Return-Path: Received: from mb2i0.ns.pitt.edu (mb2i1.ns.pitt.edu [136.142.185.162]) by imap.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisimap-7.2.2.4) ID ; Thu, 28 Mar 2002 14:39:27 -0500 (EST) Received: from list.srv.cis.pitt.edu (majordom@[136.142.185.20]) by pitt.edu (PMDF V5.2-32 #41462) with ESMTP id <01KFWBQR5VSS00JZAQ@mb2i0.ns.pitt.edu>; Thu, 28 Mar 2002 14:41:11 EST Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.2) ID ; Thu, 28 Mar 2002 14:20:40 -0500 (EST) Received: from out011.verizon.net (out011pub.verizon.net [206.46.170.135]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.2) ID for ; Thu, 28 Mar 2002 14:20:36 -0500 (EST) Received: from laptop ([141.158.127.4]) by out011.verizon.net (InterMail vM.5.01.04.05 201-253-122-122-105-20011231) with ESMTP id <20020328193756.XGE2777.out011.verizon.net@laptop> for ; Thu, 28 Mar 2002 13:37:56 -0600 Date: Thu, 28 Mar 2002 14:37:43 -0500 From: "Keith Conover, M.D., FACEP" Subject: W-EMED forwarded from Rob Thomas Sender: owner-wilderness-emergency-medicine@list.pitt.edu To: wilderness-emergency-medicine@list.pitt.edu Reply-to: wilderness-emergency-medicine@list.pitt.edu Message-id: <3CA32AB7.26833.8CEE549@localhost> MIME-version: 1.0 X-Mailer: Pegasus Mail for Windows (v4.01) Content-type: text/plain; charset=US-ASCII Content-description: Mail message body Content-transfer-encoding: 7BIT Precedence: bulk [Rob, I've added your other email address to the list as requested] Hi Mike On 22 Mar 2002, at 15:47, Mike Webster wrote: > What is the training being done for pre-hospital providers in South > Africa? Prehospital (EMS) currently has three current levels of certification for non- doctors: BAA (Basic Ambulance Assistant). Probably equivalent to EMT-B. No invasive techniques. No drugs other than Oxygen & Entonox. Oral airways. Use of ambulance equipment (Trac-splint, stair-chair, etc). AED's only. Three weeks full-time training. Often called a BAC (Basic Ambulance Course). AEA (Ambulance Emergency Assistant). Probably equivalent to EMT-I. IV's, needle- thoracentesis. Needle Crico, ECG usage, defib, Use of aspirin. Course runs about 4 months full-time. Prerequisite is a BAA. CCA / NDip (Critical Care Assistant / National Diploma Emergency Care). These are two seperate routes of training but are registered at the same level. The former goes the route of BAA -> AEA -> CCA, where CCA is 9 months full time. N Dip is a three-year full time diploma. All the bells & whistles: intubation, drugs, surgical crico, etc. All other courses are non-cert (ATLS, BTLS, ACLS, etc). Doctors do an additional module for EMS over and above their MB.CHB. >Is there a reciprocity between NREMT certification and status in South >Africa? Not to my knowledge. I seem to recall that all the S.A. paramedics I know who work in the States had to sit NREMT or regional exams. > Is the wilderness first responder training offered by providers like > WMA, SOLO, and WMI, a recognized certification in South Africa? No. The advanced onces (WEMT) fall into the same group as ACLS, ATLS, etc. Nice to have but no formal recognition by the HCPSA (Health Care Professions Council of S.A.). Furthermore, First Responder training would fall into the category of First Aid training. Currently the only nationally-accepted first-aid training must conform to the requirements of the Occupational Safety Act. No-one in government seems to have woken up to the fact that not all occupations place you in a factory / urban setting ot that people would require first-aid training for purposes other than work. This causes quite a dilemma for the outdoors professionals in that the training they are required to have by government legislation is hopelessly inappropriate for their environment. > Any other information or resources about rescue, pre-hospital medicine, > and organizations involved in these areas in South Africa would also be > very helpful. Hell, there's loads. Whaddaya need to know? Rescue: All the fire depts, with varying degrees of preparedness and competence in the various discipines. Numerous specialist groups (eg: Mountain rescue, cave rescue, off-road rescue) with varying degrees of preparedness and competence. Several trainers offering courses in industrial rope-rescue. > Thanks in advance. You're welcome. Regards Rob -- Rob Thomas (012) 482-2957 (Office hours) 082-652-1490 (All hours - try to be reasonable) --Keith Conover, M.D., FACEP http://www.pitt.edu/~kconover sent with Pegasus high-security email download free from www.pmail.com Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- X-cs: R From: Keith Conover, M.D., FACEP X-RS-ID: X-RS-Flags: 0,0,1,1,0,0,0 X-RS-Sigset: 2 To: wilderness-emergency-medicine@list.pitt.edu Subject: forwarded from Rob Thomas Reply-to: kconover@pitt.edu MIME-Version: 1.0 Content-type: text/plain; charset=ISO-8859-1 Content-transfer-encoding: 8BIT Date: Thu, 28 Mar 2002 13:06:41 -0500 [Rob, I've added your other email address to the list as requested] Hi Mike On 22 Mar 2002, at 15:47, Mike Webster wrote: > What is the training being done for pre-hospital providers in South > Africa? Prehospital (EMS) currently has three current levels of certification for non- doctors: BAA (Basic Ambulance Assistant). Probably equivalent to EMT-B. No invasive techniques. No drugs other than Oxygen & Entonox. Oral airways. Use of ambulance equipment (Trac-splint, stair-chair, etc). AED's only. Three weeks full-time training. Often called a BAC (Basic Ambulance Course). AEA (Ambulance Emergency Assistant). Probably equivalent to EMT-I. IV's, needle- thoracentesis. Needle Crico, ECG usage, defib, Use of aspirin. Course runs about 4 months full-time. Prerequisite is a BAA. CCA / NDip (Critical Care Assistant / National Diploma Emergency Care). These are two seperate routes of training but are registered at the same level. The former goes the route of BAA -> AEA -> CCA, where CCA is 9 months full time. N Dip is a three-year full time diploma. All the bells & whistles: intubation, drugs, surgical crico, etc. All other courses are non-cert (ATLS, BTLS, ACLS, etc). Doctors do an additional module for EMS over and above their MB.CHB. >Is there a reciprocity between NREMT certification and status in South >Africa? Not to my knowledge. I seem to recall that all the S.A. paramedics I know who work in the States had to sit NREMT or regional exams. > Is the wilderness first responder training offered by providers like > WMA, SOLO, and WMI, a recognized certification in South Africa? No. The advanced onces (WEMT) fall into the same group as ACLS, ATLS, etc. Nice to have but no formal recognition by the HCPSA (Health Care Professions Council of S.A.). Furthermore, First Responder training would fall into the category of First Aid training. Currently the only nationally-accepted first-aid training must conform to the requirements of the Occupational Safety Act. No-one in government seems to have woken up to the fact that not all occupations place you in a factory / urban setting ot that people would require first-aid training for purposes other than work. This causes quite a dilemma for the outdoors professionals in that the training they are required to have by government legislation is hopelessly inappropriate for their environment. > Any other information or resources about rescue, pre-hospital medicine, > and organizations involved in these areas in South Africa would also be > very helpful. Hell, there's loads. Whaddaya need to know? Rescue: All the fire depts, with varying degrees of preparedness and competence in the various discipines. Numerous specialist groups (eg: Mountain rescue, cave rescue, off-road rescue) with varying degrees of preparedness and competence. Several trainers offering courses in industrial rope-rescue. > Thanks in advance. You're welcome. Regards Rob -- Rob Thomas (012) 482-2957 (Office hours) 082-652-1490 (All hours - try to be reasonable) -- End -- Return-Path: Received: from mb2i0.ns.pitt.edu (mb2i1.ns.pitt.edu [136.142.185.162]) by imap.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisimap-7.2.2.4) ID ; Fri, 22 Mar 2002 15:48:36 -0500 (EST) Received: from list.srv.cis.pitt.edu (majordom@[136.142.185.20]) by pitt.edu (PMDF V5.2-32 #41462) with ESMTP id <01KFO0F7HLRC00IM53@mb2i0.ns.pitt.edu>; Fri, 22 Mar 2002 15:50:11 EST Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.2) ID ; Fri, 22 Mar 2002 15:31:06 -0500 (EST) Received: from hotmail.com (f18.law7.hotmail.com [216.33.237.18]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.2) ID for ; Fri, 22 Mar 2002 15:31:03 -0500 (EST) Received: from mail pickup service by hotmail.com with Microsoft SMTPSVC; Fri, 22 Mar 2002 12:47:00 -0800 Received: from 216.185.80.94 by lw7fd.law7.hotmail.msn.com with HTTP; Fri, 22 Mar 2002 20:47:00 +0000 (GMT) Date: Fri, 22 Mar 2002 15:47:00 -0500 From: Mike Webster Subject: W-EMED EMT status in South Africa Sender: owner-wilderness-emergency-medicine@list.pitt.edu To: wilderness-emergency-medicine@list.pitt.edu Reply-to: wilderness-emergency-medicine@list.pitt.edu Message-id: MIME-version: 1.0 Content-type: text/html Precedence: bulk X-Originating-IP: [216.185.80.94] X-OriginalArrivalTime: 22 Mar 2002 20:47:00.0627 (UTC) FILETIME=[B7022630:01C1D1E2]
I was hoping someone on the list might know something about this.
 
What is the training being done for pre-hospital providers in South Africa?
Is there a reciprocity between NREMT certification and status in South Africa?
Is the wilderness first responder training offered by providers like WMA, SOLO, and WMI, a recognized certification in South Africa?
Any other information or resources about rescue, pre-hospital medicine, and organizations involved in these areas in South Africa would also be very helpful.
 
Thanks in advance.
 
Mike Webster

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To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- Return-Path: Received: from mb1i0.ns.pitt.edu (mb1i1.ns.pitt.edu [136.142.185.161]) by imap.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisimap-7.2.2.4) ID ; Fri, 22 Mar 2002 14:59:28 -0500 (EST) Received: from list.srv.cis.pitt.edu (majordom@[136.142.185.20]) by pitt.edu (PMDF V5.2-32 #41462) with ESMTP id <01KFNYC37GY0003APH@mb1i0.ns.pitt.edu>; Fri, 22 Mar 2002 14:50:25 EST Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.2) ID ; Fri, 22 Mar 2002 14:32:34 -0500 (EST) Received: from out019.verizon.net (out019pub.verizon.net [206.46.170.98]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.2) ID for ; Fri, 22 Mar 2002 14:32:26 -0500 (EST) Received: from Micron ([141.158.127.4]) by out019.verizon.net (InterMail vM.5.01.04.05 201-253-122-122-105-20011231) with ESMTP id <20020322194852.CQON13286.out019.verizon.net@Micron>; Fri, 22 Mar 2002 13:48:52 -0600 Date: Fri, 22 Mar 2002 14:48:49 -0500 From: "Keith Conover, M.D., FACEP" Subject: W-EMED Trying again: Sugar as a clotting agent Sender: owner-wilderness-emergency-medicine@list.pitt.edu To: wilderness-emergency-medicine@list.pitt.edu Cc: robert@medinfo.sita.co.za, robt@rescue.org.za Reply-to: wilderness-emergency-medicine@list.pitt.edu Message-id: <3C9B4451.28631.D4B3A4@localhost> MIME-version: 1.0 X-Mailer: Pegasus Mail for Windows (v4.01) Content-type: text/plain; charset=US-ASCII Content-description: Mail message body Content-transfer-encoding: 7BIT Precedence: bulk (Forwarded from Rob Thomas from S. Africa, who was trying to post from a non-subscribed address, BTW I can't answer his question, so someone else please help! --KC) > Hi all > > Some time ago I posted a query on this list which no-one seemed able > to answer (or maybe just not interested). Hopefully there are some new > minds on the list, so I'll try again: > > I have seen several references to the wilderness use of granular sugar > as a clotting agent in cases of profuse bleeding. I'm also aware of > veterinary use of sugar as a dehydrating agent (topical application). > So now, here's the repeat of the question: > > - What's the mechanism by which sugar promotes clotting? > > - Secondary to that, is it better used sub-lingually or topically? > I've never needed to use this myself but have heard accounts of both > being effective. > > Any takers to enlighten this poor ignorant soul? > > Regards > > Rob > > -- > Rob Thomas > (012) 482-2957 (Office hours) > 082-652-1490 (All hours - try to be reasonable) --Keith Conover, M.D., FACEP listowner Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- Return-Path: Received: from mb2i0.ns.pitt.edu (mb2i1.ns.pitt.edu [136.142.185.162]) by imap.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisimap-7.2.2.4) ID ; Thu, 7 Mar 2002 13:08:54 -0500 (EST) Received: from list.srv.cis.pitt.edu (majordom@[136.142.185.20]) by pitt.edu (PMDF V5.2-32 #41462) with ESMTP id <01KF2WGNUKZ400FS3M@mb2i0.ns.pitt.edu>; Thu, 7 Mar 2002 13:10:11 EST Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.2) ID ; Thu, 07 Mar 2002 12:54:28 -0500 (EST) Received: from out016.verizon.net (out016pub.verizon.net [206.46.170.92]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.2) ID ; Thu, 07 Mar 2002 12:54:20 -0500 (EST) Received: from Micron ([141.158.127.57]) by out016.verizon.net (InterMail vM.5.01.04.05 201-253-122-122-105-20011231) with ESMTP id <20020307180825.FGHS8955.out016.verizon.net@Micron>; Thu, 07 Mar 2002 12:08:25 -0600 Date: Thu, 07 Mar 2002 13:08:23 -0500 From: "Keith Conover, M.D., FACEP" Subject: Re: W-EMED Pennsylvania Law and Wilderness EMS In-reply-to: <003f01c1c608$60bfb8e0$6cb5fea9@skyline> Sender: owner-wilderness-emergency-medicine@list.pitt.edu To: "Suzanne M. Atkinson" , wilderness-emergency-medicine@list.pitt.edu Cc: "Allegheny Mtn. Rescue Maillist" , erncrc@egroups.com, PSARC@yahoogroups.com Reply-to: wilderness-emergency-medicine@list.pitt.edu Message-id: <3C876647.4226.D260A9@localhost> MIME-version: 1.0 X-Mailer: Pegasus Mail for Windows (v4.01) Content-type: text/plain; charset=US-ASCII Content-description: Mail message body Content-transfer-encoding: 7BIT Precedence: bulk Details are available at http://www.pehsc.org. To join, you will have to commit to attending meetings. Contact PEHSC: PA Em. Health Svcs. Council and request and fill out an application to join the Task Force and mail back. Those who wish to follow the process, and perhaps submit a public comment or two, but don't want to have to go to meetings, should just keep an eye on the www.pehsc.org website. On 7 Mar 2002 at 10:46, Suzanne M. Atkinson wrote: > How do I get involved? > > Suzanne > ----- Original Message ----- > From: "Keith Conover, M.D., FACEP" > To: ; > Cc: ; "Allegheny Mtn. Rescue Maillist" > ; "NCRC Discussion List" > Sent: Thursday, March 07, 2002 6:11 AM > Subject: W-EMED Pennsylvania Law and Wilderness EMS > > > > I share this with the broader wilderness medicine community as it may > > be of interest to those in other jurisdictions. I share this with > > interested people in PA so they can TAKE PART IN THE PROCESS. As > > Lois McCoy used to always say when she was running NASAR many moons > > ago, "silence implies consent." > > > > I attended a meeting of the Medical Advisory Committee and the Act 45 > > Task Force of the Pennsylvania Emergency Health Services Council > > yesterday. I am on both to represent the Wilderness EMS Institute > > but in a broader sense to represent the wilderness EMS and search and > > rescue communities. (I think it would be a very good idea to have a > > broader representation from those communities so they have someone > > other than me propounding the needs of our communities.) > > > > The Act 45 Task Force is charged with making recommendations to the > > state legislature on how to revise the state law that covers EMS > > here. The current law doesn't cover wilderness medicine or SAR, so > > any medical care given away from a road really isn't covered under > > the law. So those with SAR teams or providing medical care as > > outdoor trip leaders don't really have the liability protection of > > the EMS laws, nor is there any effort on the state's part to assure > > high-quality medical care in such settings. > > > > Today, SAR team EMTs and medics are really first-aiders and operating > > under the statutory and common-law Good Samaritan law protections of > > the law. (Ken Brody, a lawyer for the state health department here, > > was chatting with me at lunch yesterday between the two meetings, and > > told me something new -- that in addition to whatever Good Samaritan > > statutes that are on the books, there is common law protection for > > Good Samaritans in all states -- the precise details depend on which > > "restatement of torts" are accepted in the judicial system for the > > state, but it is an important liability protection. > > > > It is possible at present in PA for doctors to delegate almost > > anything to almost anyone, and some SAR teams have done this with the > > physician providing standing orders and protocols (see www.wemsi.org > > for an example), as well as providing direct medical direction to > > individual "wilderness medics." (EMTs and paramedics don't function > > as EMTs or paramedics in the backcountry in PA so we had to make up a > > new term.) > > > > Interestingly, the State Board of Medicine is contemplating > > regulations about such delegated practice, which may impact what docs > > and "wilderness medics" can do, although Ken Brody said they are > > aware of the problem of interfacing such non-EMS medical providers > > (also those at doctor's offices, clinics, industrial sites etc.) with > > the EMS system and are working on solutions to ease this. > > > > I have been mouthing off about these issues for years, and our state > > medical director, Dr. Doug Kupas, coordinates Wilderness EMT classes > > on an irregular basis, so now is a good time to get a law passed that > > recognizes the needs of the wilderness EMS and SAR communities. This > > new law may well be a model for other states and nations, so the > > importance transcendes jurisdictional boundaries. > > > > I would urge those who are involved with wilderness EMS or SAR in PA > > and who are willing to devote some time and energy to this process to > > at least keep tabs on this process via the PEHSC website > > (www.pehsc.org), and would like to have a few additional people apply > > for membership on the Act 45 Task Force -- representatives from some > > of the SAR teams, from PSARC, from NCRC and from CDS Outdoor and > > Western PA Field Institute at least. (Yes, I know that with the way > > people wear multiple hats this could all be one or two people but > > more people is better!) > > > > Please forward this message as desired. > > > > Thank you. > > --Keith Conover, M.D., FACEP > > http://www.pitt.edu/~kconover > > sent with Pegasus high-security email > > download free from www.pmail.com > > > > Do not reproduce without author's express permission. > > To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" > > as the body of a message (no subject) To: Majordomo@list.pitt.edu > > Submissions To: wilderness-emergency-medicine@list.pitt.edu > > > > Do not reproduce without author's express permission. > To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" > as the body of a message (no subject) To: Majordomo@list.pitt.edu > Submissions To: wilderness-emergency-medicine@list.pitt.edu --Keith Conover, M.D., FACEP http://www.pitt.edu/~kconover sent with Pegasus high-security email download free from www.pmail.com Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- Return-Path: Received: from mb1i0.ns.pitt.edu (mb1i1.ns.pitt.edu [136.142.185.161]) by imap.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisimap-7.2.2.4) ID ; Thu, 7 Mar 2002 09:13:28 -0500 (EST) Received: from list.srv.cis.pitt.edu (majordom@[136.142.185.20]) by pitt.edu (PMDF V5.2-32 #41462) with ESMTP id <01KF2O75OHRC002I6Q@mb1i0.ns.pitt.edu>; Thu, 7 Mar 2002 09:13:28 EST Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.2) ID ; Thu, 07 Mar 2002 08:58:02 -0500 (EST) Received: from out009.verizon.net (out009pub.verizon.net [206.46.170.131]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.2) ID ; Thu, 07 Mar 2002 08:57:59 -0500 (EST) Received: from Micron ([141.158.127.57]) by out009.verizon.net (InterMail vM.5.01.04.05 201-253-122-122-105-20011231) with ESMTP id <20020307141202.EDQT7755.out009.verizon.net@Micron>; Thu, 07 Mar 2002 08:12:02 -0600 Date: Thu, 07 Mar 2002 09:11:58 -0500 From: "Keith Conover, M.D., FACEP" Subject: W-EMED Pennsylvania Law and Wilderness EMS Sender: owner-wilderness-emergency-medicine@list.pitt.edu To: wilderness-emergency-medicine@list.pitt.edu, erncrc@egroups.com Cc: PSARC@yahoogroups.com, "Allegheny Mtn. Rescue Maillist" , NCRC@ontosystems.com (NCRC Discussion List) Reply-to: wilderness-emergency-medicine@list.pitt.edu Message-id: <3C872EDE.11981.62CAE6@localhost> MIME-version: 1.0 X-Mailer: Pegasus Mail for Windows (v4.01) Content-type: text/plain; charset=US-ASCII Content-description: Mail message body Content-transfer-encoding: 7BIT Precedence: bulk I share this with the broader wilderness medicine community as it may be of interest to those in other jurisdictions. I share this with interested people in PA so they can TAKE PART IN THE PROCESS. As Lois McCoy used to always say when she was running NASAR many moons ago, "silence implies consent." I attended a meeting of the Medical Advisory Committee and the Act 45 Task Force of the Pennsylvania Emergency Health Services Council yesterday. I am on both to represent the Wilderness EMS Institute but in a broader sense to represent the wilderness EMS and search and rescue communities. (I think it would be a very good idea to have a broader representation from those communities so they have someone other than me propounding the needs of our communities.) The Act 45 Task Force is charged with making recommendations to the state legislature on how to revise the state law that covers EMS here. The current law doesn't cover wilderness medicine or SAR, so any medical care given away from a road really isn't covered under the law. So those with SAR teams or providing medical care as outdoor trip leaders don't really have the liability protection of the EMS laws, nor is there any effort on the state's part to assure high-quality medical care in such settings. Today, SAR team EMTs and medics are really first-aiders and operating under the statutory and common-law Good Samaritan law protections of the law. (Ken Brody, a lawyer for the state health department here, was chatting with me at lunch yesterday between the two meetings, and told me something new -- that in addition to whatever Good Samaritan statutes that are on the books, there is common law protection for Good Samaritans in all states -- the precise details depend on which "restatement of torts" are accepted in the judicial system for the state, but it is an important liability protection. It is possible at present in PA for doctors to delegate almost anything to almost anyone, and some SAR teams have done this with the physician providing standing orders and protocols (see www.wemsi.org for an example), as well as providing direct medical direction to individual "wilderness medics." (EMTs and paramedics don't function as EMTs or paramedics in the backcountry in PA so we had to make up a new term.) Interestingly, the State Board of Medicine is contemplating regulations about such delegated practice, which may impact what docs and "wilderness medics" can do, although Ken Brody said they are aware of the problem of interfacing such non-EMS medical providers (also those at doctor's offices, clinics, industrial sites etc.) with the EMS system and are working on solutions to ease this. I have been mouthing off about these issues for years, and our state medical director, Dr. Doug Kupas, coordinates Wilderness EMT classes on an irregular basis, so now is a good time to get a law passed that recognizes the needs of the wilderness EMS and SAR communities. This new law may well be a model for other states and nations, so the importance transcendes jurisdictional boundaries. I would urge those who are involved with wilderness EMS or SAR in PA and who are willing to devote some time and energy to this process to at least keep tabs on this process via the PEHSC website (www.pehsc.org), and would like to have a few additional people apply for membership on the Act 45 Task Force -- representatives from some of the SAR teams, from PSARC, from NCRC and from CDS Outdoor and Western PA Field Institute at least. (Yes, I know that with the way people wear multiple hats this could all be one or two people but more people is better!) Please forward this message as desired. Thank you. --Keith Conover, M.D., FACEP http://www.pitt.edu/~kconover sent with Pegasus high-security email download free from www.pmail.com Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- Return-Path: Received: from mb2i0.ns.pitt.edu (mb2i1.ns.pitt.edu [136.142.185.162]) by imap.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisimap-7.2.2.4) ID ; Mon, 18 Feb 2002 07:50:04 -0500 (EST) Received: from list.srv.cis.pitt.edu (majordom@[136.142.185.20]) by pitt.edu (PMDF V5.2-32 #41462) with ESMTP id <01KEEUD26CS4008QJ0@mb2i0.ns.pitt.edu>; Mon, 18 Feb 2002 07:51:00 EST Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.2) ID ; Mon, 18 Feb 2002 07:37:43 -0500 (EST) Received: from imf01bis.bellsouth.net (mail201.mail.bellsouth.net [205.152.58.141]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.2) ID for ; Mon, 18 Feb 2002 07:37:40 -0500 (EST) Received: from jtg ([208.60.233.74]) by imf01bis.bellsouth.net (InterMail vM.5.01.04.05 201-253-122-122-105-20011231) with SMTP id <20020218124953.KWFQ23434.imf01bis.bellsouth.net@jtg> for ; Mon, 18 Feb 2002 07:49:53 -0500 Date: Mon, 18 Feb 2002 07:48:36 -0500 From: JT Grandey Subject: RE: W-EMED Re: Hypothermia Rewarming In-reply-to: Sender: owner-wilderness-emergency-medicine@list.pitt.edu To: wilderness-emergency-medicine@list.pitt.edu Reply-to: wilderness-emergency-medicine@list.pitt.edu Message-id: <001401c1b87a$957e7c60$0200a8c0@jtg> MIME-version: 1.0 X-MIMEOLE: Produced By Microsoft MimeOLE V5.00.3018.1300 X-MIME-Autoconverted: from quoted-printable to 8bit by list.srv.cis.pitt.edu id HAA06477 X-Mailer: Microsoft Outlook CWS, Build 9.0.2416 (9.0.2911.0) Content-type: text/plain; charset="iso-8859-1" Content-transfer-encoding: 8bit Importance: Normal X-Priority: 3 (Normal) X-MSMail-priority: Normal Precedence: bulk Jel: A great source for hypothermia information & research is Gordon Giesbrecht, who is at the University of Manitoba. giesbrec@Ms.UManitoba.CA (just around the corner). You can tell him that I referred you. JTG -----Original Message----- From: owner-wilderness-emergency-medicine@list.pitt.edu [mailto:owner-wilderness-emergency-medicine@list.pitt.edu]On Behalf Of Jel Coward Sent: Saturday, February 16, 2002 23:59 To: wilderness-emergency-medicine@list.pitt.edu Subject: Re: W-EMED Re: Hypothermia Rewarming On the topic of hypothermia I am interested in finding any resources that have any information about cooling rates. I know that immersion studies have been done but don't know where to find them quickly. If anyone can recall any of them or point me in the right direction then I would be very grateful I am particularly interested in this at the moment having heard of a witnessed avalanche burial of about 20 minutes. The victim being in apparent cardio-respiratory arrest had CPR at the scene for about 20 minutes and then was declared dead at the scene. This sounds fairly reasonable to me but I have heard it questioned on the grounds that the skier may have been hypothermic (as far as I am aware the victim was wearing full winter ski kit, recreational skiing at the time of the avalanche and was in good health). I would be delighted to hear any thoughts or have any pointers to resources around this also Many thanks Cheers all -- Jel Coward The UK Wilderness Emergency Medical Technician and Command Physician course is 10-16th November 2002 at Glenmore Lodge, Aviemore, Scotland http://www.wildmedic.org http://www.wemsi.org jel@wildmedic.org 'There's no such thing as bad weather - just bad clothing" Anon Norwegian Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- Return-Path: Received: from mb2i0.ns.pitt.edu (mb2i1.ns.pitt.edu [136.142.185.162]) by imap.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisimap-7.2.2.4) ID ; Sun, 17 Feb 2002 00:31:02 -0500 (EST) Received: from list.srv.cis.pitt.edu (majordom@[136.142.185.20]) by pitt.edu (PMDF V5.2-32 #41462) with ESMTP id <01KED0QBUD0W008AWP@mb2i0.ns.pitt.edu>; Sun, 17 Feb 2002 00:31:55 EST Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.2) ID ; Sun, 17 Feb 2002 00:19:03 -0500 (EST) Received: from photon.look.ca (photon.look.ca [207.136.80.123]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.2) ID for ; Sun, 17 Feb 2002 00:18:59 -0500 (EST) Received: from bc-van-mut-a53-10-54.look.ca ([216.66.146.54] helo=wildmedic.org) by photon.look.ca with esmtp (Exim 3.12 #9) id 16cJtl-0004oW-00 for wilderness-emergency-medicine@list.pitt.edu; Sun, 17 Feb 2002 05:30:09 +0000 Date: Sat, 16 Feb 2002 21:03:09 -0800 From: Jel Coward Subject: Re: W-EMED Hypothermia field treatment In-reply-to: Sender: owner-wilderness-emergency-medicine@list.pitt.edu To: wilderness-emergency-medicine@list.pitt.edu Reply-to: wilderness-emergency-medicine@list.pitt.edu Message-id: MIME-version: 1.0 X-Mailer: Turnpike Integrated Version 5.01 U Precedence: bulk References: <3C599C50.3281.2AC9BE2@localhost> <000001c1b28f$fade61b0$9865fea9@mahshev> In article , Fabrice Czarnecki writes >Are you aware of any effective field treatment for sever hypothermia? Are >portable forced air systems available (and effective)? What do you think of >the HeatPac systems? > I have searched for evidence that the Little Dragon (portable warm humidified air device) is of any clinical use at all. There are numerous accolades and testimonials on various websites but I have not been able to find much in the way of proper scientific studies. Cave rescue in the UK seem to like them and the Mountain Rescue Council (MRC) bought them for all the SAR teams in the UK. I asked the MRC for the evidence on which they based the decision to purchase these (and ask folk to carry them in their packs) but I have had no response. If you find any proper evidence for their efficacy then I would be delighted to hear about it Cheers :) -- Jel Coward The UK Wilderness Emergency Medical Technician and Command Physician course is 10-16th November 2002 at Glenmore Lodge, Aviemore, Scotland http://www.wildmedic.org http://www.wemsi.org jel@wildmedic.org 'There's no such thing as bad weather - just bad clothing" Anon Norwegian Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- Return-Path: Received: from mb1i0.ns.pitt.edu (mb1i1.ns.pitt.edu [136.142.185.161]) by imap.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisimap-7.2.2.4) ID ; Sun, 17 Feb 2002 00:31:03 -0500 (EST) Received: from list.srv.cis.pitt.edu (majordom@[136.142.185.20]) by pitt.edu (PMDF V5.2-32 #41462) with ESMTP id <01KED0P7XNIE00143M@mb1i0.ns.pitt.edu>; Sun, 17 Feb 2002 00:31:01 EST Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.2) ID ; Sun, 17 Feb 2002 00:19:05 -0500 (EST) Received: from photon.look.ca (photon.look.ca [207.136.80.123]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.2) ID for ; Sun, 17 Feb 2002 00:18:59 -0500 (EST) Received: from bc-van-mut-a53-10-54.look.ca ([216.66.146.54] helo=wildmedic.org) by photon.look.ca with esmtp (Exim 3.12 #9) id 16cJtl-0004oU-00 for wilderness-emergency-medicine@list.pitt.edu; Sun, 17 Feb 2002 05:30:08 +0000 Date: Sat, 16 Feb 2002 20:58:50 -0800 From: Jel Coward Subject: Re: W-EMED Re: Hypothermia Rewarming In-reply-to: <3C681D67.509.44F41B@localhost> Sender: owner-wilderness-emergency-medicine@list.pitt.edu To: wilderness-emergency-medicine@list.pitt.edu Reply-to: wilderness-emergency-medicine@list.pitt.edu Message-id: MIME-version: 1.0 X-Mailer: Turnpike Integrated Version 5.01 U Precedence: bulk References: <000e01c1b2f6$88003b20$a7bed741@morgan> <3C681D67.509.44F41B@localhost> On the topic of hypothermia I am interested in finding any resources that have any information about cooling rates. I know that immersion studies have been done but don't know where to find them quickly. If anyone can recall any of them or point me in the right direction then I would be very grateful I am particularly interested in this at the moment having heard of a witnessed avalanche burial of about 20 minutes. The victim being in apparent cardio-respiratory arrest had CPR at the scene for about 20 minutes and then was declared dead at the scene. This sounds fairly reasonable to me but I have heard it questioned on the grounds that the skier may have been hypothermic (as far as I am aware the victim was wearing full winter ski kit, recreational skiing at the time of the avalanche and was in good health). I would be delighted to hear any thoughts or have any pointers to resources around this also Many thanks Cheers all -- Jel Coward The UK Wilderness Emergency Medical Technician and Command Physician course is 10-16th November 2002 at Glenmore Lodge, Aviemore, Scotland http://www.wildmedic.org http://www.wemsi.org jel@wildmedic.org 'There's no such thing as bad weather - just bad clothing" Anon Norwegian Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- Return-Path: Received: from mb1i0.ns.pitt.edu (mb1i1.ns.pitt.edu [136.142.185.161]) by imap.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisimap-7.2.2.4) ID ; Mon, 11 Feb 2002 19:38:17 -0500 (EST) Received: from list.srv.cis.pitt.edu (majordom@[136.142.185.20]) by pitt.edu (PMDF V5.2-32 #41462) with ESMTP id <01KE5R0JU48Q000L2M@mb1i0.ns.pitt.edu>; Mon, 11 Feb 2002 19:38:17 EST Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.2) ID ; Mon, 11 Feb 2002 19:27:07 -0500 (EST) Received: from out016.verizon.net (out016pub.verizon.net [206.46.170.92]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.2) ID for ; Mon, 11 Feb 2002 19:27:02 -0500 (EST) Received: from Micron ([141.158.127.220]) by out016.verizon.net (InterMail vM.5.01.04.05 201-253-122-122-105-20011231) with ESMTP id <20020212003720.FGMS24823.out016.verizon.net@Micron>; Mon, 11 Feb 2002 18:37:20 -0600 Date: Mon, 11 Feb 2002 19:37:09 -0500 From: "Keith Conover, M.D., FACEP" Subject: Re: W-EMED Hypothermia field treatment In-reply-to: Sender: owner-wilderness-emergency-medicine@list.pitt.edu To: Fabrice Czarnecki , wilderness-emergency-medicine@list.pitt.edu Reply-to: wilderness-emergency-medicine@list.pitt.edu Message-id: <3C681D65.26555.44ECA5@localhost> MIME-version: 1.0 X-Mailer: Pegasus Mail for Windows (v4.01) Content-type: text/plain; charset=US-ASCII Content-description: Mail message body Content-transfer-encoding: 7BIT Precedence: bulk There is a detailed review of the HeatPac charcoal vest device on my webpages, URL below. Take care. On 10 Feb 2002 at 19:56, Fabrice Czarnecki wrote: > Are you aware of any effective field treatment for sever hypothermia? Are > portable forced air systems available (and effective)? What do you think of > the HeatPac systems? > > Sincerely, > > Fabrice Czarnecki, M.D. > > > Do not reproduce without author's express permission. > To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" > as the body of a message (no subject) To: Majordomo@list.pitt.edu > Submissions To: wilderness-emergency-medicine@list.pitt.edu --Keith Conover, M.D., FACEP http://www.pitt.edu/~kconover sent with Pegasus high-security email download free from www.pmail.com Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- Return-Path: Received: from mb2i0.ns.pitt.edu (mb2i1.ns.pitt.edu [136.142.185.162]) by imap.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisimap-7.2.2.4) ID ; Mon, 11 Feb 2002 19:38:17 -0500 (EST) Received: from list.srv.cis.pitt.edu (majordom@[136.142.185.20]) by pitt.edu (PMDF V5.2-32 #41462) with ESMTP id <01KE5R1J0AUA006S2C@mb2i0.ns.pitt.edu>; Mon, 11 Feb 2002 19:39:04 EST Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.2) ID ; Mon, 11 Feb 2002 19:27:08 -0500 (EST) Received: from out016.verizon.net (out016pub.verizon.net [206.46.170.92]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.2) ID for ; Mon, 11 Feb 2002 19:27:04 -0500 (EST) Received: from Micron ([141.158.127.220]) by out016.verizon.net (InterMail vM.5.01.04.05 201-253-122-122-105-20011231) with ESMTP id <20020212003723.FGMW24823.out016.verizon.net@Micron>; Mon, 11 Feb 2002 18:37:23 -0600 Date: Mon, 11 Feb 2002 19:37:11 -0500 From: "Keith Conover, M.D., FACEP" Subject: RE: W-EMED Re: Hypothermia Rewarming In-reply-to: <000e01c1b2f6$88003b20$a7bed741@morgan> Sender: owner-wilderness-emergency-medicine@list.pitt.edu To: Morgan Young , wilderness-emergency-medicine@list.pitt.edu Reply-to: wilderness-emergency-medicine@list.pitt.edu Message-id: <3C681D67.509.44F41B@localhost> MIME-version: 1.0 X-Mailer: Pegasus Mail for Windows (v4.01) Content-type: text/plain; charset=US-ASCII Content-description: Mail message body Content-transfer-encoding: 7BIT Precedence: bulk References: Eric (this particular Eric) is an emergency physician and whitewater paddler, in Truckee, CA, if that's who we're talking about. (There are at least three Drs. Eric Weiss involved in emergency medicine in California which complicates things, two of whom have the same middle initial.) However, I've never heard of the study mentioned. Dr. Allen Steinman, however, of the U.S. Coast Guard, did a number of immersion hypothermia studies, most of which were published in Aviation, Space and Environmental Medicine. Check the hundreds of references to the Cold-Related Disorders Lesson Plan at http://www.wemsi.org. On 11 Feb 2002 at 6:20, Morgan Young wrote: > Does any one know if Dr Wiess was in the Navy? A Lt Commander? > 3rd and finnal question, is he a Surgeon and/or Plastic Surgeon? > > Morgan Young, CCEMT-P/FF > theonlymorgan2@yahoo.com > 4177333273@message.alltel.com > > > -----Original Message----- > From: owner-wilderness-emergency-medicine@list.pitt.edu > [mailto:owner-wilderness-emergency-medicine@list.pitt.edu]On Behalf Of > cheazlit@ix.netcom.com > Sent: Sunday, February 10, 2002 22:40 > To: wilderness-emergency-medicine@list.pitt.edu > Subject: W-EMED Re: Hypothermia Rewarming > > > > A couple of years ago, Dr. Eric Weiss (Emergency Medicine at Stanford > University Medical Center) was doing a study on immersion hypothermia. I > beleive it was done in cooperation with the US Navy. Basically, he was > dumping the almost-naked subjects in Monterey Bay, CA (~18 deg C in the > summer). After that he wired them up and did rewarming studies. I can't > remember if helecopters were involved in any field rewarming. > > Dr. Weiss has been a backpacker, mountaineer, and a bit of a crazy man, so > he's be a good source. > > Regards, > > Cindy Heazlit > > > wilderness-emergency-medicine@list.pitt.edu wrote: > > Dear Colleagues, > > I want to write a paper for my Aeromedical Trans. class on field re-warming > of hypothermic patients. I'd like any suggestions, please, as to sources, > focus, presentation, etc. > > As I see it so far, the issues to address are the theoretical considerations > (was there any evidence?) behind concerns re: Afterdrop, Rewarming shock, > Sudden death, and Intubation cautions. Then I need to present any new > evidence and thinking which would influence protocols and procedures for > rewarming. I think I'd also like to review the problem with susceptibility > to ventricular arrhythmias, and their resolution and treatment. Finally, I > would want to present a discussion of the means available and desirable for > rewarming in the field, and in RW and FW aircraft during evacuation, > especially any evidence-based suggestions. > > Any input would be greatly appreciated. > > Many thanks in advance! > > many blessings, > > Mordechai Y. Scher > Combat Medic 09 (IDF); NREMT-P > SJCSAR, Santa Fe NM > MedNet Ambulance Service, Torrance County EMS, NM > > myscheremtp@earthlink.net > > Do not reproduce without author's express permission. > To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" > as the body of a message (no subject) To: Majordomo@list.pitt.edu > Submissions To: wilderness-emergency-medicine@list.pitt.edu > > Do not reproduce without author's express permission. > To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" > as the body of a message (no subject) To: Majordomo@list.pitt.edu > Submissions To: wilderness-emergency-medicine@list.pitt.edu > > Do not reproduce without author's express permission. > To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" > as the body of a message (no subject) To: Majordomo@list.pitt.edu > Submissions To: wilderness-emergency-medicine@list.pitt.edu --Keith Conover, M.D., FACEP http://www.pitt.edu/~kconover sent with Pegasus high-security email download free from www.pmail.com Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- Return-Path: Received: from mb2i0.ns.pitt.edu (mb2i1.ns.pitt.edu [136.142.185.162]) by imap.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisimap-7.2.2.4) ID ; Mon, 11 Feb 2002 07:21:55 -0500 (EST) Received: from list.srv.cis.pitt.edu (majordom@[136.142.185.20]) by pitt.edu (PMDF V5.2-32 #41462) with ESMTP id <01KE51BKCLJY00451D@mb2i0.ns.pitt.edu>; Mon, 11 Feb 2002 07:22:42 EST Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.2) ID ; Mon, 11 Feb 2002 07:10:56 -0500 (EST) Received: from home.positech.net ([65.215.191.253]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.2) ID for ; Mon, 11 Feb 2002 07:10:51 -0500 (EST) Received: from morgan (buffalo-0-190-167.positech.net [65.215.190.167]) by home.positech.net (8.11.4/8.11.1) with SMTP id g1BCLuw84424 for ; Mon, 11 Feb 2002 06:21:57 -0600 Date: Mon, 11 Feb 2002 06:20:45 -0600 From: Morgan Young Subject: RE: W-EMED Re: Hypothermia Rewarming In-reply-to: Sender: owner-wilderness-emergency-medicine@list.pitt.edu To: wilderness-emergency-medicine@list.pitt.edu Reply-to: wilderness-emergency-medicine@list.pitt.edu Message-id: <000e01c1b2f6$88003b20$a7bed741@morgan> MIME-version: 1.0 X-MIMEOLE: Produced By Microsoft MimeOLE V6.00.2600.0000 X-Mailer: Microsoft Outlook 8.5, Build 4.71.2173.0 Content-type: text/plain; charset="iso-8859-1" Content-transfer-encoding: 7bit Importance: Normal X-Priority: 3 (Normal) X-MSMail-priority: Normal Precedence: bulk Does any one know if Dr Wiess was in the Navy? A Lt Commander? 3rd and finnal question, is he a Surgeon and/or Plastic Surgeon? Morgan Young, CCEMT-P/FF theonlymorgan2@yahoo.com 4177333273@message.alltel.com -----Original Message----- From: owner-wilderness-emergency-medicine@list.pitt.edu [mailto:owner-wilderness-emergency-medicine@list.pitt.edu]On Behalf Of cheazlit@ix.netcom.com Sent: Sunday, February 10, 2002 22:40 To: wilderness-emergency-medicine@list.pitt.edu Subject: W-EMED Re: Hypothermia Rewarming A couple of years ago, Dr. Eric Weiss (Emergency Medicine at Stanford University Medical Center) was doing a study on immersion hypothermia. I beleive it was done in cooperation with the US Navy. Basically, he was dumping the almost-naked subjects in Monterey Bay, CA (~18 deg C in the summer). After that he wired them up and did rewarming studies. I can't remember if helecopters were involved in any field rewarming. Dr. Weiss has been a backpacker, mountaineer, and a bit of a crazy man, so he's be a good source. Regards, Cindy Heazlit wilderness-emergency-medicine@list.pitt.edu wrote: > Dear Colleagues, I want to write a paper for my Aeromedical Trans. class on field re-warming of hypothermic patients. I'd like any suggestions, please, as to sources, focus, presentation, etc. As I see it so far, the issues to address are the theoretical considerations (was there any evidence?) behind concerns re: Afterdrop, Rewarming shock, Sudden death, and Intubation cautions. Then I need to present any new evidence and thinking which would influence protocols and procedures for rewarming. I think I'd also like to review the problem with susceptibility to ventricular arrhythmias, and their resolution and treatment. Finally, I would want to present a discussion of the means available and desirable for rewarming in the field, and in RW and FW aircraft during evacuation, especially any evidence-based suggestions. Any input would be greatly appreciated. Many thanks in advance! many blessings, Mordechai Y. Scher Combat Medic 09 (IDF); NREMT-P SJCSAR, Santa Fe NM MedNet Ambulance Service, Torrance County EMS, NM myscheremtp@earthlink.net Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- Return-Path: Received: from mb2i0.ns.pitt.edu (mb2i1.ns.pitt.edu [136.142.185.162]) by imap.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisimap-7.2.2.4) ID ; Mon, 11 Feb 2002 00:02:17 -0500 (EST) Received: from list.srv.cis.pitt.edu (majordom@[136.142.185.20]) by pitt.edu (PMDF V5.2-32 #41462) with ESMTP id <01KE4LYI3FES006BLN@mb2i0.ns.pitt.edu>; Mon, 11 Feb 2002 00:03:04 EST Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.2) ID ; Sun, 10 Feb 2002 23:51:53 -0500 (EST) Received: from imo-r02.mx.aol.com (imo-r02.mx.aol.com [152.163.225.98]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.2) ID for ; Sun, 10 Feb 2002 23:51:49 -0500 (EST) Received: from Mobile9@aol.com by imo-r02.mx.aol.com (mail_out_v32.5.) id u.8e.22c72534 (4588); Mon, 11 Feb 2002 00:01:25 -0500 (EST) Date: Mon, 11 Feb 2002 00:01:24 -0500 (EST) From: Mobile9@aol.com Subject: Re: W-EMED Re: Hypothermia Rewarming Sender: owner-wilderness-emergency-medicine@list.pitt.edu To: cheazlit@ix.netcom.com, wilderness-emergency-medicine@list.pitt.edu Reply-to: wilderness-emergency-medicine@list.pitt.edu Message-id: <8e.22c72534.2998aa24@aol.com> MIME-version: 1.0 X-Mailer: AOL 5.0 for Windows sub 139 Content-type: text/plain; charset="US-ASCII" Content-transfer-encoding: 7bit Precedence: bulk I will ask the Stanford Like Flight folks and the San Francisco helo evac folks if they have a protocol. Is time crucial for you? ======================= Ted Dunbar District Communications Officer Emergency Response USCG Auxiliary Eleventh District Northern Region (408) 257 5894 Emergency Cell (408) 230-4077 fax (408) 366 1455 Emergency page 408 362 8713 Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- Return-Path: Received: from mb2i0.ns.pitt.edu (mb2i1.ns.pitt.edu [136.142.185.162]) by imap.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisimap-7.2.2.4) ID ; Sun, 10 Feb 2002 23:40:31 -0500 (EST) Received: from list.srv.cis.pitt.edu (majordom@[136.142.185.20]) by pitt.edu (PMDF V5.2-32 #41462) with ESMTP id <01KE4L7IBO0E006BLN@mb2i0.ns.pitt.edu>; Sun, 10 Feb 2002 23:41:18 EST Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.2) ID ; Sun, 10 Feb 2002 23:29:51 -0500 (EST) Received: from randall.mail.atl.earthlink.net (randall.mail.atl.earthlink.net [207.69.200.237]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.2) ID for ; Sun, 10 Feb 2002 23:29:48 -0500 (EST) Received: from smui04.slb.mindspring.net ([199.174.114.26]) by randall.mail.atl.earthlink.net with esmtp (Exim 3.33 #1) id 16a8G2-0003ja-00 for wilderness-emergency-medicine@list.pitt.edu; Sun, 10 Feb 2002 23:40:02 -0500 Received: by smui04.slb.mindspring.net id XAA0000013731; Sun, 10 Feb 2002 23:40:01 -0500 (EST) Date: Sun, 10 Feb 2002 23:40:01 -0500 From: cheazlit@ix.netcom.com Subject: W-EMED Re: Hypothermia Rewarming Sender: owner-wilderness-emergency-medicine@list.pitt.edu To: wilderness-emergency-medicine@list.pitt.edu Reply-to: wilderness-emergency-medicine@list.pitt.edu Message-id: Precedence: bulk X-Originating-IP: 172.148.80.51 A couple of years ago, Dr. Eric Weiss (Emergency Medicine at Stanford University Medical Center) was doing a study on immersion hypothermia. I beleive it was done in cooperation with the US Navy. Basically, he was dumping the almost-naked subjects in Monterey Bay, CA (~18 deg C in the summer). After that he wired them up and did rewarming studies. I can't remember if helecopters were involved in any field rewarming. Dr. Weiss has been a backpacker, mountaineer, and a bit of a crazy man, so he's be a good source. Regards, Cindy Heazlit wilderness-emergency-medicine@list.pitt.edu wrote: > Dear Colleagues, I want to write a paper for my Aeromedical Trans. class on field re-warming of hypothermic patients. I'd like any suggestions, please, as to sources, focus, presentation, etc. As I see it so far, the issues to address are the theoretical considerations (was there any evidence?) behind concerns re: Afterdrop, Rewarming shock, Sudden death, and Intubation cautions. Then I need to present any new evidence and thinking which would influence protocols and procedures for rewarming. I think I'd also like to review the problem with susceptibility to ventricular arrhythmias, and their resolution and treatment. Finally, I would want to present a discussion of the means available and desirable for rewarming in the field, and in RW and FW aircraft during evacuation, especially any evidence-based suggestions. Any input would be greatly appreciated. Many thanks in advance! many blessings, Mordechai Y. Scher Combat Medic 09 (IDF); NREMT-P SJCSAR, Santa Fe NM MedNet Ambulance Service, Torrance County EMS, NM myscheremtp@earthlink.net Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- Return-Path: Received: from mb2i0.ns.pitt.edu (mb2i1.ns.pitt.edu [136.142.185.162]) by imap.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisimap-7.2.2.4) ID ; Sun, 10 Feb 2002 20:04:44 -0500 (EST) Received: from list.srv.cis.pitt.edu (majordom@[136.142.185.20]) by pitt.edu (PMDF V5.2-32 #41462) with ESMTP id <01KE4DNY8EPC006QKR@mb2i0.ns.pitt.edu>; Sun, 10 Feb 2002 20:05:30 EST Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.2) ID ; Sun, 10 Feb 2002 19:54:10 -0500 (EST) Received: from hotmail.com (oe63.law3.hotmail.com [209.185.240.79]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.2) ID for ; Sun, 10 Feb 2002 19:54:05 -0500 (EST) Received: from mail pickup service by hotmail.com with Microsoft SMTPSVC; Sun, 10 Feb 2002 16:56:11 -0800 Date: Sun, 10 Feb 2002 19:56:03 -0500 From: Fabrice Czarnecki Subject: W-EMED Hypothermia field treatment Sender: owner-wilderness-emergency-medicine@list.pitt.edu To: wilderness-emergency-medicine@list.pitt.edu Reply-to: wilderness-emergency-medicine@list.pitt.edu Message-id: Organization: The Gables Group, Inc. MIME-version: 1.0 X-MIMEOLE: Produced By Microsoft MimeOLE V6.00.2600.0000 X-Mailer: Microsoft Outlook Express 6.00.2600.0000 Content-type: text/plain; charset="iso-8859-1" Content-transfer-encoding: 7bit X-Priority: 3 X-MSMail-priority: Normal Precedence: bulk X-Originating-IP: [68.33.195.28] X-OriginalArrivalTime: 11 Feb 2002 00:56:11.0232 (UTC) FILETIME=[E5BD6E00:01C1B296] References: <3C599C50.3281.2AC9BE2@localhost> <000001c1b28f$fade61b0$9865fea9@mahshev> Are you aware of any effective field treatment for sever hypothermia? Are portable forced air systems available (and effective)? What do you think of the HeatPac systems? Sincerely, Fabrice Czarnecki, M.D. Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- Return-Path: Received: from mb1i0.ns.pitt.edu (mb1i1.ns.pitt.edu [136.142.185.161]) by imap.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisimap-7.2.2.4) ID ; Sun, 10 Feb 2002 19:13:59 -0500 (EST) Received: from list.srv.cis.pitt.edu (majordom@[136.142.185.20]) by pitt.edu (PMDF V5.2-32 #41462) with ESMTP id <01KE4BV0NYKC000MLB@mb1i0.ns.pitt.edu>; Sun, 10 Feb 2002 19:13:56 EST Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.2) ID ; Sun, 10 Feb 2002 18:56:34 -0500 (EST) Received: from avocet.prod.itd.earthlink.net (avocet.mail.pas.earthlink.net [207.217.120.50]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.2) ID for ; Sun, 10 Feb 2002 18:56:31 -0500 (EST) Received: from sdn-ar-003nmalbup264.dialsprint.net ([158.252.149.154] helo=mahshev) by avocet.prod.itd.earthlink.net with smtp (Exim 3.33 #1) id 16a3zT-00058t-00 for wilderness-emergency-medicine@list.pitt.edu; Sun, 10 Feb 2002 16:06:40 -0800 Date: Sun, 10 Feb 2002 17:03:23 -0700 From: "Mordechai Y. Scher" Subject: Re: W-EMED Re: FW: MEDICATION RECALL Sender: owner-wilderness-emergency-medicine@list.pitt.edu To: wilderness-emergency-medicine@list.pitt.edu Reply-to: wilderness-emergency-medicine@list.pitt.edu Message-id: <000001c1b28f$fade61b0$9865fea9@mahshev> MIME-version: 1.0 X-MIMEOLE: Produced By Microsoft MimeOLE V6.00.2600.0000 X-Mailer: Microsoft Outlook Express 6.00.2600.0000 Content-type: text/plain; charset="iso-8859-1" Content-transfer-encoding: 7bit X-Priority: 3 X-MSMail-priority: Normal Precedence: bulk References: <3C599C50.3281.2AC9BE2@localhost> Dear Colleagues, I want to write a paper for my Aeromedical Trans. class on field re-warming of hypothermic patients. I'd like any suggestions, please, as to sources, focus, presentation, etc. As I see it so far, the issues to address are the theoretical considerations (was there any evidence?) behind concerns re: Afterdrop, Rewarming shock, Sudden death, and Intubation cautions. Then I need to present any new evidence and thinking which would influence protocols and procedures for rewarming. I think I'd also like to review the problem with susceptibility to ventricular arrhythmias, and their resolution and treatment. Finally, I would want to present a discussion of the means available and desirable for rewarming in the field, and in RW and FW aircraft during evacuation, especially any evidence-based suggestions. Any input would be greatly appreciated. Many thanks in advance! many blessings, Mordechai Y. Scher Combat Medic 09 (IDF); NREMT-P SJCSAR, Santa Fe NM MedNet Ambulance Service, Torrance County EMS, NM myscheremtp@earthlink.net Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- Return-Path: Received: from mb1i0.ns.pitt.edu (mb1i1.ns.pitt.edu [136.142.185.161]) by imap.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisimap-7.2.2.4) ID ; Sat, 2 Feb 2002 22:33:33 -0500 (EST) Received: from list.srv.cis.pitt.edu (majordom@[136.142.185.20]) by pitt.edu (PMDF V5.2-32 #41462) with ESMTP id <01KDTCI7QE5G00B0QC@mb1i0.ns.pitt.edu>; Sat, 2 Feb 2002 22:33:08 EST Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.2) ID ; Sat, 02 Feb 2002 22:22:01 -0500 (EST) Received: from m23.boston.juno.com (m23.boston.juno.com [64.136.24.86]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.2) ID for ; Sat, 02 Feb 2002 22:21:58 -0500 (EST) Received: from cookie.juno.com by cookie.juno.com for <"2uK5SD2XOOcUa1OlmLs6XfonPApLNJY/5RBd5Axf6dHiZofZx1mgcg=="> Received: (from traumaboy@juno.com) by m23.boston.juno.com (jqueuemail) id GSPPRFS7; Sat, 02 Feb 2002 22:30:35 -0500 (EST) Date: Sat, 02 Feb 2002 01:36:04 -0800 From: Erik W Gunnerson Subject: Re: W-EMED [OEM] Lancet: Hi Alt Pulm Edema in 75% of Climbers Sender: owner-wilderness-emergency-medicine@list.pitt.edu To: wilderness-emergency-medicine@list.pitt.edu Reply-to: wilderness-emergency-medicine@list.pitt.edu Message-id: <20020202.194705.-1872397.2.traumaboy@juno.com> MIME-version: 1.0 X-Mailer: Juno 4.0.11 Content-type: text/plain Content-transfer-encoding: 7bit Precedence: bulk X-Juno-Line-Breaks: 2-3 X-Juno-Att: 0 X-Juno-RefParts: 0 Is there any more out there on this study - am planning a climb of MT Whitney here in Ca in August and live near sea level ? Just want the facts ? Thanks Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- Return-Path: Received: from mb1i0.ns.pitt.edu (mb1i1.ns.pitt.edu [136.142.185.161]) by imap.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisimap-7.2.2.4) ID ; Thu, 31 Jan 2002 19:35:57 -0500 (EST) Received: from list.srv.cis.pitt.edu (majordom@[136.142.185.20]) by pitt.edu (PMDF V5.2-32 #41462) with ESMTP id <01KDQDPDM0B800AUOU@mb1i0.ns.pitt.edu>; Thu, 31 Jan 2002 19:35:33 EST Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.2) ID ; Thu, 31 Jan 2002 19:26:13 -0500 (EST) Received: from out011.verizon.net (out011pub.verizon.net [206.46.170.135]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.2) ID for ; Thu, 31 Jan 2002 19:26:10 -0500 (EST) Received: from Micron ([141.158.127.220]) by out011.verizon.net (InterMail vM.5.01.04.05 201-253-122-122-105-20011231) with ESMTP id <20020201003448.BQPP9330.out011.verizon.net@Micron>; Thu, 31 Jan 2002 18:34:48 -0600 Date: Thu, 31 Jan 2002 19:34:40 -0500 From: "Keith Conover, M.D., FACEP" Subject: W-EMED Re: FW: MEDICATION RECALL In-reply-to: <2178E0EC5F7CD511A3490008C7B1D0E942154C@CHPALCTFS1> Sender: owner-wilderness-emergency-medicine@list.pitt.edu To: "Porter, Christopher" Cc: wilderness-emergency-medicine@list.pitt.edu Reply-to: wilderness-emergency-medicine@list.pitt.edu Message-id: <3C599C50.3281.2AC9BE2@localhost> MIME-version: 1.0 X-Mailer: Pegasus Mail for Windows (v4.01) Content-type: text/plain; charset=US-ASCII Content-description: Mail message body Content-transfer-encoding: 7BIT Precedence: bulk Yes. But driving is more dangerous. And anyway, oral decongestants are more of a danger to little kids who get ODs from parents giving the wrong dosage. And they really don't help much anyway, compared to Afrin and similar sprays. All oral decongestants and most diet pills are basically speed. Whether you like diet pills, methamphetamine, nicotine, caffeine, cocaine, or even chocolate -- it's all speed. Some is just worse than others. And cold medicines that have a decongestant, antihistamine and aceteaminophen are basically useless. The decongestant works but keeps you awake. The antihistamine dries the mucus so your sinuses clog up. And the acetaminophen (=paracetamol to the UK), although it does help aches and fever, will prolong viral shedding, increase nasal stuffiness, and make you more likely to get the same cold again (decrease your immune response). [Graham NMH, et al. Adverse effects of aspirin, acetaminophen, and ibuprofen on immune function, viral shedding, and clinical status in Rhinovirus-infected volunteers. J Inf Dis 1990;162:1277-1282.] And most of those liquid medicines really have only one effective ingredient: ALCHOHOL. Most are 100 proof. Interestingly, the above study didn't show any bad effects of ibuprofen (e.g., Motrin, Advil, Nuprin). So eat a good meal with some chicken soup [search for articles with titles like "the effects of warm water, warm saline, and chicken soup on nasal mucus flow velocity" if you don't believe it], take some ibuprofen, and have a hot toddy. I personally try to avoid ibuprofen as it relieves fever and we know that fever kills viruses. I like a hot bath when I have a bad cold! I will point out that pseudoephedrine (one that has _not_ been recalled yet) is on the WEMSI Personal Wilderness Medical Kit list. Maybe it shouldn't be there, after all, we do have a bottle of oxymetazoline (e.g., Afrin) nasal spray. Take care. On 31 Jan 2002 at 16:01, Porter, Christopher wrote: > Keith - In there any real danger here? > > > IMPORTANT!!! All drugs containing Phenylpropanolamine are being > recalled. You may want to try calling the 800 number listed on most > drug boxes and inquire about a REFUND. > > Please read this CAREFULLY, as I know that some of you may USE > some of these drugs (Alka Seltzer Plus for one). > > Also, please pass this on to everyone you know. STOP TAKING > anything containing this ingredient. It has been linked to > increased hemorrhagic stroke (bleeding in brain) among women ages > 18-49 in the three days after starting use of medication. Problems > were not found in men, but the FDA recommended that everyone (even > children) seek alternative medicine. > > The following medications contain Phenylpropanolamine: > Acutrim Diet Gum Appetite Suppressant Plus Dietary Supplements > Acutrim Maximum Strength Appetite Control > Alka-Seltzer Plus Children's Cold Medicine Effervescent > Alka-Seltzer Plus Cold medicine (cherry or orange) > Alka-Seltzer Plus Cold Medicine Original > Alka-Seltzer Plus Cold & Cough Medicine Effervescent > Alka-Seltzer Plus Cold & Flu Medicine Effervescent > Alka-Seltzer Plus Cold & Sinus Effervescent > Alka Seltzer Plus Night-Time Cold Medicine Effervescent > BC Allergy Sinus Cold Powder > BC Sinus Cold Powder > Comtrex Deep Chest Cold & Congestion Relief > Comtrex Flu Therapy & Fever Relief > Day & Night Contac 12-Hour Cold Capsules > Contac 12 Hour Caplets > Coricidin D Cold, Flu & Sinus > Dexatrim Caffeine Free > Dexatrim Extended Duration > Dexatrim Gelcaps > Dexatrim Vitamin C/Caffeine Free > Dimetapp Cold & Allergy Chewable Tablets > Dimetapp Cold & Cough Liqui-Gels > Dimetapp DM Cold & Cough Elixir > Dimetapp Elixir > Dimetapp 4 Hour Liquid Gels > Dimetapp 4 Hour Tablets > Dimetapp 12 Hour Extentabs Tablets > Naldecon DX Pediatric Drops > Permathene Mega-16 > Robitussin CF > Tavist-D 12 Hour Relief of Sinus & Nasal Congestion > Triaminic DM Cough Relief > Triaminic Expectorant Chest & Head Congestion > Triaminic Syrup Cold & Allergy > Triaminic Triaminicol Cold & Cough > > I just found out and called the 800# on the container for > Triaminic and they informed me that they are voluntarily recalling > the following medicines because of a certain ingredient that is > causing strokes and seizures in children: > > > Orange 3D Cold & Allergy Cherry (Pink) > 3D Cold & Cough Berry > 3D Cough Relief > Yellow 3D Expectorant > > > They are asking you to call them at 800-548-3708 with the lot number on the > box so they can send you postage for you to send it back to them, and they > will also issue you a refund. If you know of anyone else with small > children, > > To confirm these findings please take time to check the following URL: > www.fda.gov/cder/drug/infopage/ppa/default.htm > > --Keith Conover, M.D., FACEP http://www.pitt.edu/~kconover sent with Pegasus high-security email download free from www.pmail.com Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- X-cs: R From: Keith Conover, M.D., FACEP X-RS-ID: X-RS-Flags: 0,0,1,1,0,0,0 X-RS-Header: In-reply-to: <2178E0EC5F7CD511A3490008C7B1D0E942154C@CHPALCTFS1> X-RS-Sigset: 2 To: "Porter, Christopher" Subject: Re: FW: MEDICATION RECALL Cc: wilderness-emergency-medicine@list.pitt.edu Reply-to: kconover@pitt.edu MIME-Version: 1.0 Content-type: text/plain; charset=ISO-8859-1 Content-transfer-encoding: 8BIT Date: Thu, 31 Jan 2002 19:05:49 -0500 Yes. But driving is more dangerous. And anyway, oral decongestants are more of a danger to little kids who get ODs from parents giving the wrong dosage. And they really don't help much anyway, compared to Afrin and similar sprays. All oral decongestants and most diet pills are basically speed. Whether you like diet pills, methamphetamine, nicotine, caffeine, cocaine, or even chocolate -- it's all speed. Some is just worse than others. And cold medicines that have a decongestant, antihistamine and aceteaminophen are basically useless. The decongestant works but keeps you awake. The antihistamine dries the mucus so your sinuses clog up. And the acetaminophen (=paracetamol to the UK), although it does help aches and fever, will prolong viral shedding, increase nasal stuffiness, and make you more likely to get the same cold again (decrease your immune response). [Graham NMH, et al. Adverse effects of aspirin, acetaminophen, and ibuprofen on immune function, viral shedding, and clinical status in Rhinovirus-infected volunteers. J Inf Dis 1990;162:1277-1282.] And most of those liquid medicines really have only one effective ingredient: ALCHOHOL. Most are 100 proof. Interestingly, the above study didn't show any bad effects of ibuprofen (e.g., Motrin, Advil, Nuprin). So eat a good meal with some chicken soup [search for articles with titles like "the effects of warm water, warm saline, and chicken soup on nasal mucus flow velocity" if you don't believe it], take some ibuprofen, and have a hot toddy. I personally try to avoid ibuprofen as it relieves fever and we know that fever kills viruses. I like a hot bath when I have a bad cold! I will point out that pseudoephedrine (one that has _not_ been recalled yet) is on the WEMSI Personal Wilderness Medical Kit list. Maybe it shouldn't be there, after all, we do have a bottle of oxymetazoline (e.g., Afrin) nasal spray. Take care. On 31 Jan 2002 at 16:01, Porter, Christopher wrote: > Keith - In there any real danger here? > > > IMPORTANT!!! All drugs containing Phenylpropanolamine are being > recalled. You may want to try calling the 800 number listed on most > drug boxes and inquire about a REFUND. > > Please read this CAREFULLY, as I know that some of you may USE > some of these drugs (Alka Seltzer Plus for one). > > Also, please pass this on to everyone you know. STOP TAKING > anything containing this ingredient. It has been linked to > increased hemorrhagic stroke (bleeding in brain) among women ages > 18-49 in the three days after starting use of medication. Problems > were not found in men, but the FDA recommended that everyone (even > children) seek alternative medicine. > > The following medications contain Phenylpropanolamine: > Acutrim Diet Gum Appetite Suppressant Plus Dietary Supplements > Acutrim Maximum Strength Appetite Control > Alka-Seltzer Plus Children's Cold Medicine Effervescent > Alka-Seltzer Plus Cold medicine (cherry or orange) > Alka-Seltzer Plus Cold Medicine Original > Alka-Seltzer Plus Cold & Cough Medicine Effervescent > Alka-Seltzer Plus Cold & Flu Medicine Effervescent > Alka-Seltzer Plus Cold & Sinus Effervescent > Alka Seltzer Plus Night-Time Cold Medicine Effervescent > BC Allergy Sinus Cold Powder > BC Sinus Cold Powder > Comtrex Deep Chest Cold & Congestion Relief > Comtrex Flu Therapy & Fever Relief > Day & Night Contac 12-Hour Cold Capsules > Contac 12 Hour Caplets > Coricidin D Cold, Flu & Sinus > Dexatrim Caffeine Free > Dexatrim Extended Duration > Dexatrim Gelcaps > Dexatrim Vitamin C/Caffeine Free > Dimetapp Cold & Allergy Chewable Tablets > Dimetapp Cold & Cough Liqui-Gels > Dimetapp DM Cold & Cough Elixir > Dimetapp Elixir > Dimetapp 4 Hour Liquid Gels > Dimetapp 4 Hour Tablets > Dimetapp 12 Hour Extentabs Tablets > Naldecon DX Pediatric Drops > Permathene Mega-16 > Robitussin CF > Tavist-D 12 Hour Relief of Sinus & Nasal Congestion > Triaminic DM Cough Relief > Triaminic Expectorant Chest & Head Congestion > Triaminic Syrup Cold & Allergy > Triaminic Triaminicol Cold & Cough > > I just found out and called the 800# on the container for > Triaminic and they informed me that they are voluntarily recalling > the following medicines because of a certain ingredient that is > causing strokes and seizures in children: > > > Orange 3D Cold & Allergy Cherry (Pink) > 3D Cold & Cough Berry > 3D Cough Relief > Yellow 3D Expectorant > > > They are asking you to call them at 800-548-3708 with the lot number on the > box so they can send you postage for you to send it back to them, and they > will also issue you a refund. If you know of anyone else with small > children, > > To confirm these findings please take time to check the following URL: > www.fda.gov/cder/drug/infopage/ppa/default.htm > > -- End -- Return-Path: Received: from mb1i0.ns.pitt.edu (mb1i1.ns.pitt.edu [136.142.185.161]) by imap.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisimap-7.2.2.4) ID ; Thu, 31 Jan 2002 01:02:58 -0500 (EST) Received: from list.srv.cis.pitt.edu (majordom@[136.142.185.20]) by pitt.edu (PMDF V5.2-32 #41462) with ESMTP id <01KDPAUSHZRS00B0SZ@mb1i0.ns.pitt.edu>; Thu, 31 Jan 2002 01:02:50 EST Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.2) ID ; Thu, 31 Jan 2002 00:54:11 -0500 (EST) Received: from mail.iwvisp.com (pop3.iwvisp.com [198.77.196.6]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.2) ID for ; Thu, 31 Jan 2002 00:54:06 -0500 (EST) Received: from iwvisp.com ([198.77.198.149]) by mail.iwvisp.com with ESMTP (IOA-IPAD 2.54/96) id 9465000; Wed, 30 Jan 2002 22:02:34 -0800 Date: Wed, 30 Jan 2002 22:04:50 -0800 From: kit antonsen Subject: Re: W-EMED [OEM] Lancet: Hi Alt Pulm Edema in 75% of Climbers Sender: owner-wilderness-emergency-medicine@list.pitt.edu To: wilderness-emergency-medicine@list.pitt.edu Reply-to: wilderness-emergency-medicine@list.pitt.edu Message-id: <3C58DE7A.D077826A@iwvisp.com> MIME-version: 1.0 X-Mailer: Mozilla 4.72 (Macintosh; U; PPC) Content-type: text/plain; charset=us-ascii; x-mac-type="54455854"; x-mac-creator="4D4F5353" Content-transfer-encoding: 7bit Precedence: bulk X-Accept-Language: en References: <200201302255.RAA16348@web3.po.com> Sorry to come across a bit paranoid, but I went to the URL to check the article out and discovered I needed to 'become a member'. OK. But there doesn't seem to be any firm privacy policy. In these days of prolific spam, I don't jump in to giving my email address to a commercial group. Any reader comments on this site and whether or not their privacy policy is sound in spite of their lack of a statement at the login page? Charles Werntz wrote: > . . . > > http://www.thelancet.com/journal/vol359/iss9303/full/llan.359.9303.original_research.19184.1 > . . . Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- Return-Path: Received: from mb1i0.ns.pitt.edu (mb1i1.ns.pitt.edu [136.142.185.161]) by imap.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisimap-7.2.2.4) ID ; Wed, 30 Jan 2002 18:04:06 -0500 (EST) Received: from list.srv.cis.pitt.edu (majordom@[136.142.185.20]) by pitt.edu (PMDF V5.2-32 #41462) with ESMTP id <01KDOW8H4LV000AQTO@mb1i0.ns.pitt.edu>; Wed, 30 Jan 2002 18:03:59 EST Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.2) ID ; Wed, 30 Jan 2002 17:54:38 -0500 (EST) Received: from pol.net (sigma.po.com [64.74.36.80]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.2) ID for ; Wed, 30 Jan 2002 17:54:35 -0500 (EST) Received: from web3.po.com (web3.po.com [64.74.36.90]) by pol.net (8.9.3/8.8.8) with ESMTP id RAA02079 for ; Wed, 30 Jan 2002 17:55:33 -0500 (EST) Received: (from www@localhost) by web3.po.com (8.9.3+Sun/8.9.1) id RAA16348; Wed, 30 Jan 2002 17:55:33 -0500 (EST) Date: Wed, 30 Jan 2002 17:55:33 -0500 (EST) From: Charles Werntz Subject: W-EMED [OEM] Lancet: Hi Alt Pulm Edema in 75% of Climbers Sender: owner-wilderness-emergency-medicine@list.pitt.edu To: wilderness-emergency-medicine@list.pitt.edu Reply-to: wilderness-emergency-medicine@list.pitt.edu Message-id: <200201302255.RAA16348@web3.po.com> MIME-version: 1.0 Content-type: multipart/mixed; boundary="-------1012431186POLAAAIVa4fF" Content-transfer-encoding: 7bit Precedence: bulk X-Authentication-warning: web3.po.com: www set sender to cwerntz@pol.net using -f ---------1012431186POLAAAIVa4fF Content-Type: text/plain; charset=us-ascii Content-Transfer-Encoding: 7bit This article came across my occupational medicine list server and I thought it would be of interest to the list. As a flat-lander I will be even more careful when going to altitude! Carl Werntz, D.O. ---------1012431186POLAAAIVa4fF Content-Type: message/rfc822 Content-Transfer-Encoding: 7bit From: "Charles Werntz" To: Subject: Fwd: [OEM] Lancet: Hi Alt Pulm Edema in 75% of Climbers Date: 01/30/2002 03:44pm Content-Type: multipart/mixed; boundary="=_A3FECAF3.7A1B5C83" This is a MIME message. If you are reading this text, you may want to consider changing to a mail reader or gateway that understands how to properly handle MIME multipart messages. --=_A3FECAF3.7A1B5C83 Content-Type: text/plain; charset=US-ASCII Content-Transfer-Encoding: quoted-printable Content-Disposition: inline forward --=_A3FECAF3.7A1B5C83 Content-Type: message/rfc822 Received: from HSCNAVMAIL.hsc.wvu.edu by MAIL.hsc.wvu.edu; Sat, 26 Jan 2002 09:30:47 -0500 Received: from node2.hsc.wvu.edu ([10.2.2.32]) by HSCNAVMAIL.hsc.wvu.edu (NAVGW 2.5.1.12) with SMTP id M2002012609242303959 for ; Sat, 26 Jan 2002 09:24:23 -0500 Received: from thorin (thorin.mc.duke.edu [152.3.78.42]) by node2.hsc.wvu.edu (8.11.6/8.11.2) with SMTP id g0QEUOE17911 for ; Sat, 26 Jan 2002 09:30:24 -0500 Received: from horizon02.mc.duke.edu (horizon02.mc.duke.edu [152.3.78.239]) by thorin (8.12.1/8.12.1) with ESMTP id g0QEI7xY000946; Sat, 26 Jan 2002 09:18:07 -0500 (EST) Received: from horizon02.mc.duke.edu (localhost [127.0.0.1]) by horizon02.mc.duke.edu (8.11.1/8.11.1) with ESMTP id g0QEHio01262; Sat, 26 Jan 2002 09:17:44 -0500 (EST) Received: from durin.mc.duke.edu (durin.mc.duke.edu [152.3.78.41]) by horizon02.mc.duke.edu (8.11.1/8.11.1) with ESMTP id g0QE7Do00458; Sat, 26 Jan 2002 09:07:13 -0500 (EST) Received: from mail7.nc.rr.com (fe7.southeast.rr.com [24.93.67.54]) by durin.mc.duke.edu (8.12.1/8.12.1) with ESMTP id g0QE7XmR011808; Sat, 26 Jan 2002 09:07:33 -0500 (EST) Received: from Duke.edu ([66.57.12.169]) by mail7.nc.rr.com with Microsoft SMTPSVC(5.5.1877.687.68); Sat, 26 Jan 2002 09:07:12 -0500 Message-ID: <3C52B809.D963D5F0@Duke.edu> From: Gary Greenberg X-Mailer: Mozilla 4.78 [en] (Win98; U) X-Accept-Language: en MIME-Version: 1.0 To: OCC-ENV-MED-L Content-Type: text/plain; charset=us-ascii Content-Transfer-Encoding: 7bit Subject: [OEM] Lancet: Hi Alt Pulm Edema in 75% of Climbers Sender: occ-env-med-l-admin@mc.duke.edu Errors-To: occ-env-med-l-admin@mc.duke.edu X-BeenThere: occ-env-med-l@mc.duke.edu X-Mailman-Version: 2.0.1 Precedence: bulk List-Help: List-Post: List-Subscribe: , List-Id: Occupational & Environmental Medicine for Clinicians & Public Health Professionals List-Unsubscribe: , List-Archive: X-Original-Date: Sat, 26 Jan 2002 09:07:05 -0500 Date: Sat, 26 Jan 2002 09:07:05 -0500 Pulmonary extravascular fluid accumulation in recreational climbers: a prospective study http://www.thelancet.com/journal/vol359/iss9303/full/llan.359.9303.original_research.19184.1 George Cremona, Roberto Asnaghi, Paolo Baderna, Alessandro Brunetto, Tom Brutsaert, Carmelo Cavallaro, Timothy M Clark, Annalisa Cogo, Roberto Donis, Paola Lanfranchi, Andrew Luks, Nadia Novello, Stefano Panzetta, Liliana Perini, Marci Putnam, Liliana Spagnolatti, Harrieth Wagner, Peter D Wagner Unit of Respiratory Medicine, San Raffaele University Scientific Institute, Via Olgettina 60, 20132 Milano, Italy (G Cremona MD); Division of Physiology, Department of Medicine, University of California, San Diego La Jolla, CA, USA (T Brutsaert PhD , T M Clark MD, A Luks, M Putnam , H Wagner, Prof P D Wagner MD); Pulmonary and Radiological Divisions, "Salvatore Maugeri" Foundation Institute for Clinical Care and Research, Medical Center Veruno 28010, Italy (R Asnaghi MD, P Baderna MD, A Brunetto MD, C Cavallaro MD, R Donis, C F Donner, P Lanfranchi MD, N Novello MSc, S Panzetta, L Perini, L Spagnolatti MD); and Club Alpino Italiano and Pulmonary Division, University of Ferrara, Italy (A Cogo MD) Correspondence to: Dr George Cremona (e-mail:george.cremona@hsr.it) Summary Background High altitude pulmonary oedema (HAPE) that is severe enough to require urgent medical care is infrequent. We hypothesised that subclinical HAPE is far more frequent than suspected during even modest climbs of average effort. Methods We assessed 262 consecutive climbers of Monte Rosa (4559 m), before ascent and about 24 h later on the summit 1 h after arriving, by clinical examination, electrocardiography, oximetry, spirometry, carbon monoxide transfer, and closing volume. A chest radiograph was taken at altitude. Findings Only one climber was evacuated for HAPE, but 40 (15%) of 262 climbers had chest rales or interstitial oedema on radiograph after ascent. Of 37 of these climbers, 34 (92%) showed increased closing volume. Of the 197 climbers without oedema, 146 (74%) had an increase in closing volume at altitude. With no change in vital capacity, forced expiratory volume in 1 s and forced expiratory flow at 25-75% of forced vital capacity increased slightly at altitude, without evidence of oedema. If we assume that an increased closing volume at altitude indicates increased pulmonary extravascular fluid, our data suggest that three of every four healthy, recreational climbers have mild subclinical HAPE shortly after a modest climb. Interpretation The risk of HAPE might not be confined to a small group of genetically susceptible people, but likely exists for most climbers if the rate of ascent and degree of physical effort are great enough, especially if lung size is normal or low. Lancet 2002; 359: 303-309 -- Gary N. Greenberg, MD MPH Sysop / Moderator Occ-Env-Med-L MailList gary.greenberg@duke.edu Duke Occupat, Environ, Int & Fam Medicine OEM-L Maillist Website: http://occhealthnews.net ____Please_remove_this_footer_before_replying_____ Occ-Env-Med-L mailing list Broadcast address: Occ-Env-Med-L@mc.duke.edu Overview of this forum: http://mailman.mc.duke.edu/mailman/listinfo/occ-env-med-l - To manage your subscription (choose: on, off, digest), go to http://subscribe.occhealthnews.net - Today's Sponsor (not responsible for content): http://www.kodak.com/US/en/corp/environment/index.shtml Kodak Health Safety & Environment Program Our Commitment To make measurable improvements in the health, safety and environmental aspects of our products, services, and operations...every day...every month...every year. --=_A3FECAF3.7A1B5C83-- ---------1012431186POLAAAIVa4fF-- Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- Return-Path: Received: from mb2i0.ns.pitt.edu (mb2i1.ns.pitt.edu [136.142.185.162]) by imap.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisimap-7.2.2.4) ID ; Sat, 26 Jan 2002 10:28:08 -0500 (EST) Received: from list.srv.cis.pitt.edu (majordom@[136.142.185.20]) by pitt.edu (PMDF V5.2-32 #41462) with ESMTP id <01KDIV5HMU5S003M2Q@mb2i0.ns.pitt.edu>; Sat, 26 Jan 2002 10:28:35 EST Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.2) ID ; Sat, 26 Jan 2002 10:19:30 -0500 (EST) Received: from quark.look.ca (quark.look.ca [207.136.80.22]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.2) ID for ; Sat, 26 Jan 2002 10:19:27 -0500 (EST) Received: from [216.66.146.182] (helo=wildmedic.org) by quark with esmtp (Exim 3.32 #9) id 16UUjU-0002iQ-00 for wilderness-emergency-medicine@list.pitt.edu; Sat, 26 Jan 2002 15:27:09 +0000 Date: Sat, 26 Jan 2002 07:25:42 -0800 From: Jel Coward Subject: W-EMED Avalanche resus guidelines Sender: owner-wilderness-emergency-medicine@list.pitt.edu To: wilderness-emergency-medicine@list.pitt.edu Reply-to: wilderness-emergency-medicine@list.pitt.edu Message-id: MIME-version: 1.0 X-Mailer: Turnpike Integrated Version 5.01 U Precedence: bulk Hi all I think there are guidelines for deciding on when to attempt resuscitation following avalanche burial - or, more likely, when not Does anyone know where I could access something like this please? Many thanks :) -- Jel Coward The UK Wilderness Emergency Medical Technician and Command Physician course is 10-16th November 2002 at Glenmore Lodge, Aviemore, Scotland http://www.wildmedic.org http://www.wemsi.org jel@wildmedic.org 'There's no such thing as bad weather - just bad clothing" Anon Norwegian Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- Return-Path: Received: from mb1i0.ns.pitt.edu (mb1i1.ns.pitt.edu [136.142.185.161]) by imap.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisimap-7.2.2.4) ID ; Tue, 22 Jan 2002 22:46:38 -0500 (EST) Received: from list.srv.cis.pitt.edu (majordom@[136.142.185.20]) by pitt.edu (PMDF V5.2-32 #41462) with ESMTP id <01KDDZR1GH0200ACBY@mb1i0.ns.pitt.edu>; Tue, 22 Jan 2002 22:46:31 EST Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.2) ID ; Tue, 22 Jan 2002 22:38:51 -0500 (EST) Received: from home.positech.net ([65.215.191.253]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.2) ID for ; Tue, 22 Jan 2002 22:38:41 -0500 (EST) Received: from morgan (buffalo-0-190-134.positech.net [65.215.190.134]) by home.positech.net (8.11.4/8.11.1) with SMTP id g0N3l6w07133 for ; Tue, 22 Jan 2002 21:47:06 -0600 Date: Tue, 22 Jan 2002 21:45:49 -0600 From: Morgan Young Subject: RE: W-EMED forwarded from Steven Pirie (tried to post from a non-member address) In-reply-to: <14e.7a33676.297f7652@aol.com> Sender: owner-wilderness-emergency-medicine@list.pitt.edu To: wilderness-emergency-medicine@list.pitt.edu Reply-to: wilderness-emergency-medicine@list.pitt.edu Message-id: <000301c1a3c0$72d08100$86bed741@morgan> MIME-version: 1.0 X-MIMEOLE: Produced By Microsoft MimeOLE V6.00.2600.0000 X-Mailer: Microsoft Outlook 8.5, Build 4.71.2173.0 Content-type: text/plain; charset="iso-8859-1" Content-transfer-encoding: 7bit Importance: Normal X-Priority: 3 (Normal) X-MSMail-priority: Normal Precedence: bulk nope, but as a Visor Platinum owner, and a Visor Deluxe Maintainer (My wife's) I am very interested in it. Morgan Young, CCEMT-P/FF theonlymorgan2@yahoo.com 4178727339@message.alltel.com -----Original Message----- From: owner-wilderness-emergency-medicine@list.pitt.edu [mailto:owner-wilderness-emergency-medicine@list.pitt.edu]On Behalf Of Omikid@aol.com Sent: Tuesday, January 22, 2002 20:14 To: wilderness-emergency-medicine@list.pitt.edu Subject: RE: W-EMED forwarded from Steven Pirie (tried to post from a non-member address) Not that I think that it would be as good as a 12 lead, or that I would give lytics on it, but but has anyone checked into or played with the Visor EKG cartridge? I have seen reviews on it, and saw a pic. on the internet. Just curious, Omi Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- Return-Path: Received: from mb1i0.ns.pitt.edu (mb1i1.ns.pitt.edu [136.142.185.161]) by imap.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisimap-7.2.2.4) ID ; Tue, 22 Jan 2002 22:46:38 -0500 (EST) Received: from list.srv.cis.pitt.edu (majordom@[136.142.185.20]) by pitt.edu (PMDF V5.2-32 #41462) with ESMTP id <01KDDZR1GH0200ACBY@mb1i0.ns.pitt.edu>; Tue, 22 Jan 2002 22:46:31 EST Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.2) ID ; Tue, 22 Jan 2002 22:38:51 -0500 (EST) Received: from home.positech.net ([65.215.191.253]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.2) ID for ; Tue, 22 Jan 2002 22:38:41 -0500 (EST) Received: from morgan (buffalo-0-190-134.positech.net [65.215.190.134]) by home.positech.net (8.11.4/8.11.1) with SMTP id g0N3l6w07133 for ; Tue, 22 Jan 2002 21:47:06 -0600 Date: Tue, 22 Jan 2002 21:45:49 -0600 From: Morgan Young Subject: RE: W-EMED forwarded from Steven Pirie (tried to post from a non-member address) In-reply-to: <14e.7a33676.297f7652@aol.com> Sender: owner-wilderness-emergency-medicine@list.pitt.edu To: wilderness-emergency-medicine@list.pitt.edu Reply-to: wilderness-emergency-medicine@list.pitt.edu Message-id: <000301c1a3c0$72d08100$86bed741@morgan> MIME-version: 1.0 X-MIMEOLE: Produced By Microsoft MimeOLE V6.00.2600.0000 X-Mailer: Microsoft Outlook 8.5, Build 4.71.2173.0 Content-type: text/plain; charset="iso-8859-1" Content-transfer-encoding: 7bit Importance: Normal X-Priority: 3 (Normal) X-MSMail-priority: Normal Precedence: bulk nope, but as a Visor Platinum owner, and a Visor Deluxe Maintainer (My wife's) I am very interested in it. Morgan Young, CCEMT-P/FF theonlymorgan2@yahoo.com 4178727339@message.alltel.com -----Original Message----- From: owner-wilderness-emergency-medicine@list.pitt.edu [mailto:owner-wilderness-emergency-medicine@list.pitt.edu]On Behalf Of Omikid@aol.com Sent: Tuesday, January 22, 2002 20:14 To: wilderness-emergency-medicine@list.pitt.edu Subject: RE: W-EMED forwarded from Steven Pirie (tried to post from a non-member address) Not that I think that it would be as good as a 12 lead, or that I would give lytics on it, but but has anyone checked into or played with the Visor EKG cartridge? I have seen reviews on it, and saw a pic. on the internet. Just curious, Omi Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- Return-Path: Received: from mb1i0.ns.pitt.edu (mb1i1.ns.pitt.edu [136.142.185.161]) by imap.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisimap-7.2.2.4) ID ; Tue, 22 Jan 2002 21:15:23 -0500 (EST) Received: from list.srv.cis.pitt.edu (majordom@[136.142.185.20]) by pitt.edu (PMDF V5.2-32 #41462) with ESMTP id <01KDDWKWKD2Q00AEJC@mb1i0.ns.pitt.edu>; Tue, 22 Jan 2002 21:15:17 EST Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.2) ID ; Tue, 22 Jan 2002 21:07:06 -0500 (EST) Received: from imo-m08.mx.aol.com (imo-m08.mx.aol.com [64.12.136.163]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.2) ID for ; Tue, 22 Jan 2002 21:07:04 -0500 (EST) Received: from Omikid@aol.com by imo-m08.mx.aol.com (mail_out_v31_r1.25.) id h.14e.7a33676 (15870) for ; Tue, 22 Jan 2002 21:13:38 -0500 (EST) Received: from web38.aolmail.aol.com (web38.aolmail.aol.com [205.188.222.14]) by air-id06.mx.aol.com (v82.22) with ESMTP id MAILINID69-0122211338; Tue, 22 Jan 2002 21:13:38 -0500 Date: Tue, 22 Jan 2002 21:13:38 -0500 (EST) From: Omikid@aol.com Subject: RE: W-EMED forwarded from Steven Pirie (tried to post from a non-member address) Sender: owner-wilderness-emergency-medicine@list.pitt.edu To: wilderness-emergency-medicine@list.pitt.edu Reply-to: wilderness-emergency-medicine@list.pitt.edu Message-id: <14e.7a33676.297f7652@aol.com> MIME-version: 1.0 X-Mailer: Unknown (No Version) Content-type: text/plain; charset=ISO-8859-1 Content-transfer-encoding: 7bit Precedence: bulk Not that I think that it would be as good as a 12 lead, or that I would give lytics on it, but but has anyone checked into or played with the Visor EKG cartridge? I have seen reviews on it, and saw a pic. on the internet. Just curious, Omi Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- Return-Path: Received: from mb1i0.ns.pitt.edu (mb1i1.ns.pitt.edu [136.142.185.161]) by imap.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisimap-7.2.2.4) ID ; Tue, 22 Jan 2002 21:15:23 -0500 (EST) Received: from list.srv.cis.pitt.edu (majordom@[136.142.185.20]) by pitt.edu (PMDF V5.2-32 #41462) with ESMTP id <01KDDWKWKD2Q00AEJC@mb1i0.ns.pitt.edu>; Tue, 22 Jan 2002 21:15:17 EST Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.2) ID ; Tue, 22 Jan 2002 21:07:06 -0500 (EST) Received: from imo-m08.mx.aol.com (imo-m08.mx.aol.com [64.12.136.163]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.2) ID for ; Tue, 22 Jan 2002 21:07:04 -0500 (EST) Received: from Omikid@aol.com by imo-m08.mx.aol.com (mail_out_v31_r1.25.) id h.14e.7a33676 (15870) for ; Tue, 22 Jan 2002 21:13:38 -0500 (EST) Received: from web38.aolmail.aol.com (web38.aolmail.aol.com [205.188.222.14]) by air-id06.mx.aol.com (v82.22) with ESMTP id MAILINID69-0122211338; Tue, 22 Jan 2002 21:13:38 -0500 Date: Tue, 22 Jan 2002 21:13:38 -0500 (EST) From: Omikid@aol.com Subject: RE: W-EMED forwarded from Steven Pirie (tried to post from a non-member address) Sender: owner-wilderness-emergency-medicine@list.pitt.edu To: wilderness-emergency-medicine@list.pitt.edu Reply-to: wilderness-emergency-medicine@list.pitt.edu Message-id: <14e.7a33676.297f7652@aol.com> MIME-version: 1.0 X-Mailer: Unknown (No Version) Content-type: text/plain; charset=ISO-8859-1 Content-transfer-encoding: 7bit Precedence: bulk Not that I think that it would be as good as a 12 lead, or that I would give lytics on it, but but has anyone checked into or played with the Visor EKG cartridge? I have seen reviews on it, and saw a pic. on the internet. Just curious, Omi Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- Return-Path: Received: from mb1i0.ns.pitt.edu (mb1i1.ns.pitt.edu [136.142.185.161]) by imap.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisimap-7.2.2.4) ID ; Tue, 22 Jan 2002 19:11:11 -0500 (EST) Received: from list.srv.cis.pitt.edu (majordom@[136.142.185.20]) by pitt.edu (PMDF V5.2-32 #41462) with ESMTP id <01KDDS8UEZMS00A4AC@mb1i0.ns.pitt.edu>; Tue, 22 Jan 2002 19:11:02 EST Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.2) ID ; Tue, 22 Jan 2002 19:02:09 -0500 (EST) Received: from home.positech.net ([65.215.191.253]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.2) ID for ; Tue, 22 Jan 2002 19:02:06 -0500 (EST) Received: from morgan (buffalo-0-190-175.positech.net [65.215.190.175]) by home.positech.net (8.11.4/8.11.1) with SMTP id g0N0ATw87086 for ; Tue, 22 Jan 2002 18:10:30 -0600 Date: Tue, 22 Jan 2002 18:09:18 -0600 From: Morgan Young Subject: RE: W-EMED forwarded from Steven Pirie (tried to post from a non-member address) In-reply-to: <3C4D8534.11764.10D18B5@localhost> Sender: owner-wilderness-emergency-medicine@list.pitt.edu To: wilderness-emergency-medicine@list.pitt.edu Reply-to: wilderness-emergency-medicine@list.pitt.edu Message-id: <000201c1a3a2$33425860$afbed741@morgan> MIME-version: 1.0 X-MIMEOLE: Produced By Microsoft MimeOLE V6.00.2600.0000 X-Mailer: Microsoft Outlook 8.5, Build 4.71.2173.0 Content-type: text/plain; charset="iso-8859-1" Content-transfer-encoding: 7bit Importance: Normal X-Priority: 3 (Normal) X-MSMail-priority: Normal Precedence: bulk Wow, What a question. No I would not consider this in a wilderness type setting. I would consider this with Postive 12 Lead, Postive Exam, and no contraindications for fibronlytics, for a cardiac Pt. but I don't expect to have my trusty LifePak 12 in my BackPack, so I have Never considered this before. Please Keep in mind that wow, was amazement, not a "Flame". Morgan Young, CCEMT-P/FF theonlymorgan2@yahoo.com 4178727339@message.alltel.com -----Original Message----- From: owner-wilderness-emergency-medicine@list.pitt.edu [mailto:owner-wilderness-emergency-medicine@list.pitt.edu]On Behalf Of Keith Conover, M.D., FACEP Sent: Tuesday, January 22, 2002 14:29 To: wilderness-emergency-medicine@list.pitt.edu Subject: W-EMED forwarded from Steven Pirie (tried to post from a non-member address) Hello, I have a quick question for the collective knowledge of the group... I know Eminase as been bantered about (mostly over a beer) as a "one shot" wilderness lytic. What is the groups current thought on using TNK (a t-PA like drug) in the field both for AMI (unconfirmed due to the lack of a 15 Lead EKG) and CVA (with the risk of hemorrhagic stoke versus ischemic stoke)? I have this picture of the 32 year old female, 20 hours from the nearest CT Scanner. On BCP and a smoker without any other meds or co- morbidities. Presents with CVA symptoms.... No hx of trauma. Would you contemplate TNK in the field? We know that 15% of stokes are hemorragic and 85% are not (although I cannot find the reference right now). How about a AMI with a "clasical" (if there is such a thing) presentation? Look forward to your input... Cheers, Steven --Keith Conover, M.D., FACEP http://www.pitt.edu/~kconover sent with Pegasus high-security email download free from www.pmail.com Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- Return-Path: Received: from mb1i0.ns.pitt.edu (mb1i1.ns.pitt.edu [136.142.185.161]) by imap.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisimap-7.2.2.4) ID ; Tue, 22 Jan 2002 19:11:11 -0500 (EST) Received: from list.srv.cis.pitt.edu (majordom@[136.142.185.20]) by pitt.edu (PMDF V5.2-32 #41462) with ESMTP id <01KDDS8UEZMS00A4AC@mb1i0.ns.pitt.edu>; Tue, 22 Jan 2002 19:11:02 EST Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.2) ID ; Tue, 22 Jan 2002 19:02:09 -0500 (EST) Received: from home.positech.net ([65.215.191.253]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.2) ID for ; Tue, 22 Jan 2002 19:02:06 -0500 (EST) Received: from morgan (buffalo-0-190-175.positech.net [65.215.190.175]) by home.positech.net (8.11.4/8.11.1) with SMTP id g0N0ATw87086 for ; Tue, 22 Jan 2002 18:10:30 -0600 Date: Tue, 22 Jan 2002 18:09:18 -0600 From: Morgan Young Subject: RE: W-EMED forwarded from Steven Pirie (tried to post from a non-member address) In-reply-to: <3C4D8534.11764.10D18B5@localhost> Sender: owner-wilderness-emergency-medicine@list.pitt.edu To: wilderness-emergency-medicine@list.pitt.edu Reply-to: wilderness-emergency-medicine@list.pitt.edu Message-id: <000201c1a3a2$33425860$afbed741@morgan> MIME-version: 1.0 X-MIMEOLE: Produced By Microsoft MimeOLE V6.00.2600.0000 X-Mailer: Microsoft Outlook 8.5, Build 4.71.2173.0 Content-type: text/plain; charset="iso-8859-1" Content-transfer-encoding: 7bit Importance: Normal X-Priority: 3 (Normal) X-MSMail-priority: Normal Precedence: bulk Wow, What a question. No I would not consider this in a wilderness type setting. I would consider this with Postive 12 Lead, Postive Exam, and no contraindications for fibronlytics, for a cardiac Pt. but I don't expect to have my trusty LifePak 12 in my BackPack, so I have Never considered this before. Please Keep in mind that wow, was amazement, not a "Flame". Morgan Young, CCEMT-P/FF theonlymorgan2@yahoo.com 4178727339@message.alltel.com -----Original Message----- From: owner-wilderness-emergency-medicine@list.pitt.edu [mailto:owner-wilderness-emergency-medicine@list.pitt.edu]On Behalf Of Keith Conover, M.D., FACEP Sent: Tuesday, January 22, 2002 14:29 To: wilderness-emergency-medicine@list.pitt.edu Subject: W-EMED forwarded from Steven Pirie (tried to post from a non-member address) Hello, I have a quick question for the collective knowledge of the group... I know Eminase as been bantered about (mostly over a beer) as a "one shot" wilderness lytic. What is the groups current thought on using TNK (a t-PA like drug) in the field both for AMI (unconfirmed due to the lack of a 15 Lead EKG) and CVA (with the risk of hemorrhagic stoke versus ischemic stoke)? I have this picture of the 32 year old female, 20 hours from the nearest CT Scanner. On BCP and a smoker without any other meds or co- morbidities. Presents with CVA symptoms.... No hx of trauma. Would you contemplate TNK in the field? We know that 15% of stokes are hemorragic and 85% are not (although I cannot find the reference right now). How about a AMI with a "clasical" (if there is such a thing) presentation? Look forward to your input... Cheers, Steven --Keith Conover, M.D., FACEP http://www.pitt.edu/~kconover sent with Pegasus high-security email download free from www.pmail.com Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- Return-Path: Received: from mb2i0.ns.pitt.edu (mb2i1.ns.pitt.edu [136.142.185.162]) by imap.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisimap-7.2.2.4) ID ; Tue, 22 Jan 2002 18:04:26 -0500 (EST) Received: from list.srv.cis.pitt.edu (majordom@[136.142.185.20]) by pitt.edu (PMDF V5.2-32 #41462) with ESMTP id <01KDDPWRV22A002DTI@mb2i0.ns.pitt.edu>; Tue, 22 Jan 2002 18:04:49 EST Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.2) ID ; Tue, 22 Jan 2002 17:56:45 -0500 (EST) Received: from web2.po.com (web2.po.com [64.74.36.72]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.2) ID for ; Tue, 22 Jan 2002 17:56:42 -0500 (EST) Received: (from www@localhost) by web2.po.com (8.8.8+Sun/8.8.8) id RAA00099; Tue, 22 Jan 2002 17:56:21 -0500 (EST) Date: Tue, 22 Jan 2002 17:56:21 -0500 (EST) From: Charles Werntz Subject: W-EMED re: wilderness thrombolytics Sender: owner-wilderness-emergency-medicine@list.pitt.edu To: wilderness-emergency-medicine@list.pitt.edu Reply-to: wilderness-emergency-medicine@list.pitt.edu Message-id: <200201222256.RAA00099@web2.po.com> MIME-version: 1.0 Content-type: text/plain Content-transfer-encoding: 7bit Precedence: bulk X-Authentication-warning: web2.po.com: www set sender to cwerntz@pol.net using -f Two thoughts on wilderness thrombolytics: 1. Admittedly, the use of a drug which might reverse this hypothetical patient's problem is alluring. It should be noted that the studies of systemic thrombolysis for stoke patents have been mixed (as opposed to local thrombolysis administered to the site of the clot, which seems to have better outcomes.) One of the key tenents of medicine is "Do no harm". Without the proper diagnostic workup, I would not be comfortable using a medication with such a significant inherent risk of perminant side effects. 2. Ignoring the medical considerations, I do not know the cost of TNK, but if it is anything like t-PA I suspect that having that vial in your pack would cost more than the rest of the trip (including the airfare to Nepal). Just one opinion, Carl Werntz, D.O. Mountaineer Area Rescue Group ------------------ Reply Separator -------------------- Originally From: "Keith Conover, M.D., FACEP" Subject: W-EMED forwarded from Steven Pirie (tried to post from a non- member address) Date: 01/22/2002 03:28pm Hello, I have a quick question for the collective knowledge of the group... I know Eminase as been bantered about (mostly over a beer) as a "one shot" wilderness lytic. What is the groups current thought on using TNK (a t-PA like drug) in the field both for AMI (unconfirmed due to the lack of a 15 Lead EKG) and CVA (with the risk of hemorrhagic stoke versus ischemic stoke)? I have this picture of the 32 year old female, 20 hours from the nearest CT Scanner. On BCP and a smoker without any other meds or co- morbidities. Presents with CVA symptoms.... No hx of trauma. Would you contemplate TNK in the field? We know that 15% of stokes are hemorragic and 85% are not (although I cannot find the reference right now). How about a AMI with a "clasical" (if there is such a thing) presentation? Look forward to your input... Cheers, Steven Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- Return-Path: Received: from mb2i0.ns.pitt.edu (mb2i1.ns.pitt.edu [136.142.185.162]) by imap.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisimap-7.2.2.4) ID ; Tue, 22 Jan 2002 18:04:26 -0500 (EST) Received: from list.srv.cis.pitt.edu (majordom@[136.142.185.20]) by pitt.edu (PMDF V5.2-32 #41462) with ESMTP id <01KDDPWRV22A002DTI@mb2i0.ns.pitt.edu>; Tue, 22 Jan 2002 18:04:49 EST Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.2) ID ; Tue, 22 Jan 2002 17:56:45 -0500 (EST) Received: from web2.po.com (web2.po.com [64.74.36.72]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.2) ID for ; Tue, 22 Jan 2002 17:56:42 -0500 (EST) Received: (from www@localhost) by web2.po.com (8.8.8+Sun/8.8.8) id RAA00099; Tue, 22 Jan 2002 17:56:21 -0500 (EST) Date: Tue, 22 Jan 2002 17:56:21 -0500 (EST) From: Charles Werntz Subject: W-EMED re: wilderness thrombolytics Sender: owner-wilderness-emergency-medicine@list.pitt.edu To: wilderness-emergency-medicine@list.pitt.edu Reply-to: wilderness-emergency-medicine@list.pitt.edu Message-id: <200201222256.RAA00099@web2.po.com> MIME-version: 1.0 Content-type: text/plain Content-transfer-encoding: 7bit Precedence: bulk X-Authentication-warning: web2.po.com: www set sender to cwerntz@pol.net using -f Two thoughts on wilderness thrombolytics: 1. Admittedly, the use of a drug which might reverse this hypothetical patient's problem is alluring. It should be noted that the studies of systemic thrombolysis for stoke patents have been mixed (as opposed to local thrombolysis administered to the site of the clot, which seems to have better outcomes.) One of the key tenents of medicine is "Do no harm". Without the proper diagnostic workup, I would not be comfortable using a medication with such a significant inherent risk of perminant side effects. 2. Ignoring the medical considerations, I do not know the cost of TNK, but if it is anything like t-PA I suspect that having that vial in your pack would cost more than the rest of the trip (including the airfare to Nepal). Just one opinion, Carl Werntz, D.O. Mountaineer Area Rescue Group ------------------ Reply Separator -------------------- Originally From: "Keith Conover, M.D., FACEP" Subject: W-EMED forwarded from Steven Pirie (tried to post from a non- member address) Date: 01/22/2002 03:28pm Hello, I have a quick question for the collective knowledge of the group... I know Eminase as been bantered about (mostly over a beer) as a "one shot" wilderness lytic. What is the groups current thought on using TNK (a t-PA like drug) in the field both for AMI (unconfirmed due to the lack of a 15 Lead EKG) and CVA (with the risk of hemorrhagic stoke versus ischemic stoke)? I have this picture of the 32 year old female, 20 hours from the nearest CT Scanner. On BCP and a smoker without any other meds or co- morbidities. Presents with CVA symptoms.... No hx of trauma. Would you contemplate TNK in the field? We know that 15% of stokes are hemorragic and 85% are not (although I cannot find the reference right now). How about a AMI with a "clasical" (if there is such a thing) presentation? Look forward to your input... Cheers, Steven Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- Return-Path: Received: from mb2i0.ns.pitt.edu (mb2i1.ns.pitt.edu [136.142.185.162]) by imap.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisimap-7.2.2.4) ID ; Tue, 22 Jan 2002 15:29:47 -0500 (EST) Received: from list.srv.cis.pitt.edu (majordom@[136.142.185.20]) by pitt.edu (PMDF V5.2-32 #41462) with ESMTP id <01KDDKIY6JWS003DQL@mb2i0.ns.pitt.edu>; Tue, 22 Jan 2002 15:30:07 EST Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.2) ID ; Tue, 22 Jan 2002 15:21:47 -0500 (EST) Received: from out019.verizon.net (out019pub.verizon.net [206.46.170.98]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.2) ID for ; Tue, 22 Jan 2002 15:21:44 -0500 (EST) Received: from Micron ([141.158.127.220]) by out019.verizon.net (InterMail vM.5.01.04.02 201-253-122-122-102-20011128) with ESMTP id <20020122202856.HFMG9107.out019.verizon.net@Micron> for ; Tue, 22 Jan 2002 14:28:56 -0600 Date: Tue, 22 Jan 2002 15:28:52 -0500 From: "Keith Conover, M.D., FACEP" Subject: W-EMED forwarded from Steven Pirie (tried to post from a non-member address) Sender: owner-wilderness-emergency-medicine@list.pitt.edu To: wilderness-emergency-medicine@list.pitt.edu Reply-to: wilderness-emergency-medicine@list.pitt.edu Message-id: <3C4D8534.11764.10D18B5@localhost> MIME-version: 1.0 X-Mailer: Pegasus Mail for Windows (v4.01) Content-type: text/plain; charset=US-ASCII Content-description: Mail message body Content-transfer-encoding: 7BIT Precedence: bulk Hello, I have a quick question for the collective knowledge of the group... I know Eminase as been bantered about (mostly over a beer) as a "one shot" wilderness lytic. What is the groups current thought on using TNK (a t-PA like drug) in the field both for AMI (unconfirmed due to the lack of a 15 Lead EKG) and CVA (with the risk of hemorrhagic stoke versus ischemic stoke)? I have this picture of the 32 year old female, 20 hours from the nearest CT Scanner. On BCP and a smoker without any other meds or co- morbidities. Presents with CVA symptoms.... No hx of trauma. Would you contemplate TNK in the field? We know that 15% of stokes are hemorragic and 85% are not (although I cannot find the reference right now). How about a AMI with a "clasical" (if there is such a thing) presentation? Look forward to your input... Cheers, Steven --Keith Conover, M.D., FACEP http://www.pitt.edu/~kconover sent with Pegasus high-security email download free from www.pmail.com Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- Return-Path: Received: from mb2i0.ns.pitt.edu (mb2i1.ns.pitt.edu [136.142.185.162]) by imap.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisimap-7.2.2.4) ID ; Mon, 21 Jan 2002 18:31:24 -0500 (EST) Received: from list.srv.cis.pitt.edu (majordom@[136.142.185.20]) by pitt.edu (PMDF V5.2-32 #41462) with ESMTP id <01KDCCKU04J4000BBE@mb2i0.ns.pitt.edu>; Mon, 21 Jan 2002 18:31:46 EST Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.2) ID ; Mon, 21 Jan 2002 18:23:39 -0500 (EST) Received: from mb1i0.ns.pitt.edu (mb1i1.ns.pitt.edu [136.142.185.161]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.2) ID for ; Mon, 21 Jan 2002 18:23:37 -0500 (EST) Received: from skyline ("port 1038"@[136.142.20.101]) by pitt.edu (PMDF V5.2-32 #41462) with SMTP id <01KDCCJ8EULM00A4KG@mb1i0.ns.pitt.edu> for wilderness-emergency-medicine@list.pitt.edu; Mon, 21 Jan 2002 18:30:31 -0500 (EST) Date: Mon, 21 Jan 2002 18:37:03 -0800 From: "Suzanne M. Atkinson" Subject: Re: W-EMED Flexeril Sender: owner-wilderness-emergency-medicine@list.pitt.edu To: wilderness-emergency-medicine@list.pitt.edu Reply-to: wilderness-emergency-medicine@list.pitt.edu Message-id: <002501c1a2ed$ae35e100$6cb5fea9@skyline> MIME-version: 1.0 X-MIMEOLE: Produced By Microsoft MimeOLE V5.50.4133.2400 X-Mailer: Microsoft Outlook Express 5.50.4133.2400 Content-type: text/plain; charset="iso-8859-1" Content-transfer-encoding: 7bit X-Priority: 3 X-MSMail-priority: Normal Precedence: bulk References: <3C4B3FE9.5967.2B78B06@localhost> I had an experience in which taking Flexeril dramatically INCREASED my pain to an near unbearable point. My thinking is that my whole back was trying to compensate for a strain in one small area in order to protect that joint area. When I took the flexeril, the larger back muscles were unable to compensate for the strain in the smaller muscles and the pain increased. So now I am very careful if & when I take it. Suzanne Atkinson ----- Original Message ----- From: "Keith Conover, M.D., FACEP" To: Sent: Sunday, January 20, 2002 7:08 PM Subject: W-EMED Flexeril > In past editions of the Personal Wilderness Medical Kit List > published at www.wemsi.org, we had recommended including the "muscle > relaxant" cyclobenzaprine (e.g., Flexeril) as an adjunct to the > treatmen of muscle strains (e.g., neck and back strains). > > However, looking at the original studies of cyclobenzaprine from a > modern evidence-based view, you can't really tell much about whether > it really works or not. > > We just completed a study at the Mercy Hospital of Pittsburgh to > actually look at this in a prospective, double-blind, placebo- > controlled fashion. While I would caution the academics among us to > await publication for peer review, as one who was not one of the > investigators but looked at the study design, it seems excellent. > > Finding: adding cyclobenzaprine (e.g., Flexeril) to ibuprofen did not > decrease pain but did make people groggy, at least in ED patients > with back/neck strain. > > Based on this, I will recommend that people not include > cyclobenzaprine (e.g., Flexeril) in their wilderness medical kits. > Given the suspicion that it didn't work, cyclobenzaprine had already > been removed from the WEMSI Personal Wilderness Medical Kit list in > its latest incarnation (2.0), available at http://www.wemsi.org. > > Take care. > --Keith Conover, M.D., FACEP > http://www.pitt.edu/~kconover > sent with Pegasus high-security email > download free from www.pmail.com > > Do not reproduce without author's express permission. > To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" > as the body of a message (no subject) To: Majordomo@list.pitt.edu > Submissions To: wilderness-emergency-medicine@list.pitt.edu > Do not reproduce without author's express permission. 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