Thursday, March 20, 2008

Wilderness Medicine Tip of the Week


Woman killed by Eagle Ray! Mortality from stingrays is increasingly reported. Read on...

The LA times today reports that a woman encountered a stingray that leaped into the boat she was traveling in. She may have died from a wound inflicted by the calcium carbonate barb of a full size eagle ray (example pictured above).
The UNM wilderness medicine class visited the stingray exhibit 2 days ago for a scenario-based learning experience; marine stings were discussed in great detail at the Albuquerque Biopark aquarium. As we discussed, approximately 4 instances of stingray barbs penetrating the heart have been reported in Australia. Most readers no doubt are aware of Steve Irwin's well-publicized untimely death by this mechanism. Exsanguination and arterial lacerations have also caused human deaths.
Short of cardiac penetrating trauma, first aid consists of immersion of the affected extremity in non-scalding hot water. The venom that surrounds the calcium carbonate barb is heat labile. Prompt hot water treatment results in impressive pain relief. Xrays may be necessary to rule out retained foreign bodies. Tetanus vaccination is indicated - as in all lacerations. Be aware that marine injuries may be complicated by unusual pathogens - such as Vibrio species and Mycobacterium marinum.
The best approach is to avoid being stung altogether. Most bathers can avoid injury by shuffling their feet when entering the water. Otherwise - avoid cornering a large sting ray in shallow water - as Steve Irwin reportedly did. The recent death of the boater encountering a leaping ray, while seemingly bizarre, has been reported more than once in Australia. If a ray leaps into your boat, you may just be out of luck! Be aware that the stinging barb is located about 1/3 of the distance down the tail from the body of the fish.

Finally, note that hot water is the treatment of choice for most penetrating marine stings, including stonefish, scorpionfish, even invertebrate stings such as urchins. Hot water is increasingly recognized as effective treatment for box jellyfish stings and portuguese man of war stings. More on that later!

Monday, March 03, 2008

Médecine de la montagne/Medicina de la montaña

For Francophones and Castillano wilderness enthusiasts:

Médecine de la montagne et de l’environnement.
Ici vous avez un site pour l’information sur la pratique de médecine dans les terrains extrêmes, et la médecine “d’improvisation.” Il y aura des podcasts sous cette rubrique en français dans l’avenir. Notre conférences sur la médecine de la montagne à Quito Equateur et Chamonix faisaient un, no, deux tabacs! Nous avons un mois de médecine de l’environnement chaque mars à Nouveau Mexique, et nous aurions notre prochaine course de médecine de la montagne à Mont Rainier, dans l’état de Washington. Nous sommes en train de collaborer avec l’Ifremmont (www.ifremmont.org) pour developer la formation de médecine de l’environement en français et anglais. Voilà une photo de notre course de survie et navigation dans le désert de Nouveau-Mexique. Vous pourriez nous contacter a www.mountainandamrinemedicine.com/contact/ pour plus d’infos.

Medicina en ambientes extremos
Aquí hay un sitio dedicada a la medicina en terrenos remotos, incluyendo medicina en el yermo y medicina improvisaciónal. Para los hispanohablantes, hemos proporcionado “minicursos” sobre estos tópicos. Infórmense aquí en este sitio lo que estamos haciendo en cuanto de la capacitación de un tópico muy interesante. Recientemente, hemos hecho un congreso de mal de montañas y altura a Quito Ecuador y Chamonix Francia, un curso de buceo en Bonaire (al mar caribe) y tendremos un congreso a Monte Rainier, en el estado de Washington. Hemos hablado en el congreso internacional de la Sociedad Mexicana de Medicina de Emergencias (a México, DF.) sobre la tema de “Hipotermia,” y vamos participar al congreso de la Sociedad Argentinas de Emergencias, a Buenos Aires el 11-13 junio 2008. La foto es una foto de navegación y supervivencia en el desierto de Nuevo México. Escriben al sitio de www.mountainandamrinemedicine.com/contact/ para mas información. También hay información sobre el sitio de www.reeme.org.

Sunday, March 02, 2008

Bizarre death in Chamonix

According to reports, a man fell from a cable car (gondola) in Chamonix, France to his death. The gondola was one that travels to get to Planpraz, the mid-station to Le Brevent. This is of interest, because I took that gondola as did many of the Chamonix High Altitude Medicine participants during our marvelous excursion and course there last summer.
Read more
http://snowheads.com/ski-forum/viewtopic.php?t=37292

This is what the area looks like in winter.

Link to description of our course in July, 2007.