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, 19 Dec 2000 08:09:53 -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 <01JXVQVCTV6O002M4I@mb1i0.ns.pitt.edu>; Tue, 19 Dec 2000 08:09:54 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, 19 Dec 2000 08:08:40 -0500 (EST) Received: from gtei1.bellatlantic.net ([199.45.40.145]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.2) ID for ; Tue, 19 Dec 2000 08:08:37 -0500 (EST) Received: from Micron (adsl-141-151-144-199.bellatlantic.net [141.151.144.199]) by gtei1.bellatlantic.net (8.9.1/8.9.1) with ESMTP id IAA26889 for ; Tue, 19 Dec 2000 08:08:29 -0500 (EST) Date: Tue, 19 Dec 2000 08:08:36 -0500 From: "Keith Conover, M.D., FACEP" Subject: W-EMED kitchen sink kits 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: <3A3F1784.3579.273FCD8@localhost> MIME-version: 1.0 X-Mailer: Pegasus Mail for Win32 (v3.12c) Content-type: text/plain; charset=US-ASCII Content-transfer-encoding: 7BIT Precedence: bulk ust a Majordomo note, which will explain why I had to forward this: if you put words like can cel, or su b s cribe, or un su b sc ribe, in the first few lines of Majordomo, it'll bounce the message to the listowner. This may seem stupid behaviour at first, but after thinking about all the silly messages to the wrong address that the list has been spared, it actually seems fairly smart. (If only it could detect the spam, too . . . . ) (forwarded with an edit) From: monica curry Subject: Re: W-EMED Re:Wilderness Airway kit To: wilderness-emergency-medicine@list.pitt.edu question: does the amount of water you need to carry to reconstitute the anaesthesiologist can-cel the effectiveness of this method? any guesses on the shelf life of product? long night, no sleep...... > Kitchen Sink: take one anaesthesiologist with lots of trauma > experience. Ask him or her to get everything he or she might need > for a bad airway -- gum elastic bougie, LMA, retrograde kit, Shouldn't be a problem. As long you choose residents, the chance to sleep for an unlimited time would probably be a great improvement over their usual state, so shelf life should be OK. And being compressed into a little foil package shouldn't be a problem, considering all the places I remember sleeping as an intern. Might be a problem for the equipment, though -- --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 ; Sat, 16 Dec 2000 18:44:33 -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 <01JXS665XVTM002CO0@mb1i0.ns.pitt.edu>; Sat, 16 Dec 2000 18:44:33 EST Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.2) ID ; Sat, 16 Dec 2000 18:44:20 -0500 (EST) Received: from postmaster.enron.com (outbound5.enron.com [192.152.140.9]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.2) ID for ; Sat, 16 Dec 2000 18:44:17 -0500 (EST) Received: from nahou-msmsw01px.corp.enron.com ([172.28.10.37]) by postmaster.enron.com (8.8.8/8.8.8/postmaster-1.00) with ESMTP id XAA25631 for ; Sat, 16 Dec 2000 23:43:36 +0000 (GMT) Received: from ectlon-ln1.nt.enron.co.uk (unverified) by nahou-msmsw01px.corp.enron.com (Content Technologies SMTPRS 4.1.5) with ESMTP id ; Sat, 16 Dec 2000 17:43:36 -0600 Received: from space4 ([63.30.197.34]) by ectlon-ln1.nt.enron.co.uk (Lotus Domino Release 5.0.1 (Intl)) with SMTP id 2000121623401390:12200 ; Sat, 16 Dec 2000 23:40:13 +0000 Date: Sat, 16 Dec 2000 23:40:15 +0000 From: No-Qualifying-Zero-Down-Homes@lanmore.ac.uk Subject: W-EMED RETIRE in 5 years on Real Estate Wealth w/o $0 DOWN & NO QUALIFYING MORTGAGES ! 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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 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, 16 Dec 2000 17:19:28 -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 <01JXS36OXIXA00401Z@mb2i0.ns.pitt.edu>; Sat, 16 Dec 2000 17:19:28 EST Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.2) ID ; Sat, 16 Dec 2000 17:16:48 -0500 (EST) Received: from smtp02.mrf.mail.rcn.net (smtp02.mrf.mail.rcn.net [207.172.4.61]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.2) ID for ; Sat, 16 Dec 2000 17:16:45 -0500 (EST) Received: from 207-172-77-42.s42.tnt1.lee.va.dialup.rcn.com ([207.172.77.42] helo=erols.com) by smtp02.mrf.mail.rcn.net with esmtp (Exim 3.16 #5) id 147PdD-0003K7-00 ; Sat, 16 Dec 2000 17:16:44 -0500 Date: Sat, 16 Dec 2000 17:14:26 -0500 From: Gene Harrison Subject: W-EMED [Fwd: Sick caver requests information] Sender: owner-wilderness-emergency-medicine@list.pitt.edu To: List WEMS , Keith Conover , Barry Chute , Bob Hoke , Gene Harrison , Trudy Bloem Reply-to: wilderness-emergency-medicine@list.pitt.edu Message-id: <3A3BE941.9A2998D6@erols.com> MIME-version: 1.0 X-Mailer: Mozilla 4.76 [en]C-20000509M (Win98; U) Content-type: text/plain; charset=us-ascii Content-transfer-encoding: 7bit Precedence: bulk X-Accept-Language: en All, Received this via Potomac Speleological Club email list and thought that several of our cave and wilderness medical personnel may have observations or suggestions. Per the message, caving may be related, but it is perhaps indeterminate at this time. Although I do not know Trudy or Brian personally, I am a member of PSC as well as WEMSI Staff and NCRC, et al, and Bob and Barry are reliable sources. Recommend copy responses directly to Trudy Bloem . I would think she could provide additional diagnostic indications. Thanks All! Gene Harrison :) Bob Hoke wrote: > > Hi folks, > > I received the message below from Trudy Bloem and Brian Judge. > They are Canadian cavers who come to West Virginia and the PSC > fieldhouse fairly frequently. If anyone can suggest any sources > of information for them please contact Trudy directly. > > Also, if you know of any other contacts who might be helpful > please forward Trudy's request on to them. > > Thanks. > > Bob Hoke > > ------------------------------------------------------------------------ > > Subject: Sick caver requests info > Date: Fri, 15 Dec 2000 01:46:15 -0500 > From: Bob Hoke > To: Barry Chute , Roxanne Shively > > Barry and Roxanne, > > I received the message below from Trudy Bloem and Brian Judge. > They are Canadian cavers who come to West Virginia and the PSC > fieldhouse fairly frequently. If either of you can suggest any > sources of information for them please contact Trudy directly. > > Also, if you know of any other contacts who might be helpful > please forward Trudy's request on to them. > > Thanks. > > Bob Hoke > > ------------------------------------------------------------------------ > > Subject: Urgent Request > Date: Thu, 14 Dec 2000 21:33:59 -0500 > From: Trudy Bloem > To: 'Bob Hoke' > > Hi Bob: > A friend of ours, Marcus Buck, TCG member, has taken quite ill. He was > admitted to hospital with flu like symptoms and recurring high fever and > has since been transferred to McMaster Research Hospital in Hamilton. He > does not have meningitis of any sort. His case has the infectious disease > physicians very concerned and baffled. They do not know what the problem > is. He is in serious condition, enlarged liver, fever, with some fluid now > collecting in the lungs and around the heart, on antibiotics (they can not > be specific with this medication as they do not yet know what they are > treating) and oxygen assisted and totally bedridden. The physicians are > wondering whether he has picked up anything while caving. He is an active > research caver and is a karst geologist. Are there any articles on caving > related or specific illnesses (viral, bacterial or parasitic based) that > yourself or anyone through the fieldhouse would know about? Norma Moore, > his wife, has put out a request to other cavers whose profession is in that > are with hopes that information may be out there for the doctors' to make > use of. If you can find out anything it would be greatly appreciated. > Cheers > Trudy Bloem & Brian Judge 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, 16 Dec 2000 19:30:26 -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 <01JXS7R3AZ3O002B37@mb1i0.ns.pitt.edu>; Sat, 16 Dec 2000 19:30:27 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, 16 Dec 2000 19:30:06 -0500 (EST) Received: from korporate.co.uk (korporate.co.uk [128.121.248.177]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.2) ID ; Sat, 16 Dec 2000 19:29:59 -0500 (EST) Received: from n232.OnlineToday.Com_[204.181.201.232] [204.181.201.232] by korporate.co.uk (SMTPD32-6.04) id ABC7190108; Sat, 16 Dec 2000 08:45:59 +0000 Received: from mailer.ug.eds.com by n232.OnlineToday.Com with ESMTP; Sat, 16 Dec 2000 01:46:45 -0800 Date: Sat, 16 Dec 2000 01:46:37 -0800 From: dave@china.com Subject: W-EMED Don't miss this $700 Give Away 14977 Sender: owner-wilderness-emergency-medicine@list.pitt.edu To: Undisclosed.Recipients@list.pitt.edu Reply-to: wilderness-emergency-medicine@list.pitt.edu Message-id: <000076750aca$00003a31$00003a81@mailer.ug.eds.com> MIME-version: 1.0 Content-type: text/html; charset="iso-8859-1" Content-transfer-encoding: quoted-printable X-Priority: 3 X-MSMail-priority: Normal Precedence: bulk
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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 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 ; Wed, 13 Dec 2000 13:28:02 -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 <01JXNO8PUEUG003DVN@mb2i0.ns.pitt.edu>; Wed, 13 Dec 2000 13:28:03 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, 13 Dec 2000 13:26:14 -0500 (EST) Received: from patan.sun.com (patan.Sun.COM [192.18.98.43]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.2) ID for ; Wed, 13 Dec 2000 13:26:10 -0500 (EST) Received: from ireserver.Ireland.Sun.COM ([129.156.220.7]) by patan.sun.com (8.9.3+Sun/8.9.3) with ESMTP id DAA08019 for ; Tue, 12 Dec 2000 03:51:57 -0800 (PST) Received: from ireserver (flesk.Ireland.Sun.COM [129.156.228.10]) by ireserver.Ireland.Sun.COM (8.8.8+Sun/8.8.8/ENSMAIL,v2.0) with SMTP id LAA00241 for ; Tue, 12 Dec 2000 11:51:56 +0000 (GMT) Date: Tue, 12 Dec 2000 11:52:36 +0000 (GMT) From: William Flynn - Sunsoft x86 Subject: Re: W-EMED oops! 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: <200012121151.LAA00241@ireserver.Ireland.Sun.COM> MIME-version: 1.0 X-Mailer: dtmail 1.3.0 @(#)CDE Version 1.4 SunOS 5.8 i86pc i386 Content-type: TEXT/plain; charset=us-ascii Content-MD5: UoGemoWQVKTe7UQRhN/kGg== Precedence: bulk Cindy > Well now I feel really stupid. Not only did I forget a title to my last post, but I also accidently deleted one of the replies. > > The e-mail I deleted came from Sun in Ireland. Could that person please e-mail me again? No problem. The mail is appended below. BTW The cold packs I was thinking of are the ones you squeeze to start them getting cold. William. Dublin & Wicklow Mountain Rescue Team ------------- Begin Forwarded Message ------------- Date: Mon, 11 Dec 2000 16:22:10 +0000 (GMT) From: William Flynn - Sunsoft x86 Subject: Re: Your Message Sent on Mon, 11 Dec 2000 01:22:56 -0500 (EST) To: cheazlit@ix.netcom.com Cindy, You could try using cold packs, normaly used for treating knocks and sprains in sports. William Dublin & Wicklow Mountain Rescue Team 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 Dec 2000 14:32:17 -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 <01JXKXVONTBU0020NM@mb1i0.ns.pitt.edu>; Mon, 11 Dec 2000 14:32:16 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 Dec 2000 14:31:19 -0500 (EST) Received: from granger.mail.mindspring.net (granger.mail.mindspring.net [207.69.200.148]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.2) ID for ; Mon, 11 Dec 2000 14:31:16 -0500 (EST) Received: from smui03.slb.mindspring.net (smui03.slb.mindspring.net [199.174.114.22]) by granger.mail.mindspring.net (8.9.3/8.8.5) with ESMTP id OAA00650 for ; Mon, 11 Dec 2000 14:31:15 -0500 (EST) Received: by smui03.slb.mindspring.net id OAA0000031683; Mon, 11 Dec 2000 14:32:14 -0500 (EST) Date: Mon, 11 Dec 2000 14:32:14 -0500 From: cheazlit@ix.netcom.com Subject: W-EMED oops! Sender: owner-wilderness-emergency-medicine@list.pitt.edu To: wilderness-emergency-medicine@list.pitt.edu Cc: wilderness-emergency-medicine@list.pitt.edu Reply-to: wilderness-emergency-medicine@list.pitt.edu Message-id: Precedence: bulk X-Originating-IP: 192.31.86.35 Well now I feel really stupid. Not only did I forget a title to my last post, but I also accidently deleted one of the replies. The e-mail I deleted came from Sun in Ireland. Could that person please e-mail me again? My apologies! It looks like I have too many irons in the fire! Cindy Heazlit 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 Dec 2000 09:25:56 -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 <01JXKN6VV50W001RBX@mb1i0.ns.pitt.edu>; Mon, 11 Dec 2000 09:25:57 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 Dec 2000 09:25:27 -0500 (EST) Received: from imo-r02.mx.aol.com (imo-r02.mx.aol.com [152.163.225.2]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.2) ID for ; Mon, 11 Dec 2000 09:25:20 -0500 (EST) Received: from Kathrynpark@cs.com by imo-r02.mx.aol.com (mail_out_v28.34.) id h.5b.ef679bf (3865) for ; Mon, 11 Dec 2000 09:24:47 -0500 (EST) Date: Mon, 11 Dec 2000 09:24:46 -0500 (EST) From: Kathrynpark@cs.com Subject: W-EMED Re: 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: <5b.ef679bf.27663dae@cs.com> MIME-version: 1.0 X-Mailer: Unknown sub 107 Content-type: text/plain; charset="US-ASCII" Content-transfer-encoding: 7bit Precedence: bulk Hi Cindy, I wonder if you will also need to be concerned with bad air in the volcanic cave sections. I am told there are machines that can detect certain poisonous gases that you could bring, or maybe a canary? (Just kidding) I bet the trade off regarding padding and evaporation would be: pad underneath, and leave the top open under the webbing. When we did this in the NCRC classwork, it seemed like the most painful part was when we didn't pad enough underneath. You wouldn't have to protect them from water with a tarp, because the water would help to keep the temperature down. Sounds like an EXCELLENT course, wish I could come! Kathryn Park 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 Dec 2000 01:25:32 -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 <01JXK6F8PD9M002YK3@mb2i0.ns.pitt.edu>; Mon, 11 Dec 2000 01:25:32 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 Dec 2000 01:23:04 -0500 (EST) Received: from smtp10.atl.mindspring.net (smtp10.atl.mindspring.net [207.69.200.246]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.2) ID for ; Mon, 11 Dec 2000 01:23:02 -0500 (EST) Received: from sji-ca5-234.ix.netcom.com (sji-ca5-234.ix.netcom.com [209.109.234.234]) by smtp10.atl.mindspring.net (8.9.3/8.8.5) with SMTP id BAA02100 for wilderness-emergency-medicine@list.pitt.edu; Mon, 11 Dec 2000 01:22:56 -0500 (EST) Date: Mon, 11 Dec 2000 01:22:56 -0500 (EST) From: cheazlit@ix.netcom.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: <2000121022276141@ix.netcom.com> MIME-version: 1.0 X-Mailer: Netcomplete v4.0, from NETCOM On-Line Communications, Inc. Content-type: text/plain; charset=us-ascii Precedence: bulk Hello All, I am teaching a cave rescue class in Hawai`i this February. The caves there have a broad range of temperatures - from the very cold caves high up in the mountains, to the very hot caves that have just been formed from the volcanoes. I am looking at patient packaging/transport techniques for all of these environments. While there is a lot of publication on packaging for hypothermia, I don't see much on patient packaging/transport in a warm (hot!) environment. The caves I'm especially looking at run from 68-125 degrees F. I'm looking for standards/papers etc. for packaging and transport of patients in this environment. I realize that I really have to watch my rescuers in the hotter caves. Some have suggested bringing extra water and dowsing the trunk of the body with it for cooling. Any other techniques? One of the tricky things I'm dealing with is padding the patient so that the tie-in webbing/straps don't cut in. But padding means blocking evaporation! Any advice on these challenges is much appreciated. Thanks in advance! Cindy Heazlit Instructor, National Cave Rescue Commission Wilderness First Responder cheazlit@ix.netcom.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 ; Sun, 10 Dec 2000 01:44:30 -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 <01JXISSF3MBW001LL9@mb1i0.ns.pitt.edu>; Sun, 10 Dec 2000 01:44:30 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 Dec 2000 01:43:59 -0500 (EST) Received: from imo-d02.mx.aol.com (imo-d02.mx.aol.com [205.188.157.34]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.2) ID for ; Sun, 10 Dec 2000 01:43:56 -0500 (EST) Received: from Omikid@aol.com by imo-d02.mx.aol.com (mail_out_v28.34.) id h.2b.e598330 (3973) for ; Sun, 10 Dec 2000 01:43:21 -0500 (EST) Date: Sun, 10 Dec 2000 01:43:20 -0500 (EST) From: Omikid@aol.com Subject: Re: W-EMED Aquamira 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: <2b.e598330.27648008@aol.com> MIME-version: 1.0 X-Mailer: Windows AOL sub 123 Content-type: text/plain; charset="US-ASCII" Content-transfer-encoding: 7bit Precedence: bulk I am allergic to Iodine, and have used both just a filter, as well as a filter/clorine combo...you can get chlorine water purification tablets as well as chlorine "drink drops" though I have not seen (nor looked for) the liquid type here in the US. I still have some of the tablets that I procured in Thailand and carry them in my pack for an emergency. The chlorine tastes awful, and the liquid type wreaks havoc if it spills in your pack. Between chlorine and boiling, boiling is better in my opinion --if you have the means, and time to do so. For the most part even while overseas I have used only a filter and have never had any problems. ('course maybe I have just been lucky.) Just my two cents worth, Naomi 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, 9 Dec 2000 16:16:08 -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 <01JXI8XR0N1U002OXX@mb2i0.ns.pitt.edu>; Sat, 9 Dec 2000 16:16:08 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, 09 Dec 2000 16:13:43 -0500 (EST) Received: from smtppop2pub.verizon.net (smtppop2pub.gte.net [206.46.170.21]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.2) ID for ; Sat, 09 Dec 2000 16:13:36 -0500 (EST) Received: from gtei1.bellatlantic.net (gtei1.bellatlantic.net [199.45.39.159]) by smtppop2pub.verizon.net with ESMTP ; Sat, 09 Dec 2000 15:12:07 -0600 (CST) Received: from Laptop (adsl-141-151-137-150.bellatlantic.net [141.151.137.150]) by gtei1.bellatlantic.net (8.9.1/8.9.1) with ESMTP id QAA17109; Sat, 09 Dec 2000 16:13:01 -0500 (EST) Date: Sat, 09 Dec 2000 16:13:50 -0500 From: "Keith Conover, M.D., FACEP" Subject: Re: W-EMED High Altitude Popcorn In-reply-to: <3A2B7F9A.A41D2370@tcd.ie> Sender: owner-wilderness-emergency-medicine@list.pitt.edu To: Gerry Butler , wilderness-emergency-medicine@list.pitt.edu Reply-to: wilderness-emergency-medicine@list.pitt.edu Message-id: <3A325A3E.6511.14A75E31@localhost> MIME-version: 1.0 X-Mailer: Pegasus Mail for Win32 (v3.12c) Content-type: text/plain; charset=US-ASCII Content-transfer-encoding: 7BIT Precedence: bulk > The local guides insisted that members of the group ate popcorn every day, > which on enquiry by my friend was stated to be as effective as Diamox (or > acetazolamide) for altitude sickness. I prefer daily 2000 volt electrical shocks myself, there's about as much evidence for this as for popcorn as far as I know. But seriously, a high-carbohydrate diet has been shown to lessen AMS scores. Though some studies found no effect, most did. 1. Consolazio CF, Matoush LO, Johnson HL, Krzywicki HJ, Daws TA, Isaac GJ. Effects of high- carbohydrate diets on performance and clinical symptomatology after rapid ascent to high altitude. Federation Proceedings 1969; 28:937-943.that high- carbohydrate diet decreases incidence of AMS symptoms. Consolazio CF, Johnson HL, Krzywicki HJ. Body fluids, body composition, and metabolic aspects of high- altitude adaptation. In: Consolazio CF, Johnson HL, Krzywicki HJ, eds. Physiological adaptations: deserts and mountains. Ny: Academic Press, 1972:227-241. Dramise JG, Inouye CM, Christensen BM, Fults RD, Canham JE, Consolazio CF. Effects of a glucose meal on human pulmonary function at 1600-m and 4300- m altitudes. Aviat Space Environ Med 1975; 46:365-368. Porcelli MJ, Gugelchuk GM. A trek to the top: a review of acute mountain sickness. J Am Osteopath Assoc 1995; 95:718-20.mountain sickness (AMS) affects, to varying degrees, all travelers to high altitudes (elevations greater than 5280 feet). In a small percentage of patients, AMS can lead to high-altitude pulmonary edema (HAPE) or high-altitude cerebral edema (HACE). Symptoms of AMS range from a combination of headache, insomnia, anorexia, nausea, and dizziness, to more serious manifestations, such as vomiting, dyspnea, muscle weakness, oliguria, peripheral edema, and retinal hemorrhage. Although the primary cause of these symptoms is related to the reduced oxygen content and humidity of the ambient air at high altitudes, the physiologic pathway relating hypoxemia to AMS and its sequelae remains unclear. Tips on self-diagnosis and symptom recognition are critical elements to be included in educating patients who are contemplating a trip to high altitudes. Preventive strategies include allowing 2 days of acclimatization before engaging in strenuous exercise at high altitudes, avoiding alcohol, and increasing fluid intake. Conditioning exercise for patients older than 35 years is also recommended before departure. A high- carbohydrate, low-fat, low-salt diet can also aid in preventing the onset of AMS. Acetazolamide (125 mg two or three times daily, or once at bedtime) has also been shown to reduce susceptibility to AMS and the incidence of HAPE and HACE. Although effective in treating cerebral symptoms of AMS, dexamethasone is not routinely recommended as a prophylactic agent for AMS. Swenson ER, MacDonald A, Vatheuer M, et al. Acute mountain sickness is not altered by a high carbohydrate diet nor associated with elevated circulating cytokines. Aviat Space Environ Med 1997; 68:499-503.investigated whether a diet of increased carbohydrate content reduces the symptoms of acute mountain sickness (AMS) and whether concentrations of circulating cytokines rise and correlate with hypoxia and AMS. There were 19 healthy volunteers who ingested in randomized order both a high carbohydrate (68% CHO) or normal carbohydrate (45% CHO) diet for 4 d. On the 4th d, subjects were exposed to 8 h of 10% normobaric oxygen. Each subject completed the Lake Louise Consensus Questionnaire (LLCQ: a questionnaire developed to quantify the common symptoms and consequences of AMS) at the beginning and end of each hypoxic session, at which times venous blood was obtained for the following cytokines: interleukins 1 beta, 6 and 8 (IL-1 beta, IL- 6, IL-8) and tumor necrosis factor alpha (TNF-alpha). AMS symptoms did not differ significantly between the diets (LLCQ scores: 68% CHO = 10.1 +/- 3.8 vs. 45% CHO = 10.3 +/- 4.1). Cytokine concentrations did not change with hypoxia on either diet, nor did individual changes correlate with AMS symptoms. We conclude that a high carbohydrate diet for 4 d does not reduce the symptoms of AMS; and plasma cytokine concentrations do not change with hypoxia and the development of AMS and, thus, are not likely mediators of this syndrome. --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 ; Sat, 9 Dec 2000 16:16:08 -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 <01JXI8XQMG48001LL9@mb1i0.ns.pitt.edu>; Sat, 9 Dec 2000 16:16:07 EST Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.2) ID ; Sat, 09 Dec 2000 16:13:43 -0500 (EST) Received: from smtppop2pub.verizon.net (smtppop2pub.gte.net [206.46.170.21]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.2) ID for ; Sat, 09 Dec 2000 16:13:37 -0500 (EST) Received: from gtei1.bellatlantic.net (gtei1.bellatlantic.net [199.45.39.159]) by smtppop2pub.verizon.net with ESMTP ; Sat, 09 Dec 2000 15:12:09 -0600 (CST) Received: from Laptop (adsl-141-151-137-150.bellatlantic.net [141.151.137.150]) by gtei1.bellatlantic.net (8.9.1/8.9.1) with ESMTP id QAA17112; Sat, 09 Dec 2000 16:13:02 -0500 (EST) Date: Sat, 09 Dec 2000 16:13:50 -0500 From: "Keith Conover, M.D., FACEP" Subject: Re: W-EMED Aquamira In-reply-to: <3A2B0B8E.B6A3B64A@vnet.net> Sender: owner-wilderness-emergency-medicine@list.pitt.edu To: Sam Chewning , wilderness-emergency-medicine@list.pitt.edu Reply-to: wilderness-emergency-medicine@list.pitt.edu Message-id: <3A325A3E.44.14A75E67@localhost> MIME-version: 1.0 X-Mailer: Pegasus Mail for Win32 (v3.12c) Content-type: text/plain; charset=US-ASCII Content-transfer-encoding: 7BIT Precedence: bulk On 3 Dec 2000, at 22:12, Sam Chewning wrote: > > I read your information about aquamira. A friend of mine is allergic > to iodine. What is your current rec. for filtration and purification? Difficult to answer. Boiling certainly works, and at or near sea level, bringing to a boil is adequate (no need for any more boiling than this). Filter systems with a very small pore diameter are probably an easier solution -- but miss viruses. A combination of a small-pore filter with chlorine would probably be best -- plain old Clorox in a tiny bottle would work. I suspect this new Aquamira or the equivalent Canadian system would be better, though -- more stable, lasts longer, disinfects better. --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 ; Thu, 7 Dec 2000 23:35:19 -0500 (EST) Disposition-notification-to: kruegerd@earthlink.net Received: from list.srv.cis.pitt.edu (majordom@[136.142.185.20]) by pitt.edu (PMDF V5.2-32 #41462) with ESMTP id <01JXFVOKRYOU0027T2@mb2i0.ns.pitt.edu>; Thu, 7 Dec 2000 23:35:19 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 Dec 2000 23:34:33 -0500 (EST) Received: from falcon.prod.itd.earthlink.net (falcon.prod.itd.earthlink.net [207.217.120.74]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.2) ID for ; Thu, 07 Dec 2000 23:34:20 -0500 (EST) Received: from oemcomputer (nyf-ny7-05.ix.netcom.com [198.211.17.133]) by falcon.prod.itd.earthlink.net (EL-8_9_3_3/8.9.3) with SMTP id UAA15132 for ; Thu, 07 Dec 2000 20:31:42 -0800 (PST) Date: Thu, 07 Dec 2000 23:31:52 -0500 From: David Krueger Subject: Re: W-EMED SPAM. 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: <007601c060cf$caff4e40$2a10d3c6@oemcomputer> MIME-version: 1.0 X-MIMEOLE: Produced By Microsoft MimeOLE V5.00.2919.6600 X-Mailer: Microsoft Outlook Express 5.00.2919.6600 Content-type: text/plain; charset="iso-8859-1" Content-transfer-encoding: 7bit X-Priority: 3 X-MSMail-priority: Normal Precedence: bulk References: <002e01c06087$6d3c6560$6d0aa8c0@worldfactors.com> Good Deal! ----- Original Message ----- From: "Sol Roter" To: Sent: Thursday, December 07, 2000 2:53 PM Subject: RE: W-EMED SPAM. > Spoke to the fellow this afternoon. He agreed it was wrong to send SPAM to > our list. He says he will immediately remove the list from his mail program. > Let's see if he delivers. > > Sol > > -----Original Message----- > From: owner-wilderness-emergency-medicine@list.pitt.edu > [mailto:owner-wilderness-emergency-medicine@list.pitt.edu]On Behalf Of > Sol Roter > Sent: December 6, 2000 9:49 AM > To: wilderness-emergency-medicine@list.pitt.edu > Subject: RE: W-EMED . > > > I have put a call into them. I want to share my love for SPAM with them > first hand. > > Sol Roter > > -----Original Message----- > From: owner-wilderness-emergency-medicine@list.pitt.edu > [mailto:owner-wilderness-emergency-medicine@list.pitt.edu]On Behalf Of > hjghjgjh@yahoo.com > Sent: December 5, 2000 9:30 PM > To: undisclosed-recipients:; > Subject: W-EMED . > > > The Internet's Finest and Most Reliable Bulk Email Provider! > > Since 1996, Tech Data Technologies has provided bulk email service to > thousands of well-satisfied customers. We offer the most competitive prices > in the industry, made possible by our high percentage of repeat business. We > have the most advanced, direct email technology, employed by only a > knowledgeable few in the world. Our expert programmers have made it possible > for us to penetrate any email blocking filter in use. > > We have over 120 million active email addresses, increasing our list at the > rate of half a million to one million a month. We will put your product or > service instantly and directly into the hands of millions of prospects! You > will have instant, guaranteed results, something no other form of marketing > can claim. Our turn around time is a remarkable 24 hours. > > Our email addresses are sorted by country, state and target. Your marketing > campaign will speed with pinpoint accuracy to your desired audience! > > Your message can be presented in any language you wish, as plain text if you > desire simplicity, or in html with color and graphics. > > Call us for a free consultation at (323)- 851- 8386 [U.S.A.]. We are open > 24 hours a day, 7 days a week. No one understands the global market like we > do. > > For a limited time, take advantage of our holiday special -- two million > general U.S. emails for just $450 per million! We include, at no cost, a > bullet proof email address for 30 days, a $400 value! > > BULK EMAIL PRICES > > 500,000........................$375 > 750,000........................$562 > 1,200,000........................$720 > 1,600,000.................. ...$960 > 3,000,000......................$1,500 > 3,000,000+ ...................PLEASE CALL FOR A QUOTE > > > Resellers welcome. We accept Visa, MasterCard and check by FAX. > > DON'T WAIT! LET TECH DATA TECHNOLOGIES BE YOUR PARTNER!! > > > Under Bill s.1618 TITLE III passed by the 105th U.S. Congress this letter is > not considered "spam" as long as we include: 1) contact information and, 2) > the way to be removed from future mailings (see below).To Remove Yourself > >>From This List: reply to this email with the email > address that you would like removed and the word REMOVE in the subject > heading. > > > 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 > 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 Dec 2000 14:52:59 -0500 (EST) Disposition-notification-to: roter.lcc@home.com Received: from list.srv.cis.pitt.edu (majordom@[136.142.185.20]) by pitt.edu (PMDF V5.2-32 #41462) with ESMTP id <01JXFDFYZEYM001DNK@mb1i0.ns.pitt.edu>; Thu, 7 Dec 2000 14:52:59 EST Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.2) ID ; Thu, 07 Dec 2000 14:52:31 -0500 (EST) Received: from mail1.rdc3.on.home.com (mail1.rdc3.on.home.com [24.2.9.40]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.2) ID for ; Thu, 07 Dec 2000 14:52:14 -0500 (EST) Received: from mars ([24.42.96.21]) by mail1.rdc3.on.home.com (InterMail vM.4.01.03.00 201-229-121) with SMTP id <20001207195207.QAFG20018.mail1.rdc3.on.home.com@mars> for ; Thu, 07 Dec 2000 11:52:07 -0800 Date: Thu, 07 Dec 2000 14:53:52 -0500 From: Sol Roter Subject: RE: W-EMED SPAM. In-reply-to: <000701c05f93$a42519e0$6d0aa8c0@worldfactors.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: <002e01c06087$6d3c6560$6d0aa8c0@worldfactors.com> MIME-version: 1.0 X-MIMEOLE: Produced By Microsoft MimeOLE V5.00.3018.1300 X-Mailer: Microsoft Outlook CWS, Build 9.0.2416 (9.0.2911.0) Content-type: text/plain; charset="iso-8859-1" Content-transfer-encoding: 7bit Importance: Normal X-Priority: 3 (Normal) X-MSMail-priority: Normal Precedence: bulk Spoke to the fellow this afternoon. He agreed it was wrong to send SPAM to our list. He says he will immediately remove the list from his mail program. Let's see if he delivers. Sol -----Original Message----- From: owner-wilderness-emergency-medicine@list.pitt.edu [mailto:owner-wilderness-emergency-medicine@list.pitt.edu]On Behalf Of Sol Roter Sent: December 6, 2000 9:49 AM To: wilderness-emergency-medicine@list.pitt.edu Subject: RE: W-EMED . I have put a call into them. I want to share my love for SPAM with them first hand. Sol Roter -----Original Message----- From: owner-wilderness-emergency-medicine@list.pitt.edu [mailto:owner-wilderness-emergency-medicine@list.pitt.edu]On Behalf Of hjghjgjh@yahoo.com Sent: December 5, 2000 9:30 PM To: undisclosed-recipients:; Subject: W-EMED . The Internet's Finest and Most Reliable Bulk Email Provider! Since 1996, Tech Data Technologies has provided bulk email service to thousands of well-satisfied customers. We offer the most competitive prices in the industry, made possible by our high percentage of repeat business. We have the most advanced, direct email technology, employed by only a knowledgeable few in the world. Our expert programmers have made it possible for us to penetrate any email blocking filter in use. We have over 120 million active email addresses, increasing our list at the rate of half a million to one million a month. We will put your product or service instantly and directly into the hands of millions of prospects! You will have instant, guaranteed results, something no other form of marketing can claim. Our turn around time is a remarkable 24 hours. Our email addresses are sorted by country, state and target. Your marketing campaign will speed with pinpoint accuracy to your desired audience! Your message can be presented in any language you wish, as plain text if you desire simplicity, or in html with color and graphics. Call us for a free consultation at (323)- 851- 8386 [U.S.A.]. We are open 24 hours a day, 7 days a week. No one understands the global market like we do. For a limited time, take advantage of our holiday special -- two million general U.S. emails for just $450 per million! We include, at no cost, a bullet proof email address for 30 days, a $400 value! BULK EMAIL PRICES 500,000........................$375 750,000........................$562 1,200,000........................$720 1,600,000.................. ...$960 3,000,000......................$1,500 3,000,000+ ...................PLEASE CALL FOR A QUOTE Resellers welcome. We accept Visa, MasterCard and check by FAX. DON'T WAIT! LET TECH DATA TECHNOLOGIES BE YOUR PARTNER!! Under Bill s.1618 TITLE III passed by the 105th U.S. Congress this letter is not considered "spam" as long as we include: 1) contact information and, 2) the way to be removed from future mailings (see below).To Remove Yourself >>From This List: reply to this email with the email address that you would like removed and the word REMOVE in the subject heading. 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 ; Thu, 7 Dec 2000 07:41:37 -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 <01JXEYE5C87W002AYO@mb2i0.ns.pitt.edu>; Thu, 7 Dec 2000 07:41:37 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 Dec 2000 07:40:16 -0500 (EST) Received: from imo-r17.mail.aol.com (imo-r17.mx.aol.com [152.163.225.71]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.2) ID for ; Thu, 07 Dec 2000 07:40:14 -0500 (EST) Received: from Mkeowl@aol.com by imo-r17.mx.aol.com (mail_out_v28.34.) id h.99.d9e418c (4181) for ; Thu, 07 Dec 2000 07:39:35 -0500 (EST) Date: Thu, 07 Dec 2000 07:39:35 -0500 (EST) From: Mkeowl@aol.com Subject: Re: W-EMED (Fwd) BOUNCE wilderness-emergency-medicine@list.pitt.edu: 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: <99.d9e418c.2760df07@aol.com> MIME-version: 1.0 X-Mailer: Unknown sub 171 Content-type: multipart/alternative; boundary="part1_99.d9e418c.2760df07_boundary" Content-disposition: Inline Precedence: bulk --part1_99.d9e418c.2760df07_boundary Content-Type: text/plain; charset="US-ASCII" Content-Transfer-Encoding: 7bit I personally have only have about 4 spam sent to my computer in the last week. Not all that bad -- compared to the junk I get from AOL (sometimes 8 a day...) Linda (home at last!...), Chouette (Wow! I thought you had sold our house and we were to live in the car forever...), and Cricket (is THIS where we LIVE? REALLY???!!) all in VA --part1_99.d9e418c.2760df07_boundary Content-Type: text/html; charset="US-ASCII" Content-Transfer-Encoding: 7bit I personally have only have about 4 spam sent to my computer in the last
week. Not all that bad -- compared to the junk I get from AOL (sometimes 8 a
day...)

Linda (home at last!...), Chouette (Wow! I thought you had sold our house and
we were to live in the car forever...), and Cricket (is THIS where we LIVE?
REALLY???!!) all in VA --part1_99.d9e418c.2760df07_boundary-- 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 ; Wed, 6 Dec 2000 18:32:14 -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 <01JXE6TGU2BY0024E1@mb2i0.ns.pitt.edu>; Wed, 6 Dec 2000 18:32:15 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, 06 Dec 2000 18:31:52 -0500 (EST) Received: from gtei2.bellatlantic.net (gtei2.bellatlantic.net [199.45.39.161]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.2) ID for ; Wed, 06 Dec 2000 18:31:48 -0500 (EST) Received: from Laptop (adsl-141-151-137-150.bellatlantic.net [141.151.137.150]) by gtei2.bellatlantic.net (8.9.1/8.9.1) with ESMTP id SAA23799; Wed, 06 Dec 2000 18:31:38 -0500 (EST) Date: Wed, 06 Dec 2000 18:32:07 -0500 From: "Keith Conover, M.D., FACEP" Subject: W-EMED (Fwd) BOUNCE wilderness-emergency-medicine@list.pitt.edu: Sender: owner-wilderness-emergency-medicine@list.pitt.edu To: aking@wfumc.edu Cc: wilderness-emergency-medicine@list.pitt.edu Reply-to: wilderness-emergency-medicine@list.pitt.edu Message-id: <3A2E8627.12839.5B2FB19@localhost> MIME-version: 1.0 X-Mailer: Pegasus Mail for Win32 (v3.12c) Content-type: text/plain; charset=US-ASCII Content-transfer-encoding: 7BIT Precedence: bulk At the point of belaboring the obvious, a reminder to all that (1) majordomo filters out such requests when sent to the list address, sparing all the list members from such semi-spam, and (2) each and every message from the list contains information on how to get off the list at the end, and (3) to remember that, occasionally, Majordomo will misunderstand a word in the first several lines of your message as relating to a request that should really be routed to Majordomo or somewhere else -- and will send the message instead to the listowner, and (4) sorry for the spam -- it's still better for list members that the list remain open for now (though the spam is getting worse, and it may become necessary to "close" the list so that members may only send messages under the address under which they subscribed. BTW, the listowners do NOT respond to messages that should be sent to Majordomo, but are sent to the list and bounced to the listowners. Thank you. ------- Forwarded message follows ------- From: owner-wilderness-emergency-medicine@list.pitt.edu Date sent: Wed, 06 Dec 2000 08:05:55 -0500 (EST) Subject: BOUNCE wilderness-emergency-medicine@list.pitt.edu: Admin request of type /\bremove\s+me\b/i at line 1 To: owner-wilderness-emergency-medicine@list.pitt.edu From owner-wilderness-emergency-medicine@list.pitt.edu Wed Dec 6 08:05:52 2000 Received: from mail.wfubmc.edu ([152.11.200.6]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.2) ID for ; Wed, 6 Dec 2000 08:05:52 -0500 (EST) Received: from webmail ([152.11.200.5]) by mail.wfubmc.edu (Netscape Messaging Server 3.61) with SMTP id AAA651D for ; Wed, 6 Dec 2000 08:10:23 -0500 From: aking@wfubmc.edu (Anita King) To: wilderness-emergency-medicine@list.pitt.edu Subject: REMOVE X-Mailer: Netscape Messenger Express 3.5.2 [Mozilla/4.0 (compatible; MSIE 5.0; AOL 5.0; Windows 98; Compaq; DigExt)] Date: Wed, 6 Dec 2000 08:10:22 -0500 Message-ID: <77376B253FE.AAA651D@mail.wfubmc.edu> REMOVE ME NOW aking@wfumc.edu ------- End of forwarded message ------- --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 ; Wed, 6 Dec 2000 10:43:03 -0500 (EST) Disposition-notification-to: kruegerd@earthlink.net Received: from list.srv.cis.pitt.edu (majordom@[136.142.185.20]) by pitt.edu (PMDF V5.2-32 #41462) with ESMTP id <01JXDQFPYDL200245Z@mb2i0.ns.pitt.edu>; Wed, 6 Dec 2000 10:43:02 EST Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.2) ID ; Wed, 06 Dec 2000 10:42:47 -0500 (EST) Received: from snipe.prod.itd.earthlink.net (snipe.prod.itd.earthlink.net [207.217.120.62]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.2) ID for ; Wed, 06 Dec 2000 10:42:44 -0500 (EST) Received: from oemcomputer (nyf-ny8-06.ix.netcom.com [198.211.17.198]) by snipe.prod.itd.earthlink.net (EL-8_9_3_3/8.9.3) with SMTP id HAA12777 for ; Wed, 06 Dec 2000 07:42:41 -0800 (PST) Date: Wed, 06 Dec 2000 10:42:47 -0500 From: David Krueger Subject: Re: W-EMED . 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: <000b01c05f9b$320daae0$c611d3c6@oemcomputer> MIME-version: 1.0 X-MIMEOLE: Produced By Microsoft MimeOLE V5.00.2919.6600 X-Mailer: Microsoft Outlook Express 5.00.2919.6600 Content-type: text/plain; charset="iso-8859-1" Content-transfer-encoding: 7bit X-Priority: 3 X-MSMail-priority: Normal Precedence: bulk References: <000701c05f93$a42519e0$6d0aa8c0@worldfactors.com> Thanks! ----- Original Message ----- From: "Sol Roter" To: Sent: Wednesday, December 06, 2000 9:48 AM Subject: RE: W-EMED . > I have put a call into them. I want to share my love for SPAM with them > first hand. > > Sol Roter > > -----Original Message----- > From: owner-wilderness-emergency-medicine@list.pitt.edu > [mailto:owner-wilderness-emergency-medicine@list.pitt.edu]On Behalf Of > hjghjgjh@yahoo.com > Sent: December 5, 2000 9:30 PM > To: undisclosed-recipients:; > Subject: W-EMED . > > > The Internet's Finest and Most Reliable Bulk Email Provider! > > Since 1996, Tech Data Technologies has provided bulk email service to > thousands of well-satisfied customers. We offer the most competitive prices > in the industry, made possible by our high percentage of repeat business. We > have the most advanced, direct email technology, employed by only a > knowledgeable few in the world. Our expert programmers have made it possible > for us to penetrate any email blocking filter in use. > > We have over 120 million active email addresses, increasing our list at the > rate of half a million to one million a month. We will put your product or > service instantly and directly into the hands of millions of prospects! You > will have instant, guaranteed results, something no other form of marketing > can claim. Our turn around time is a remarkable 24 hours. > > Our email addresses are sorted by country, state and target. Your marketing > campaign will speed with pinpoint accuracy to your desired audience! > > Your message can be presented in any language you wish, as plain text if you > desire simplicity, or in html with color and graphics. > > Call us for a free consultation at (323)- 851- 8386 [U.S.A.]. We are open > 24 hours a day, 7 days a week. No one understands the global market like we > do. > > For a limited time, take advantage of our holiday special -- two million > general U.S. emails for just $450 per million! We include, at no cost, a > bullet proof email address for 30 days, a $400 value! > > BULK EMAIL PRICES > > 500,000........................$375 > 750,000........................$562 > 1,200,000........................$720 > 1,600,000.................. ...$960 > 3,000,000......................$1,500 > 3,000,000+ ...................PLEASE CALL FOR A QUOTE > > > Resellers welcome. We accept Visa, MasterCard and check by FAX. > > DON'T WAIT! LET TECH DATA TECHNOLOGIES BE YOUR PARTNER!! > > > Under Bill s.1618 TITLE III passed by the 105th U.S. Congress this letter is > not considered "spam" as long as we include: 1) contact information and, 2) > the way to be removed from future mailings (see below).To Remove Yourself > >From This List: reply to this email with the email > address that you would like removed and the word REMOVE in the subject > heading. > > > 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 ; Wed, 6 Dec 2000 09:47:30 -0500 (EST) Disposition-notification-to: roter.lcc@home.com Received: from list.srv.cis.pitt.edu (majordom@[136.142.185.20]) by pitt.edu (PMDF V5.2-32 #41462) with ESMTP id <01JXDOHVTU14002412@mb2i0.ns.pitt.edu>; Wed, 6 Dec 2000 09:47:31 EST Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.2) ID ; Wed, 06 Dec 2000 09:47:14 -0500 (EST) Received: from mail2.rdc3.on.home.com (mail2.rdc3.on.home.com [24.2.9.41]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.2) ID for ; Wed, 06 Dec 2000 09:47:11 -0500 (EST) Received: from mars ([24.42.96.21]) by mail2.rdc3.on.home.com (InterMail vM.4.01.03.00 201-229-121) with SMTP id <20001206144705.CKOX21515.mail2.rdc3.on.home.com@mars> for ; Wed, 06 Dec 2000 06:47:05 -0800 Date: Wed, 06 Dec 2000 09:48:47 -0500 From: Sol Roter Subject: RE: W-EMED . 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: <000701c05f93$a42519e0$6d0aa8c0@worldfactors.com> MIME-version: 1.0 X-MIMEOLE: Produced By Microsoft MimeOLE V5.00.3018.1300 X-Mailer: Microsoft Outlook CWS, Build 9.0.2416 (9.0.2911.0) Content-type: text/plain; charset="iso-8859-1" Content-transfer-encoding: 7bit Importance: Normal X-Priority: 3 (Normal) X-MSMail-priority: Normal Precedence: bulk I have put a call into them. I want to share my love for SPAM with them first hand. Sol Roter -----Original Message----- From: owner-wilderness-emergency-medicine@list.pitt.edu [mailto:owner-wilderness-emergency-medicine@list.pitt.edu]On Behalf Of hjghjgjh@yahoo.com Sent: December 5, 2000 9:30 PM To: undisclosed-recipients:; Subject: W-EMED . The Internet's Finest and Most Reliable Bulk Email Provider! Since 1996, Tech Data Technologies has provided bulk email service to thousands of well-satisfied customers. We offer the most competitive prices in the industry, made possible by our high percentage of repeat business. We have the most advanced, direct email technology, employed by only a knowledgeable few in the world. Our expert programmers have made it possible for us to penetrate any email blocking filter in use. We have over 120 million active email addresses, increasing our list at the rate of half a million to one million a month. We will put your product or service instantly and directly into the hands of millions of prospects! You will have instant, guaranteed results, something no other form of marketing can claim. Our turn around time is a remarkable 24 hours. Our email addresses are sorted by country, state and target. Your marketing campaign will speed with pinpoint accuracy to your desired audience! 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Under Bill s.1618 TITLE III passed by the 105th U.S. Congress this letter is not considered "spam" as long as we include: 1) contact information and, 2) the way to be removed from future mailings (see below).To Remove Yourself From This List: reply to this email with the email address that you would like removed and the word REMOVE in the subject heading. 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 ; Wed, 6 Dec 2000 07:28:41 -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 <01JXDJMRJ9YQ00245Z@mb2i0.ns.pitt.edu>; Wed, 6 Dec 2000 07:28:40 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, 06 Dec 2000 07:28:05 -0500 (EST) Received: from ns.websoftkorea.co.kr ([210.123.86.1]) by list.srv.cis.pitt.edu with SMTP (8.8.8/8.8.8/cisls-7.2.2.2) ID for ; Wed, 06 Dec 2000 07:28:00 -0500 (EST) Received: from i2Or8Ry04 (unverified [63.57.183.85]) by ns.websoftkorea.co.kr (EMWAC SMTPRS 0.83) with SMTP id ; Wed, 06 Dec 2000 19:40:13 +0900 Date: 06 Dec 00 2:30:07 AM From: hjghjgjh@yahoo.com Subject: W-EMED . Sender: owner-wilderness-emergency-medicine@list.pitt.edu To: undisclosed-recipients: ; Reply-to: wilderness-emergency-medicine@list.pitt.edu Message-id: Precedence: bulk The Internet's Finest and Most Reliable Bulk Email Provider! Since 1996, Tech Data Technologies has provided bulk email service to thousands of well-satisfied customers. We offer the most competitive prices in the industry, made possible by our high percentage of repeat business. We have the most advanced, direct email technology, employed by only a knowledgeable few in the world. Our expert programmers have made it possible for us to penetrate any email blocking filter in use. We have over 120 million active email addresses, increasing our list at the rate of half a million to one million a month. We will put your product or service instantly and directly into the hands of millions of prospects! You will have instant, guaranteed results, something no other form of marketing can claim. Our turn around time is a remarkable 24 hours. Our email addresses are sorted by country, state and target. Your marketing campaign will speed with pinpoint accuracy to your desired audience! Your message can be presented in any language you wish, as plain text if you desire simplicity, or in html with color and graphics. Call us for a free consultation at (323)- 851- 8386 [U.S.A.]. We are open 24 hours a day, 7 days a week. No one understands the global market like we do. For a limited time, take advantage of our holiday special -- two million general U.S. emails for just $450 per million! We include, at no cost, a bullet proof email address for 30 days, a $400 value! BULK EMAIL PRICES 500,000........................$375 750,000........................$562 1,200,000........................$720 1,600,000.................. ...$960 3,000,000......................$1,500 3,000,000+ ...................PLEASE CALL FOR A QUOTE Resellers welcome. We accept Visa, MasterCard and check by FAX. DON'T WAIT! LET TECH DATA TECHNOLOGIES BE YOUR PARTNER!! Under Bill s.1618 TITLE III passed by the 105th U.S. Congress this letter is not considered "spam" as long as we include: 1) contact information and, 2) the way to be removed from future mailings (see below).To Remove Yourself From This List: reply to this email with the email address that you would like removed and the word REMOVE in the subject heading. 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, 4 Dec 2000 14:09:43 -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 <01JXB529YO2Y00180B@mb1i0.ns.pitt.edu>; Mon, 4 Dec 2000 14:09:43 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, 04 Dec 2000 14:09:11 -0500 (EST) Received: from usarc-fw2.army.mil (usarc-fw2.army.mil [160.136.109.6]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.2) ID for ; Mon, 04 Dec 2000 14:09:01 -0500 (EST) Received: from usarc-fw2.army.mil (root@localhost) by usarc-fw2.army.mil with ESMTP id OAA28893 for ; Mon, 04 Dec 2000 14:01:35 -0500 (EST) Received: from arnetbridge1.usarc.army.mil ([55.125.1.251]) by usarc-fw2.army.mil with ESMTP id OAA28884 for ; Mon, 04 Dec 2000 14:01:34 -0500 (EST) Received: by ARNETBRIDGE1 with Internet Mail Service (5.5.2650.21) id ; Mon, 04 Dec 2000 14:05:38 -0500 Date: Mon, 04 Dec 2000 14:12:05 -0500 From: "Chapman, Charles MAJ 78th TSD" Subject: RE: W-EMED SPAM 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: <5B0BEAD8AB92D311B6990008C75D951C3E00BB@078divts-emh2.78divex.usarc.army.mil> MIME-version: 1.0 X-Mailer: Internet Mail Service (5.5.2650.21) Content-type: text/plain; charset="iso-8859-1" Precedence: bulk Just delete them like Doc Conover says!! -----Original Message----- From: David Krueger [mailto:kruegerd@earthlink.net] Sent: Sunday, December 03, 2000 21:41 To: wilderness-emergency-medicine@list.pitt.edu Subject: W-EMED SPAM Are sales solicitations for sexual aids allowed through this list? I received one this evening for a Viagra alternative! kruegerd@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 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, 4 Dec 2000 11:56:37 -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 <01JXB0F9AEN6001119@mb1i0.ns.pitt.edu>; Mon, 4 Dec 2000 11:56:37 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, 04 Dec 2000 11:55:31 -0500 (EST) Received: from hotmail.com (f41.law7.hotmail.com [216.33.237.41]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.2) ID for ; Mon, 04 Dec 2000 11:55:22 -0500 (EST) Received: from mail pickup service by hotmail.com with Microsoft SMTPSVC; Mon, 04 Dec 2000 08:55:20 -0800 Received: from 216.254.152.227 by lw7fd.law7.hotmail.msn.com with HTTP; Mon, 04 Dec 2000 16:55:20 +0000 (GMT) Date: Mon, 04 Dec 2000 09:55:20 -0700 From: Mike Webster Subject: W-EMED Re:Aquamira 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/plain; format=flowed Precedence: bulk X-Originating-IP: [216.254.152.227] X-OriginalArrivalTime: 04 Dec 2000 16:55:20.0777 (UTC) FILETIME=[FCA99B90:01C05E12] There is a product being marketed in Canada called Pristine that sounds similar to the Aquamira purification system. Pristine is being marketed as an alternative to iodine, being that it is easy to carry like iodine (as opposed to a heavier water filter that could break down) but has no after taste. Pristine is sold in a two bottle system. Bottle (A) contains 2% stabilized chlorine dioxide, while bottle (B) contains 5% food grade phosphoric acid. For 1 liter of water, it is suggested to add 7 drops of part (A) to 7 drops of part (B) in a seperate mixing cap, wait 10 minutes then add to the 1 liter of water and then let stand 15 minutes before drinking. If the water is very cold then more time and a stronger solution mix is needed. Pristine is manufactured and sold by Advance Chemicals Ltd. from Langley, British Columbia. I believe this product is fairly similar to Aquamira. I have used Pristine for 3 to 4 day long trips in the British Columbia interior however I was drinking water from glacial sources that potentially wasn't contaminated anyway. But, I do know people that have used the same product for 2 week long canoe trips in Ontario where giardia levels are much more prevalent. In both cases, this product seemed to work as no one became sick, during or after. And there is no after taste. Mike Webster, WEMT Toronto, Canada _____________________________________________________________________________________ Get more from the Web. FREE MSN Explorer download : http://explorer.msn.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 ; Mon, 4 Dec 2000 06:27:51 -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 <01JXAOXNPVV60013JP@mb1i0.ns.pitt.edu>; Mon, 4 Dec 2000 06:27:51 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, 04 Dec 2000 06:27:30 -0500 (EST) Received: from truxa1.tcd.ie (truxa1.tcd.ie [134.226.1.158]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.2) ID for ; Mon, 04 Dec 2000 06:27:24 -0500 (EST) Received: from tcd.ie (pc155.mee.tcd.ie [134.226.86.155]) by truxa1.tcd.ie (8.9.3/8.9.3) with ESMTP id LAA05222 for ; Mon, 04 Dec 2000 11:27:11 +0000 (GMT) Date: Mon, 04 Dec 2000 11:27:22 +0000 From: Gerry Butler Subject: W-EMED High Altitude Popcorn 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: <3A2B7F9A.A41D2370@tcd.ie> Organization: TELTEC-TCD, Ireland MIME-version: 1.0 X-Mailer: Mozilla 4.75 [en] (WinNT; U) Content-type: text/plain; charset=us-ascii Content-transfer-encoding: 7bit Precedence: bulk X-Accept-Language: en Query for the list: On a recent trip to Nepal, a friend (EMT-B) was a youth leader on a trekking group. The local guides insisted that members of the group ate popcorn every day, which on enquiry by my friend was stated to be as effective as Diamox (or acetazolamide) for altitude sickness. Any idea if this is actually the case and what principles are involved. Gerry -- Dr. Gerard Butler CEng MIEE, (EI0CH, WEMT) TELTEC Radio Systems and Propagation Group, Trinity College, Dublin Ireland (Ph +353-1-6081743) Dublin+Wicklow Mountain Rescue Team 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, 3 Dec 2000 22:14:48 -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 <01JXA7PDVLOE001JSJ@mb2i0.ns.pitt.edu>; Sun, 3 Dec 2000 22:14:49 EST Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.2) ID ; Sun, 03 Dec 2000 22:14:37 -0500 (EST) Received: from smtp3.vnet.net (smtp3.vnet.net [166.82.1.33]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.2) ID for ; Sun, 03 Dec 2000 22:14:35 -0500 (EST) Received: from vnet.net (pool-209-138-191-244-bltm.grid.net [209.138.191.244]) by smtp3.vnet.net (8.10.1/8.10.1) with ESMTP id eB43ETE19182 for ; Sun, 03 Dec 2000 22:14:33 -0500 (EST) Date: Sun, 03 Dec 2000 22:12:14 -0500 From: Sam Chewning Subject: Re: W-EMED Aquamira 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: <3A2B0B8E.B6A3B64A@vnet.net> MIME-version: 1.0 X-Mailer: Mozilla 4.04 [en]C-bls40 (Win95; U) Content-type: text/plain; charset=us-ascii Content-transfer-encoding: 7bit Precedence: bulk References: <3A2A20F4.7841.2B5D67F@localhost> Keith Conover, M.D., FACEP wrote: > Hello Keith, I read your information about aquamira. A friend of mine is allergic to iodine. What is your current rec. for filtration and purification? Thanks Sam 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, 3 Dec 2000 21:41:20 -0500 (EST) Disposition-notification-to: kruegerd@earthlink.net Received: from list.srv.cis.pitt.edu (majordom@[136.142.185.20]) by pitt.edu (PMDF V5.2-32 #41462) with ESMTP id <01JXA6JV69IW0014RK@mb1i0.ns.pitt.edu>; Sun, 3 Dec 2000 21:41:20 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, 03 Dec 2000 21:40:59 -0500 (EST) Received: from scaup.prod.itd.earthlink.net (scaup.prod.itd.earthlink.net [207.217.121.49]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.2) ID for ; Sun, 03 Dec 2000 21:40:55 -0500 (EST) Received: from oemcomputer (nyf-ny5-15.ix.netcom.com [198.211.17.15]) by scaup.prod.itd.earthlink.net (EL-8_9_3_3/8.9.3) with SMTP id SAA09065 for ; Sun, 03 Dec 2000 18:40:52 -0800 (PST) Date: Sun, 03 Dec 2000 21:41:00 -0500 From: David Krueger Subject: W-EMED SPAM 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: <001601c05d9b$a579a260$0f11d3c6@oemcomputer> MIME-version: 1.0 X-MIMEOLE: Produced By Microsoft MimeOLE V5.00.2919.6600 X-Mailer: Microsoft Outlook Express 5.00.2919.6600 Content-type: text/plain; charset="iso-8859-1" Content-transfer-encoding: 7bit X-Priority: 3 X-MSMail-priority: Normal Precedence: bulk Are sales solicitations for sexual aids allowed through this list? I received one this evening for a Viagra alternative! kruegerd@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 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, 3 Dec 2000 14:13:48 -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 <01JX9QWZP6FQ001MOY@mb2i0.ns.pitt.edu>; Sun, 3 Dec 2000 14:13:47 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, 03 Dec 2000 14:13:07 -0500 (EST) Received: from mail.szbts.gov.cn ([202.96.164.167]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.2) ID for ; Sun, 03 Dec 2000 14:12:59 -0500 (EST) Received: from h809 (1Cust241.tnt3.mia5.da.uu.net [63.30.200.241]) by mail.szbts.gov.cn (8.8.8/8.8.8) with SMTP id DAA09291; Mon, 04 Dec 2000 03:06:26 +0800 (CST) Date: Mon, 04 Dec 2000 03:06:26 +0800 (CST) From: HV@derfriseur.de Subject: W-EMED At Last, Herbal V, the All Natural Alternative is Available! 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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 ; Sun, 3 Dec 2000 10:31:52 -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 <01JX9J5TW3WE000ZU8@mb1i0.ns.pitt.edu>; Sun, 3 Dec 2000 10:31:51 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, 03 Dec 2000 10:31:23 -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 ; Sun, 03 Dec 2000 10:31:21 -0500 (EST) Received: from Laptop ("port 1676"@[136.142.23.164]) by pitt.edu (PMDF V5.2-32 #41462) with ESMTP id <01JX9J555RJ40014RK@mb1i0.ns.pitt.edu> for wilderness-emergency-medicine@list.pitt.edu; Sun, 03 Dec 2000 10:31:20 -0500 (EST) Date: Sun, 03 Dec 2000 10:31:16 -0500 From: "Keith Conover, M.D., FACEP" Subject: Re: W-EMED Aquamira In-reply-to: <3A28FA97.CBA9C1B3@rmi.net> Sender: owner-wilderness-emergency-medicine@list.pitt.edu To: Buck Tilton , wilderness-emergency-medicine@list.pitt.edu Reply-to: wilderness-emergency-medicine@list.pitt.edu Message-id: <3A2A20F4.7841.2B5D67F@localhost> MIME-version: 1.0 X-Mailer: Pegasus Mail for Win32 (v3.12c) Content-type: text/plain; charset=US-ASCII Content-transfer-encoding: 7BIT Precedence: bulk On 2 Dec 2000, at 6:35, Buck Tilton wrote: > I keep hearing claims that a field water treatment called Aquamira > works, but I haven't been able to find any facts. Does anyone know > anything about the product? Thanks very much. Hi, Buck. Never heard of it, but you spurred my interest. I hope there are some microbiologists and chemists out there who can help, but below is what I've been able to find out. A quick search at www.profusion.com (my favorite metasearch site) led me onwards, and onwards, and I found: - a "review" at http://www.outdoorreview.com/reviews/Water_Filters/ which is actually just a plea for a review, - http://www.mcnett.com/Fishing/index.html (distributor's website) where the is a bunch of information, including a PDF datasheet. It's interesting in that there are two parts to it. First is that there is an AquaMira water bottle, with a "tortuous path" charcoal filter that is the "approximate equivalent" of a 2-micron filter. And a two-micron filter isn't a very small filter, i.e., it won't filter out bacteria, though it may filter out big things like Giardia or leaves . There is also a chemical system, which can be used with the bottle/filter system, which uses chlorine dioxide rather than chlorine itself, combined with an activated charcoal filter. As you and many others know, chlorine, though used for municipal water treatment, requires long contact times to kill most pathogens, and even with long treatment times, won't kill some of them. Interestingly, the only claims made on the website are that "kills odor-causing bacteria and improves the taste of water from rivers, lakes, streams, tap water and more." Doesn't say it'll keep you from getting hepatitis, the runs, or the purple-spotted mange. The FAQ says "Water treated with AQUAMIRA is safe to drink on a regular basis when treated as directed. Other water treatment chemicals may create foul tastes and odors, and discolor water. Some chemicals, like iodine, chlorine, and other halogens, create potentially harmful by-products." Note that that's PURE WATER treated with the stuff, not what you squeeze out of pond-scum. So they don't _claim_ that it's the equivalent of other water treatments such as microfiltration or iodine methods. Interestingly, if you check http://www.adventuretravel.com/2000wc_sponsors.htm you'll see "AquaMira - McNett Corporation Water Treatment and Filtration Technology. The official water treatment and filter of the Adventure Travel Society. Water purification treatment to kill a wide range of bacteria, viruses, and protozoa including E. Coli, Hepatitis A, Poliovirus, Giardia & Cryptosporidium." which I guess is an official statement that the think it actually kills these things. Chlorine dioxide is apparently well-accepted as a municipal water treatment; see http://www.clo2.com/ . One of the reasons it's popular is that, compared to other free chlorine methods, it produces less in the way of chlorinated organic products (big problem for paper mills, still a concern for municipal water, less of a concern for wilderness use). It "bleaches" and kills various microorganisms. It breaks down to chlorite ion, which is not nearly so effective a disinfectant as chlorine dioxide -- which is why the system insists the chlorine dioxide be made fresh each time with the Aquamira system. More chemical details are available at http://www.clo2.com/reading/drinking/recent/recent.html . Clorox and similar "chlorine" bleaches (see http://www.esemag.com/0596/bleach.html) contain sodium hypochlorite, NaOCl. In water, this dissociates to sodium ions (Na+) and hypochlorite ions, also known as chlorite ions (OCl-). These are essentially the breakdown product of chlorine dioxide, but a weak disinfectant in their own right. This can be an effective water disinfectant, and is recommended for disaster situations (see http://www.fema.gov/pte/foodwtr.htm) at 16 drops of 5.25% sodium hypochlorite ("regular" Clorox) per gallon, which is four drops per liter, for a 30 minute contact time. This, however, has been shown to not kill off some pathogenic organisms (Entamoeba histolytica cysts are the classic case) and even long contact times, especially with lots of organic material in the water, or with very cold water, may not kill certain pathogens. Too, "chlorine" bleaches with sodium hypochlorite tend to decompose at a rate of about 0.5-1% per month. So, chlorine dioxide should theoretically be superior to chlorine methods -- and as indicated in some of the above references, is used in many municipal water treatment facilities, replacing gaseous chlorine or sodium hypochlorite solutions to minimize carcinogenic chlorinated organic compounds. However, chlorine dioxide is only _one_ component of these systems, and I was unable to find any information about E histolytica being killed by chlorine dioxide, nor any comparison of chlorine dioxide compared to iodine-resin filters (my current favorite), iodine tablets or solution. --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 ; Sun, 3 Dec 2000 08:06:35 -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 <01JX9E3PS9BG000ZU8@mb1i0.ns.pitt.edu>; Sun, 3 Dec 2000 08:06:35 EST Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.2) ID ; Sun, 03 Dec 2000 08:05:57 -0500 (EST) Received: from mb2i0.ns.pitt.edu (mb2i1.ns.pitt.edu [136.142.185.162]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.2) ID for ; Sun, 03 Dec 2000 08:05:54 -0500 (EST) Received: from Laptop ("port 1251"@[136.142.23.164]) by pitt.edu (PMDF V5.2-32 #41462) with ESMTP id <01JX9E2RUQ4M001MOY@mb2i0.ns.pitt.edu> for wilderness-emergency-medicine@list.pitt.edu; Sun, 03 Dec 2000 08:05:53 -0500 (EST) Date: Sun, 03 Dec 2000 08:05:48 -0500 From: "Keith Conover, M.D., FACEP" Subject: Re: W-EMED Re:Wilderness Airway kit In-reply-to: <1e.df1435d.275a8a5b@aol.com> Sender: owner-wilderness-emergency-medicine@list.pitt.edu To: Search4umedc@aol.com, wilderness-emergency-medicine@list.pitt.edu Reply-to: wilderness-emergency-medicine@list.pitt.edu Message-id: <3A29FEDC.24665.230A601@localhost> MIME-version: 1.0 X-Mailer: Pegasus Mail for Win32 (v3.12c) Content-type: text/plain; charset=US-ASCII Content-transfer-encoding: 7BIT Precedence: bulk On 2 Dec 2000, at 12:24, Search4umedc@aol.com wrote: > Does any one have suggestions on what I should carry in an ALS airway > kit? I'm a straight blade fan in tubing - will a size 2 and 3 be > enough? Weight is a consideration, especially the O2 Minimalist: take a single 6.5 or 7.0 ET tube, two pair of exam gloves, and learn digital intubation. Heavy-duty lightweight: get two Eveready Lithium disposable AA cells, and two spares, and an AA-cell standard laryngoscope handle, and some of the extremely lightweight German disposable plastic blades -- I got mine from Parr (www.parr-emergency.com). Kitchen Sink: take one anaesthesiologist with lots of trauma experience. Ask him or her to get everything he or she might need for a bad airway -- gum elastic bougie, LMA, retrograde kit, fiberoptic scope, generator for the fiberoptic scope. Package equipment and anaesthesiologist neatly, send to Mountain House so they can freeze-dry and compress and seal in foil like the LRP military rations. 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 -- 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, 2 Dec 2000 12:25:42 -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 <01JX88UNI41I001L4E@mb2i0.ns.pitt.edu>; Sat, 2 Dec 2000 12:25:43 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 Dec 2000 12:25:20 -0500 (EST) Received: from imo-d09.mx.aol.com (imo-d09.mx.aol.com [205.188.157.41]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.2) ID for ; Sat, 02 Dec 2000 12:25:17 -0500 (EST) Received: from Search4umedc@aol.com by imo-d09.mx.aol.com (mail_out_v28.33.) id h.1e.df1435d (7543) for ; Sat, 02 Dec 2000 12:24:43 -0500 (EST) Date: Sat, 02 Dec 2000 12:24:43 -0500 (EST) From: Search4umedc@aol.com Subject: W-EMED Re:Wilderness Airway kit 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: <1e.df1435d.275a8a5b@aol.com> MIME-version: 1.0 X-Mailer: AOL for Macintosh sub 53 Content-type: text/plain; charset="US-ASCII" Content-transfer-encoding: 7bit Precedence: bulk Does any one have suggestions on what I should carry in an ALS airway kit? I'm a straight blade fan in tubing - will a size 2 and 3 be enough? Weight is a consideration, especially the O2 Thanks Stef 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 Dec 2000 08:41:23 -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 <01JX810J3EWS000WVY@mb1i0.ns.pitt.edu>; Sat, 2 Dec 2000 08:41:23 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 Dec 2000 08:39:02 -0500 (EST) Received: from mail.rmi.net (chevalier.rmi.net [166.93.8.14]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.2) ID for ; Sat, 02 Dec 2000 08:38:59 -0500 (EST) Received: from rmi.net (dial-77.27.mtrco.rmi.net [166.93.77.27]) by mail.rmi.net (8.9.3+Sun/8.9.3) with ESMTP id GAA17381 for ; Sat, 02 Dec 2000 06:38:57 -0700 (MST) Date: Sat, 02 Dec 2000 06:35:20 -0700 From: Buck Tilton Subject: W-EMED Aquamira 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: <3A28FA97.CBA9C1B3@rmi.net> Organization: Wilderness Medicine Institute MIME-version: 1.0 X-Mailer: Mozilla 4.5 (Macintosh; I; 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: <3A1ECB5A.4673.4894476@localhost> I keep hearing claims that a field water treatment called Aquamira works, but I haven't been able to find any facts. Does anyone know anything about the product? Thanks very much. "Keith Conover, M.D., FACEP" wrote: > On 21 Nov 2000, at 21:45, MYScher@aol.com wrote: > > > Greetings Dr. Conover! > > > > In a W-EMED posting of 8/22/00 you wrote " When in the field with any > > hypothermic patient, add as much heat as you can. Given the danger of > > spontaneous v. fib, the sooner you can rewarm, the better." > > > > On the WEMSI website, in Advanced Treatment of Hypothermia you wrote that > > active rewarming should be delayed for the advanced facility. > > > > Could you clarify this for me, please? > > > > I'm preparing a discussion of this for my classmates for next week, and I > > don't clearly grasp what you're advocating. Is "add as much heat as you can" > > because we can't realistically rewarm the patient much in the field, vs. > > active (effective) rewarming? What would you suggest for an ambulance crew > > that might be transporting such a patient after a handoff from a rescue team? > > > > Thank you for your time. Any other suggestions would be greatly appreciated. > > > > Mordechai Y. Scher > > Combat Medic 09 (IDF) > > EMT, Spencer Rescue > > Paramedic student/intern > > Good question. > > 1. The amount of heat we can add in the field is very limited, so > massive rewarming (as in a hot tub) with attendant risk of rewarming > shock -- is impossible in the field. > > 2. The article you refer to (http://www.wemsi.org/alg.html) is actually > not by me, but is an "unofficial" posting at the website -- please > check http://www.wemsi.org/cold-30.pdf for the "official" > recommendations. > > 3. There was some talk about "avoid rapid rewarming in the field" in > the past, but the thrust of recent research and teaching has been to > kill this. > > By copy of this post I'll ask our Webmaster to make this more clear > on the Web site. > > Thanks. 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 -- ************************ Buck Tilton Wilderness Medicine Institute of NOLS P. O. Box 9 Pitkin, CO 81241 Phone 970-641-3572 Fax 970-641-0882 buck_tilton@nols.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 ; Wed, 29 Nov 2000 22:52:07 -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 <01JX4NU8P8CS000SDM@mb1i0.ns.pitt.edu>; Wed, 29 Nov 2000 22:52:06 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, 29 Nov 2000 22:51:31 -0500 (EST) Received: from smtp1.mail.yahoo.com (smtp1.mail.yahoo.com [128.11.69.60]) by list.srv.cis.pitt.edu with SMTP (8.8.8/8.8.8/cisls-7.2.2.2) ID for ; Wed, 29 Nov 2000 22:51:28 -0500 (EST) Received: from unknown (HELO morgan) (205.182.107.197) by smtp.mail.vip.suc.yahoo.com with SMTP; Wed, 29 Nov 2000 18:17:39 +0000 Date: Wed, 29 Nov 2000 12:17:31 -0600 From: Morgan Young Subject: RE: W-EMED Medical Clip Art 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: <000901c05a30$a3b12700$c56bb6cd@morgan> MIME-version: 1.0 X-MIMEOLE: Produced By Microsoft MimeOLE V5.50.4133.2400 X-Mailer: Microsoft Outlook 8.5, Build 4.71.2173.0 Content-type: multipart/alternative; boundary="----=_NextPart_000_000A_01C059FE.5916B700" Importance: Normal X-Priority: 3 (Normal) X-MSMail-priority: Normal Precedence: bulk X-Apparently-From: This is a multi-part message in MIME format. ------=_NextPart_000_000A_01C059FE.5916B700 Content-Type: text/plain; charset="iso-8859-1" Content-Transfer-Encoding: 7bit Forgive me, but what is a: "NRAEMT-T"? I have never seen that before. Richard Morgan Young, EMT-P myoung@midwestpaging.com for alphanumeric pages. theonlymorgan2@yahoo.com permanent Email Address My ICQ Number is13139183. The Enemy is anybody who is going to get you Killed, No matter which side he is on. -Joseph Heller "If your going to Dance with disaster you might as well lead." "People sleep peaceably in their beds at night only because rough men stand ready to do violence on their behalf." --George Orwell-- -----Original Message----- From: owner-wilderness-emergency-medicine@list.pitt.edu [mailto:owner-wilderness-emergency-medicine@list.pitt.edu]On Behalf Of RescueRayS@aol.com Sent: Wednesday, November 29, 2000 07:40 To: wilderness-emergency-medicine@list.pitt.edu Subject: W-EMED Medical Clip Art You can find the best medical clip art at www.lifeart.com - Free downloadable images or buy the software package that fills your needs. Raymond A. Schleif, MMSc., CIC, IT, NRAEMT-T Director of Clinical Studies Sisters of Charity Medical Centers, EMS Programs Training Institute for Medical Emergencies & Rescue ------=_NextPart_000_000A_01C059FE.5916B700 Content-Type: text/html; charset="iso-8859-1" Content-Transfer-Encoding: quoted-printable

Forgive=20 me, but what is a:  "NRAEMT-T"?
I have=20 never seen that before.
 
Richard Morgan Young, = EMT-P
myoung@midwestpaging.com for = alphanumeric=20 pages.
theonlymorgan2@yahoo.com = permanent=20 Email Address
My ICQ Number is13139183.
The Enemy is anybody who is going to = get you=20 Killed, No matter which side he is on. -Joseph Heller
"If your going to Dance with disaster = you might as=20 well lead."
"People sleep peaceably in their = beds at=20 night only because rough men stand ready to do violence on their = behalf."=20 --George Orwell--
 
-----Original Message-----
From:=20 owner-wilderness-emergency-medicine@list.pitt.edu=20 [mailto:owner-wilderness-emergency-medicine@list.pitt.edu]On Behalf = Of=20 RescueRayS@aol.com
Sent: Wednesday, November 29, 2000=20 07:40
To:=20 wilderness-emergency-medicine@list.pitt.edu
Subject: W-EMED = Medical=20 Clip Art

You = can find the=20 best medical clip art at www.lifeart.com - Free downloadable
images = or buy=20 the software package that fills your needs.


Raymond = A. Schleif,=20 MMSc., CIC, IT, NRAEMT-T
Director of Clinical Studies
Sisters of = Charity=20 Medical Centers, EMS Programs
Training Institute for Medical = Emergencies=20 & Rescue
------=_NextPart_000_000A_01C059FE.5916B700-- _________________________________________________________ Do You Yahoo!? Get your free @yahoo.com address at http://mail.yahoo.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 ; Wed, 29 Nov 2000 08:41:49 -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 <01JX3U60QZ5G000Q01@mb1i0.ns.pitt.edu>; Wed, 29 Nov 2000 08:41:49 EST Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.2) ID ; Wed, 29 Nov 2000 08:41:03 -0500 (EST) Received: from imo-r07.mx.aol.com (imo-r07.mx.aol.com [152.163.225.7]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.2) ID for ; Wed, 29 Nov 2000 08:41:00 -0500 (EST) Received: from RescueRayS@aol.com by imo-r07.mx.aol.com (mail_out_v28.34.) id h.a4.ca28ab1 (3979) for ; Wed, 29 Nov 2000 08:40:18 -0500 (EST) Date: Wed, 29 Nov 2000 08:40:17 -0500 (EST) From: RescueRayS@aol.com Subject: W-EMED Medical Clip Art 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: Unknown sub 148 Content-type: multipart/alternative; boundary="part1_a4.ca28ab1.27566141_boundary" Content-disposition: Inline Precedence: bulk --part1_a4.ca28ab1.27566141_boundary Content-Type: text/plain; charset="US-ASCII" Content-Transfer-Encoding: 7bit You can find the best medical clip art at www.lifeart.com - Free downloadable images or buy the software package that fills your needs. Raymond A. Schleif, MMSc., CIC, IT, NRAEMT-T Director of Clinical Studies Sisters of Charity Medical Centers, EMS Programs Training Institute for Medical Emergencies & Rescue --part1_a4.ca28ab1.27566141_boundary Content-Type: text/html; charset="US-ASCII" Content-Transfer-Encoding: 7bit You can find the best medical clip art at www.lifeart.com - Free downloadable
images or buy the software package that fills your needs.


Raymond A. Schleif, MMSc., CIC, IT, NRAEMT-T
Director of Clinical Studies
Sisters of Charity Medical Centers, EMS Programs
Training Institute for Medical Emergencies & Rescue
--part1_a4.ca28ab1.27566141_boundary-- 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, 29 Nov 2000 03:52:27 -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 <01JX3K29B5QK000OCC@mb1i0.ns.pitt.edu>; Wed, 29 Nov 2000 03:52:27 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, 29 Nov 2000 03:51:58 -0500 (EST) Received: from mx.lightlink.com (root@mx.lightlink.com [205.232.34.15]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.2) ID for ; Wed, 29 Nov 2000 03:51:55 -0500 (EST) Received: from officeweb.lightlink.com (cci-ndhudson.clarityconnect.net [209.150.235.205]) by mx.lightlink.com (8.8.8/8.8.8) with ESMTP id DAA16658 for ; Wed, 29 Nov 2000 03:51:50 -0500 Date: Wed, 29 Nov 2000 03:51:21 -0500 From: nigel dyson-hudson Subject: W-EMED sorry if off topic: someone looking for med clip art Fwd: Clip art Sender: owner-wilderness-emergency-medicine@list.pitt.edu X-Sender: ndh@pop3.lightlink.com To: wilderness-emergency-medicine@list.pitt.edu Reply-to: wilderness-emergency-medicine@list.pitt.edu Message-id: <5.0.0.25.2.20001129034517.00a95d80@pop3.lightlink.com> MIME-version: 1.0 X-Mailer: QUALCOMM Windows Eudora Version 5.0 Content-type: text/plain; charset="us-ascii"; format=flowed Precedence: bulk folks, from an other mailing list, this person is looking for medical clip art. Please reply directly. thanks, nigel BTW, keep the list "open" allowing any e-mail address, I have a number of addresses and trying to remember which one to use when replying is a pain. Also, Smartgroups, www.smartgroups.com has an e-mail list with no advertisting, calender, photo album - Northern New Jersey Grotto, nnjg.org, uses them. >X-Authentication-Warning: hwg.org: Host pop.chartertn.net [208.27.20.5] >claimed to be mail1 >Date: Mon, 27 Nov 2000 19:03:32 -0500 >From: christopherm >X-Mailer: Mozilla 4.76 [en] (Win98; U) >X-Accept-Language: en >To: HWG-Basics >Subject: Clip art >Sender: owner-hwg-basics@hwg.org > >Hello List, > >Could someone please suggest a site to get some medical related clip art >needed for a doctors office site. Thought they would have something I >could scan, but no such luck. Thanks in advance. > >-- >_____________________________________________ > >Christopher Menke >ICQ # 1600546 >http://www.virtualis.com/vr/cmenke/index.html >The day Microsoft makes something that doesn't suck is probably >the day they start making vacuum cleaners. nigel dyson-hudson, InternetSmiths, ndh@InternetSmiths.com "mad dogs and Englishmen" and I am both! 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, 28 Nov 2000 08:34:16 -0500 (EST) Disposition-notification-to: MlleYvonneBeretta@email.msn.com Received: from list.srv.cis.pitt.edu (majordom@[136.142.185.20]) by pitt.edu (PMDF V5.2-32 #41462) with ESMTP id <01JX2FLAR0QW00126K@mb2i0.ns.pitt.edu>; Tue, 28 Nov 2000 08:34:15 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, 28 Nov 2000 08:31:55 -0500 (EST) Received: from smtp.email.msn.com (cpimssmtpu02.email.msn.com [207.46.181.18]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.2) ID ; Tue, 28 Nov 2000 08:28:42 -0500 (EST) Received: from oemcomputer - 63.23.136.72 by email.msn.com with Microsoft SMTPSVC; Tue, 28 Nov 2000 05:28:20 -0800 Date: Tue, 28 Nov 2000 08:27:35 -0500 From: MlleYvonneBeretta Subject: W-EMED Re: [wilderness-emergency-medicine] Digest Number 72 Sender: owner-wilderness-emergency-medicine@list.pitt.edu To: Majordomo@list.pitt.edu Cc: wilderness-emergency-medicine@list.pitt.edu Reply-to: wilderness-emergency-medicine@list.pitt.edu Message-id: <164701c0593e$f9965fc0$f18e173f@oemcomputer> 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: multipart/related; boundary="----=_NextPart_000_1643_01C05915.0FA48780"; type="multipart/alternative" X-Priority: 3 X-MSMail-priority: Normal Precedence: bulk This is a multi-part message in MIME format. ------=_NextPart_000_1643_01C05915.0FA48780 Content-Type: multipart/alternative; boundary="----=_NextPart_001_1644_01C05915.0FAC28A0" ------=_NextPart_001_1644_01C05915.0FAC28A0 Content-Type: text/plain; charset="Windows-1252" Content-Transfer-Encoding: quoted-printable MESSAGE: subscribe wilderness-emergency-medicine Mlle. Yvonne Beretta Mountain trekker Please send me your confirmation of this E-Mail. Please do not shut down your website. Presently, I am new at this about 2yrs and I travel quarterly to the = mountains because of the stress in New York City. I admire everyone at Wilderness Emergency Medical Services Institute = there, to me you are unsung heros and heroines doing an heroic effort = which walks on a blade with trauma everyday.=20 Everyone who works at Wilderness Emergency Medical Services Institute is = OUTSTANDING!!! I personally, consider everyone there to be role models in the most = positive way compared to what I see here in the South Bronx, a New York = City Ghetto. So, don't give up Hope. Ok? =20 Please reflect...some trauma is phyiscal but most of it is psychological = so if you feel or think you are not getting the proper response, = reflect, because most everyone in any present environment is = experiencing some type of physical or emotional, mental trauma on some = level so... as soon as they take stock to reflect, they will seek out = help or tools of proper advice. =20 But for trekker like myself I go to nature the last frontier. Can U Relate??? Sincerely,=20 Mlle. Yvonne Beretta Back streets trekker of New York Ctiy ghettos of the South Bronx Question for my reflection? Please, explain this email attached below and why do you want to shut = down? Happy Holiday to all!=20 Message: 1 Date: Mon, 27 Nov 2000 07:25:21 -0500 From: "Dan Plemons" Subject: Re: W-EMED Shuting down. Don't do it!!!! You are a great learning resource for me. =20 dan Plemons, Occasional missionary to way out of the way places where your knowledge = may come in handy, >>> "Gosta" Friday, November 24, 2000 >>> It would be very sad if you had to shut down. Personally, I'd rather put = up with a few spams even if they are annoying. G=F6sta Liljeqvist Intensive Care Paramedic Sydney/Australia. ------=_NextPart_001_1644_01C05915.0FAC28A0 Content-Type: text/html; charset="Windows-1252" Content-Transfer-Encoding: quoted-printable
 
 
 
 
 
 
 

MESSAGE: subscribe=20 wilderness-emergency-medicine

Mlle. Yvonne=20 Beretta
Mountain = trekker
 
 
 
Please send me your = confirmation of this=20 E-Mail.
 
Please do not shut down your = website.
 
Presently, I am new at this = about 2yrs=20 and I travel quarterly to the mountains because of the stress in New = York=20 City.
I admire=20 everyone at Wilderness Emergency Medical Services = Institute there, to me you are unsung heros = and heroines=20 doing an heroic effort which walks on a blade with trauma=20 everyday. 
 
Everyone who works at Wilderness = Emergency=20 Medical Services Institute is OUTSTANDING!!!
I personally, consider = everyone there to=20 be role models in the most positive way compared to what I see here = in the=20 South Bronx, a New York City Ghetto.  So, don't give up Hope.=20 Ok? 
Please reflect...some trauma = is phyiscal=20 but most of it is psychological so if you feel or think you are not = getting the=20 proper response, reflect, because most everyone in any present = environment is=20 experiencing some type of physical or emotional, mental trauma on some = level=20 so... as soon as they take stock to reflect, they will seek out help or = tools of=20 proper advice. 
 
But for trekker like myself = I go to=20 nature the last frontier.
 
Can U = Relate???
 
 
Sincerely, =
 
Mlle. Yvonne=20 Beretta
Back streets trekker of = New York=20 Ctiy
ghettos of the South=20 Bronx
 
Question for my reflection?
 
Please, explain this email = attached=20 below and why do you want to shut=20 down?
 
Happy Holiday to all!=20
 
Message:=20 1
   Date: Mon, 27 Nov 2000 07:25:21 -0500
   = From:=20 "Dan Plemons" <DanP@darlington.k12.sc.us>
Subject: Re: W-EMED Shuting down.

Don't do = it!!!! You are=20 a great learning resource for me. 
dan Plemons,
Occasional=20 missionary to way out of the way places where your knowledge may come in = handy,

>>> "Gosta" <gosta@primus.com.au> Friday,=20 November 24, 2000 >>>
It would be very sad if you had to = shut down.=20 Personally, I'd rather put up with a few spams even if they are=20 annoying.

G=F6sta Liljeqvist
Intensive Care Paramedic=20 Sydney/Australia.

 
 
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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 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, 27 Nov 2000 07:29:23 -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 <01JX0Z1HX9R2000XK9@mb2i0.ns.pitt.edu>; Mon, 27 Nov 2000 07:29:21 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, 27 Nov 2000 07:28:15 -0500 (EST) Received: from Darlington.k12.sc.us ([207.232.247.130]) by list.srv.cis.pitt.edu with SMTP (8.8.8/8.8.8/cisls-7.2.2.2) ID for ; Mon, 27 Nov 2000 07:28:12 -0500 (EST) Received: from NETDOM1-Message_Server by Darlington.k12.sc.us with Novell_GroupWise; Mon, 27 Nov 2000 07:14:20 -0500 Date: Mon, 27 Nov 2000 07:25:21 -0500 From: Dan Plemons Subject: Re: W-EMED Shuting down. 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-MIME-Autoconverted: from quoted-printable to 8bit by list.srv.cis.pitt.edu id HAA26341 X-Mailer: Novell GroupWise 5.5.2 Content-type: text/plain; charset=ISO-8859-1 Content-disposition: inline Content-transfer-encoding: 8BIT Precedence: bulk Don't do it!!!! You are a great learning resource for me. dan Plemons, Occasional missionary to way out of the way places where your knowledge may come in handy, >>> "Gosta" Friday, November 24, 2000 >>> It would be very sad if you had to shut down. Personally, I'd rather put up with a few spams even if they are annoying. Gösta Liljeqvist Intensive Care Paramedic Sydney/Australia. 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, 25 Nov 2000 15:15:45 -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 <01JWYMR1Q61I000APA@mb1i0.ns.pitt.edu>; Sat, 25 Nov 2000 15:15:45 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, 25 Nov 2000 15:15:23 -0500 (EST) Received: from bunyip.flash.net (bunyip.flash.net [209.30.2.15]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.2) ID for ; Sat, 25 Nov 2000 15:15:15 -0500 (EST) Received: from jsa2 (ppp-64-217-173-24.dialup.elpstx.swbell.net [64.217.173.24]) by bunyip.flash.net (8.9.3/Pro-8.9.3) with SMTP id OAA05040 for ; Sat, 25 Nov 2000 14:15:08 -0600 (CST) Date: Sat, 25 Nov 2000 13:24:31 -0700 From: Steve Subject: Re: W-EMED Hyperventilation in Head Trauma 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: <004601c0571d$b8cbb580$18add940@jsa2> MIME-version: 1.0 X-MIMEOLE: Produced By Microsoft MimeOLE V4.72.3110.3 X-Mailer: Microsoft Outlook Express 4.72.3110.1 Content-type: text/plain; charset="iso-8859-1" Content-transfer-encoding: 7bit X-Priority: 3 X-MSMail-priority: Normal Precedence: bulk Remember there is generally a 4-6 mmHg gradient between ETCO2 and PaCO2; this gradient may be increased by hypotension, patient position, lung disease and many other factors. Also, inhalational anesthetic agents (including N2O) are potent cerebral vasodilators. Hyperventilation is commonly used in the OR for neurosurgical procedures but the situation is somewhat different than head trauma. Steve Anderson,MD neuroanesthesiologist lurker -----Original Message----- From: Suzanne Atkinson To: wilderness-emergency-medicine@list.pitt.edu Date: Saturday, November 25, 2000 12:13 PM Subject: Re: W-EMED Hyperventilation in Head Trauma > >----- Original Message ----- >From: GATORDOC > >> The primary concern with hyperventilation is that although it does >decrease >> ICP, the decrease in cerebral blood flow can lead to brain ischemia. The >> current practice in the Emergency Dept is to mildly hyperventilate so that >> the pCO2 is between 30-35mmHg. The practice of hyperventilating to a pCO2 >> of 25mmHg has been abandoned. > >I asked the question about ischemia to a neurosurgeon whose case I watched >last week. the case lasted about 4 hours, and the ETCO2 was at 20mmHg the >entire case. He said that ischemia isn't an issue because as long as the >patient is receiving 100% O2, the PaO2 would remain high. I guess >neurosurgeons can get away with being more aggressive than folks in the ER >or in the street? > >Suzanne > >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 ; Sat, 25 Nov 2000 13:58:34 -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 <01JWYK2C2LB8000DZP@mb1i0.ns.pitt.edu>; Sat, 25 Nov 2000 13:58:34 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, 25 Nov 2000 13:58:14 -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 ; Sat, 25 Nov 2000 13:58:12 -0500 (EST) Received: from snickers ("port 1034"@[136.142.22.111]) by pitt.edu (PMDF V5.2-32 #41462) with SMTP id <01JWYK1UKNAY000APA@mb1i0.ns.pitt.edu> for wilderness-emergency-medicine@list.pitt.edu; Sat, 25 Nov 2000 13:58:11 -0500 (EST) Date: Sat, 25 Nov 2000 14:03:19 -0500 From: Suzanne Atkinson Subject: Re: W-EMED Hyperventilation in Head Trauma 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: <001301c05712$60b3d540$0300a8c0@snickers> MIME-version: 1.0 X-MIMEOLE: Produced By Microsoft MimeOLE V5.00.2615.200 X-Mailer: Microsoft Outlook Express 5.00.2615.200 Content-type: text/plain; charset="iso-8859-1" Content-transfer-encoding: 7bit X-Priority: 3 X-MSMail-priority: Normal Precedence: bulk References: <3A1ECB5A.4673.4894476@localhost> <001101c056a1$e11ef640$0300a8c0@snickers> <001301c056fa$a29ec220$c55d07cf@default> ----- Original Message ----- From: GATORDOC > The primary concern with hyperventilation is that although it does decrease > ICP, the decrease in cerebral blood flow can lead to brain ischemia. The > current practice in the Emergency Dept is to mildly hyperventilate so that > the pCO2 is between 30-35mmHg. The practice of hyperventilating to a pCO2 > of 25mmHg has been abandoned. I asked the question about ischemia to a neurosurgeon whose case I watched last week. the case lasted about 4 hours, and the ETCO2 was at 20mmHg the entire case. He said that ischemia isn't an issue because as long as the patient is receiving 100% O2, the PaO2 would remain high. I guess neurosurgeons can get away with being more aggressive than folks in the ER or in the street? Suzanne 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, 25 Nov 2000 12:22:00 -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 <01JWYGONJ07Q000AP9@mb1i0.ns.pitt.edu>; Sat, 25 Nov 2000 12:22:01 EST Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.2) ID ; Sat, 25 Nov 2000 12:21:43 -0500 (EST) Received: from mtiwmhc24.worldnet.att.net (mtiwmhc24.worldnet.att.net [204.127.131.49]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.2) ID for ; Sat, 25 Nov 2000 12:21:40 -0500 (EST) Received: from pavilionwin98 ([12.93.30.38]) by mtiwmhc24.worldnet.att.net (InterMail vM.4.01.03.10 201-229-121-110) with SMTP id <20001125172109.GOWB13270.mtiwmhc24.worldnet.att.net@pavilionwin98> for ; Sat, 25 Nov 2000 17:21:09 +0000 Date: Sat, 25 Nov 2000 12:24:07 -0500 From: Roy Alson Subject: Re: W-EMED Hyperventilation in Head Trauma 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: <003c01c05704$8889ecc0$0101a8c0@pavilionwin98> MIME-version: 1.0 X-MIMEOLE: Produced By Microsoft MimeOLE V5.50.4133.2400 X-Mailer: Microsoft Outlook Express 5.50.4133.2400 Content-type: multipart/mixed; boundary="----=_NextPart_000_0039_01C056DA.9B93FC40" X-Priority: 3 X-MSMail-priority: Normal Precedence: bulk References: <3A1ECB5A.4673.4894476@localhost> <001101c056a1$e11ef640$0300a8c0@snickers> This is a multi-part message in MIME format. ------=_NextPart_000_0039_01C056DA.9B93FC40 Content-Type: text/plain; charset="iso-8859-1" Content-Transfer-Encoding: 7bit Suzanne, There is a pretty good discussion of this topic in the 4th edition of the BTLS text. It follows the guidelines set forth by the Brain Trauma foundation for prehospital management of the closed head injury patient. Their guidelines are available at their website: www.braintrauma.org Roy Alson, MD ----- Original Message ----- From: "Suzanne Atkinson" To: Sent: Saturday, November 25, 2000 12:38 AM Subject: W-EMED Hyperventilation in Head Trauma > Having taken a recent W-EMT course we learned that hyperventilation was no > longer 'en vogue' for head trauma in the field. This confused me a bit, as > I know that hyperventilation does decrease the amount of blood flowing to > the brain, thereby reducing intracranial pressure. During neurosurgery when > a craniotomy is performed, patients are also hyperventilated quite a bit to > help reduce the swelling of the brain. After having pestered a neurosurgeon > for some time he decided he had better things to do (more craniotomies I'm > sure...) so I finally turned to an EMT instructor who told me that the > current reccommendations for hyperventilation were only in cases where there > are clinical signs of ICP (a blown pupil for example). > > So here is (are) my questions for the group, I am looking for input at all > levels of care...wilderness, pre-hospital, ER, and medical/surgical > management of a possible head trauma patient: > > When is hyperventilation indicated, and is there any difference if you are > in a wilderness setting or on the street? Once a possible head trauma > victim arrives in the ER, would they begin to hyperventilate there if it had > not already been started in the field? Is there any reason to encourage > AOx1or2 victims to hyperventilate if they do not need to be bagged (yet)? > Have any of you ever witnessed a reversal of increasing ICP as a result of > hyperventilation in any setting (i.e. a groggy patient becoming more lucid, > a dilated pupil becoming smaller...)? Is it in the realm of possibilities > to do emergent treponation in the wilderness if the alternative is certain > death (obviously only by trained neurosurgeons)? > > Thanks in advance! > > Suzanne Atkinson > MS-III, University of Pittsburgh School of Medicine > W-EMT, Allegheny Mountain Rescue Group > > > 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 > ------=_NextPart_000_0039_01C056DA.9B93FC40 Content-Type: text/x-vcard; name="Roy Alson.vcf" Content-Transfer-Encoding: quoted-printable Content-Disposition: attachment; filename="Roy Alson.vcf" BEGIN:VCARD VERSION:2.1 N:Alson;Roy FN:Roy Alson ORG:Wake Forest University School of Medicine TITLE:Dr. TEL;WORK;VOICE:(336) 716-2193 TEL;HOME;VOICE:(336) 768-3105 TEL;WORK;FAX:(336) 716-5438 ADR;WORK:;;301 Medical Center Blvd.;Winston-Salem;NC;27157-1089 LABEL;WORK;ENCODING=3DQUOTED-PRINTABLE:301 Medical Center = Blvd.=3D0D=3D0AWinston-Salem, NC 27157-1089 EMAIL;PREF;INTERNET:ralson@wfubmc.edu REV:20001125T172407Z END:VCARD ------=_NextPart_000_0039_01C056DA.9B93FC40-- 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, 25 Nov 2000 10:16:36 -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 <01JWYCB5OFIQ000PBR@mb2i0.ns.pitt.edu>; Sat, 25 Nov 2000 10:16:36 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, 25 Nov 2000 10:16:06 -0500 (EST) Received: from picusnet.com (mail.picusnet.com [207.7.90.2]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.2) ID for ; Sat, 25 Nov 2000 10:16:03 -0500 (EST) Received: from default [207.7.93.197] by picusnet.com (SMTPD32-6.05) id A7AC1E4500D8; Sat, 25 Nov 2000 10:15:56 -0500 Date: Sat, 25 Nov 2000 10:13:20 -0600 From: GATORDOC Subject: Re: W-EMED Hyperventilation in Head Trauma 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: <001301c056fa$a29ec220$c55d07cf@default> MIME-version: 1.0 X-MIMEOLE: Produced By Microsoft MimeOLE V5.00.2919.6600 X-Mailer: Microsoft Outlook Express 5.00.2919.6600 Content-type: text/plain; charset="iso-8859-1" Content-transfer-encoding: 7bit X-Priority: 3 X-MSMail-priority: Normal Precedence: bulk References: <3A1ECB5A.4673.4894476@localhost> <001101c056a1$e11ef640$0300a8c0@snickers> The primary concern with hyperventilation is that although it does decrease ICP, the decrease in cerebral blood flow can lead to brain ischemia. The current practice in the Emergency Dept is to mildly hyperventilate so that the pCO2 is between 30-35mmHg. The practice of hyperventilating to a pCO2 of 25mmHg has been abandoned. ----- Original Message ----- From: "Suzanne Atkinson" To: Sent: Friday, November 24, 2000 11:38 PM Subject: W-EMED Hyperventilation in Head Trauma > Having taken a recent W-EMT course we learned that hyperventilation was no > longer 'en vogue' for head trauma in the field. This confused me a bit, as > I know that hyperventilation does decrease the amount of blood flowing to > the brain, thereby reducing intracranial pressure. During neurosurgery when > a craniotomy is performed, patients are also hyperventilated quite a bit to > help reduce the swelling of the brain. After having pestered a neurosurgeon > for some time he decided he had better things to do (more craniotomies I'm > sure...) so I finally turned to an EMT instructor who told me that the > current reccommendations for hyperventilation were only in cases where there > are clinical signs of ICP (a blown pupil for example). > > So here is (are) my questions for the group, I am looking for input at all > levels of care...wilderness, pre-hospital, ER, and medical/surgical > management of a possible head trauma patient: > > When is hyperventilation indicated, and is there any difference if you are > in a wilderness setting or on the street? Once a possible head trauma > victim arrives in the ER, would they begin to hyperventilate there if it had > not already been started in the field? Is there any reason to encourage > AOx1or2 victims to hyperventilate if they do not need to be bagged (yet)? > Have any of you ever witnessed a reversal of increasing ICP as a result of > hyperventilation in any setting (i.e. a groggy patient becoming more lucid, > a dilated pupil becoming smaller...)? Is it in the realm of possibilities > to do emergent treponation in the wilderness if the alternative is certain > death (obviously only by trained neurosurgeons)? > > Thanks in advance! > > Suzanne Atkinson > MS-III, University of Pittsburgh School of Medicine > W-EMT, Allegheny Mountain Rescue Group > > > 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 ; Sat, 25 Nov 2000 05:46:07 -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 <01JWY2UT1UAI000MS8@mb2i0.ns.pitt.edu>; Sat, 25 Nov 2000 05:46:07 EST Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.2) ID ; Sat, 25 Nov 2000 05:45:31 -0500 (EST) Received: from lynchburg.net (mail.lynchburg.net [216.207.176.4]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.2) ID for ; Sat, 25 Nov 2000 05:45:29 -0500 (EST) Received: from vaio [216.207.180.150] by lynchburg.net (SMTPD32-6.04) id A94A5A050146; Sat, 25 Nov 2000 05:49:46 -0500 Date: Sat, 25 Nov 2000 05:50:33 -0500 From: Greg Turner Subject: Re: W-EMED Hyperventilation in Head Trauma 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: <001a01c056cd$89ed7960$d531fea9@vaio> MIME-version: 1.0 X-MIMEOLE: Produced By Microsoft MimeOLE V4.72.3155.0 X-Mailer: Microsoft Outlook Express 4.72.3155.0 Content-type: text/plain; charset="iso-8859-1" Content-transfer-encoding: 7bit X-Priority: 3 X-MSMail-priority: Normal Precedence: bulk >From my training recently, I have been told that you only hyperventilate with S/S pointing toward possible herniation. One reason to limit hyperventilation, as I was told by a surgeon, was that the effects are self limiting on time (meaning the vaso constriction is only temp.) and that once used, it is no longer effective if tried again during that resuscitative effort. GLT -----Original Message----- From: Suzanne Atkinson To: wilderness-emergency-medicine@list.pitt.edu Date: Saturday, November 25, 2000 1:14 AM Subject: W-EMED Hyperventilation in Head Trauma >Having taken a recent W-EMT course we learned that hyperventilation was no >longer 'en vogue' for head trauma in the field. This confused me a bit, as >I know that hyperventilation does decrease the amount of blood flowing to >the brain, thereby reducing intracranial pressure. During neurosurgery when >a craniotomy is performed, patients are also hyperventilated quite a bit to >help reduce the swelling of the brain. After having pestered a neurosurgeon >for some time he decided he had better things to do (more craniotomies I'm >sure...) so I finally turned to an EMT instructor who told me that the >current reccommendations for hyperventilation were only in cases where there >are clinical signs of ICP (a blown pupil for example). > >So here is (are) my questions for the group, I am looking for input at all >levels of care...wilderness, pre-hospital, ER, and medical/surgical >management of a possible head trauma patient: > >When is hyperventilation indicated, and is there any difference if you are >in a wilderness setting or on the street? Once a possible head trauma >victim arrives in the ER, would they begin to hyperventilate there if it had >not already been started in the field? Is there any reason to encourage >AOx1or2 victims to hyperventilate if they do not need to be bagged (yet)? >Have any of you ever witnessed a reversal of increasing ICP as a result of >hyperventilation in any setting (i.e. a groggy patient becoming more lucid, >a dilated pupil becoming smaller...)? Is it in the realm of possibilities >to do emergent treponation in the wilderness if the alternative is certain >death (obviously only by trained neurosurgeons)? > >Thanks in advance! > >Suzanne Atkinson >MS-III, University of Pittsburgh School of Medicine >W-EMT, Allegheny Mountain Rescue Group > > >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 ; Sat, 25 Nov 2000 00:33:18 -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 <01JWXRWZMCAE000ADZ@mb1i0.ns.pitt.edu>; Sat, 25 Nov 2000 00:33:18 EST Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.2) ID ; Sat, 25 Nov 2000 00:33:04 -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 ; Sat, 25 Nov 2000 00:33:01 -0500 (EST) Received: from snickers ("port 2085"@[136.142.24.22]) by pitt.edu (PMDF V5.2-32 #41462) with SMTP id <01JWXRWILMRI000CK8@mb1i0.ns.pitt.edu> for wilderness-emergency-medicine@list.pitt.edu; Sat, 25 Nov 2000 00:32:56 -0500 (EST) Date: Sat, 25 Nov 2000 00:38:01 -0500 From: Suzanne Atkinson Subject: W-EMED Hyperventilation in Head Trauma 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: <001101c056a1$e11ef640$0300a8c0@snickers> MIME-version: 1.0 X-MIMEOLE: Produced By Microsoft MimeOLE V5.00.2615.200 X-Mailer: Microsoft Outlook Express 5.00.2615.200 Content-type: text/plain; charset="iso-8859-1" Content-transfer-encoding: 7bit X-Priority: 3 X-MSMail-priority: Normal Precedence: bulk References: <3A1ECB5A.4673.4894476@localhost> Having taken a recent W-EMT course we learned that hyperventilation was no longer 'en vogue' for head trauma in the field. This confused me a bit, as I know that hyperventilation does decrease the amount of blood flowing to the brain, thereby reducing intracranial pressure. During neurosurgery when a craniotomy is performed, patients are also hyperventilated quite a bit to help reduce the swelling of the brain. After having pestered a neurosurgeon for some time he decided he had better things to do (more craniotomies I'm sure...) so I finally turned to an EMT instructor who told me that the current reccommendations for hyperventilation were only in cases where there are clinical signs of ICP (a blown pupil for example). So here is (are) my questions for the group, I am looking for input at all levels of care...wilderness, pre-hospital, ER, and medical/surgical management of a possible head trauma patient: When is hyperventilation indicated, and is there any difference if you are in a wilderness setting or on the street? Once a possible head trauma victim arrives in the ER, would they begin to hyperventilate there if it had not already been started in the field? Is there any reason to encourage AOx1or2 victims to hyperventilate if they do not need to be bagged (yet)? Have any of you ever witnessed a reversal of increasing ICP as a result of hyperventilation in any setting (i.e. a groggy patient becoming more lucid, a dilated pupil becoming smaller...)? Is it in the realm of possibilities to do emergent treponation in the wilderness if the alternative is certain death (obviously only by trained neurosurgeons)? Thanks in advance! Suzanne Atkinson MS-III, University of Pittsburgh School of Medicine W-EMT, Allegheny Mountain Rescue Group 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 ; Fri, 24 Nov 2000 22:39:26 -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 <01JWXNXTS02G000KVS@mb2i0.ns.pitt.edu>; Fri, 24 Nov 2000 22:39:27 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, 24 Nov 2000 22:38:58 -0500 (EST) Received: from gtei1.bellatlantic.net (gtei1.bellatlantic.net [199.45.39.159]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.2) ID for ; Fri, 24 Nov 2000 22:38:56 -0500 (EST) Received: from Laptop (adsl-141-151-141-39.bellatlantic.net [141.151.141.39]) by gtei1.bellatlantic.net (8.9.1/8.9.1) with ESMTP id WAA07378; Fri, 24 Nov 2000 22:38:43 -0500 (EST) Date: Fri, 24 Nov 2000 22:38:49 -0500 From: "Keith Conover, M.D., FACEP" Subject: Re: W-EMED Shuting down. In-reply-to: <003d01c05682$36543780$c32086cb@gosta> Sender: owner-wilderness-emergency-medicine@list.pitt.edu To: Gosta , wilderness-emergency-medicine@list.pitt.edu Reply-to: wilderness-emergency-medicine@list.pitt.edu Message-id: <3A1EEDF9.4843.8576B@localhost> MIME-version: 1.0 X-Mailer: Pegasus Mail for Win32 (v3.12c) Content-type: text/plain; charset=US-ASCII Content-transfer-encoding: 7BIT Precedence: bulk Hmmm. I guess I wasn't clear about what I was mumbling about. "Closing" the list doesn't mean shutting it down -- just changing the policy so that only those subscribed to the list can post messages -- and only from precisely the address from which they originally subscribed. Unfortunately, even "closing" the list doesn't eliminate spam. Spammers can join the list, post spam, and then abandon that subscription address. I guess we could require that people send me an email and I could approve all new addresses -- but I'm not really interested in taking on all that work. And spammers could just lie to me, anyway! Take care. Sorry for any confusion. On 25 Nov 2000, at 12:51, Gosta wrote: > It would be very sad if you had to shut down. Personally, I'd rather put > up with a few spams even if they are annoying. --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 ; Fri, 24 Nov 2000 20:12:13 -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 <01JWXIT9MF4M000KVS@mb2i0.ns.pitt.edu>; Fri, 24 Nov 2000 20:12:13 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, 24 Nov 2000 20:11:29 -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 ; Fri, 24 Nov 2000 20:11:13 -0500 (EST) Received: from klaptop ("port 1141"@[136.142.23.17]) by pitt.edu (PMDF V5.2-32 #41462) with ESMTP id <01JWXIRX2HG0000DZP@mb1i0.ns.pitt.edu> for wilderness-emergency-medicine@list.pitt.edu; Fri, 24 Nov 2000 20:11:12 -0500 (EST) Date: Fri, 24 Nov 2000 20:11:06 -0500 From: "Keith Conover, M.D., FACEP" Subject: Re: W-EMED [MountainTrauma] "C" Spine clearance In-reply-to: <12695b5a6.b5a612695@med.unc.edu> Sender: owner-wilderness-emergency-medicine@list.pitt.edu To: Seth Hawkins , wilderness-emergency-medicine@list.pitt.edu Reply-to: wilderness-emergency-medicine@list.pitt.edu Message-id: <3A1ECB5A.21763.489443E@localhost> MIME-version: 1.0 X-Mailer: Pegasus Mail for Win32 (v3.12c) Content-type: text/plain; charset=US-ASCII Content-transfer-encoding: 7BIT Precedence: bulk On 22 Nov 2000, at 11:10, Seth Hawkins wrote: > However, a fundamental component of the Nexus protocol is absence of focal > neurological deficits. It's hard to imagine adequately ruling out such > deficits without some type of neuro exam, so saying the neuro exam > contributes "nothing" to the protocol is perhaps an overstatement. Hi, Seth. Maybe I should have been more specific. My thought -- alert, nonintoxicated people don't have a neuro deficit without knowing it. Therefore, the history _should_ be adequate to pick this up. Actually, it might be interesting to look at the NEXUS data carefully to see if there are cases of unstable cervical fracture detected by exam with no neuro complaints. I'm not saying we shouldn't do an exam, I just think it adds little if anything to the history. Thoughts? --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 ; Fri, 24 Nov 2000 20:12:14 -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 <01JWXIT9NGFU000CK8@mb1i0.ns.pitt.edu>; Fri, 24 Nov 2000 20:12:13 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, 24 Nov 2000 20:11:22 -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 ; Fri, 24 Nov 2000 20:11:15 -0500 (EST) Received: from klaptop ("port 1141"@[136.142.23.17]) by pitt.edu (PMDF V5.2-32 #41462) with ESMTP id <01JWXIRX2HG0000DZP@mb1i0.ns.pitt.edu> for wilderness-emergency-medicine@list.pitt.edu; Fri, 24 Nov 2000 20:11:14 -0500 (EST) Date: Fri, 24 Nov 2000 20:11:06 -0500 From: "Keith Conover, M.D., FACEP" Subject: W-EMED Re: Rewarming hypothermic pt. ? In-reply-to: <99.ce577a1.274c8d59@aol.com> Sender: owner-wilderness-emergency-medicine@list.pitt.edu To: MYScher@aol.com Cc: wilderness-emergency-medicine@list.pitt.edu, Bernie Roche Reply-to: wilderness-emergency-medicine@list.pitt.edu Message-id: <3A1ECB5A.4673.4894476@localhost> MIME-version: 1.0 X-Mailer: Pegasus Mail for Win32 (v3.12c) Content-type: text/plain; charset=US-ASCII Content-transfer-encoding: 7BIT Precedence: bulk On 21 Nov 2000, at 21:45, MYScher@aol.com wrote: > Greetings Dr. Conover! > > In a W-EMED posting of 8/22/00 you wrote " When in the field with any > hypothermic patient, add as much heat as you can. Given the danger of > spontaneous v. fib, the sooner you can rewarm, the better." > > On the WEMSI website, in Advanced Treatment of Hypothermia you wrote that > active rewarming should be delayed for the advanced facility. > > Could you clarify this for me, please? > > I'm preparing a discussion of this for my classmates for next week, and I > don't clearly grasp what you're advocating. Is "add as much heat as you can" > because we can't realistically rewarm the patient much in the field, vs. > active (effective) rewarming? What would you suggest for an ambulance crew > that might be transporting such a patient after a handoff from a rescue team? > > Thank you for your time. Any other suggestions would be greatly appreciated. > > Mordechai Y. Scher > Combat Medic 09 (IDF) > EMT, Spencer Rescue > Paramedic student/intern Good question. 1. The amount of heat we can add in the field is very limited, so massive rewarming (as in a hot tub) with attendant risk of rewarming shock -- is impossible in the field. 2. The article you refer to (http://www.wemsi.org/alg.html) is actually not by me, but is an "unofficial" posting at the website -- please check http://www.wemsi.org/cold-30.pdf for the "official" recommendations. 3. There was some talk about "avoid rapid rewarming in the field" in the past, but the thrust of recent research and teaching has been to kill this. By copy of this post I'll ask our Webmaster to make this more clear on the Web site. Thanks. 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 -- 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, 24 Nov 2000 20:12:14 -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 <01JWXITA5UWS000MT1@mb2i0.ns.pitt.edu>; Fri, 24 Nov 2000 20:12:14 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, 24 Nov 2000 20:11:23 -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 ; Fri, 24 Nov 2000 20:11:16 -0500 (EST) Received: from klaptop ("port 1141"@[136.142.23.17]) by pitt.edu (PMDF V5.2-32 #41462) with ESMTP id <01JWXIRX2HG0000DZP@mb1i0.ns.pitt.edu> for wilderness-emergency-medicine@list.pitt.edu; Fri, 24 Nov 2000 20:11:15 -0500 (EST) Date: Fri, 24 Nov 2000 20:11:06 -0500 From: "Keith Conover, M.D., FACEP" Subject: W-EMED spam update 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: <3A1ECB5A.26466.48944A8@localhost> MIME-version: 1.0 X-Mailer: Pegasus Mail for Win32 (v3.12c) Content-type: text/plain; charset=US-ASCII Content-transfer-encoding: 7BIT Precedence: bulk Apologies again for the occasional spam. Please use your delete key and don't let it get under your skin. If the spam gets bad enough, I will close the list entirely -- but there are enough people this will shut out (can't post from even slightly different addresses) that I will avoid this until absolutely needed. Yes, transferring to eGroups would allow aliases -- but then you get advertising "spam" as well. Thanks for your patience. --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, 23 Nov 2000 08:47:55 -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 <01JWVGMI5SVO000GKF@mb2i0.ns.pitt.edu>; Thu, 23 Nov 2000 08:47:55 EST Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.2) ID ; Thu, 23 Nov 2000 08:47:27 -0500 (EST) Received: from mercury.janrix.com (mercury.janrix.com [207.22.155.12]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.2) ID for ; Thu, 23 Nov 2000 08:47:24 -0500 (EST) Received: from tacker ([207.22.155.181]) by mercury.janrix.com (Build 93 8.9.3/NT-8.9.3) with SMTP id JAA06424; Thu, 23 Nov 2000 09:07:56 -0500 Date: Thu, 23 Nov 2000 08:51:03 -0500 From: Tacker Vordemberge Subject: W-EMED HAPPY THANKSGIVING! Sender: owner-wilderness-emergency-medicine@list.pitt.edu To: Reply-to: wilderness-emergency-medicine@list.pitt.edu Message-id: <008801c05554$6e0af6c0$b59b16cf@tacker> 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: multipart/related; boundary="----=_NextPart_000_0084_01C0552A.832E2240"; type="multipart/alternative" X-Priority: 3 X-MSMail-priority: Normal Precedence: bulk This is a multi-part message in MIME format. ------=_NextPart_000_0084_01C0552A.832E2240 Content-Type: multipart/alternative; boundary="----=_NextPart_001_0085_01C0552A.8335C360" ------=_NextPart_001_0085_01C0552A.8335C360 Content-Type: text/plain; charset="iso-8859-1" Content-Transfer-Encoding: quoted-printable Retter and I would like to wish you and your family a fun and safe but = most of all a Happy Thanksgiving. Please remember those who must work on = this day to protect you and keep you safe both here and overseas!!!!!!! Tacker & Retter "That others may live.........." (910)482-6394 (Pager) (910)487-9827 (Home) tacker@janrix.com 9198343441.1001570@pagenet.net (E-mail to my Pager) tackerv@hotmail.com A.O.L. I.M.: tackerv I.C.Q. # 18027783 ------=_NextPart_001_0085_01C0552A.8335C360 Content-Type: text/html; charset="iso-8859-1" Content-Transfer-Encoding: quoted-printable
Retter and I would like to = wish you and=20 your family a fun and safe but most of all a Happy Thanksgiving. = Please remember those who must work on this day to protect you = and keep=20 you safe both here and overseas!!!!!!!
 
Tacker & Retter
"That others = may=20 live.........."
(910)482-6394 (Pager)
(910)487-9827 = (Home)
tacker@janrix.com
9198343441.1001570@pagenet= .net=20 (E-mail to my Pager)
tackerv@hotmail.com
A.O.L. = I.M.:=20 tackerv
I.C.Q. # = 18027783
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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 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 ; Wed, 22 Nov 2000 11:11:49 -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 <01JWU7CKUDQ2000B8H@mb2i0.ns.pitt.edu>; Wed, 22 Nov 2000 11:11:49 EST Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.2) ID ; Wed, 22 Nov 2000 11:10:04 -0500 (EST) Received: from zonetail.med.unc.edu (zonetail.med.unc.edu [152.19.4.12]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.2) ID for ; Wed, 22 Nov 2000 11:10:02 -0500 (EST) Received: from med.unc.edu (apex.med.unc.edu [152.19.4.80]) by zonetail.med.unc.edu (8.9.3/8.9.3) with ESMTP id LAA09563 for ; Wed, 22 Nov 2000 11:10:01 -0500 (EST) Date: Wed, 22 Nov 2000 11:10:01 -0500 (EST) From: Seth Hawkins Subject: Re: W-EMED [MountainTrauma] "C" Spine clearance 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: <12695b5a6.b5a612695@med.unc.edu> MIME-version: 1.0 X-Mailer: Netscape Webmail Content-type: text/plain; charset=us-ascii Content-language: en Content-disposition: inline Content-transfer-encoding: 7bit Precedence: bulk X-Accept-Language: en However, a fundamental component of the Nexus protocol is absence of focal neurological deficits. It's hard to imagine adequately ruling out such deficits without some type of neuro exam, so saying the neuro exam contributes "nothing" to the protocol is perhaps an overstatement. seth ---------------------------- Seth Collings Hawkins, MD The University of Pittsburgh Emergency Medicine Residency e-alias: 527 Gettysburg Street PGH PA 1 5 2 0 6 - 4 5 4 7 ---------------------------- ----- Original Message ----- From: "Keith Conover, M.D., FACEP" Date: Tuesday, November 21, 2000 12:26 pm Subject: Re: W-EMED [MountainTrauma] "C" Spine clearance > On 20 Nov 2000, at 10:36, Timothy E. Burdick wrote: > > > My understanding is that the spine clearing protocols are not > free from > > false-negatives, but are petty reliable if done correctly. It > takes lots > > of practice to do a good neuro eval, based on my own learning as > well as > > time spent teaching these skills. > > Check http://www.pitt.edu/~kconover/ftp/spine3.txt > > For the text of an editorial on the topic from the Journal of > Wilderness Medicine (now Wilderness and Environmental Medicine). > > The neuro exam actually is just the icing on the cake -- it > probably > contributes nothing to the protocol. The protocol as proposed > should really catch all unstable spine injuries, at least as far > as > known now. The recent Nexus trial supports this -- nobody with a > cervical spine injury that would be dangerous to an alert, > nonintoxicated patient was found using similar criteria: > > 1.Hoffman JR, Mower WR, Wolfson AB, Todd KH, Zucker MI. > Validity of a set of clinical criteria to rule out injury to the > cervical > spine in patients with blunt trauma. National Emergency X- > Radiography Utilization Study Group [see comments]. N Engl J Med > 2000; 343:94-9. > BACKGROUND: Because clinicians fear missing occult cervical- > spine injuries, they obtain cervical radiographs for nearly all > patients > who present with blunt trauma. Previous research suggests that a > set of clinical criteria (decision instrument) can identify > patients who > have an extremely low probability of injury and who consequently > have no need for imaging studies. METHODS: We conducted a > prospective, observational study of such a decision instrument at > 21 > centers across the United States. The decision instrument required > patients to meet five criteria in order to be classified as having > a low > probability of injury: no midline cervical tenderness, no focal > neurologic deficit, normal alertness, no intoxication, and no > painful, > distracting injury. We examined the performance of the decision > rule in 34,069 patients who underwent radiography of the cervical > spine after blunt trauma. RESULTS: The decision instrument > identified all but 8 of the 818 patients who had cervical-spine > injury > (sensitivity, 99.0 percent [95 percent confidence interval, 98.0 > to > 99.6 percent]). The negative predictive value was 99.8 percent (95 > percent confidence interval, 99.6 to 100 percent), the specificity > was 12.9 percent, and the positive predictive value was 2.7 > percent. > Only two of the patients classified as unlikely to have an injury > according to the decision instrument met the preset definition of > a > clinically significant injury (sensitivity, 99.6 percent [95 > percent > confidence interval, 98.6 to 100 percent]; negative predictive > value, > 99.9 percent [95 percent confidence interval, 99.8 to 100 > percent]; > specificity, 12.9 percent; positive predictive value, 1.9 > percent), and > only one of these two patients received surgical treatment. > According to the results of assessment with the decision > instrument, > radiographic imaging could have been avoided in the cases of 4309 > (12.6 percent) of the 34,069 evaluated patients. CONCLUSIONS: A > simple decision instrument based on clinical criteria can help > physicians to identify reliably the patients who need radiography > of > the cervical spine after blunt trauma. Application of this > instrument > could reduce the use of imaging in such patients. > > > --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.eduSubmissions 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, 21 Nov 2000 16:24:23 -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 <01JWT3YQXXE20004NG@mb1i0.ns.pitt.edu>; Tue, 21 Nov 2000 16:24:21 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, 21 Nov 2000 16:23:44 -0500 (EST) Received: from exchange01.resumecard.com (host220.resumecard.com [4.17.135.220]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.2) ID for ; Tue, 21 Nov 2000 16:23:38 -0500 (EST) Date: Tue, 21 Nov 2000 15:20:12 -0500 From: NotJobs Recruiting Subject: W-EMED NotJobs.com has a career opportunity for you 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-MIMEOLE: Produced By Microsoft Exchange V6.0.4417.0 X-MIME-Autoconverted: from quoted-printable to 8bit by list.srv.cis.pitt.edu id QAA12558 Content-type: text/plain; charset=iso-8859-1 Content-transfer-encoding: 8BIT Precedence: bulk Thread-Topic: NotJobs.com has a career opportunity for you Thread-Index: AcBT+Wij5Mazcb/eEdShPgBQBNEFeA== content-class: urn:content-classes:message NotJobs.com (the anti-job board) is doing extensive recruiting of candidates with skills sets such as yours. 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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 ; Tue, 21 Nov 2000 12:38:25 -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 <01JWSW3KAUG200033Q@mb1i0.ns.pitt.edu>; Tue, 21 Nov 2000 12:38:24 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, 21 Nov 2000 12:36:16 -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 ; Tue, 21 Nov 2000 12:36:07 -0500 (EST) Received: from klaptop ("port 2741"@[136.142.20.81]) by pitt.edu (PMDF V5.2-32 #41462) with ESMTP id <01JWSVOG8P4G00033Q@mb1i0.ns.pitt.edu> for wilderness-emergency-medicine@list.pitt.edu; Tue, 21 Nov 2000 12:27:06 -0500 (EST) Date: Tue, 21 Nov 2000 12:26:58 -0500 From: "Keith Conover, M.D., FACEP" Subject: Re: W-EMED [MountainTrauma] "C" Spine clearance In-reply-to: <43240416@donner.Dartmouth.EDU> Sender: owner-wilderness-emergency-medicine@list.pitt.edu To: Timothy.E.Burdick@Dartmouth.EDU (Timothy E. Burdick), wilderness-emergency-medicine@list.pitt.edu Reply-to: wilderness-emergency-medicine@list.pitt.edu Message-id: <3A1A6A12.382.A6BD038@localhost> MIME-version: 1.0 X-Mailer: Pegasus Mail for Win32 (v3.12c) Content-type: text/plain; charset=US-ASCII Content-transfer-encoding: 7BIT Precedence: bulk On 20 Nov 2000, at 10:36, Timothy E. Burdick wrote: > My understanding is that the spine clearing protocols are not free from > false-negatives, but are petty reliable if done correctly. It takes lots > of practice to do a good neuro eval, based on my own learning as well as > time spent teaching these skills. Check http://www.pitt.edu/~kconover/ftp/spine3.txt For the text of an editorial on the topic from the Journal of Wilderness Medicine (now Wilderness and Environmental Medicine). The neuro exam actually is just the icing on the cake -- it probably contributes nothing to the protocol. The protocol as proposed should really catch all unstable spine injuries, at least as far as known now. The recent Nexus trial supports this -- nobody with a cervical spine injury that would be dangerous to an alert, nonintoxicated patient was found using similar criteria: 1.Hoffman JR, Mower WR, Wolfson AB, Todd KH, Zucker MI. Validity of a set of clinical criteria to rule out injury to the cervical spine in patients with blunt trauma. National Emergency X- Radiography Utilization Study Group [see comments]. N Engl J Med 2000; 343:94-9. BACKGROUND: Because clinicians fear missing occult cervical- spine injuries, they obtain cervical radiographs for nearly all patients who present with blunt trauma. Previous research suggests that a set of clinical criteria (decision instrument) can identify patients who have an extremely low probability of injury and who consequently have no need for imaging studies. METHODS: We conducted a prospective, observational study of such a decision instrument at 21 centers across the United States. The decision instrument required patients to meet five criteria in order to be classified as having a low probability of injury: no midline cervical tenderness, no focal neurologic deficit, normal alertness, no intoxication, and no painful, distracting injury. We examined the performance of the decision rule in 34,069 patients who underwent radiography of the cervical spine after blunt trauma. RESULTS: The decision instrument identified all but 8 of the 818 patients who had cervical-spine injury (sensitivity, 99.0 percent [95 percent confidence interval, 98.0 to 99.6 percent]). The negative predictive value was 99.8 percent (95 percent confidence interval, 99.6 to 100 percent), the specificity was 12.9 percent, and the positive predictive value was 2.7 percent. Only two of the patients classified as unlikely to have an injury according to the decision instrument met the preset definition of a clinically significant injury (sensitivity, 99.6 percent [95 percent confidence interval, 98.6 to 100 percent]; negative predictive value, 99.9 percent [95 percent confidence interval, 99.8 to 100 percent]; specificity, 12.9 percent; positive predictive value, 1.9 percent), and only one of these two patients received surgical treatment. According to the results of assessment with the decision instrument, radiographic imaging could have been avoided in the cases of 4309 (12.6 percent) of the 34,069 evaluated patients. CONCLUSIONS: A simple decision instrument based on clinical criteria can help physicians to identify reliably the patients who need radiography of the cervical spine after blunt trauma. Application of this instrument could reduce the use of imaging in such patients. --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 ; Mon, 20 Nov 2000 10:38:52 -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 <01JWRDM1XIFG00008E@mb1i0.ns.pitt.edu>; Mon, 20 Nov 2000 10:38:52 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, 20 Nov 2000 10:36:48 -0500 (EST) Received: from mailhub.Dartmouth.EDU (mailhub.dartmouth.edu [129.170.16.6]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.2) ID for ; Mon, 20 Nov 2000 10:36:43 -0500 (EST) Received: from donner.Dartmouth.EDU (donner.dartmouth.edu [129.170.208.3]) by mailhub.Dartmouth.EDU (8.9.3+DND/8.9.3) with ESMTP id KAA03948 for ; Mon, 20 Nov 2000 10:36:42 -0500 (EST) Date: Mon, 20 Nov 2000 10:36:42 -0500 (EST) From: Timothy.E.Burdick@Dartmouth.EDU (Timothy E. Burdick) Subject: Re: W-EMED [MountainTrauma] "C" Spine clearance 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: <43240416@donner.Dartmouth.EDU> MIME-version: 1.0 X-MIME-Autoconverted: from quoted-printable to 8bit by list.srv.cis.pitt.edu id KAA29666 Content-type: text/plain; charset=iso-8859-1 Content-disposition: inline Content-transfer-encoding: 8bit Precedence: bulk --- You wrote: Neurologically intact no neck pain --- end of quote --- I am assuming here that neurologically intact includes cranial nerves, sensory exam (sharp vs dull) of the entire body, motor exam of extensors/flexor groups of all four extremities, and reflexes (biceps, triceps, patellar, Achilles, and Babinski), and cerebellar function (finger-nose, heel-shin, tandem walk last). If the patient is reliable (alert, oriented x 4, answering questions appropriately, no distracting injuries, no mind-altering substances on board) and free of pain/tenderness/deformity throughout head and all of spine (not just neck), and if a carryout is not simple (delayed or puts rescuers or patient at risk), I would walk them out. I would be sure to reassess status regularly, especially if subdural might be creating a lucid interval initially. Abnormal motor-sensory-reflex exam of of chest/abdomen/extremities can help rule out spinal injuries below the neck. My understanding is that the spine clearing protocols are not free from false-negatives, but are petty reliable if done correctly. It takes lots of practice to do a good neuro eval, based on my own learning as well as time spent teaching these skills. The thing that I keep in mind is this: what are the risks to the patient/rescuers if we choose NOT to clear a spine when faced with a negative exam? If the risks/costs are minimal, I would take spine precautions even with a normal exam. Bad weather in a high pass might be good indication to clear the spine with a negative exam and walk to a safer location. Comments? Tim Burdick 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, 19 Nov 2000 06:17:08 -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 <01JWPQ76NHHQ00J0WS@mb2i0.ns.pitt.edu>; Sun, 19 Nov 2000 06:17:08 EST Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.2) ID ; Sun, 19 Nov 2000 06:13:11 -0500 (EST) Received: from anchor-post-31.mail.demon.net (anchor-post-31.mail.demon.net [194.217.242.89]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.2) ID for ; Sun, 19 Nov 2000 06:13:06 -0500 (EST) Received: from crynllwyn.demon.co.uk ([193.237.28.123]) by anchor-post-31.mail.demon.net with esmtp (Exim 2.12 #1) id 13xSP9-0004HK-0V for wilderness-emergency-medicine@list.pitt.edu; Sun, 19 Nov 2000 11:13:03 +0000 Date: Sun, 19 Nov 2000 11:12:05 +0000 From: Jel Coward Subject: W-EMED [MountainTrauma] "C" Spine clearance 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 I would appreciate comments on the following which was posted to another list by Davy Gunn who is involved in mountain rescue in Scotland - particularly his questions about the rest of the spine - do we have any particular evidence on this question? Cheers all -----Original message----- Subject: [MountainTrauma] "C" Spine clearance Newsgroups: !MountainTrauma To: Mountain Trauma From: David Gunn Reply-To: MountainTrauma@egroups.com Date: Fri, 17 Nov 2000 12:17:33 +0000 Message-ID: <000501c05090$7a279120$6a30883e@fpfzqlga> While agreeing that in a wilderness setting with a neurologicaly intact and conscious casualty with no neck pain and where a history suggesting neck injury is unlikely we could clear a "C" spine, I am left as a rescuer wondering how this guideline lets me clear the rest of the spine. What guidance have we for clearing the Thoracic or Lumbar spine ? None - we go on history and mechanism of possible injury ! Good practice (and "Trauma Rules") suggest we view a Cervical collar as a flag saying "this spine could be injured" and using an "all or nothing" approach we package the whole spine not just the neck. As rescuers how does clearing the "C" spine get you out of the fact that a lot of casualties, especially in winter, also have crushed Lumbar vertebrae due to indirect force ? I believe that both Stephen Hearns and his colleague with the two studies, could have some good evidence to help us with this dilemma. For those with an interest I have posted a picture on the egroups web at "Files" of a fallen climber. Fallen 1,200ft on soft snow. Neurologicaly intact and with no neck pain, alert and conscious. 3 hour carry from a high route in poor conditions. Wants to walk out. Should we let her ? Answers please Davy Gunn -- Jel Coward 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 ; Fri, 17 Nov 2000 20:24:46 -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 <01JWNR7ELY2K00790O@mb1i0.ns.pitt.edu>; Fri, 17 Nov 2000 20:24:46 EST Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.2) ID ; Fri, 17 Nov 2000 20:23:55 -0500 (EST) Received: from finch-post-11.mail.demon.net (finch-post-11.mail.demon.net [194.217.242.39]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.2) ID for ; Fri, 17 Nov 2000 20:23:52 -0500 (EST) Received: from crynllwyn.demon.co.uk ([193.237.28.123]) by finch-post-11.mail.demon.net with esmtp (Exim 2.12 #1) id 13wwjN-000GdQ-0B for wilderness-emergency-medicine@list.pitt.edu; Sat, 18 Nov 2000 01:23:50 +0000 Date: Sat, 18 Nov 2000 01:23:26 +0000 From: Jel Coward Subject: W-EMED airway rewarming - forwarded post 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 In article , David Syme writes >I've managed to delete the original letter from Stephen Hearns about >this. > >I feel the point is to evaluate these devices to see whether they are >actually worth using. Although they are widely recommended, there seems >to be little data about their use. I feel that using Stan Grant's cold >room to test their effectiveness is a step in the right direction. >Rather along the lines of finding out that the Cas Bags we use are >pretty poor, by and large, despite a feeling that they are suitable for >the job. > >I'm open to correction (as always). > Sorry - missed the previous - again Are we talking about little dragons? I have been trying to find a chemist who can tell me how much energy can be released from this much soda lime for a while? Does anyone know? Interesting that they have been purchased and distributed by MRC already - can anyone from the MRC point me to the evidence for their use please? Cheers -- Jel Coward The UK Wilderness Emergency Medical Technician and Command Physician course site has been updated - take a look for course dates in 2000!! 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 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, 16 Nov 2000 17:41:03 -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 <01JWM773DBMI00IG3B@mb2i0.ns.pitt.edu>; Thu, 16 Nov 2000 17:41:03 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, 16 Nov 2000 17:39:41 -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 ; Thu, 16 Nov 2000 17:39:37 -0500 (EST) Received: from klaptop ("port 1278"@[136.142.21.80]) by pitt.edu (PMDF V5.2-32 #41462) with ESMTP id <01JWM74W1IC2006XTJ@mb1i0.ns.pitt.edu> for wilderness-emergency-medicine@list.pitt.edu; Thu, 16 Nov 2000 17:39:18 -0500 (EST) Date: Thu, 16 Nov 2000 17:39:15 -0500 From: "Keith Conover, M.D., FACEP" Subject: Re: Re: W-EMED CSF and Head Injuries In-reply-to: <200011141646.LAA23519@web2.po.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: <3A141BC3.28257.AB6DA8E@localhost> MIME-version: 1.0 X-Mailer: Pegasus Mail for Win32 (v3.12c) Content-type: text/plain; charset=US-ASCII Content-transfer-encoding: 7BIT Precedence: bulk On 14 Nov 2000, at 11:46, Charles Werntz wrote: > Other than that, the leak may actually be therapeutic as it would slow the > build-up of intracranial pressure by acting as a sort of relief valve. Thinking more about this, there are two main cases where you notice CSF leaking out. 1. People who are obviously gorked and have badness in the head/face. Noting the CSF leak is useful for subsequent medical providers but really it's the badness in the head/face that makes you treat and transfer for badness there. 2. People who are really just fine but maybe have a basilar skull fracture with a little CSF leak. We see these patients in our trauma center when, a week after being discharged, they note the continued rhinorrhea or otorrhea and maybe Battle sign (retroauricular ecchymosis = bruises behind the ears). We check another CT (very, very low yield) and say "hmm, you have a basilar skull fracture" and give written instructions with the signs of meningitis and say "come back to clinic next week and we'll recheck you." Some of the people in the (1) category may get some prophylactic antibiotics, but the (2) people don't -- it just selects out resistant organisms. Need to be careful about looking for otitis or sinusitis in these patients, though, and treat agressively. Take care. P.S. there ARE wilderness emergency docs who go into the field in NYS, at least two of the ER docs from Glens Falls do this with the DEC rangers. --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, 16 Nov 2000 00:53:46 -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 <01JWL817NRVM006NXS@mb1i0.ns.pitt.edu>; Thu, 16 Nov 2000 00:53:46 EST Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.2) ID ; Thu, 16 Nov 2000 00:53:02 -0500 (EST) Received: from buzz.slic.com (qmailr@eagle.slic.com [216.73.13.5]) by list.srv.cis.pitt.edu with SMTP (8.8.8/8.8.8/cisls-7.2.2.2) ID for ; Thu, 16 Nov 2000 00:52:59 -0500 (EST) Received: (qmail 9341 invoked from network); Thu, 16 Nov 2000 06:19:55 +0000 Received: from saratoga-async61.slic.com (HELO oemcomputer) (216.207.140.61) by eagle.slic.com with SMTP; Thu, 16 Nov 2000 06:19:55 +0000 Date: Thu, 16 Nov 2000 00:44:05 -0500 From: Michelle Schonzeit Subject: Re: W-EMED Looking for a volunteer opportunity 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: <01d201c04f91$efd77160$3d8ccfd8@oemcomputer> MIME-version: 1.0 X-MIMEOLE: Produced By Microsoft MimeOLE V5.00.2014.211 X-Mailer: Microsoft Outlook Express 5.00.2014.211 Content-type: multipart/alternative; boundary="----=_NextPart_000_0010_01C04F66.52717680" X-Priority: 3 X-MSMail-priority: Normal Precedence: bulk References: <20001116011013.BFYJ20301.tomts7-srv.bellnexxia.net@Two> This is a multi-part message in MIME format. ------=_NextPart_000_0010_01C04F66.52717680 Content-Type: text/plain; charset="iso-8859-1" Content-Transfer-Encoding: quoted-printable Bernie and the list, I just want to say how great it is that people in the SAR and = medical communities are so willing to help others. Obviously they are = willing to drop things a 1:30 am to go out and help people in need of = medical care, but it also so great to see people willing to help those = aspiring to learn more in their field.=20 I'm young and I can't begin to really thank all of the people who = have given me opportunities to learn more and gain experience. I have = found that I really love wilderness medicine and rescue work, but I = would never have the knowledge and skills that I have currently, if = people hadn't been willing to let me tag along. I can only hope that by = getting an early start, I'll be able to do a lot in my lifetime and = someday be able to provide similar opportunities to other people. = However I've still got a really long way to go. :) I certainly wish I could help Shannon and while I can't think of = anything right off the top of my head in the Adirondacks, I will = certainly ask around. In the meanwhile, THANKS to all of you out there who are helping out the = next generation! 73s, Michelle Schonzeit - schonzeit@slic.com OEC - EMT=20 SAR of the Northern Adirondacks - Training Officer Whiteface Mt. Ski Patrol =20 ----- Original Message -----=20 From: Bernie Roche=20 To: wilderness-emergency-medicine@list.pitt.edu=20 Sent: Wednesday, November 15, 2000 8:11 PM Subject: Re: W-EMED Looking for a volunteer opportunity At 04:07 PM 11/14/00 +0000, Shannon Koppenhoefer wrote: >I am looking to gain some experience with wilderness medicine /=20 >rescue / emergency response during my vacation this year. I work full = >time for Toronto Ambulance and am certified at the EMT - Basic and=20 >Wilderness levels. Can anyone suggest places I may look into /=20 >directions I may begin my search ??? I have about 2 weeks off=20 >depending how I select my time.=20 > >If you do have suggestions, can you please email me at=20 >shannon@artraining.on.ca > >Thanks ! Hi, all: I have talked with this person (she lives in my area) and she seems to = have a lot on the ball. Let's see if we can get her plugged in = somewhere. Who's the Joshua Tree paramedic who was at OTR about 4 or 5 years ago? = Is he on the list? It seems to me the National Park service gets a = high number of incidents during the summer season...can we find a = "ride-along" (perhaps I should rephrase that to a "hike-along") spot for = Shannon? Or can we get here into the Adirondacks, or perhaps someone from one = of our many response groups has an idea? Keith: Can you take her along to Scotland, Vanuatu, or whatever = Godforsaken place you're going next? C'mon, gang...we can do it...if not, I'll have to take her down to OTR = and teach her how to get a 350 lb. unconscious drunk out of the hot tub. = Surely one of us has a learning spot with a group or team with a = relatively high acticity level. Best Wishes, Bernie Roche, RN, BScN, W-EMT, OSJ WEMSI Web Site Administrator http://www.wemsi.org/ broche@tcn.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=20 ------=_NextPart_000_0010_01C04F66.52717680 Content-Type: text/html; charset="iso-8859-1" Content-Transfer-Encoding: quoted-printable
Bernie and the list,
 
    I just want to say how great it is that people = in the=20 SAR and medical communities are so willing to help others. Obviously = they are=20 willing to drop things a 1:30 am to go out and help people in need = of=20 medical care, but it also so great to see people willing to help those = aspiring=20 to learn more in their field.
 
    I'm young and I can't begin to really thank all = of the=20 people who have given me opportunities to learn more and gain = experience. I have=20 found that I really love wilderness medicine and rescue work, but I = would never=20 have the knowledge and skills that I have currently, if people hadn't = been=20 willing to let me tag along. I can only hope that by getting an early = start,=20 I'll be able to do a lot in my lifetime and someday be able to provide=20 similar opportunities to other people. However I've still got a=20 really long way to go.  :)
 
  I certainly wish I could help Shannon and while I can't = think of=20 anything right off the top of my head in the Adirondacks, I will = certainly ask=20 around.
 
In the meanwhile, THANKS to all of you out there who are helping = out the=20 next generation!
 
73s,
 
Michelle Schonzeit - schonzeit@slic.com OEC - EMT =
SAR of the Northern Adirondacks - Training Officer
Whiteface Mt. Ski Patrol  
----- Original Message -----
From:=20 Bernie=20 Roche
To: wilderness-emergency-= medicine@list.pitt.edu=20
Sent: Wednesday, November 15, = 2000 8:11=20 PM
Subject: Re: W-EMED Looking for = a=20 volunteer opportunity

At 04:07 PM 11/14/00 +0000, Shannon Koppenhoefer wrote:
>I am = looking to=20 gain some experience with wilderness medicine /
>rescue / = emergency=20 response during my vacation this year. I work full
>time for = Toronto=20 Ambulance and am certified at the EMT - Basic and
>Wilderness = levels.=20 Can anyone suggest places I may look into /
>directions I may = begin my=20 search ??? I have about 2 weeks off
>depending how I select my = time.=20
>
>If you do have suggestions, can you please email me at =
>shannon@artraining.on.ca
>
>Thanks = !


Hi,=20 all:

I have talked with this person (she lives in my area) and = she=20 seems to have a lot on the ball.  Let's see if we can get her = plugged in=20 somewhere.

Who's the Joshua Tree paramedic who was at OTR about = 4 or 5=20 years ago?  Is he on the list?  It seems to me the National = Park=20 service gets a high number of incidents during the summer season...can = we find=20 a "ride-along" (perhaps I should rephrase that to a "hike-along") spot = for=20 Shannon?

Or can we get here into the Adirondacks, or perhaps = someone=20 from one of our many response groups has an idea?

Keith:  = Can you=20 take her along to Scotland, Vanuatu, or whatever Godforsaken place = you're=20 going next?

C'mon, gang...we can do it...if not, I'll have to = take her=20 down to OTR and teach her how to get a 350 lb. unconscious drunk out = of the=20 hot tub.  Surely one of us has a learning spot with a group or = team with=20 a relatively high acticity level.



Best Wishes,

Bernie Roche, RN, BScN, W-EMT, OSJ

WEMSI Web Site Administrator

broche@tcn.net Do = not=20 reproduce without author's express permission. To unsubscribe, send = the text=20 "unsubscribe wilderness-emergency-medicine" as the body of a message = (no=20 subject) To: Majordomo@list.pitt.edu Submissions To:=20 wilderness-emergency-medicine@list.pitt.edu = ------=_NextPart_000_0010_01C04F66.52717680-- 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 ; Wed, 15 Nov 2000 20:13:16 -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 <01JWKY8FJJXU00J536@mb2i0.ns.pitt.edu>; Wed, 15 Nov 2000 20:13:15 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, 15 Nov 2000 20:10:49 -0500 (EST) Received: from tomts7-srv.bellnexxia.net (tomts7.bellnexxia.net [209.226.175.40]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.2) ID for ; Wed, 15 Nov 2000 20:10:44 -0500 (EST) Received: from Two ([64.229.116.82]) by tomts7-srv.bellnexxia.net (InterMail vM.4.01.03.00 201-229-121) with SMTP id <20001116011013.BFYJ20301.tomts7-srv.bellnexxia.net@Two> for ; Wed, 15 Nov 2000 20:10:13 -0500 Date: Wed, 15 Nov 2000 20:11:41 -0500 From: Bernie Roche Subject: Re: W-EMED Looking for a volunteer opportunity In-reply-to: <8urnv9+imni@eGroups.com> Sender: owner-wilderness-emergency-medicine@list.pitt.edu X-Sender: broche@titan.tcn.net To: wilderness-emergency-medicine@list.pitt.edu Reply-to: wilderness-emergency-medicine@list.pitt.edu Message-id: <20001116011013.BFYJ20301.tomts7-srv.bellnexxia.net@Two> MIME-version: 1.0 X-Mailer: QUALCOMM Windows Eudora Pro Version 4.0 Content-type: text/html; charset="us-ascii" Precedence: bulk At 04:07 PM 11/14/00 +0000, Shannon Koppenhoefer wrote:
>I am looking to gain some experience with wilderness medicine /
>rescue / emergency response during my vacation this year. I work full
>time for Toronto Ambulance and am certified at the EMT - Basic and
>Wilderness levels. Can anyone suggest places I may look into /
>directions I may begin my search ??? I have about 2 weeks off
>depending how I select my time.
>
>If you do have suggestions, can you please email me at
>shannon@artraining.on.ca
>
>Thanks !


Hi, all:

I have talked with this person (she lives in my area) and she seems to have a lot on the ball.  Let's see if we can get her plugged in somewhere.

Who's the Joshua Tree paramedic who was at OTR about 4 or 5 years ago?  Is he on the list?  It seems to me the National Park service gets a high number of incidents during the summer season...can we find a "ride-along" (perhaps I should rephrase that to a "hike-along") spot for Shannon?

Or can we get here into the Adirondacks, or perhaps someone from one of our many response groups has an idea?

Keith:  Can you take her along to Scotland, Vanuatu, or whatever Godforsaken place you're going next?

C'mon, gang...we can do it...if not, I'll have to take her down to OTR and teach her how to get a 350 lb. unconscious drunk out of the hot tub.  Surely one of us has a learning spot with a group or team with a relatively high acticity level.

Best Wishes,

Bernie Roche, RN, BScN, W-EMT, OSJ

WEMSI Web Site Administrator

broche@tcn.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 ; Wed, 15 Nov 2000 17:14:26 -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 <01JWKRYR6LXE00774Q@mb1i0.ns.pitt.edu>; Wed, 15 Nov 2000 17:14:26 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, 15 Nov 2000 17:13:44 -0500 (EST) Received: from pelican.talon.net (root@pelican.talon.net [207.8.228.18]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.2) ID for ; Wed, 15 Nov 2000 17:13:11 -0500 (EST) Received: from talon.net (207-8-229-136.usr-3.ppp.talon.net [207.8.229.136]) by pelican.talon.net (8.9.3/8.9.3) with ESMTP id RAA06043 for ; Wed, 15 Nov 2000 17:13:08 -0500 (EST) Date: Wed, 15 Nov 2000 17:20:06 -0500 From: Brian Subject: Re: W-EMED Mind Body Spirit Products 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: <3A130C15.2671F11B@talon.net> MIME-version: 1.0 X-Mailer: Mozilla 4.7 [en]C-CCK-MCD EZN47 (Win95; I) Content-type: text/plain; charset=us-ascii Content-transfer-encoding: 7bit Precedence: bulk X-Accept-Language: en References: <200011151842.TAA08155@bill.hayeslemmerz-man.es> Been wondering where all this spam been coming from now i see can someone put a stop to it ?? Thanks Brian 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 ; Wed, 15 Nov 2000 12:45:12 -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 <01JWKIKWVJAM00J3TV@mb2i0.ns.pitt.edu>; Wed, 15 Nov 2000 12:45:11 EST Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.2) ID ; Wed, 15 Nov 2000 12:44:14 -0500 (EST) Received: from bill.hayeslemmerz-man.es ([194.224.192.172]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.2) ID for ; Wed, 15 Nov 2000 12:44:09 -0500 (EST) Received: from oemcomputer (dyn1-tnt11-180.chicago.il.ameritech.net [199.179.173.180]) by bill.hayeslemmerz-man.es (8.9.3/8.7.3) with SMTP id TAA08155; Wed, 15 Nov 2000 19:42:44 +0100 Date: Wed, 15 Nov 2000 19:42:44 +0100 From: top@vsf.de Subject: W-EMED Mind Body Spirit Products Sender: owner-wilderness-emergency-medicine@list.pitt.edu To: top@vsf.de Reply-to: wilderness-emergency-medicine@list.pitt.edu Message-id: <200011151842.TAA08155@bill.hayeslemmerz-man.es> MIME-version: 1.0 Content-type: text/plain; charset=unknown-8bit Precedence: bulk I'm Marc Lesser, the Founder and President of Brush Dance. 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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 ; Wed, 15 Nov 2000 10:32:32 -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 <01JWKDXGZJB2006PFU@mb1i0.ns.pitt.edu>; Wed, 15 Nov 2000 10:32:32 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, 15 Nov 2000 10:30:44 -0500 (EST) Received: from m9.jersey.juno.com (m9.jersey.juno.com [64.136.16.72]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.2) ID for ; Wed, 15 Nov 2000 10:30:37 -0500 (EST) Received: from cookie.juno.com by cookie.juno.com for <"ks/OKpImkgtZf2xJL1bm5ORZAlQvZOmzMTa016uCqr176jfVQmYtIA=="> Received: (from mtnbikemedic1@juno.com) by m9.jersey.juno.com (queuemail) id FNW52DHE; Wed, 15 Nov 2000 10:29:43 -0500 (EST) Date: Wed, 15 Nov 2000 09:30:05 -0600 From: Hans L Erdman Subject: W-EMED Wilderness Evac 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: <20001115.093008.-83727.2.MtnBikeMedic1@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: 2-3,18-19,26-32 X-Juno-Att: 0 X-Juno-RefParts: 0 I have been interested in the sub-thread about evacuation from wilderness areas that has been developing concurrent with the head injury discussion. I need some clarification from the New Yorkers out there. I am a native New Yorker, born in Elmira, raised in Ithaca, and grew up in the Adirondacks. For many years I was very active in SAR digs, and took part in a number of major Adirondack and upstate searches from 1972 until 1988. I remember helping Pete Fish and Gary Hogeson carry a New Jersey park ranger out from Indian Pass with an ankle fracture, because they couldn't get an EnCon chopper out of Albany, and there was no 9SP in Saranac Lake. I also recall winch loading a hypothermia patient into EnCon 606 from the same spot. The pictures I've seen of 9SP show a winch on the side. Does the NYSP/Life Flight helicopter DO wilderness evac? I know (all) about the weather up there. I thought that the idea behind an SP chopper in Saranac Lake was to respond to wilderness emergencies faster than waiting on EnCon to fly from Albany, pick up the HEART team at Placid Hospital and then fly into the High Peaks. At least with the HEART (Helicopter Emergency Air Rescue Team) you usually had a PA (Mark Ipolito) or a doc (Hickman) on board. Does the program still exist? Now I live in Minnesota, with the BWCA up north. When the big July 4th storm hit two summers ago, the US Forest Service and Minnesota DNR put up all their float planes (4) and two 206L Jet Rangers to do SAR in the impacted area. (Roughly 1/3 of the BWCA) and pulled out a number of injured and/or stranded canoeists. They had to land every time, as neither chopper had a winch. The closest winch equipped ships are US Coast Guard Jayhawk and Dolphin in Traverse City, Michigan. I was curious what the status of things is in the Adirondacks. Thanks, Hans Erdman, WEMT USFS Volunteer Backcounty Patrol National Mountain Bike Patrol Instructor ________________________________________________________________ YOU'RE PAYING TOO MUCH FOR THE INTERNET! Juno now offers FREE Internet Access! Try it today - there's no risk! 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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 ; Tue, 14 Nov 2000 21:34:14 -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 <01JWJMRHLNGG006C98@mb1i0.ns.pitt.edu>; Tue, 14 Nov 2000 21:34:13 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, 14 Nov 2000 21:33:21 -0500 (EST) Received: from mail1.toronto.istar.net (mail1.toronto.istar.net [209.89.75.17]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.2) ID for ; Tue, 14 Nov 2000 21:33:17 -0500 (EST) Received: from ip104.ottawa7.dialup.canada.psi.net ([154.5.69.104]) by mail1.toronto.istar.net with esmtp (Exim 2.02 #1) id 13vsNy-0002XH-00 for wilderness-emergency-medicine@list.pitt.edu; Tue, 14 Nov 2000 21:33:19 -0500 Date: Tue, 14 Nov 2000 21:33:30 -0500 From: "Steven D. Pirie" Subject: W-EMED CSF and Head Injuries In-reply-to: <200011141646.LAA23519@web2.po.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: MIME-version: 1.0 Content-type: text/plain; charset="us-ascii" Precedence: bulk Hello again, >The only thing I can imagine up is that in the face of a "halo sign", I >would >want to point that person toward receiving definitive care at a >center which >has neurosurgical services available. This is key... Since the evacuating facility (in my case) more then often does not have a neurosurgeon, I would want to give them a "heads up" to move one forward (in relationship to the forward edge of battle area) to meet up with my patient at the place where I am evacuating the patient. (If it is a surgical facility, great all's they need now is the neurosurgeon, if it is not a surgical facility they will need to send a neuro field surgical team). In talking with some of my fellow Officers today, they reminded me of the recommendations that the International Committee for the Red Cross (ICRC) uses for all patients that have a tear of the dura (positive halo... maybe). In a situation where I may wait up to 3-4 days for evacuation, I would want to start antibiotics (assuming that I had them available) based on the leaking of CSF. Currently for all head injuries that involve a tear of the dura the ICRC recommends the following antibiotic treatment. 1.Benzyl Penicillin IV q 6 h x 24 hours then Pen V 500 mg PO q 6 h x 4 days and 2. Chloramphenicol 1 gm IV q 6 h x 24 hours then 500 mg QID x 4 days OR 2. Ampicillin 500 mg IV q 6 h x 24 h then 500 mg QID x 4 days and 3. Gentamicin 240 mg IV once a day for 5 days and 4. Metronidazole 500 mg IV TID x 5 days (or suppositories) Any thoughts? Would you start heavy abx for a person with a suspected (based on a positive halo sign?) CSF leak due to head injury if you knew you were looking at a 48-72 hour evac? Cheers, Steven ---------------------------------------------------------- Lt. Steven D. Pirie, RN, BScN, UE General Duty Ward Officer - Military In-Patient Unit Canadian Forces Support Unit Ottawa - Civic Hospital Site 2 Health Support Operational Training Unit ---------------------------------------------------------- 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 for ; Tue, 14 Nov 2000 23:37:11 -0500 (EST) Disposition-notification-to: theonlymorgan2@yahoo.com Received: from list.srv.cis.pitt.edu (root@[136.142.185.20]) by pitt.edu (PMDF V5.2-32 #41462) with ESMTP id <01JWJR1YPUMA00I32A@mb2i0.ns.pitt.edu> for kconover+owner-wilderness-emergency-medicine@imap.pitt.edu (ORCPT rfc822;kconover+2Bowner-wilderness-emergency-medicine@pitt.edu); Tue, 14 Nov 2000 23:37:12 EST Received: from smtp1b.mail.yahoo.com (smtp3.mail.yahoo.com [128.11.68.135]) by list.srv.cis.pitt.edu with SMTP (8.8.8/8.8.8/cisls-7.2.2.2) ID for ; Tue, 14 Nov 2000 23:37:08 -0500 (EST) Received: from buffalo009.positech.net (HELO morgan) (205.182.107.245) by smtp.mail.vip.suc.yahoo.com with SMTP; Tue, 14 Nov 2000 19:18:01 +0000 Date: Tue, 14 Nov 2000 13:17:54 -0600 From: Morgan Young Subject: Re: W-EMED CSF and Head Injuries To: owner-wilderness-emergency-medicine@list.pitt.edu Message-id: <000001c04e6f$97099d60$f56bb6cd@morgan> MIME-version: 1.0 X-MIMEOLE: Produced By Microsoft MimeOLE V5.50.4133.2400 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 X-Apparently-From: what is ABX? owner-wilderness-emergency-medicine@list.pitt.edu wrote on 11/14/00 2:21: Hi Steve, I would not change my management in the patient that you describe based upon a "ring sign" or halo. I am interested in whether other Medical Command Physicians on the list would change any orders for care (that is, change the orders or evacuation urgency based solely upon the added information of the ring sign) in the patient described. I have to admit, although I have instructed many WEMT courses, my "wilderness" practice is almost entirely based on the 4-8 hour evacuation time frame. I am interested to hear if anyone would truly alter their practice or currently oversees units that are equipped to alter their care in the case that has been presented. Doug Douglas F. Kupas, MD, EMT-P, FACEP Director, EMS Programs Department of Emergency Medicine Geisinger Medical Center Danville, PA ---------- > From: Steven D. Pirie > To: wilderness-emergency-medicine@list.pitt.edu Subject: W-EMED CSF and Head Injuries > Date: Tuesday, November 14, 2000 12:04 AM > > Hello again, > > What a great thread, it is nice to see people exchanging info... > > >The presence/absence of leaking CSF has absolutely no effect on the > >>pre-hospital or wilderness treatment of a possible head injury; the most > >>important S/S are level of consciousness and vital signs. > > I agree that it might not have such a value in the urban environment, but in the wilderness environment it might be worth something. Especially if you are far away from help (i.e. 2+ days). For me, having a stable patient > who presented with a "minor" (as described by the patient) traumatic head wound, and had evidence of CSF leaking, vs. one who did not would change my > evacuation priority (land vs. air) and my comtemplation of antibiotic therapy (especially if I was out for longer periods, thus increasing evac time). > > For instance... You are two days from help. John is rock climbing, and has > a little fall, his partner reports that he hit the rock face "pretty hard" > and was unresponsive for "less then a minute or two". > > O/E headache 8/10, "sight" dizzyness, small single layer closure type laceration and hematoma to the back of the skull, scape to the face and nose, as well as a small trickle of blood from the nose. He also finds it hard to concentrate. > T= 37, P=90, R=20, B/P 138/90. There was 10 or so minutes of blured vision, > and now John feels tired and is a little more irritable then normal. The bleeding from the nose has stopped and his sinuses are full (he too has had > a cold for a few days), so he blows and clears his nose. What are your thoughts? Now if a positive halo sign was present either from the blood, or > nasal secretions would it change your sphincer tone? > > If the patient has the classic major head trauma, then I agree, no change in treatment (except maybe Abx while waiting for evac) don't worry about the fluid from the ears with respect to if it is CSF or not. > > Cheers, > > Steven > > ---------------------------------------------------------- Lt. Steven D. Pirie, RN, BScN, UE > General Duty Ward Officer - Military In-Patient Unit Canadian Forces Support Unit Ottawa - Civic Hospital Site > 2 Health Support Operational Training Unit > ---------------------------------------------------------- > > > 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 Richard M. Young, EMT-P theonlymorgan2@yahoo.com myoung@midwestpagig.com 1-800-753-2259 Pager 1-417-531-8059 Mobile This was sent by a Handspring Visor! _________________________________________________________ Do You Yahoo!? Get your free @yahoo.com address at http://mail.yahoo.com -- 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, 14 Nov 2000 12:55:06 -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 <01JWJ4MTKVBM006IBW@mb1i0.ns.pitt.edu>; Tue, 14 Nov 2000 12:55:04 EST Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.2) ID ; Tue, 14 Nov 2000 12:54:17 -0500 (EST) Received: from buzz.slic.com (qmailr@eagle.slic.com [216.73.13.5]) by list.srv.cis.pitt.edu with SMTP (8.8.8/8.8.8/cisls-7.2.2.2) ID for ; Tue, 14 Nov 2000 12:54:14 -0500 (EST) Received: (qmail 29583 invoked from network); Tue, 14 Nov 2000 18:21:04 +0000 Received: from greenwich-async76.slic.com (HELO oemcomputer) (216.207.138.76) by eagle.slic.com with SMTP; Tue, 14 Nov 2000 18:21:04 +0000 Date: Tue, 14 Nov 2000 12:57:24 -0500 From: Michelle Schonzeit Subject: Re: W-EMED CSF and Head Injuries 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: <002301c04e64$5a4a78a0$4c8acfd8@oemcomputer> MIME-version: 1.0 X-MIMEOLE: Produced By Microsoft MimeOLE V5.00.2014.211 X-Mailer: Microsoft Outlook Express 5.00.2014.211 Content-type: text/plain; charset="iso-8859-1" Content-transfer-encoding: 7bit X-Priority: 3 X-MSMail-priority: Normal Precedence: bulk References: <200011141648.LAA26692@gate1.health.state.ny.us> Ray & Steve, I've just got to add my 2 cents in here regarding the upstate NY comment. I too live in upstate NY (less than 1 hour from Quebec, in fact) and I can assure you that we are NOT going to evac someone from the high peaks region of the Northern Adirondacks in a few hours with out some kind of divine intervention. One of the biggest problem we have in this area is that people down state don't have a clue what they can run into in the 'daks and get themselves in BIG trouble. Regarding the CSF and halo effect (that will actually keep this post somewhat on topic), I actually ran into a situation where a skier at Whiteface had a head injury and what looked like CSF draining from his nose. For the heck of it I tried putting some on a 4x4 and while I wasn't able to see much with the snow that was rapidly accumulating, from what I could see it did not have a halo. I was later told by the ER dock it was CSF and that "it works best to see the halo on paper... 4x4s are too absorbent... and that even in ER it didn't work all the time" On the mountain I really would have thought it was just snot mixed with blood, but regardless this wasn't going to make any difference in our evacuation. Think Snow, Michelle Schonzeit - EMT - OEC Whiteface Ski Patrol Search and Rescue of the N. Adirondacks ----- Original Message ----- From: Raymond R. Thielke To: Sent: Tuesday, November 14, 2000 11:48 AM Subject: Re: W-EMED CSF and Head Injuries > > > Dear Steve, > > I must admit that I have an upstate NY definition of "wilderness:" most ground > evac accomplished in a few hours - 1day, medevac in 1-2 hours (often less.) > With 1 or 2 RARE execptions, an MD in the field is unheard of (unless he/she is > visiting from PA...) FYI, the downstate NY definition of wilderness is, "I > walked about 2 blocks into the woods." (An NYC EMT/P friend of mine actually > said this!) > Take Care... > Ray Thielke > 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, 14 Nov 2000 11:49:32 -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 <01JWJ2CKE1YK00ICWU@mb2i0.ns.pitt.edu>; Tue, 14 Nov 2000 11:49:32 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, 14 Nov 2000 11:49:07 -0500 (EST) Received: from gate1.health.state.ny.us (gate.health.state.ny.us [192.135.176.62]) by list.srv.cis.pitt.edu with SMTP (8.8.8/8.8.8/cisls-7.2.2.2) ID for ; Tue, 14 Nov 2000 11:49:01 -0500 (EST) Received: by gate1.health.state.ny.us id LAA26692 (InterLock SMTP Gateway 4.2 for wilderness-emergency-medicine@list.pitt.edu) ; Tue, 14 Nov 2000 11:48:24 -0500 Received: by gate1.health.state.ny.us (Internal Mail Agent-1); Tue, 14 Nov 2000 11:48:24 -0500 Date: Tue, 14 Nov 2000 11:48:08 -0500 From: "Raymond R. Thielke" Subject: Re: W-EMED CSF and Head Injuries 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: <200011141648.LAA26692@gate1.health.state.ny.us> MIME-version: 1.0 Content-type: text/plain; charset=us-ascii Content-disposition: inline Precedence: bulk X-Lotus-FromDomain: NYSDOH Dear Steve, I must admit that I have an upstate NY definition of "wilderness:" most ground evac accomplished in a few hours - 1day, medevac in 1-2 hours (often less.) With 1 or 2 RARE execptions, an MD in the field is unheard of (unless he/she is visiting from PA...) FYI, the downstate NY definition of wilderness is, "I walked about 2 blocks into the woods." (An NYC EMT/P friend of mine actually said this!) We agree totally about the urban enviroment: if my patient is "leaking," I cover it with a dressing and let the trauma center figure out what it is...(gross over-simplification!) In the scenario you present, my "sphincter tone" would be high initially: slightly evelated B/P, irritability, confirmed loss of cons., MOI. My Tx & transport decisions would be based on additonal info: How long since injury to patient contact? (Have these s/s developed over 10 minutes or 2 days?) My most important info would be any changes in subsequent V/S and/or mental state. I'd be watching this guy like a hawk (my wife would argue "vulture.") I would note a halo if observed but wouldn't specifically test for it. Take Care... Ray Thielke "Douglas F. Kupas" on 11/14/2000 02:57:29 AM Please respond to wilderness-emergency-medicine@list.pitt.edu To: wilderness-emergency-medicine@list.pitt.edu cc: (bcc: Raymond R. Thielke/Syracuse/DOH) Subject: Re: W-EMED CSF and Head Injuries Hi Steve, I would not change my management in the patient that you describe based upon a "ring sign" or halo. I am interested in whether other Medical Command Physicians on the list would change any orders for care (that is, change the orders or evacuation urgency based solely upon the added information of the ring sign) in the patient described. I have to admit, although I have instructed many WEMT courses, my "wilderness" practice is almost entirely based on the 4-8 hour evacuation time frame. I am interested to hear if anyone would truly alter their practice or currently oversees units that are equipped to alter their care in the case that has been presented. Doug Douglas F. Kupas, MD, EMT-P, FACEP Director, EMS Programs Department of Emergency Medicine Geisinger Medical Center Danville, PA ---------- > From: Steven D. Pirie > To: wilderness-emergency-medicine@list.pitt.edu > Subject: W-EMED CSF and Head Injuries > Date: Tuesday, November 14, 2000 12:04 AM > > Hello again, > > What a great thread, it is nice to see people exchanging info... > > >The presence/absence of leaking CSF has absolutely no effect on the > >>pre-hospital or wilderness treatment of a possible head injury; the most > >>important S/S are level of consciousness and vital signs. > > I agree that it might not have such a value in the urban environment, but > in the wilderness environment it might be worth something. Especially if > you are far away from help (i.e. 2+ days). For me, having a stable patient > who presented with a "minor" (as described by the patient) traumatic head > wound, and had evidence of CSF leaking, vs. one who did not would change my > evacuation priority (land vs. air) and my comtemplation of antibiotic > therapy (especially if I was out for longer periods, thus increasing evac > time). > > For instance... You are two days from help. John is rock climbing, and has > a little fall, his partner reports that he hit the rock face "pretty hard" > and was unresponsive for "less then a minute or two". > > O/E headache 8/10, "sight" dizzyness, small single layer closure type > laceration and hematoma to the back of the skull, scape to the face and > nose, as well as a small trickle of blood from the nose. He also finds it > hard to concentrate. > T= 37, P=90, R=20, B/P 138/90. There was 10 or so minutes of blured vision, > and now John feels tired and is a little more irritable then normal. The > bleeding from the nose has stopped and his sinuses are full (he too has had > a cold for a few days), so he blows and clears his nose. What are your > thoughts? Now if a positive halo sign was present either from the blood, or > nasal secretions would it change your sphincer tone? > > If the patient has the classic major head trauma, then I agree, no change > in treatment (except maybe Abx while waiting for evac) don't worry about > the fluid from the ears with respect to if it is CSF or not. > > Cheers, > > Steven > > ---------------------------------------------------------- > Lt. Steven D. Pirie, RN, BScN, UE > General Duty Ward Officer - Military In-Patient Unit > Canadian Forces Support Unit Ottawa - Civic Hospital Site > 2 Health Support Operational Training Unit > ---------------------------------------------------------- > > > 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 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, 14 Nov 2000 11:49:42 -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 <01JWJ2CRMX3U006IBW@mb1i0.ns.pitt.edu>; Tue, 14 Nov 2000 11:49:42 EST Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.2) ID ; Tue, 14 Nov 2000 11:49:08 -0500 (EST) Received: from web2.po.com (web2.po.com [204.178.220.34]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.2) ID for ; Tue, 14 Nov 2000 11:48:59 -0500 (EST) Received: (from www@localhost) by web2.po.com (8.8.8+Sun/8.8.8) id LAA23519; Tue, 14 Nov 2000 11:46:09 -0500 (EST) Date: Tue, 14 Nov 2000 11:46:09 -0500 (EST) From: Charles Werntz Subject: Re: Re: W-EMED CSF and Head Injuries 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: <200011141646.LAA23519@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 I am trying to think how the halo sign would change my treatment recommendations beyond those based upon the clinical picture (AVPU, etc.) The only thing I can imagine up is that in the face of a "halo sign", I would want to point that person toward receiving definitive care at a center which has neurosurgical services available. Thus I might try to arrange for transport to a tertiary center rather than having the patient taken initially to a local hospital. In areas of the country where making transfers and arranging for helicopters is difficult, being able to discuss a CSF leak may help in making the case with the tertiary hospital to accept the patient. Other than that, the leak may actually be therapeutic as it would slow the build-up of intracranial pressure by acting as a sort of relief valve. Carl Werntz, DO Internal Medicine Mountaineer Area Rescue Group ------------------ Reply Separator -------------------- Originally From: "Douglas F. Kupas" Subject: Re: W-EMED CSF and Head Injuries Date: 11/14/2000 02:57am Hi Steve, I would not change my management in the patient that you describe based upon a "ring sign" or halo. I am interested in whether other Medical Command Physicians on the list would change any orders for care (that is, change the orders or evacuation urgency based solely upon the added information of the ring sign) in the patient described. I have to admit, although I have instructed many WEMT courses, my "wilderness" practice is almost entirely based on the 4-8 hour evacuation time frame. I am interested to hear if anyone would truly alter their practice or currently oversees units that are equipped to alter their care in the case that has been presented. Doug Douglas F. Kupas, MD, EMT-P, FACEP Director, EMS Programs Department of Emergency Medicine Geisinger Medical Center Danville, PA ---------- > From: Steven D. Pirie > To: wilderness-emergency-medicine@list.pitt.edu > Subject: W-EMED CSF and Head Injuries > Date: Tuesday, November 14, 2000 12:04 AM > > Hello again, > > What a great thread, it is nice to see people exchanging info... > > >The presence/absence of leaking CSF has absolutely no effect on the > >>pre-hospital or wilderness treatment of a possible head injury; the most > >>important S/S are level of consciousness and vital signs. > > I agree that it might not have such a value in the urban environment, but > in the wilderness environment it might be worth something. Especially if > you are far away from help (i.e. 2+ days). For me, having a stable patient > who presented with a "minor" (as described by the patient) traumatic head > wound, and had evidence of CSF leaking, vs. one who did not would change my > evacuation priority (land vs. air) and my comtemplation of antibiotic > therapy (especially if I was out for longer periods, thus increasing evac > time). > > For instance... You are two days from help. John is rock climbing, and has > a little fall, his partner reports that he hit the rock face "pretty hard" > and was unresponsive for "less then a minute or two". > > O/E headache 8/10, "sight" dizzyness, small single layer closure type > laceration and hematoma to the back of the skull, scape to the face and > nose, as well as a small trickle of blood from the nose. He also finds it > hard to concentrate. > T= 37, P=90, R=20, B/P 138/90. There was 10 or so minutes of blured vision, > and now John feels tired and is a little more irritable then normal. The > bleeding from the nose has stopped and his sinuses are full (he too has had > a cold for a few days), so he blows and clears his nose. What are your > thoughts? Now if a positive halo sign was present either from the blood, or > nasal secretions would it change your sphincer tone? > > If the patient has the classic major head trauma, then I agree, no change > in treatment (except maybe Abx while waiting for evac) don't worry about > the fluid from the ears with respect to if it is CSF or not. > > Cheers, > > Steven > > ---------------------------------------------------------- > Lt. Steven D. Pirie, RN, BScN, UE > General Duty Ward Officer - Military In-Patient Unit > Canadian Forces Support Unit Ottawa - Civic Hospital Site > 2 Health Support Operational Training Unit > ---------------------------------------------------------- > > > 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 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, 14 Nov 2000 11:10:56 -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 <01JWJ0ZPGE8U006KQW@mb1i0.ns.pitt.edu>; Tue, 14 Nov 2000 11:10:55 EST Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.2) ID ; Tue, 14 Nov 2000 11:10:11 -0500 (EST) Received: from ml.egroups.com (ml.egroups.com [208.50.144.77]) by list.srv.cis.pitt.edu with SMTP (8.8.8/8.8.8/cisls-7.2.2.2) ID for ; Tue, 14 Nov 2000 11:10:07 -0500 (EST) Received: from [10.1.10.65] by ml.egroups.com with NNFMP; Tue, 14 Nov 2000 16:10:05 +0000 Date: Tue, 14 Nov 2000 16:07:05 +0000 From: Shannon Koppenhoefer Subject: W-EMED Looking for a volunteer opportunity 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: <8urnv9+imni@eGroups.com> MIME-version: 1.0 X-Mailer: eGroups Message Poster Content-type: text/plain; charset=ISO-8859-1 Precedence: bulk User-Agent: eGroups-EW/0.82 X-eGroups-Return: shannon@artraining.on.ca X-Originating-IP: 154.20.82.103 I am looking to gain some experience with wilderness medicine / rescue / emergency response during my vacation this year. I work full time for Toronto Ambulance and am certified at the EMT - Basic and Wilderness levels. Can anyone suggest places I may look into / directions I may begin my search ??? I have about 2 weeks off depending how I select my time. If you do have suggestions, can you please email me at shannon@artraining.on.ca 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 ; Tue, 14 Nov 2000 03:00:11 -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 <01JWIJUAILLG002NA3@mb1i0.ns.pitt.edu>; Tue, 14 Nov 2000 03:00:11 EST Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.2) ID ; Tue, 14 Nov 2000 02:58:39 -0500 (EST) Received: from mail.ptd.net (mail1.ha-net.ptd.net [207.44.96.65]) by list.srv.cis.pitt.edu with SMTP (8.8.8/8.8.8/cisls-7.2.2.2) ID for ; Tue, 14 Nov 2000 02:58:36 -0500 (EST) Received: (qmail 6997 invoked from network); Tue, 14 Nov 2000 07:58:56 +0000 Received: from du13008.blo.ptd.net (HELO dkupas.ptdprolog.net) ([204.186.13.8]) (envelope-sender ) by mail.ptd.net (qmail-ldap-1.03) with SMTP for ; Tue, 14 Nov 2000 07:58:56 +0000 Date: Tue, 14 Nov 2000 02:57:29 -0500 From: "Douglas F. Kupas" Subject: Re: W-EMED CSF and Head Injuries 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: <200011140758.CAA01714@list.srv.cis.pitt.edu> MIME-version: 1.0 X-Mailer: Microsoft Internet Mail 4.70.1155 Content-type: text/plain; charset=ISO-8859-1 Content-transfer-encoding: 7bit X-Priority: 3 X-MSMail-priority: Normal Precedence: bulk Hi Steve, I would not change my management in the patient that you describe based upon a "ring sign" or halo. I am interested in whether other Medical Command Physicians on the list would change any orders for care (that is, change the orders or evacuation urgency based solely upon the added information of the ring sign) in the patient described. I have to admit, although I have instructed many WEMT courses, my "wilderness" practice is almost entirely based on the 4-8 hour evacuation time frame. I am interested to hear if anyone would truly alter their practice or currently oversees units that are equipped to alter their care in the case that has been presented. Doug Douglas F. Kupas, MD, EMT-P, FACEP Director, EMS Programs Department of Emergency Medicine Geisinger Medical Center Danville, PA ---------- > From: Steven D. Pirie > To: wilderness-emergency-medicine@list.pitt.edu > Subject: W-EMED CSF and Head Injuries > Date: Tuesday, November 14, 2000 12:04 AM > > Hello again, > > What a great thread, it is nice to see people exchanging info... > > >The presence/absence of leaking CSF has absolutely no effect on the > >>pre-hospital or wilderness treatment of a possible head injury; the most > >>important S/S are level of consciousness and vital signs. > > I agree that it might not have such a value in the urban environment, but > in the wilderness environment it might be worth something. Especially if > you are far away from help (i.e. 2+ days). For me, having a stable patient > who presented with a "minor" (as described by the patient) traumatic head > wound, and had evidence of CSF leaking, vs. one who did not would change my > evacuation priority (land vs. air) and my comtemplation of antibiotic > therapy (especially if I was out for longer periods, thus increasing evac > time). > > For instance... You are two days from help. John is rock climbing, and has > a little fall, his partner reports that he hit the rock face "pretty hard" > and was unresponsive for "less then a minute or two". > > O/E headache 8/10, "sight" dizzyness, small single layer closure type > laceration and hematoma to the back of the skull, scape to the face and > nose, as well as a small trickle of blood from the nose. He also finds it > hard to concentrate. > T= 37, P=90, R=20, B/P 138/90. There was 10 or so minutes of blured vision, > and now John feels tired and is a little more irritable then normal. The > bleeding from the nose has stopped and his sinuses are full (he too has had > a cold for a few days), so he blows and clears his nose. What are your > thoughts? Now if a positive halo sign was present either from the blood, or > nasal secretions would it change your sphincer tone? > > If the patient has the classic major head trauma, then I agree, no change > in treatment (except maybe Abx while waiting for evac) don't worry about > the fluid from the ears with respect to if it is CSF or not. > > Cheers, > > Steven > > ---------------------------------------------------------- > Lt. Steven D. Pirie, RN, BScN, UE > General Duty Ward Officer - Military In-Patient Unit > Canadian Forces Support Unit Ottawa - Civic Hospital Site > 2 Health Support Operational Training Unit > ---------------------------------------------------------- > > > 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, 14 Nov 2000 02:52:01 -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 <01JWIJK69Z8Y00IGDF@mb2i0.ns.pitt.edu>; Tue, 14 Nov 2000 02:52:01 EST Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.2) ID ; Tue, 14 Nov 2000 02:49:58 -0500 (EST) Received: from mail.ptd.net (mail1.ha-net.ptd.net [207.44.96.65]) by list.srv.cis.pitt.edu with SMTP (8.8.8/8.8.8/cisls-7.2.2.2) ID for ; Tue, 14 Nov 2000 02:49:56 -0500 (EST) Received: (qmail 11717 invoked from network); Tue, 14 Nov 2000 07:50:15 +0000 Received: from du13008.blo.ptd.net (HELO dkupas.ptdprolog.net) ([204.186.13.8]) (envelope-sender ) by mail.ptd.net (qmail-ldap-1.03) with SMTP for ; Tue, 14 Nov 2000 07:50:15 +0000 Date: Tue, 14 Nov 2000 02:46:52 -0500 From: "Douglas F. Kupas" Subject: Re: W-EMED The Halo test for CSF? 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: <200011140749.CAA01642@list.srv.cis.pitt.edu> MIME-version: 1.0 X-Mailer: Microsoft Internet Mail 4.70.1155 Content-type: text/plain; charset=ISO-8859-1 Content-transfer-encoding: 7bit X-Priority: 3 X-MSMail-priority: Normal Precedence: bulk Hi everyone, I do not think that the question is whether blood + CSF = halo. The question is how often is this true and what other things can be confused with it. While anecdotal "experimentation" is encouraged as a natural extension of curiosity which often leads to a true scientific investigation, anecdote is often dangerous to follow in clinical practice. I too have clearly seen the halo on bedsheets, and this often means CSF, but the Fales study clearly shows that other substances can also lead to the halo, and it is not specific to CSF. Steve, you have started your observation in the identical way that Dr. Fales did. He then extended the project to a scientific study with an increased number of substances sampled. I think that you will find his article in the Annals to be interesting reading. Doug Douglas F. Kupas, MD, EMT-P, FACEP Director, EMS Programs Department of Emergency Medicine Geisinger Medical Center Danville, PA ---------- > From: Steven D. Pirie > To: wilderness-emergency-medicine@list.pitt.edu > Subject: W-EMED The Halo test for CSF? > Date: Monday, November 13, 2000 10:04 PM > > Hello again, > > >So - the ring sign is not exclusive to cerebrospinal fluid and the > >glucose strips are unreliable. I learned about the 'ring sign' fairly > >recently, so I don't think the word has gotten around yet. > > So at work today I thought I'd try a not so scientific study to see what I > could find... > > I took a few drops of my blood (and a few from an "extra" blood sample that > was kicking about) and placed them on a 2"x2" piece of gauze.. no ring. > > Then I took a few drops of my nasal discharge (from the cold I have had for > the past 4 or so days) and placed a drop or two on some 2x2 gauze... no > ring. > > I then took a wee little walk up to the neuro-observation unit, and > borrowed (after convenincing the nurse that I was not crazy, see comments > to follow) some CSF fluid from an EVD that was going to be emptied... sure > enough I produced the classic "halo" ring on the piece of gauze. The > neuro-obs nurse noted to me that the "halo" sign is common in that part of > the woods, as they see it on the bed sheets every so often, often before > every noticing the leak proper... ("find the halo, call the doc") and could > not beleive that I "wanted to try it for myself". > > So there you go, limited, anecdotal findings complements of a slow day at > work. > > Cheers, > > Steven > > ---------------------------------------------------------- > Lt. Steven D. Pirie, RN, BScN, UE > General Duty Ward Officer - Military In-Patient Unit > Canadian Forces Support Unit Ottawa - Civic Hospital Site > 2 Health Support Operational Training Unit > ---------------------------------------------------------- > > > > 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, 14 Nov 2000 01:08:24 -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 <01JWIFXPIW9Y006LHK@mb1i0.ns.pitt.edu>; Tue, 14 Nov 2000 01:08:24 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, 14 Nov 2000 01:08:12 -0500 (EST) Received: from smtp02.iafrica.com (smtp02.iafrica.com [196.7.0.140]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.2) ID for ; Tue, 14 Nov 2000 01:08:06 -0500 (EST) Received: from [196.7.216.15] (helo=clyde.sita.co.za) by smtp02.iafrica.com with esmtp (Exim 1.92 #1) for wilderness-emergency-medicine@list.pitt.edu id 13vZGE-000G1J-00; Tue, 14 Nov 2000 08:08:02 +0200 Received: (from uucp@localhost) by clyde.sita.co.za (8.11.1/8.11.1) with UUCP id eAE65iD24581 for wilderness-emergency-medicine@list.pitt.edu; Tue, 14 Nov 2000 08:05:44 +0200 Received: from medinfo.sita.co.za (medinfo.sita.co.za [196.16.129.16]) by bonnie.sita.co.za (8.11.1/8.11.1) with ESMTP id eAE64Yb15135 for ; Tue, 14 Nov 2000 08:04:34 +0200 Received: from MEDINFO/SpoolDir by medinfo.sita.co.za (Mercury 1.44); Tue, 14 Nov 2000 08:04:22 +0200 Received: from SpoolDir by MEDINFO (Mercury 1.44); Tue, 14 Nov 2000 08:03:56 +0200 Date: Tue, 14 Nov 2000 08:03:51 +0200 From: Rob Thomas Subject: W-EMED: Sugar for bleeding? 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: <18882B61CA@medinfo.sita.co.za> Organization: State I.T. Agency, S.A. X-Mailer: Pegasus Mail v3.31 Precedence: bulk X-Real-Sender: ROBT Hi all As I mentioned quite some time ago I'm aware of the use of sugar as a clotting agent and (although I've never had to use it) have heard anecdotal reports of it working. However, I'm completely clueless as to how it works. If anyone on the list has the time and the inclination to explain the mechanisms and physiology behind this to me in words of 3 syllables or less I'd love to hear it. TIA Regards Rob -- Rob Thomas +27-12-482-2957 07h30-16h30 GMT+0200 +27-82-652-1490 all hours (try to be reasonable) 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, 14 Nov 2000 01:03:41 -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 <01JWIFRTVFFG002NA3@mb1i0.ns.pitt.edu>; Tue, 14 Nov 2000 01:03:40 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, 14 Nov 2000 01:03:14 -0500 (EST) Received: from smtp02.iafrica.com (smtp02.iafrica.com [196.7.0.140]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.2) ID for ; Tue, 14 Nov 2000 01:03:08 -0500 (EST) Received: from [196.7.216.15] (helo=clyde.sita.co.za) by smtp02.iafrica.com with esmtp (Exim 1.92 #1) for wilderness-emergency-medicine@list.pitt.edu id 13vZBO-000Fwg-00; Tue, 14 Nov 2000 08:03:02 +0200 Received: (from uucp@localhost) by clyde.sita.co.za (8.11.1/8.11.1) with UUCP id eAE60ff24297 for wilderness-emergency-medicine@list.pitt.edu; Tue, 14 Nov 2000 08:00:41 +0200 Received: from medinfo.sita.co.za (medinfo.sita.co.za [196.16.129.16]) by bonnie.sita.co.za (8.11.1/8.11.1) with ESMTP id eAE616b14990 for ; Tue, 14 Nov 2000 08:01:06 +0200 Received: from MEDINFO/SpoolDir by medinfo.sita.co.za (Mercury 1.44); Tue, 14 Nov 2000 08:00:55 +0200 Received: from SpoolDir by MEDINFO (Mercury 1.44); Tue, 14 Nov 2000 08:00:49 +0200 Date: Tue, 14 Nov 2000 08:00:46 +0200 From: Rob Thomas Subject: Re: W-EMED Club evening talk: help needed 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: <187ACF5BE7@medinfo.sita.co.za> Organization: State I.T. Agency, S.A. X-Mailer: Pegasus Mail v3.31 Precedence: bulk X-Real-Sender: ROBT Hi all I'd like to thank all who sent me suggestions and information for the talk mentioned above. I had a whale of a time setting this one up. My fiance and I went out to a nearby hill with a few volunteer models and did a few mock improvisations of various techniques then photographed them onto slide. I also had a bunch of other items placed on slide such as the concept of improvisation (using rolled paper as a funnel, a coin, knife or scissors as a screwdriver, etc), as well as some of the general tools of improvisation (duct-tape, cloth plaster, gauze, clothing, "kip- mats", tent-poles, trekking-poles, etc). The talk went down well and I've had a couple of requests for re-shows. With time I intend scanning these slides and attempting to build an electronic presentation from them. When I do I'll make it freely available to whomever wants to use it. Again - thanks for the input and the assistance. Regards Rob -- Rob Thomas +27-12-482-2957 07h30-16h30 GMT+0200 +27-82-652-1490 all hours (try to be reasonable) 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, 14 Nov 2000 00:04:53 -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 <01JWIDPXSR8600IHYN@mb2i0.ns.pitt.edu>; Tue, 14 Nov 2000 00:04:52 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, 14 Nov 2000 00:04:13 -0500 (EST) Received: from mail1.toronto.istar.net (mail1.toronto.istar.net [209.89.75.17]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.2) ID for ; Tue, 14 Nov 2000 00:04:06 -0500 (EST) Received: from ip14.ottawa8.dialup.canada.psi.net ([154.5.70.14] helo=[154.5.32.33]) by mail1.toronto.istar.net with esmtp (Exim 2.02 #1) id 13vYGm-00032t-00 for wilderness-emergency-medicine@list.pitt.edu; Tue, 14 Nov 2000 00:04:33 -0500 Date: Tue, 14 Nov 2000 00:04:20 -0500 From: "Steven D. Pirie" Subject: W-EMED CSF and Head Injuries 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 Content-type: text/plain; charset="us-ascii" Precedence: bulk References: <200011132144.QAA20923@gate1.health.state.ny.us> Hello again, What a great thread, it is nice to see people exchanging info... >The presence/absence of leaking CSF has absolutely no effect on the >>pre-hospital or wilderness treatment of a possible head injury; the most >>important S/S are level of consciousness and vital signs. I agree that it might not have such a value in the urban environment, but in the wilderness environment it might be worth something. Especially if you are far away from help (i.e. 2+ days). For me, having a stable patient who presented with a "minor" (as described by the patient) traumatic head wound, and had evidence of CSF leaking, vs. one who did not would change my evacuation priority (land vs. air) and my comtemplation of antibiotic therapy (especially if I was out for longer periods, thus increasing evac time). For instance... You are two days from help. John is rock climbing, and has a little fall, his partner reports that he hit the rock face "pretty hard" and was unresponsive for "less then a minute or two". O/E headache 8/10, "sight" dizzyness, small single layer closure type laceration and hematoma to the back of the skull, scape to the face and nose, as well as a small trickle of blood from the nose. He also finds it hard to concentrate. T= 37, P=90, R=20, B/P 138/90. There was 10 or so minutes of blured vision, and now John feels tired and is a little more irritable then normal. The bleeding from the nose has stopped and his sinuses are full (he too has had a cold for a few days), so he blows and clears his nose. What are your thoughts? Now if a positive halo sign was present either from the blood, or nasal secretions would it change your sphincer tone? If the patient has the classic major head trauma, then I agree, no change in treatment (except maybe Abx while waiting for evac) don't worry about the fluid from the ears with respect to if it is CSF or not. Cheers, Steven ---------------------------------------------------------- Lt. Steven D. Pirie, RN, BScN, UE General Duty Ward Officer - Military In-Patient Unit Canadian Forces Support Unit Ottawa - Civic Hospital Site 2 Health Support Operational Training Unit ---------------------------------------------------------- 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, 13 Nov 2000 22:05:18 -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 <01JWI9JOSA2G00IG0Z@mb2i0.ns.pitt.edu>; Mon, 13 Nov 2000 22:05:18 EST Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.2) ID ; Mon, 13 Nov 2000 22:04:27 -0500 (EST) Received: from mail1.toronto.istar.net (mail1.toronto.istar.net [209.89.75.17]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.2) ID for ; Mon, 13 Nov 2000 22:04:25 -0500 (EST) Received: from ip33.ottawa11.dialup.canada.psi.net ([154.5.32.33]) by mail1.toronto.istar.net with esmtp (Exim 2.02 #1) id 13vWOx-0002V5-00 for wilderness-emergency-medicine@list.pitt.edu; Mon, 13 Nov 2000 22:04:52 -0500 Date: Mon, 13 Nov 2000 22:04:41 -0500 From: "Steven D. Pirie" Subject: W-EMED The Halo test for CSF? In-reply-to: <14864.15326.280153.991122@amoeba.cugc.org> 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/plain; charset="us-ascii" Precedence: bulk References: <200011131650.LAA02736@list.srv.cis.pitt.edu> <200011131650.LAA02736@list.srv.cis.pitt.edu> Hello again, >So - the ring sign is not exclusive to cerebrospinal fluid and the >glucose strips are unreliable. I learned about the 'ring sign' fairly >recently, so I don't think the word has gotten around yet. So at work today I thought I'd try a not so scientific study to see what I could find... I took a few drops of my blood (and a few from an "extra" blood sample that was kicking about) and placed them on a 2"x2" piece of gauze.. no ring. Then I took a few drops of my nasal discharge (from the cold I have had for the past 4 or so days) and placed a drop or two on some 2x2 gauze... no ring. I then took a wee little walk up to the neuro-observation unit, and borrowed (after convenincing the nurse that I was not crazy, see comments to follow) some CSF fluid from an EVD that was going to be emptied... sure enough I produced the classic "halo" ring on the piece of gauze. The neuro-obs nurse noted to me that the "halo" sign is common in that part of the woods, as they see it on the bed sheets every so often, often before every noticing the leak proper... ("find the halo, call the doc") and could not beleive that I "wanted to try it for myself". So there you go, limited, anecdotal findings complements of a slow day at work. Cheers, Steven ---------------------------------------------------------- Lt. Steven D. Pirie, RN, BScN, UE General Duty Ward Officer - Military In-Patient Unit Canadian Forces Support Unit Ottawa - Civic Hospital Site 2 Health Support Operational Training Unit ---------------------------------------------------------- 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, 13 Nov 2000 20:26:58 -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 <01JWI64Q3F6Q00IPV5@mb2i0.ns.pitt.edu>; Mon, 13 Nov 2000 20:26:57 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, 13 Nov 2000 20:26:08 -0500 (EST) Received: from macs.mxim.com (macs.mxim.com [204.17.143.130]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.2) ID for ; Mon, 13 Nov 2000 20:26:05 -0500 (EST) Received: from localhost (localhost [127.0.0.1]) by macs.mxim.com (8.7/8.6.9) with SMTP id RAA23032 for ; Mon, 13 Nov 2000 17:25:30 -0800 (PST) Date: Mon, 13 Nov 2000 17:25:30 -0800 (PST) From: Hal Lillywhite Subject: Re: W-EMED Extractor for snake envenomations In-reply-to: "Your message of Sun, 12 Nov 2000 18:19:26 EST." <002301c04cff$007c6e20$0300a8c0@snickers> 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: <200011140125.RAA23032@macs.mxim.com> MIME-version: 1.0 X-Mailer: exmh version 2.0.1 12/23/97 Content-type: text/plain; charset=us-ascii Precedence: bulk >A recent article in Wilderness and Environmental Medicine seemed to >conclude that extractor kits were not helpful in the field >management of snake envenomations, and in some cases were even >harmful, causing increased swelling and tissue necrosis at the site >of suction placement. I don't have access to the magazine but have a question about this: What do they mean by an "extractor kit?" Do they by chance mean the old fashioned razor blade, rubber suction cup and surgical tubing to make a constricting band? If so, they are 100% correct. That system was worse than useless. The rubber suction cup did not develop enough vacuum to do any good and the suggested cutting was likely to do more damage than the snake did. The constricting band is a good idea but must be managed carefully or swelling will cause it to overtighten. However if they are talking about the Sawyer Extractor (a single device, I've never heard it called a kit) then I would question the conclusion. This device, if used in the first few minutes after envenomantion, can remove some of the poison and is thus effective. If you wait too long, however, the venom will be dispersed and the extractor useless. It is also useful for things like bee stings. If you have more questions I suggest you contact Dr. Steve Grenard, grenard@con2.com He has spent a lot of time studying snake bite and its treatment. 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, 13 Nov 2000 17:55:34 -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 <01JWI0TZLKEM006GX3@mb1i0.ns.pitt.edu>; Mon, 13 Nov 2000 17:55:31 EST Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.2) ID ; Mon, 13 Nov 2000 17:54:49 -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, 13 Nov 2000 17:54:46 -0500 (EST) Received: from unixs1.cis.pitt.edu ("port 63897"@[136.142.185.31]) by pitt.edu (PMDF V5.2-32 #41462) with SMTP id <01JWI0T21QQG002NA3@mb1i0.ns.pitt.edu> for wilderness-emergency-medicine@list.pitt.edu; Mon, 13 Nov 2000 17:54:46 -0500 (EST) Date: Mon, 13 Nov 2000 17:54:45 -0500 (EST) From: Suzanne M Atkinson Subject: Re: W-EMED Glucose test strips for CSF? In-reply-to: <200011132144.QAA20923@gate1.health.state.ny.us> Sender: owner-wilderness-emergency-medicine@list.pitt.edu X-Sender: smast27@unixs1.cis.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/PLAIN; charset=US-ASCII Precedence: bulk > "myth" data that Dr. Kupas offered.) The presence/absence of leaking CSF has > absolutely no effect on the pre-hospital or wilderness treatment of a possible > head injury; the most important S/S are level of consciousness and vital signs. thanks, this answers my question exactly! suzanne 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, 13 Nov 2000 16:46:33 -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 <01JWHYFC4BDC006GX3@mb1i0.ns.pitt.edu>; Mon, 13 Nov 2000 16:46:27 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, 13 Nov 2000 16:45:23 -0500 (EST) Received: from gate1.health.state.ny.us (gate.health.state.ny.us [192.135.176.62]) by list.srv.cis.pitt.edu with SMTP (8.8.8/8.8.8/cisls-7.2.2.2) ID for ; Mon, 13 Nov 2000 16:45:15 -0500 (EST) Received: by gate1.health.state.ny.us id QAA20923 (InterLock SMTP Gateway 4.2 for wilderness-emergency-medicine@list.pitt.edu) ; Mon, 13 Nov 2000 16:44:36 -0500 Received: by gate1.health.state.ny.us (Internal Mail Agent-1); Mon, 13 Nov 2000 16:44:36 -0500 Date: Mon, 13 Nov 2000 16:44:31 -0500 From: "Raymond R. Thielke" Subject: Re: W-EMED Glucose test strips for CSF? 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: <200011132144.QAA20923@gate1.health.state.ny.us> MIME-version: 1.0 Content-type: text/plain; charset=us-ascii Content-disposition: inline Precedence: bulk X-Lotus-FromDomain: NYSDOH Hear, hear, Dr. Kupas! The first test of usefulness for any Dx procedure must be the "So what?" test. Having been an EMT and EMT/P for 24+ years, I've NEVER bothered to worry about the "halo test." (Although, I didn't know about the "myth" data that Dr. Kupas offered.) The presence/absence of leaking CSF has absolutely no effect on the pre-hospital or wilderness treatment of a possible head injury; the most important S/S are level of consciousness and vital signs. (The above opinions are my own...) Raymond R. Thielke, EMT/P, MA(c) Syracuse, NY "Douglas F. Kupas" on 11/13/2000 11:43:54 AM Please respond to wilderness-emergency-medicine@list.pitt.edu To: wilderness-emergency-medicine@list.pitt.edu cc: (bcc: Raymond R. Thielke/Syracuse/DOH) Subject: Re: W-EMED Glucose test strips for CSF? Hi Larry, Thank you for doing the literature search that I was only going to allude to. I worked with Drs. Fales and Dula at Geisinger Medical Center when they published the first reference in your list. The "ring sign" is one of many myths in medicine that have gone on to be disproved. Bottom line is that blood alone, blood and CSF or blood and snot all can give a ring sign. It is intuitive that the same problems would be present when trying to use the dextrostick, but I thank you for summarizing the studies in such a nice way. As a matter of interest, when Drs. Fales and Dula were writing the article, they found many textbooks listing the "halo sign", but they could not find any initial study that any of these textbooks used as a reference to this mythical sign. As a side point, do we really care if there is CSF draining from the ear of a possibly head injured patient? If they have the signs and symptoms of a severe head injury, we will treat them as a severe head injury. If they are wide awake and draining snot and blood with a positive halo sign, we should probably treat them like a wide awake patient who has sustained some degree of head injury, and treat their symptoms as we otherwise would (ignoring the information about CSF). If they truely have a basilar skull fracture, rhinorrhea or otorhea will probably not be their most significant sign of a severe head injury. Anytime someone has drainage from a body opening, it makes sense to prevent contamination, but otherwise, I can't think of anything that I would do differently. I do not think that this information alone would lead me to initiate antibiotics in the field if the patient were wide awake and without any other signs of open skull fracture. A similar situation is the patient with a unilateral widely dilated pupil after a head injury. If the patient is wide awake and has no other signs of severe closed head injury, then they probably have a "traumatic pupil" and the pupillary findings are do to local truama to the eye, not increased intracranial pressure and impending hernitation. Likewise, a patient with no other signs of a severe head injury that has rhinorrea or otorhea probably has a greater chance of having a truamatic local injury (e.g. traumatic rupture of the tympanic membrane) than a severe head injury. Doug Douglas F. Kupas, MD, EMT-P, FACEP Director, EMS Programs Department of Emergency Medicine Geisinger Medical Center Danville, PA ---------- > From: Steven D. Pirie > To: wilderness-emergency-medicine@list.pitt.edu > Subject: Re: W-EMED Glucose test strips for CSF? > Date: Sunday, November 12, 2000 10:24 PM > > Suzanne, > ---------- > From: Larry Nathanson > To: wilderness-emergency-medicine@list.pitt.edu > Subject: Re: W-EMED Glucose test strips for CSF? > Date: Monday, November 13, 2000 1:27 AM > > At 06:16 PM 11/12/00 -0500, you wrote: > >I'm not sure if this is a common practice in the field, but I recently > >learned that you can use glucose test strips to test fluid (nose/ears) to > >see if it is CSF. (CSF should have a glucose level of about 40% of the > >blood level). > > > As Lt. Pirie points out, you can put a few drops on gauze or paper towel, > and see if a distinctive ring or halo forms. [1] > > Some textbooks have recommended using glucose reagent strips, where a > higher glucose level would suggest CSF leak. However, newer textbooks > recommend against this [2], as the literature has shown a number of > problems with false negatives [3], and false positives ("normal" rhinorrhea > with "CSF" glucose level.) [4] [5] > > --L > > ========================================================= > [1] > Dula DJ Fales W > The 'ring sign': is it a reliable indicator for cerebral spinal fluid? > In: Ann Emerg Med (1993 Apr) 22(4):718-20 > > STUDY OBJECTIVE: To study the development of a ring sign when blood > is mixed with various fluids. METHODS: One drop of blood and one drop > of either spinal fluid, saline, tap water, or rhinorrhea fluid were > placed simultaneously on filter paper, and the specimens were > examined after ten minutes for the development of a ring. A variety > of filter paper agents were used, including standard laboratory > filter paper, paper towels, coffee filters, and bed linens. RESULTS: > All fluids, when mixed with blood, gave rise to a ring sign; blood > alone did not. The type of filter paper did not affect the > development of a ring. CONCLUSION: In this experimental setting, the > ring or halo sign is reliable for detecting cerebrospinal fluids but > is not exclusive for cerebrospinal fluid. > > ======================================================= > [2] > Rosen: Emergency Medicine: Concepts and Clinical Practice, 4th ed., P 449. > > >The patient should be observed for CSF rhinorrhea as an indication of a > >fracture of the cribriform plate or associated structures. Unfortunately > >the measurement of the glucose level in the discharge has proved to be > >misleading in differentiating CSF from other nasal discharge. The > >concurrent existence of epistaxis may further cloud the issue. The > >presence of a rapidly advancing outer ring when a drop of the discharge is > >placed on filter paper > >may be indicative of the presence of CSF. > > ====================================================== > [3] > Katz RT Kaplan PE > Glucose oxidase sticks and cerebrospinal fluid rhinorrhea. > In: Arch Phys Med Rehabil (1985 Jun) 66(6):391-3 > > The recognition of cerebrospinal leakage from a fistula is an > important consideration for any physician caring for a head-injured > population. Several procedures including radiographic, intrathecal > dye, nuclear medicine tracer studies, computerized tomography with > metrizamide injection, and immunological fixation have been reported > to help in the diagnosis. Introduction of glucose oxidase test sticks > has been traditionally touted to be a reliable bedside indicator of > CSF rhinorrhea; this case study demonstrates a falsely negative > result from glucose oxidase sticks. > > ================================================================== > [4] > Steedman DJ Gordon M > CSF rhinorrhoeae: significance of the glucose oxidase strip test. > In: Injury (1987 Sep) 18(5):327-8 > > Many authoritative medical textbooks recommended use of glucose > oxidase reagent strips to distinguish cerebrospinal fluid rhinorrhoea > from clear nasal discharge following head injury. A study of 50 > subjects with clear nasal and lacrimal secretions, demonstrated a > large proportion of positive results for glucose (44 per cent). > Thirteen secretions (26 per cent) contained glucose in a > concentration within the normal range for CSF. The recommended use of > glucose oxidase test strips for differentiating CSF leakage from > other clear nasal secretions is therefore without foundation. > > ===================================================================== > [5] > Hull HF Morrow G > Glucorrhea revisited. Prolonged promulgation of another plastic pearl. > In: JAMA (1975 Dec 8) 234(10):1052-3 > > Glucose oxidase test strips were used to evaluate the presence of > glucose in nasal secretions and tears in a group of normal children. > Substantial amounts of glucose were present in 15 of 17 samples of > nasal discharge and 10 of 15 samples of tears. The use of glucose > oxidase test strips for diagnosis of cerebrospinal fluid rhinorrhea, > therefore, is without merit. > > ================================================================= > > 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 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, 13 Nov 2000 15:28:35 -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 <01JWHVOSFQVW006KQW@mb1i0.ns.pitt.edu>; Mon, 13 Nov 2000 15:28:33 EST Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.2) ID ; Mon, 13 Nov 2000 15:27:09 -0500 (EST) Received: from amoeba.cugc.org (amoeba.cugc.org [166.84.0.30]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.2) ID for ; Mon, 13 Nov 2000 15:26:59 -0500 (EST) Received: by amoeba.cugc.org (Postfix, from userid 100) id 833761273E; Mon, 13 Nov 2000 15:26:52 -0500 (EST) Date: Mon, 13 Nov 2000 15:26:51 -0500 (EST) From: B00jum! Subject: Re: W-EMED Glucose test strips for CSF? In-reply-to: <200011131650.LAA02736@list.srv.cis.pitt.edu> 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: <14864.15326.280153.991122@amoeba.cugc.org> MIME-version: 1.0 X-Mailer: VM 6.43 under 20.4 "Emerald" XEmacs Lucid Content-type: text/plain; charset=us-ascii Content-transfer-encoding: 7bit Precedence: bulk References: <200011131650.LAA02736@list.srv.cis.pitt.edu> Douglas F. Kupas writes: > Hi Larry, > Thank you for doing the literature search that I was only going to allude > to. I worked with Drs. Fales and Dula at Geisinger Medical Center when > they published the first reference in your list. The "ring sign" is one of > many myths in medicine that have gone on to be disproved. Bottom line is > that blood alone, blood and CSF or blood and snot all can give a ring sign. > So - the ring sign is not exclusive to cerebrospinal fluid and the glucose strips are unreliable. I learned about the 'ring sign' fairly recently, so I don't think the word has gotten around yet. > > ========================================================= > > [1] > > Dula DJ Fales W > > The 'ring sign': is it a reliable indicator for cerebral spinal fluid? > > In: Ann Emerg Med (1993 Apr) 22(4):718-20 > > > development of a ring. CONCLUSION: In this experimental setting, the > > ring or halo sign is reliable for detecting cerebrospinal fluids but > > is not exclusive for cerebrospinal fluid. -- Glen Acord - Eugene, OR 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, 13 Nov 2000 11:51:18 -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 <01JWHO49ICAG00IECO@mb2i0.ns.pitt.edu>; Mon, 13 Nov 2000 11:51:11 EST Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.2) ID ; Mon, 13 Nov 2000 11:50:17 -0500 (EST) Received: from mail.ptd.net (mail1.ha-net.ptd.net [207.44.96.65]) by list.srv.cis.pitt.edu with SMTP (8.8.8/8.8.8/cisls-7.2.2.2) ID for ; Mon, 13 Nov 2000 11:50:14 -0500 (EST) Received: (qmail 27317 invoked from network); Mon, 13 Nov 2000 16:50:28 +0000 Received: from du13071.blo.ptd.net (HELO dkupas.ptdprolog.net) ([204.186.13.71]) (envelope-sender ) by mail.ptd.net (qmail-ldap-1.03) with SMTP for ; Mon, 13 Nov 2000 16:50:28 +0000 Date: Mon, 13 Nov 2000 11:43:54 -0500 From: "Douglas F. Kupas" Subject: Re: W-EMED Glucose test strips for CSF? 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: <200011131650.LAA02736@list.srv.cis.pitt.edu> MIME-version: 1.0 X-Mailer: Microsoft Internet Mail 4.70.1155 Content-type: text/plain; charset=ISO-8859-1 Content-transfer-encoding: 7bit X-Priority: 3 X-MSMail-priority: Normal Precedence: bulk Hi Larry, Thank you for doing the literature search that I was only going to allude to. I worked with Drs. Fales and Dula at Geisinger Medical Center when they published the first reference in your list. The "ring sign" is one of many myths in medicine that have gone on to be disproved. Bottom line is that blood alone, blood and CSF or blood and snot all can give a ring sign. It is intuitive that the same problems would be present when trying to use the dextrostick, but I thank you for summarizing the studies in such a nice way. As a matter of interest, when Drs. Fales and Dula were writing the article, they found many textbooks listing the "halo sign", but they could not find any initial study that any of these textbooks used as a reference to this mythical sign. As a side point, do we really care if there is CSF draining from the ear of a possibly head injured patient? If they have the signs and symptoms of a severe head injury, we will treat them as a severe head injury. If they are wide awake and draining snot and blood with a positive halo sign, we should probably treat them like a wide awake patient who has sustained some degree of head injury, and treat their symptoms as we otherwise would (ignoring the information about CSF). If they truely have a basilar skull fracture, rhinorrhea or otorhea will probably not be their most significant sign of a severe head injury. Anytime someone has drainage from a body opening, it makes sense to prevent contamination, but otherwise, I can't think of anything that I would do differently. I do not think that this information alone would lead me to initiate antibiotics in the field if the patient were wide awake and without any other signs of open skull fracture. A similar situation is the patient with a unilateral widely dilated pupil after a head injury. If the patient is wide awake and has no other signs of severe closed head injury, then they probably have a "traumatic pupil" and the pupillary findings are do to local truama to the eye, not increased intracranial pressure and impending hernitation. Likewise, a patient with no other signs of a severe head injury that has rhinorrea or otorhea probably has a greater chance of having a truamatic local injury (e.g. traumatic rupture of the tympanic membrane) than a severe head injury. Doug Douglas F. Kupas, MD, EMT-P, FACEP Director, EMS Programs Department of Emergency Medicine Geisinger Medical Center Danville, PA ---------- > From: Steven D. Pirie > To: wilderness-emergency-medicine@list.pitt.edu > Subject: Re: W-EMED Glucose test strips for CSF? > Date: Sunday, November 12, 2000 10:24 PM > > Suzanne, > ---------- > From: Larry Nathanson > To: wilderness-emergency-medicine@list.pitt.edu > Subject: Re: W-EMED Glucose test strips for CSF? > Date: Monday, November 13, 2000 1:27 AM > > At 06:16 PM 11/12/00 -0500, you wrote: > >I'm not sure if this is a common practice in the field, but I recently > >learned that you can use glucose test strips to test fluid (nose/ears) to > >see if it is CSF. (CSF should have a glucose level of about 40% of the > >blood level). > > > As Lt. Pirie points out, you can put a few drops on gauze or paper towel, > and see if a distinctive ring or halo forms. [1] > > Some textbooks have recommended using glucose reagent strips, where a > higher glucose level would suggest CSF leak. However, newer textbooks > recommend against this [2], as the literature has shown a number of > problems with false negatives [3], and false positives ("normal" rhinorrhea > with "CSF" glucose level.) [4] [5] > > --L > > ========================================================= > [1] > Dula DJ Fales W > The 'ring sign': is it a reliable indicator for cerebral spinal fluid? > In: Ann Emerg Med (1993 Apr) 22(4):718-20 > > STUDY OBJECTIVE: To study the development of a ring sign when blood > is mixed with various fluids. METHODS: One drop of blood and one drop > of either spinal fluid, saline, tap water, or rhinorrhea fluid were > placed simultaneously on filter paper, and the specimens were > examined after ten minutes for the development of a ring. A variety > of filter paper agents were used, including standard laboratory > filter paper, paper towels, coffee filters, and bed linens. RESULTS: > All fluids, when mixed with blood, gave rise to a ring sign; blood > alone did not. The type of filter paper did not affect the > development of a ring. CONCLUSION: In this experimental setting, the > ring or halo sign is reliable for detecting cerebrospinal fluids but > is not exclusive for cerebrospinal fluid. > > ======================================================= > [2] > Rosen: Emergency Medicine: Concepts and Clinical Practice, 4th ed., P 449. > > >The patient should be observed for CSF rhinorrhea as an indication of a > >fracture of the cribriform plate or associated structures. Unfortunately > >the measurement of the glucose level in the discharge has proved to be > >misleading in differentiating CSF from other nasal discharge. The > >concurrent existence of epistaxis may further cloud the issue. The > >presence of a rapidly advancing outer ring when a drop of the discharge is > >placed on filter paper > >may be indicative of the presence of CSF. > > ====================================================== > [3] > Katz RT Kaplan PE > Glucose oxidase sticks and cerebrospinal fluid rhinorrhea. > In: Arch Phys Med Rehabil (1985 Jun) 66(6):391-3 > > The recognition of cerebrospinal leakage from a fistula is an > important consideration for any physician caring for a head-injured > population. Several procedures including radiographic, intrathecal > dye, nuclear medicine tracer studies, computerized tomography with > metrizamide injection, and immunological fixation have been reported > to help in the diagnosis. Introduction of glucose oxidase test sticks > has been traditionally touted to be a reliable bedside indicator of > CSF rhinorrhea; this case study demonstrates a falsely negative > result from glucose oxidase sticks. > > ================================================================== > [4] > Steedman DJ Gordon M > CSF rhinorrhoeae: significance of the glucose oxidase strip test. > In: Injury (1987 Sep) 18(5):327-8 > > Many authoritative medical textbooks recommended use of glucose > oxidase reagent strips to distinguish cerebrospinal fluid rhinorrhoea > from clear nasal discharge following head injury. A study of 50 > subjects with clear nasal and lacrimal secretions, demonstrated a > large proportion of positive results for glucose (44 per cent). > Thirteen secretions (26 per cent) contained glucose in a > concentration within the normal range for CSF. The recommended use of > glucose oxidase test strips for differentiating CSF leakage from > other clear nasal secretions is therefore without foundation. > > ===================================================================== > [5] > Hull HF Morrow G > Glucorrhea revisited. Prolonged promulgation of another plastic pearl. > In: JAMA (1975 Dec 8) 234(10):1052-3 > > Glucose oxidase test strips were used to evaluate the presence of > glucose in nasal secretions and tears in a group of normal children. > Substantial amounts of glucose were present in 15 of 17 samples of > nasal discharge and 10 of 15 samples of tears. The use of glucose > oxidase test strips for diagnosis of cerebrospinal fluid rhinorrhea, > therefore, is without merit. > > ================================================================= > > 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 ; Mon, 13 Nov 2000 01:29:37 -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 <01JWH2EN0CTC006FFC@mb1i0.ns.pitt.edu>; Mon, 13 Nov 2000 01:29:37 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, 13 Nov 2000 01:28:34 -0500 (EST) Received: from mail2.panix.com (mail2.panix.com [166.84.0.213]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.2) ID for ; Mon, 13 Nov 2000 01:28:31 -0500 (EST) Received: from panix.com (mail2.panix.com [166.84.0.213]) by mail2.panix.com (Postfix) with ESMTP id 4683D9084 for ; Mon, 13 Nov 2000 01:28:31 -0500 (EST) Received: from gateway.panix.com (panix3.panix.com [166.84.0.228]) by panix.com (Postfix) with ESMTP id 273A543B1E for ; Mon, 13 Nov 2000 01:28:30 -0500 (EST) Date: Mon, 13 Nov 2000 01:27:51 -0500 From: Larry Nathanson Subject: Re: W-EMED Glucose test strips for CSF? In-reply-to: <001e01c04cfe$88807ce0$0300a8c0@snickers> Sender: owner-wilderness-emergency-medicine@list.pitt.edu X-Sender: lan@localhost To: wilderness-emergency-medicine@list.pitt.edu Reply-to: wilderness-emergency-medicine@list.pitt.edu Message-id: <4.3.2.7.2.20001113012412.00c4cdb0@localhost> MIME-version: 1.0 X-Mailer: QUALCOMM Windows Eudora Version 4.3.2 Content-type: text/plain; charset="us-ascii"; format=flowed Precedence: bulk References: At 06:16 PM 11/12/00 -0500, you wrote: >I'm not sure if this is a common practice in the field, but I recently >learned that you can use glucose test strips to test fluid (nose/ears) to >see if it is CSF. (CSF should have a glucose level of about 40% of the >blood level). As Lt. Pirie points out, you can put a few drops on gauze or paper towel, and see if a distinctive ring or halo forms. [1] Some textbooks have recommended using glucose reagent strips, where a higher glucose level would suggest CSF leak. However, newer textbooks recommend against this [2], as the literature has shown a number of problems with false negatives [3], and false positives ("normal" rhinorrhea with "CSF" glucose level.) [4] [5] --L ========================================================= [1] Dula DJ Fales W The 'ring sign': is it a reliable indicator for cerebral spinal fluid? In: Ann Emerg Med (1993 Apr) 22(4):718-20 STUDY OBJECTIVE: To study the development of a ring sign when blood is mixed with various fluids. METHODS: One drop of blood and one drop of either spinal fluid, saline, tap water, or rhinorrhea fluid were placed simultaneously on filter paper, and the specimens were examined after ten minutes for the development of a ring. A variety of filter paper agents were used, including standard laboratory filter paper, paper towels, coffee filters, and bed linens. RESULTS: All fluids, when mixed with blood, gave rise to a ring sign; blood alone did not. The type of filter paper did not affect the development of a ring. CONCLUSION: In this experimental setting, the ring or halo sign is reliable for detecting cerebrospinal fluids but is not exclusive for cerebrospinal fluid. ======================================================= [2] Rosen: Emergency Medicine: Concepts and Clinical Practice, 4th ed., P 449. >The patient should be observed for CSF rhinorrhea as an indication of a >fracture of the cribriform plate or associated structures. Unfortunately >the measurement of the glucose level in the discharge has proved to be >misleading in differentiating CSF from other nasal discharge. The >concurrent existence of epistaxis may further cloud the issue. The >presence of a rapidly advancing outer ring when a drop of the discharge is >placed on filter paper >may be indicative of the presence of CSF. ====================================================== [3] Katz RT Kaplan PE Glucose oxidase sticks and cerebrospinal fluid rhinorrhea. In: Arch Phys Med Rehabil (1985 Jun) 66(6):391-3 The recognition of cerebrospinal leakage from a fistula is an important consideration for any physician caring for a head-injured population. Several procedures including radiographic, intrathecal dye, nuclear medicine tracer studies, computerized tomography with metrizamide injection, and immunological fixation have been reported to help in the diagnosis. Introduction of glucose oxidase test sticks has been traditionally touted to be a reliable bedside indicator of CSF rhinorrhea; this case study demonstrates a falsely negative result from glucose oxidase sticks. ================================================================== [4] Steedman DJ Gordon M CSF rhinorrhoeae: significance of the glucose oxidase strip test. In: Injury (1987 Sep) 18(5):327-8 Many authoritative medical textbooks recommended use of glucose oxidase reagent strips to distinguish cerebrospinal fluid rhinorrhoea from clear nasal discharge following head injury. A study of 50 subjects with clear nasal and lacrimal secretions, demonstrated a large proportion of positive results for glucose (44 per cent). Thirteen secretions (26 per cent) contained glucose in a concentration within the normal range for CSF. The recommended use of glucose oxidase test strips for differentiating CSF leakage from other clear nasal secretions is therefore without foundation. ===================================================================== [5] Hull HF Morrow G Glucorrhea revisited. Prolonged promulgation of another plastic pearl. In: JAMA (1975 Dec 8) 234(10):1052-3 Glucose oxidase test strips were used to evaluate the presence of glucose in nasal secretions and tears in a group of normal children. Substantial amounts of glucose were present in 15 of 17 samples of nasal discharge and 10 of 15 samples of tears. The use of glucose oxidase test strips for diagnosis of cerebrospinal fluid rhinorrhea, therefore, is without merit. ================================================================= 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, 13 Nov 2000 00:56:44 -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 <01JWH18WAZ9O006FFC@mb1i0.ns.pitt.edu>; Mon, 13 Nov 2000 00:56:45 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, 13 Nov 2000 00:55:19 -0500 (EST) Received: from mail1.toronto.istar.net (mail1.toronto.istar.net [209.89.75.17]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.2) ID for ; Mon, 13 Nov 2000 00:55:09 -0500 (EST) Received: from ip60.ottawa4.dialup.canada.psi.net ([154.5.13.60]) by mail1.toronto.istar.net with esmtp (Exim 2.02 #1) id 13vCaj-0001CM-00 for wilderness-emergency-medicine@list.pitt.edu; Mon, 13 Nov 2000 00:55:42 -0500 Date: Mon, 13 Nov 2000 00:55:50 -0500 From: "Steven D. Pirie" Subject: Re: W-EMED Glucose test strips for CSF? In-reply-to: <001101c04d2d$c7c64220$0300a8c0@snickers> 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/plain; charset="us-ascii" Precedence: bulk References: Suzanne, >> Instead of using glucose test strips what I do is place a drop or two of >> the fluid in question on a piece of gauze. >What if all you have is clear fluid? You will still get a halo, you just will not get the inner dark circle or blood also. >Will a skull fracture always/usually result in both blood and CSF as >drainage? You can just get CSF or CSF and blood, or it just might be you standard nasal rhinorrhea caused by a cold (in which case you will not get a halo). Take care, Steven ---------------------------------------------------------- Lt. Steven D. Pirie, RN, BScN, UE General Duty Ward Officer - Military In-Patient Unit Canadian Forces Support Unit Ottawa - Civic Hospital Site 2 Health Support Operational Training Unit ---------------------------------------------------------- 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, 12 Nov 2000 23:50:13 -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 <01JWGYXEP2M600HSQ1@mb2i0.ns.pitt.edu>; Sun, 12 Nov 2000 23:50:13 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, 12 Nov 2000 23:49:30 -0500 (EST) Received: from mb2i0.ns.pitt.edu (mb2i1.ns.pitt.edu [136.142.185.162]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.2) ID for ; Sun, 12 Nov 2000 23:49:25 -0500 (EST) Received: from snickers ("port 1232"@[136.142.22.159]) by pitt.edu (PMDF V5.2-32 #41462) with SMTP id <01JWGYWDMDL000HSQ1@mb2i0.ns.pitt.edu> for wilderness-emergency-medicine@list.pitt.edu; Sun, 12 Nov 2000 23:49:24 -0500 (EST) Date: Sun, 12 Nov 2000 23:54:17 -0500 From: Suzanne Atkinson Subject: Re: W-EMED Glucose test strips for CSF? 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: <001101c04d2d$c7c64220$0300a8c0@snickers> MIME-version: 1.0 X-MIMEOLE: Produced By Microsoft MimeOLE V5.00.2615.200 X-Mailer: Microsoft Outlook Express 5.00.2615.200 Content-type: text/plain; charset="iso-8859-1" Content-transfer-encoding: 7bit X-Priority: 3 X-MSMail-priority: Normal Precedence: bulk References: that sounds like a good trick too. What if all you have is clear fluid? Will a skull fracture always/usually result in both blood and CSF as drainage? Or, to put it another way, is it unusual to have just clear CSF as draininage? Thanks, Suzanne ----- Original Message ----- From: Steven D. Pirie To: Sent: Sunday, November 12, 2000 10:24 PM Subject: Re: W-EMED Glucose test strips for CSF? > Suzanne, > > >I'm not sure if this is a common practice in the field, but I recently > >learned that you can use glucose test strips to test fluid (nose/ears) to > >see if it is CSF. > > >I am wondering if anyone really does this in the field? > > Instead of using glucose test strips what I do is place a drop or two of > the fluid in question on a piece of gauze. If a light outer ring forms > around a dark inner ring (works really well if the fluid is mixed with > blood) then you have a "positive halo sign" and thus CSF in the fluid, it > seems to work pretty well and requires no additional equipment to be > brought along for the trip. > > The reason why I do not carry glucose test strips is that I am concerned > about the accuracy with respect to post expiry use and use after storage in > my bag when exposed to high and low temperatures. > > Cheers, > > Steven > > ---------------------------------------------------------- > Lt. Steven D. Pirie, RN, BScN, UE > General Duty Ward Officer - Military In-Patient Unit > Canadian Forces Support Unit Ottawa - Civic Hospital Site > 2 Health Support Operational Training Unit > ---------------------------------------------------------- > > > > 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, 12 Nov 2000 22:24:30 -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 <01JWGVX5GHDK00IM93@mb2i0.ns.pitt.edu>; Sun, 12 Nov 2000 22:24:30 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, 12 Nov 2000 22:23:55 -0500 (EST) Received: from mail1.toronto.istar.net (mail1.toronto.istar.net [209.89.75.17]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.2) ID for ; Sun, 12 Nov 2000 22:23:51 -0500 (EST) Received: from ip189.ottawa7.dialup.canada.psi.net ([154.5.69.189]) by mail1.toronto.istar.net with esmtp (Exim 2.02 #1) id 13vAEF-00048F-00 for wilderness-emergency-medicine@list.pitt.edu; Sun, 12 Nov 2000 22:24:21 -0500 Date: Sun, 12 Nov 2000 22:24:29 -0500 From: "Steven D. Pirie" Subject: Re: W-EMED Glucose test strips for CSF? In-reply-to: <001e01c04cfe$88807ce0$0300a8c0@snickers> 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/plain; charset="us-ascii" Precedence: bulk References: Suzanne, >I'm not sure if this is a common practice in the field, but I recently >learned that you can use glucose test strips to test fluid (nose/ears) to >see if it is CSF. >I am wondering if anyone really does this in the field? Instead of using glucose test strips what I do is place a drop or two of the fluid in question on a piece of gauze. If a light outer ring forms around a dark inner ring (works really well if the fluid is mixed with blood) then you have a "positive halo sign" and thus CSF in the fluid, it seems to work pretty well and requires no additional equipment to be brought along for the trip. The reason why I do not carry glucose test strips is that I am concerned about the accuracy with respect to post expiry use and use after storage in my bag when exposed to high and low temperatures. Cheers, Steven ---------------------------------------------------------- Lt. Steven D. Pirie, RN, BScN, UE General Duty Ward Officer - Military In-Patient Unit Canadian Forces Support Unit Ottawa - Civic Hospital Site 2 Health Support Operational Training Unit ---------------------------------------------------------- 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, 12 Nov 2000 18:14:43 -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 <01JWGN7FUL0M00IM93@mb2i0.ns.pitt.edu>; Sun, 12 Nov 2000 18:14:42 EST Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.2) ID ; Sun, 12 Nov 2000 18:14:35 -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 ; Sun, 12 Nov 2000 18:14:33 -0500 (EST) Received: from snickers ("port 1036"@[136.142.22.74]) by pitt.edu (PMDF V5.2-32 #41462) with SMTP id <01JWGN77NSCS00600G@mb1i0.ns.pitt.edu> for wilderness-emergency-medicine@list.pitt.edu; Sun, 12 Nov 2000 18:14:32 -0500 (EST) Date: Sun, 12 Nov 2000 18:19:26 -0500 From: Suzanne Atkinson Subject: W-EMED Extractor for snake envenomations 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: <002301c04cff$007c6e20$0300a8c0@snickers> MIME-version: 1.0 X-MIMEOLE: Produced By Microsoft MimeOLE V5.00.2615.200 X-Mailer: Microsoft Outlook Express 5.00.2615.200 Content-type: text/plain; charset="iso-8859-1" Content-transfer-encoding: 7bit X-Priority: 3 X-MSMail-priority: Normal Precedence: bulk References: A recent article in Wilderness and Environmental Medicine seemed to conclude that extractor kits were not helpful in the field management of snake envenomations, and in some cases were even harmful, causing increased swelling and tissue necrosis at the site of suction placement. Does anyone have any thoughts either supporting or negating the conclusions of article? Does this mean we can stop carrying extractors in our first aid kits, or should I still go out and buy one? Suzanne M. Atkinson University of Pittsburgh School of Medicine, MS-III Allegheny Mountain Rescue Group, WEMT 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, 12 Nov 2000 18:12:11 -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 <01JWGN4AW1MQ00600G@mb1i0.ns.pitt.edu>; Sun, 12 Nov 2000 18:12:11 EST Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.2) ID ; Sun, 12 Nov 2000 18:11:14 -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 ; Sun, 12 Nov 2000 18:11:12 -0500 (EST) Received: from snickers ("port 1035"@[136.142.22.74]) by pitt.edu (PMDF V5.2-32 #41462) with SMTP id <01JWGN31WYL200600G@mb1i0.ns.pitt.edu> for wilderness-emergency-medicine@list.pitt.edu; Sun, 12 Nov 2000 18:11:11 -0500 (EST) Date: Sun, 12 Nov 2000 18:16:04 -0500 From: Suzanne Atkinson Subject: W-EMED Glucose test strips for CSF? 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: <001e01c04cfe$88807ce0$0300a8c0@snickers> MIME-version: 1.0 X-MIMEOLE: Produced By Microsoft MimeOLE V5.00.2615.200 X-Mailer: Microsoft Outlook Express 5.00.2615.200 Content-type: text/plain; charset="iso-8859-1" Content-transfer-encoding: 7bit X-Priority: 3 X-MSMail-priority: Normal Precedence: bulk References: I'm not sure if this is a common practice in the field, but I recently learned that you can use glucose test strips to test fluid (nose/ears) to see if it is CSF. (CSF should have a glucose level of about 40% of the blood level). I am wondering if anyone really does this in the field? Will it change your management of the situation while in the field? How sensitive of a test is it? Thanks, Suzanne Atkinson University of Pittsburgh School of Medicine, MS-III Allegheny Mountain Rescue Group, WEMT 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, 12 Nov 2000 01:20:24 -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 <01JWFNRVWZVM005LKC@mb1i0.ns.pitt.edu>; Sun, 12 Nov 2000 01:20:24 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, 12 Nov 2000 01:17:10 -0500 (EST) Received: from mail1.toronto.istar.net (mail1.toronto.istar.net [209.89.75.17]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.2) ID for ; Sun, 12 Nov 2000 01:17:07 -0500 (EST) Received: from ip219.ottawa7.dialup.canada.psi.net ([154.5.69.219]) by mail1.toronto.istar.net with esmtp (Exim 2.02 #1) id 13uqSR-0000Vc-00 for wilderness-emergency-medicine@list.pitt.edu; Sun, 12 Nov 2000 01:17:40 -0500 Date: Sun, 12 Nov 2000 13:17:49 -0500 From: "Steven D. Pirie" Subject: W-EMED Topical Abx and wound care In-reply-to: <90f6aa0e.aa0e90f6@med.unc.edu> 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/plain; charset="us-ascii" Precedence: bulk Tom, Just some thoughts, >I agree with the excellent advice of Dr. Russo. I would add that any >"topical" ointment is not intended for use inside a wound. Would you lube a Foley cath with it? Another WMED use of topical Abx is when you are packing a nasal cavity in the field. I also carry the polysporin opth oint, as it can be used for everything from a finger lube, topical abx to an opth abx. >Any deep wound should be irrigated thoroughly with clean water and closed >with >duck tape or steri strips if in the field. I would add to this that surgical debridement (within the confines of the providers skill set) is also key to preventing a wound infection, especially if on a longer trip. I would be keen on packing a "deep" wound open as opposed to an attempted closure (either with sutures, staples or the methods you described) for the following reasons: a) allows for unrestricted swelling of tissues thus allowing the wound to decompress and thus avoiding tissue ischemia. b) it allows the exudation of serum. c) you prevent the creation of an anaerobic environment d) as a "second check" on the delayed primary closure to ensure that you did not leave behind any incompletely excised tissue or contamination. Enjoyed your post and the thread. Steven ---------------------------------------------------------- Lt. Steven D. Pirie, RN, BScN, UE General Duty Ward Officer - Military In-Patient Unit Canadian Forces Support Unit Ottawa - Civic Hospital Site 2 Health Support Operational Training Unit ---------------------------------------------------------- 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, 9 Nov 2000 10:35:32 -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 <01JWC0A4M2QI006GD4@mb1i0.ns.pitt.edu>; Thu, 9 Nov 2000 10:34:45 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, 09 Nov 2000 10:34:19 -0500 (EST) Received: from zonetail.med.unc.edu (zonetail.med.unc.edu [152.19.4.12]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.2) ID for ; Thu, 09 Nov 2000 10:34:16 -0500 (EST) Received: from med.unc.edu (apex.med.unc.edu [152.19.4.80]) by zonetail.med.unc.edu (8.9.3/8.9.3) with ESMTP id KAA06166 for ; Thu, 09 Nov 2000 10:34:15 -0500 (EST) Date: Thu, 09 Nov 2000 10:34:15 -0500 (EST) From: Tom Bush Subject: Re: W-EMED antibiotic ointment 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: <90f6aa0e.aa0e90f6@med.unc.edu> MIME-version: 1.0 X-Mailer: Netscape Webmail Content-type: multipart/mixed; boundary="--75e56d3861ab59b9" Content-language: en Precedence: bulk X-Accept-Language: en This is a multi-part message in MIME format. ----75e56d3861ab59b9 Content-Type: text/plain; charset=us-ascii Content-Disposition: inline Content-Transfer-Encoding: 7bit Buck, I agree with the excellent advice of Dr. Russo. I would add that any "topical" ointment is not intended for use inside a wound. Any deep wound should be irrigated thoroughly with clean water and closed with duck tape or steri strips if in the field. The ointment is applied "topically" after the wound is cleaned and closed. As Dr. Russo points out, any peroxide, betadine or antibiotic ointment placed inside a wound kills new cells and may provide an excellent growth medium for bacterial growth. Although mupirocin (Bacroban) has a more narrow spectrum of activity than Polysporin it is more effective at treatment of some staph and strep organisms. Any ointment containing neomycin should be avoided as a small percentage of the population may be sensitised (ie allergic). There is some cross reactivity with polymixin although this is small (1-3%). Another issue to consider is preperations that combine ointments with antifungals or steroids. Make sure you know the ingredients of any ointment in your kit. The most useful ointment to carry may be Polysporin Ophthalmic ointment as it can be used in the eye as well as on the skin. I also carry a small amount of mupirocin to treat impetigo. The bottom line may be that these ointments are easy to carry and are best at preventing infections rather than treating an established infection. I don't think they speed healing although if a wound gets infected, it takes longer to heal. Don't forget that ointments are also useful for lubrication of an examining finger or catheter, tube etc. They may also help some of that squeaky gear we all seem to have. Tom Bush NP University of North Carolina Department of Orthopaedics Chapel Hill NC Tom_Bush@med.unc.edu ----- Original Message ----- From: Buck Tilton Date: Thursday, November 9, 2000 8:16 am Subject: W-EMED antibiotic ointment > I'm in need of a bit of expert input. Are antibiotic ointments > worth their > weight in a wilderness first aid kit? I've been told they might > actually retard > healing in some cases. If they are worth carrying, how should they > best be > used? Thanks. > > -- > ************************ > Buck Tilton > Wilderness Medicine Institute of NOLS > P. O. Box 9 > Pitkin, CO 81241 > Phone 970-641-3572 > Fax 970-641-0882 > buck_tilton@nols.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.eduSubmissions To: wilderness-emergency- > medicine@list.pitt.edu ----75e56d3861ab59b9 Content-Type: text/x-vcard; name="explore.vcf"; charset=us-ascii Content-Disposition: attachment; filename="explore.vcf Content-Description: Card for Tom Bush Content-Transfer-Encoding: 7bit begin:vcard n:Bush;Tom fn:Tom Bush NP tel;fax:919.966.7956 tel;work:919.966.9242 org:University of North Carolina at Chapel Hill;Orthopaedics adr:;;CB #7055;Chapel Hill;NC;27599-7055; version:2.1 email;internet:Tom_Bush@med.unc.edu title:Clinical Assistant Professor end:vcard ----75e56d3861ab59b9-- 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, 9 Nov 2000 09:07:07 -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 <01JWBX7GE6ZQ00GSEX@mb2i0.ns.pitt.edu>; Thu, 9 Nov 2000 09:07:06 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, 09 Nov 2000 09:06:50 -0500 (EST) Received: from kiwi.negia.net (kiwi.negia.net [206.61.0.5]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.2) ID for ; Thu, 09 Nov 2000 09:06:42 -0500 (EST) Received: from 8umfq (b1ppp20.negia.net [208.30.14.20]) by kiwi.negia.net (8.9.3/8.9.3) with SMTP id JAA17223 for ; Thu, 09 Nov 2000 09:05:15 -0500 (EST) Date: Thu, 09 Nov 2000 09:02:14 -0500 From: Garth and Natalie Russo Subject: RE: W-EMED antibiotic ointment In-reply-to: <3A0AA3A6.7EEF81E7@rmi.net> 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-MIMEOLE: Produced By Microsoft MimeOLE V5.00.2919.6600 X-Mailer: Microsoft Outlook IMO, Build 9.0.2416 (9.0.2911.0) Content-type: text/plain; charset="iso-8859-1" Content-transfer-encoding: 7bit Importance: Normal X-Priority: 3 (Normal) X-MSMail-priority: Normal Precedence: bulk Buck: The trends in wound managment these days are to strive for healing without scabbing or "eschar" formation. The scab traps debris underneath it and dissallows vertical healing, limiting the wound to edge in healing with a cycle of scab, peel, scab, peel that we are all familiar with. This process increases the risk for an infection and the chances of scarring, it also delays total time to final wound healing. So there are two important points I try to make with folks. First, an initially clean wound has a good chance of healing without infection if well maintained and so it is the "oint" that generates a moist receptive environment to new cells that are attempting to fullfil the healing process. Second, the "antibiotic" is less important and perhaps choice should be made based on which ones are least likely to generate any toxicity. Neomycin has a bad reputation these days as being a skin sensitizer and so many of us recommend a generic "double" as opposed to "triple" antibiotic oint as the cheapest most effective option. In the wilderness environment, the antibiotic might take on more importance the longer the trip or the greater the group size. There is one oint, "bactroban", is the brand, that can effectively treat superficial cellulitis and impetigo. If one had only one choice, and money was not a significant concern, this would be my choice/recommendation. The little sample packets are available for all the oints if you search. Many oints also are packaged for opthalmic use and so might be more appropriate for a travel/backcountry kit both by size/weight, but also because you could put them in an eye. Petroleum products have taken a hit over concerns about cell toxicity and therefore delays in wound healing or increases in wound burden to clean up those who succumb, but my take is this is not too significant. It is most important to have folks use simple cleaning measures (soap, potable water, and gentle mechanical friction)for this reason as repeated peroxide washings or Betadyne soaking is pretty toxic to young cells. The biggest trend in wound management these days is away from oints and towards occlusive dressings that have a cellophane like quality (Tegaderm, Viasorb, etc.)so that the wound can't dry too much. These are an excellent addition to a kit... Hope this helps, Garth Russo, MD University of Georgia Athens, Georgia garth@negia.net -----Original Message----- From: owner-wilderness-emergency-medicine@list.pitt.edu [mailto:owner-wilderness-emergency-medicine@list.pitt.edu]On Behalf Of Buck Tilton Sent: Thursday, November 09, 2000 8:16 AM To: wilderness-emergency-medicine@list.pitt.edu Subject: W-EMED antibiotic ointment I'm in need of a bit of expert input. Are antibiotic ointments worth their weight in a wilderness first aid kit? I've been told they might actually retard healing in some cases. If they are worth carrying, how should they best be used? Thanks. -- ************************ Buck Tilton Wilderness Medicine Institute of NOLS P. O. Box 9 Pitkin, CO 81241 Phone 970-641-3572 Fax 970-641-0882 buck_tilton@nols.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 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, 9 Nov 2000 08:19:42 -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 <01JWBVJOURKI006GSJ@mb1i0.ns.pitt.edu>; Thu, 9 Nov 2000 08:19:41 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, 09 Nov 2000 08:19:23 -0500 (EST) Received: from mail.rmi.net (chevalier.rmi.net [166.93.8.14]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.2) ID for ; Thu, 09 Nov 2000 08:19:20 -0500 (EST) Received: from rmi.net (dial-77.92.mtrco.rmi.net [166.93.77.92]) by mail.rmi.net (8.9.3+Sun/8.9.3) with ESMTP id GAA15674 for ; Thu, 09 Nov 2000 06:19:18 -0700 (MST) Date: Thu, 09 Nov 2000 06:16:22 -0700 From: Buck Tilton Subject: W-EMED antibiotic ointment 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: <3A0AA3A6.7EEF81E7@rmi.net> Organization: Wilderness Medicine Institute MIME-version: 1.0 X-Mailer: Mozilla 4.5 (Macintosh; I; 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: <91.2afb79e.273bebb3@aol.com> I'm in need of a bit of expert input. Are antibiotic ointments worth their weight in a wilderness first aid kit? I've been told they might actually retard healing in some cases. If they are worth carrying, how should they best be used? Thanks. -- ************************ Buck Tilton Wilderness Medicine Institute of NOLS P. O. Box 9 Pitkin, CO 81241 Phone 970-641-3572 Fax 970-641-0882 buck_tilton@nols.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 ; Fri, 3 Nov 2000 09:55:37 -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 <01JW3L4ULIC800565E@mb1i0.ns.pitt.edu>; Fri, 3 Nov 2000 09:55:03 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, 03 Nov 2000 09:51:40 -0500 (EST) Received: from gtei2.bellatlantic.net (gtei2.bellatlantic.net [199.45.39.161]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.2) ID for ; Fri, 03 Nov 2000 09:51:37 -0500 (EST) Received: from keith (adsl-141-151-143-206.bellatlantic.net [141.151.143.206]) by gtei2.bellatlantic.net (8.9.1/8.9.1) with ESMTP id JAA14286; Fri, 03 Nov 2000 09:51:11 -0500 (EST) Date: Fri, 03 Nov 2000 09:51:08 -0500 From: "Keith Conover, M.D., FACEP" Subject: Re: W-EMED Need a SOP for MD used in SAR... In-reply-to: <2f.c631d26.2730c0cb@aol.com> Sender: owner-wilderness-emergency-medicine@list.pitt.edu To: Mkeowl@aol.com, wilderness-emergency-medicine@list.pitt.edu Reply-to: wilderness-emergency-medicine@list.pitt.edu Message-id: <3A028A8C.17260.5DF00B8@localhost> MIME-version: 1.0 X-Mailer: Pegasus Mail for Win32 (v3.12c) Content-type: text/plain; charset=US-ASCII Content-transfer-encoding: 7BIT Precedence: bulk Suggest you check the Wilderness Command Physician document at www.wemsi.org. Take care. On 31 Oct 2000, at 19:41, Mkeowl@aol.com wrote: > Where would I find SOPs or other related info to write a 'job > description' for a Family Physician who is interested in working with > a SAR unit? He has taken CE in Wilderness Medicine and is now > interested in working in SAR. > > Thanks for your help. > > Linda R. Uihlein > Blue and Gray SAR Dogs, VA > EMT, WEMT > 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 --