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(Ebook) Field Guide To Wilderness Medicine by Paul S. Auerbach, Benjamin B. Constance, Luanne Freer ISBN 9780323100458, 0323100457 Sample

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FIELD GUIDE TO
WILDERNESS
MEDICINE
This page intentionally left blank
FIELD GUIDE TO
WILDERNESS
MEDICINE
Fourth Edition

Editors
Paul S. Auerbach,
MD, MS, FACEP, FAWM
Redlich Family Professor of Surgery
Division of Emergency Medicine
Stanford University School of Medicine
Stanford, California
Benjamin B. Constance, MD
Clinical Instructor
Division of Emergency Medicine
Stanford University School of Medicine
Stanford, California
Luanne Freer, MD, FACEP, FAWM
Medical Director, Medcor
Yellowstone National Park
Founder and Director
Everest Base Camp Medical Clinic
Himalayan Rescue Association
Bozeman, Montana

Associate Editors
Howard J. Donner, MD
Wilderness Medicine Consultant, Educator, Guide
Truckee, California
Eric A. Weiss, MD, FACEP
Associate Professor of Surgery
Division of Emergency Medicine
Stanford University School of Medicine
Stanford, California
1600 John F. Kennedy Blvd.
Ste 1800
Philadelphia, PA 19103-2899
FIELD GUIDE TO WILDERNESS MEDICINE  ISBN: 978-0-323-10045-8
Fourth Edition
Copyright © 2013, 2008, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc.
No part of this publication may be reproduced or transmitted in any form or by any
means, electronic or mechanical, including photocopying, recording, or any information
storage and retrieval system, without permission in writing from the publisher. Details on
how to seek permission, further information about the Publisher’s permissions policies
and our arrangements with organizations such as the Copyright Clearance Center and the
Copyright Licensing Agency, can be found at our website: www.elsevier.com/permissions.
This book and the individual contributions contained in it are protected under copyright
by the Publisher (other than as may be noted herein).

Notices

Knowledge and best practice in this field are constantly changing. As new research
and experience broaden our understanding, changes in research methods,
professional practices, or medical treatment may become necessary.
Practitioners and researchers must always rely on their own experience and
knowledge in evaluating and using any information, methods, compounds, or
experiments described herein. In using such information or methods they should be
mindful of their own safety and the safety of others, including parties for whom
they have a professional responsibility.
With respect to any drug or pharmaceutical products identified, readers are
advised to check the most current information provided (i) on procedures featured
or (ii) by the manufacturer of each product to be administered, to verify the
recommended dose or formula, the method and duration of administration, and
contraindications. It is the responsibility of practitioners, relying on their own
experience and knowledge of their patients, to make diagnoses, to determine
dosages and the best treatment for each individual patient, and to take all
appropriate safety precautions.
To the fullest extent of the law, neither the Publisher nor the authors,
contributors, or editors assume any liability for any injury and/or damage to persons
or property as a matter of products liability, negligence or otherwise, or from any
use or operation of any methods, products, instructions, or ideas contained in the
material herein.

Library of Congress Cataloging-in-Publication Data


Field guide to wilderness medicine / Paul S. Auerbach … [et al.]. – 4th ed.
   p. ; cm.
Rev. ed. of: Field guide to wilderness medicine / Paul S. Auerbach. 3rd ed. c2008.
Includes bibliographical references and index.
ISBN 978-0-323-10045-8 (pbk. : alk. paper)
I. Auerbach, Paul S. II. Auerbach, Paul S. Field guide to wilderness medicine.
[DNLM: 1. Emergencies–Handbooks. 2. Wilderness Medicine–Handbooks.
3. Emergency Treatment–Handbooks. 4. Wounds and Injuries–therapy–Handbooks.
WB 39]
616.02’5–dc23
2012046268
Content Strategist: Stefanie Jewell-Thomas
Content Development Specialists: Heather Krehling and Julia Rose Roberts
Publishing Services Manager: Anne Altepeter
Project Manager: Jessica L. Becher
Design Direction: Steven Stave
Working together to grow
Printed in the United States of America libraries in developing countries
www.elsevier.com | www.bookaid.org | www.sabre.org

Last digit is the print number: 9 8 7 6 5 4 3 2 1


This book is dedicated to every person who takes the time to
assist others in need of care, whether in the wilderness, on
the battlefield, or in relief after a catastrophic event. At a
time of worldwide concern about the intentions of men and
women toward their fellow humans, those who accept this
responsibility are the future, and we applaud them.
This page intentionally left blank
Preface

Accompanying the sixth edition of the textbook Wilderness Medi-


cine, this fourth edition of Field Guide to Wilderness Medicine
welcomes two new editors, Drs. Luanne Freer and Benjamin Con-
stance. They are excited to carry forward the tradition of providing
a concise guide for medical practitioners dedicated to caring for
persons in austere wilderness settings.
This book continues to present clinical and therapeutic informa-
tion that is appropriate for a trained health care provider to practice
medicine in the field.
As is tradition, this guide relies upon the collected wisdom of
contributors to the textbook. They are tireless and wise, and I am
grateful for their remarkable skills, enthusiasm, and generosity.
Based on their comments and those of countless readers, each
edition improves upon its predecessor and creates a practical and
accessible book to assist the practitioners of wilderness medicine.
Although directed toward trained health care providers, the Field
Guide to Wilderness Medicine offers useful information for any
level of wilderness responder.
Wilderness medicine has emerged as a full-fledged medical
specialty supported and advanced by many energetic training,
education, and experiential organizations; academic medical
centers; university outdoor programs; the military; and indepen-
dent experts. This book is intended to advance their efforts.
Be cautious, be safe, and seek every opportunity to help others.
I hope this field guide makes you more confident and effective as
you do your best to practice the art of wilderness medicine. I also
hope that you take the time to better understand the challenges
imposed by humans upon our planet. To preserve the wilderness,
we each must fulfill our responsibilities to understand global envi-
ronmental science and be proactive in preserving the landscape.

—Paul S. Auerbach

vii
This page intentionally left blank
Acknowledgments

The wilderness medicine community includes many extraordinary


individuals. For the creation of this book, I thank all of the con-
tributors to the textbook Wilderness Medicine.
—Paul S. Auerbach

Wilderness medicine is a specialty with its own heroes, mentors,


and innovators. I thank my mentors, Paul Auerbach, Robert Norris,
Grant Lipman, Thomas Miner, David Townes, and Brigitte Schran-
Brown for their endless support and inspiration. I offer a special
thanks to my late father, Dr. Mark Constance, for introducing me
to both medicine and the mountains; and my mother, Paula Con-
stance, for all of her support. My ultimate gratitude goes to my
loving wife, Agatha, for her support and encouragement during
every step of this project.
—Benjamin Constance

I thank my family of friends in Yellowstone National Park for


showing me the relevance of wilderness medicine, the Wilderness
Medical Society for the opportunity to learn from the best, and the
growing community of wilderness medicine enthusiasts for remind-
ing me that there is always more to learn.
—Luanne Freer

ix
This page intentionally left blank
Contents

Color plates follow page xvi

1 High-Altitude Medicine 1

2 Avalanche Safety and Rescue 13

3 Hypothermia 31

4 Frostbite and Other Cold-Induced Tissue


Injuries 40

5 Heat Illness 45

6 Wildland Fires 52

7 Burns and Smoke Inhalation 63

8 Solar Radiation and Photoprotection 72

9 Lightning Injuries 78

10 Emergency Airway Management 82

11 Emergency Oxygen Administration 103

12 Trauma Emergencies: Assessment and


Stabilization 114

13 Shock 136

14 Head Injury 139

15 Chest Trauma 146

16 Intra-abdominal Injuries 154

17 Maxillofacial Trauma 156

18 Orthopedic Injuries, Splints, and


Slings 162

19 Firearm and Arrow Injuries/Fishhook


Injury 223

20 Lacerations, Abrasions, and Dressings 228


xi
xii Contents

21 Sprains and Strains 242

22 Foot Problems and Care 249

23 Bandaging and Taping Techniques 256

24 Pain Management 281

25 Life-Threatening Emergencies (Rescue


Breathing/CPR/Choking) 303

26 Allergic Reaction 312

27 Cardiopulmonary Emergencies 317

28 Neurologic Emergencies 321

29 Diabetic Emergencies 328

30 Genitourinary Tract Disorders 334

31 Gynecologic and Obstetric


Emergencies 342

32 Wilderness Eye Emergencies 370

33 Ear, Nose, and Throat Emergencies 394

34 Dental Emergencies 401

35 Mental Health 412

36 Global Humanitarian Relief and Disaster


Medicine 419

37 Snake and Other Reptile Bites 435

38 Bites and Stings From Arthropods and


Mosquitoes 446

39 Protection From Blood-Feeding


Arthropods 473

40 Toxic Plants 491

41 Mushroom Toxicity 510

42 Animal Attacks 517

43 Zoonoses 523

44 Diarrhea and Constipation 537


Contents xiii

45 Field Water Disinfection 554

46 Hydration and Dehydration 572

47 Malaria 576

48 Travel-Acquired Illnesses 614

49 Immunizations for Travel 628

50 Drowning and Cold-Water Immersion 646

51 Scuba Diving–Related Disorders 655

52 Injuries From Nonvenomous Aquatic


Animals 665

53 Envenomation by Marine Life 671

54 Seafood Toxidromes 686

55 Aquatic Skin Disorders 696

56 Search and Rescue 707

57 Improvised Litters and Carries 732

58 Aeromedical Transport 759

59 Survival 775

60 Knots 807

61 Wilderness Medical Kits 823

62 Children in the Wilderness 853

63 Emergency Veterinary Medicine 859

64 Leave No Trace 882

Appendix A Avalanche Resources 887

Appendix B Glasgow Coma Scale, Simplified


Motor Score, and Other Measures
of Responsiveness 889

Appendix C SCAT3 891

Appendix D Lake Louise Score for the


Diagnosis of AMS 900
xiv Contents

Appendix E Contingency Supplies for


Wilderness Travel 902

Appendix F Repair Supplies for Wilderness


Travel 906

Appendix G Priority First-Aid Equipment,


Supplies, and Medications 907

Appendix H Antimicrobials 910

Appendix I Wilderness Eye Kit 913

Appendix J Recommended Oral Antibiotics for


Prophylaxis of Domestic Animal
and Human Bite Wounds 916

Appendix K Therapy for Parasitic


Infections 918

Appendix L Sample Basic Wilderness Survival


Kit 921

Appendix M Sample Winter Survival Kit 923

Appendix N Sample Desert Survival Kit 924

Appendix O Sample Camp and Survival Gear


for Jungle Travel 925

Appendix P Vehicle Cold Weather Survival


Kit 927

Appendix Q Pediatric Wilderness Medical Kit:


Basic Supplies 929

Appendix R Drug Storage and Stability 931

Appendix S Guide to Initial Dosage of Certain


Antivenoms for Treating Bites by
Medically Important Snakes
Outside the Americas 946
FIELD GUIDE TO
WILDERNESS
MEDICINE
This page intentionally left blank
PLATE 1 A Nordic skier with first-degree frostbite (central pallor having
cleared after rewarming) of the abdominal skin; despite wearing a parka, this
skier reported having skied for 90 minutes in −23.3° C (−10° F) temperature,
unaware that his shirt had come untucked from his trousers. (Courtesy Luanne
Freer, MD.)

PLATE 2 A climber with second-degree frostbite of the fifth finger sustained


after only several seconds exposure to −45.6° C (−50° F) windchill when gloves
were briefly removed to handle placement of a carabiner to the fixed rope.
Clear bullae developed after rewarming. (Courtesy Luanne Freer, MD.)

PLATE 3 A climber with second-, third-, and fourth-degree frostbite of the


hand. Note fingers 1 through 4 with hemorrhagic bullae over the areas of
third-degree injury, clear bullae over the dorsum of the hand with second-
degree injury, and deeply violaceous and unblistered fourth-degree injury of
the distal phalanx of the fifth finger. (Courtesy Luanne Freer, MD.)
PLATE 4 A climber with fourth-degree or PLATE 5 Lichtenberg figure (pathognomonic
full-thickness frostbite injury just hours sign of lightning injury that resolves spontane-
after rewarming. Note absence of any ously and needs no treatment). (Courtesy
blistering. Fingers are insensate, and cap- Mary Ann Cooper, MD.)
illary refill is absent. (Courtesy Luanne
Freer, MD.)

PLATE 6 Punctate burns from lightning injury. (Courtesy Arthur Kahn, MD.)

PLATE 7 Southern Pacific rattlesnake PLATE 8 Cottonmouth water moccasin


(Crotalus viridis helleri) is one of nine (Agkistrodon piscivorus). The open-
subspecies of western rattlesnakes mouthed threat gesture is characteristic
(C. viridis spp.). (Courtesy Michael of this semiaquatic pit viper. (Courtesy
Cardwell/Extreme Wildlife Photography.) Sherman Minton, MD.)
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