question:
Riding a mountain bike on the desert trails, from time to time I take a spill. It’s rocky here (Phoenix, AZ) and I get bruises and scrapes. What is the best way to treat the scrapes and what it the best pain medication for the soreness from the bruises?
Thanks, Ravi

Answer:
Ravi,
I have been there and done that. Here is an excerpt from our book, A Comprehensive Guide to Wilderness & Travel Medicine on abrasions: (more…)

Dr. Weiss Advice – Improvisational Technique – Wound Irrigation Using a Plastic Bag and Safety Pin

Fill a clean plastic sandwich or garbage bag with disinfected water and puncture the bottom of the bag with a safety pin or pointy knife. Hold the bag just above the wound and squeeze the top firmly to being irrigating.

Carry a first aid kit with wound irrigation supplies!

Learn more wilderness medicine, improvised techniques and first aid tips – click here for Dr. Weiss’s Comprehensive Guide to Wilderness and Travel Medicine.

Dr. Weiss Advice – Improvisational Technique – Quick Relief of Dental Pain

Bleeding and pain from the mouth can often be relieved by placing a moistened tea bag onto the bleeding site or into the socket that is bleeding.

Carry a Dental Medic with you!

Learn more improvisational techniques and first aid tips – click here for Dr. Weiss’s Comprehensive Guide to Wilderness and Travel Medicine.

Dr. Weiss Advice – Improvisational Technique – Making a Sling with Safety Pins

If the victim is wearing a long-sleeved shirt or jacket, pin the sleeved arm to the chest portion of the garment with two safety pins. If the victim is wearing a short-sleeved shirt, fold the bottom of the shirt up and over the arm to create a pouch. Pin this to the sleeve and chest section of the shirt to immobilize the arm.

Learn more improvisational techniques and first aid tips – click here for Dr. Weiss’s Comprehensive Guide to Wilderness and Travel Medicine.

Dr. Weiss Advice – Improvisational Technique – Creating Ankle Support Using a SAM Splint

Wrap a SAM Splint around the foot and ankle, with the shoe in place and secure it with tape. This will help stabilize the joint while walking. You may need to stop periodically to tighten or re-wrap the splint.

You can buy a SAM splint here.

Learn more improvisational techniques and first aid tips – click here for Dr. Weiss’s Comprehensive Guide to Wilderness and Travel Medicine.

Dr. Weiss Advice – Improvisational Technique – Replacing a Lost Filling

Melt some candle wax and allow it to cool until it is just soft and pliable. Place the wax into the cavity or lost filling site and smooth it out with your finger. Have the victim bite down to seal the wax in place and remove any excess wax.

Check out our Dental Medic kit here.

Learn more improvised techniques and first aid tips – click here for Dr. Weiss’s Comprehensive Guide to Wilderness and Travel Medicine.