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The New York Academy of Medicine By Exchange Digitized by the Internet Archive 2015 in https://archive.org/details/alaskamedicine3536unse I i LASKA MEDICINE Volume 35, Number 1 January/February/March 1993 OfficialJournal of: ALASKA STATE MEDICAL ASSOCIATION AMERICAN SOCIETY FOR CIRCUMPOLAR HEALTH In this issue: Cold Injury: A Collection of Papers by William J. Mills, M.D. and Colleagues Quality Health Care The Valley In I • Physician Specialists • 24-Hour Emergency Room • Multiple Surgical Services Laser surgery Short stay surgery In-Patient surgery • Intensive and Coronary Care • Birthing Alternatives • Lab and Imaging in Wasilla and Palmer • Ultrasound • CT Scanning • Accredited Mammography Home Care and Wellness Programs • Nuclear Medicine • MRI Physician Referral Line • JCAHO Accredited Weight Loss Program mLLEY HOSPITAL 515 E. Dahlia P.O. 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GlobalExcellencein DiabetesCare EliLillyandCompany Indianapolis,Indiana 46285 HI-7911-B-249343 ©1992.elilillyandcompany Alaska Medicine, January, February, March Page 1 The Commitment Continues • To continue providing frostbite and burn care through our Thermal Services Program. For information on this service, please contact Providence Hospital, Nancy Higgins,R.N., Director of Critical Care, 562-2211, Ext. 3640. • To be there when you and your patients need us - allowing Alaskans to stay in Alaska for their care. t SISTERS OF ^ PROVIDENCE pi PROVIDENCE HOSPITAL PO BOX 196604 • ANCHORAGE.ALASKA995196604 • PHONE(907)5622211 THE COMMITMENT CONTINUES ALASKA MEDICINE OfficialJournalof: Alaska State Medical Association American Society for Circumpolar Health Volume 35 January/February/March 1993 Number 1 ALASKA MEDICINEisowned and pub- Editor’s Notes 4 lished by theAlaska State MedicalAssocia- Donald R. Rogers, M.D. and Robert S. Pozos, Ph.D. tion. TheAmericanSocietyforCircumpolar HealthhasdesignatedAlASKA MEDICINE REPRINT OF PUBLISHED ARTICLES asitsofficialscientificjournal. ALASKA MEDICINEdoesnotholditself Frostbite: Experiencewith Rapid Rewarming responsibleforstatementsmadebyanycon- tributor.Statementsoropinionsexpressedin and UltrasonicTherapy, Part 1 5 ALASKA MEDICINEreflect theviewsofthe Frostbite: Part II 10 author(s) and not the official policy of the Frostbite: Part III 19 Alaska State Medical Association unlessso Frostbite and Hypothermia - Current Concepts 28 statedA.lthough all advertising material isex- Frostbite - A Discussion ofthe Problem and a Review ofan Alaskan Experience 29 pected toconform to ethical standards, ac- ceptance does not imply endorsement by SummaryofTreatment ofthe Cold Injured Patient 50 ALASKAMEDICINE. Accidental Hypothermia: Management Approach 54 MaterialprintedinALASKAMEDICINE SummaryofTreatment ofthe Cold Injured Patient- iscoveredbycopyright. Nopartofthispub- Hypothermia 57 licationmaybereproducedortransmittedin anyformwithoutwrittenpermission. Frostbite 61 ALASKA MEDICINE is printed by A.T. Publishing, Inc., 8600 Hartzell Road, An- ORIGINAL ARTICLES: chorage, Alaska 99507. Copyright 1993. Algorithm forTreatment ofFrostbite Pull-Out AlaskaStateMedicalAssociation. Comment and Recapitulation 69 EDITOR William J. Mills,Jr., M.D. A DonaldR. Rogers,M.D. Cold and Freezing: Historical ChronologyofLaboratory Investigation and Clinical Experience 89 EDITORIALBOARD William J. Mills,Jr., M.D.,James O’Malley, M.D., and WilliamMills,M.D. Bruno Kappes, Ph.D. WilliamBowers,M.D. Peripheral Non-Freezing Cold Injury: Immersion Injury 117 RodmanWilson,M.D. William J. Mills,Jr. M.D. and William J. Mills, III JohnJ.Kottra,M.D. Psychological and Psychophysiological Factors in Prevention StevenTucker,M.D. ThomasJ.Harrison,M.D. and Treatment ofCold Injuries 131 C.MichaelHerndon,M.D. Bruno Kappes, Ph.D., William J. Mills,Jr., M.D., and RichardNeubauer,M.D. James O'Malley, M.D. PRODUCTION EDITOR Letters to the Editor 141 VernaJ.Paluba Alaska Medicine, Vol. 1, Number 1, March 1959 143 NATIONALADVERTISING: ALASKAMEDICINEgratefullyacknowledges the following for StateMedicalJournalAdvertisingBureau, their monetarycontributions to this issue: AlaskaArcticMedical Inc.,711 SouthBlvd,OakPark,IL60302, Phone708/383-8800. Research Foundation, Alaska RegionalHospitalandStaff, American Societyfor CircumpolarHealth, Robert Gottstein, MedicalArts BUSINESSANDADVERTISING Pharmacy, andProvidence HospitalandStaff. AlaskaStateMedicalAssociation, 4107 LaurelStreet,Anchorage,Alaska99508 Aboutthecover: ClassicHand-“Thishandrepresentsafrozenextremity(superficialto 907/562-2662. deep)24hoursafterrapidrewarminginwateratatemperatureof108degreesF.(42 SUBSCRIPTIONPRICE:$30peryear degreesC.).Exposure20minutes,ambienttemperature+5degreesF(-15degreesC), winds50-60knots,ArcticAlaska.(Windchillfactornear-45degreesF. (-43degrees Singlecopies:$10.00 C.). The large, clear, and pink blebs, extending to the digital tips, with adequate capillaryfillingofthenailbeds,representsanexcellentearlyprognosticsign. Editor’s Note Ithasbeenmyprivilegetohaveknown DoctorBill devoteanissuetohissubject,torepublishtheoriginal Mills for a little over a quarter ofa century, during articles, and to allow him to update that body of We which interval I have followed with admiration, his knowledge. also solicited an article from Dr. work in thermal injury. He has become a world- James O'Malley, a second generation Anchoragesur- renowned authority on the subject and commands geon, Dr. Mill'sprotegeand probablesuccessorin the appropriaterespectfrom hiscolleagues. (I'm merelya field; and from Dr. Bruno Kappes, a psychologist on pathologist,so myexperience has been oblique.) the thermal injury team. When Dr. Mills retired recently and noticed the Wehopeyoufindthisissueinterestinghistorically, need for a project, it occurred to us that since he had and useful in dealingwith cold injured patients. publishedhisearlypapersinAlaskaMedicine(ofwhich he was the founding editor — thus insuring accep- (S) tance), and that this littlejournalwas not then listed in IndexMedicus,someofhis light was,and remains, Donald R. Rogers, M.D. hidden under the proverbial bushel. We decided to Editor,Alaska Medicine Letter to the Editor: This issue of Alaska Medicine pays appropriate induces a decrease in metabolic rate associated with tributetoDr. W. Mills,whoisacknowledgedasoneof dehydration. The “Metabolic Icebox” term used to thediscoverersofthepresentmethodusedtosuccess- describe this state was originated by Dr. Mills to de- fully treat frostbite and hypothermia. I have had the scribe thevariouseffects ofhypothermia. pleasureofinteractingwith Dr. Millseversince I met In addition to being published widely and being a himatahypothermiameetingheldin RhodeIsland in guestspeakeratNationaland International meetings, 1977. During those days, therewas considerable con- he continues to be interested in the cellular effect of troversy concerningvarious rewarming therapies, es- frostbite. He is impressive with his zeal to constantly pecially in the field. In the course of one of these seek various clinical or basic science clues towards discussions, Dr. Mills described his clinical efforts in predictingtheeffectivenessofvariousrewarmingstrat- rewarminghypothermicvictimsinthefield,andhospi- egies. tal. Dr. Mills in manyways popularized nationallythe Dr. Millswas awareofthespecial problem associ- notion ofhypothermia and established Alaska as one atedwith theidentification and treatmentoffrostbite of the key areas to conduct cold weather/cold water and hypothermia. He was able to draw on his vast research.Manyfrostbite/hypothermicvictimshavebeen experienceasaphysician/scientistandarriveatseveral saved by the direct or indirect efforts of Dr. Mill’s observations. Besides his scholarly activity which is research in this important area. evidencedbya republication ofsomeofhis articlesin Ihave known Bill not onlyas a physician/scientist, this volume, he has worked unceasingly to help pro- but also as a friend. He symbolizes what the classic duce a high altitude laboratoryat Mt. McKinley. This physician should be, both a scientist and a clinician he did as Director of the Center for High Latitude with asenseofcompassion. Health Research, University of Alaska, Anchorage. His efforts along with those of other scientists has (S) produced an outdoor laboratory that is constantly being used to evaluate human performance at high Robert S. Pozos, Ph.D. altitudes. Director,Thermal Physiology His major accomplishments in the field of hypo- Naval Health Research Center thermia includetheastuteobservation thathypothermia San Diego, CA92186-5122 Page 4 Volume 35, Number 1