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Dental Emergencies – Tips from Dr. Weiss

Friday, June 25th, 2010

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.

 

A Comprehensive Guide to Wilderness and Travel Medicine

 

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.

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Altitude Illness – Tips From Dr. Weiss including “When to Worry”

Monday, May 24th, 2010

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

 

A Comprehensive Guide to Wilderness and Travel Medicine

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.