Auerbach’s Wilderness Medicine PDF
Preview Auerbach’s Wilderness Medicine
AUERBACH’S WILDERNESS MEDICINE AUERBACH’S WILDERNESS MEDICINE SEVENTH EDITION EDITOR PAUL S. AUERBACH MD, MS, FACEP, MFAWM, FAAEM Redlich Family Professor Department of Emergency Medicine Stanford University School of Medicine Stanford, California ASSOCIATE EDITORS TRACY A. CUSHING, MD, MPH Associate Professor Department of Emergency Medicine University of Colorado School of Medicine Aurora, Colorado N. STUART HARRIS, MD, MFA, FRCP (Edin) Associate Professor of Emergency Medicine Harvard Medical School Chief, Division of Wilderness Medicine Department of Emergency Medicine Massachusetts General Hospital Boston, Massachusetts 1600 John F. Kennedy Blvd. Ste. 1800 Philadelphia, PA 19103-2899 AUERBACH’S WILDERNESS MEDICINE, SEVENTH EDITION ISBN: 978-0-323-35942-9 Copyright © 2017 by Elsevier, Inc. All rights reserved. Chapter 12 is in the public domain. Chapter 25 Copyright © 2017 Grant S. Lipman, Brian J. Krabak. Chapter 70 Copyright © 2017 Charles Gideon Hawley, Michael Jacobs. Chapter 5, Mary Ann Cooper retains rights for images. Chapter 5, Ronald L. Holle retains rights for images. Chapter 36, David Warrell retains rights for images. Previous editions copyrighted 2012, 2007, 2001, 1995 by Mosby, an imprint of Elsevier, Inc. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or any information storage and retrieval system, without permission in writing from the publisher. Details on how to seek permission, further information about the Publisher’s permissions policies and our arrangements with organizations such as the Copyright Clearance Center and the Copyright Licensing Agency, can be found at our website: www.elsevier.com/permissions. This book and the individual contributions contained in it are protected under copyright by the Publisher (other than as may be noted herein). Notices Knowledge and best practice in this field are constantly changing. As new research and experience broaden our understanding, changes in research methods, professional practices, or medical treatment may become necessary. Practitioners and researchers must always rely on their own experience and knowledge in evaluating and using any information, methods, compounds, or experiments described herein. In using such information or methods they should be mindful of their own safety and the safety of others, including parties for whom they have a professional responsibility. With respect to any drug or pharmaceutical products identified, readers are advised to check the most current information provided (i) on procedures featured or (ii) by the manufacturer of each product to be administered, to verify the recommended dose or formula, the method and duration of administration, and contraindications. It is the responsibility of practitioners, relying on their own experience and knowledge of their patients, to make diagnoses, to determine dosages and the best treatment for each individual patient, and to take all appropriate safety precautions. To the fullest extent of the law, neither the Publisher nor the authors, contributors, or editors, assume any liability for any injury and/or damage to persons or property as a matter of products liability, negligence or otherwise, or from any use or operation of any methods, products, instructions, or ideas contained in the material herein. International Standard Book Number: 978-0-323-35942-9 Executive Content Strategist: Kate Dimock Content Development Manager: Lucia Gunzel Publishing Services Manager: Patricia Tannian Senior Project Manager: John Casey Designer: Brian Salisbury Printed in United States of America Last digit is the print number: 9 8 7 6 5 4 3 2 1 Contributors Javier A. Adachi, MD, FACP, FIDSA Brian S.S. Auerbach, JD, MA, BE Associate Professor Associate Division of Internal Medicine Pepper Hamilton LLP Department of Infectious Diseases, Infection Control and Philadelphia, Pennsylvania Employee Health Adjunct Professor Paul S. Auerbach, MD, MS, FACEP, MFAWM, FAAEM Section of Infectious Diseases Redlich Family Professor Department of Medicine Department of Emergency Medicine Baylor College of Medicine Stanford University School of Medicine Adjunct Professor Stanford, California; Center for Infectious Diseases Adjunct Professor The University of Texas Health Science Center at Houston Department of Military and Emergency Medicine School of Public Health F. Edward Hébert School of Medicine Houston, Texas Uniformed Services University of the Health Sciences Bethesda, Maryland Norberto Navarrete Aldana, MD Emergency Physician Howard D. Backer, MD, MPH, FACEP, FAWM Burns Intensive Care Unit Director Hospital Simón Bolivar California Emergency Medical Services Authority Bogotá, Colombia Sacramento, California Martin E. Alexander, PhD, RPF Aaron L. Baggish, MD Adjunct Professor Assistant Professor Wildland Fire Science and Management Cardiology Division Department of Renewable Resources Department of Medicine Alberta School of Forest Science and Management Associate Director University of Alberta Cardiovascular Performance Center Senior Fire Behavior Research Officer (Retired) Massachusetts General Hospital Canadian Forest Service, Northern Forestry Centre Boston, Massachusetts Edmonton, Alberta, Canada Buddha Basnyat, MD, MSc, FACP, FRCP (Edin) Susan Anderson, MD Director Clinical Associate Professor Oxford University Clinical Research Unit–Nepal Division of Infectious Disease and Geographic Medicine Medical Director Center for Innovation and Global Health Nepal International Clinic and Himalayan Rescue Association Stanford, California; Kathmandu, Nepal Director of Travel Medicine Palo Alto Medical Foundation Pete Bettinger, PhD Palo Alto, California Professor School of Forestry and Natural Resources Christopher J. Andrews, BE, MBBS, MEngSc, University of Georgia PhD, JD, EDIC, GDLP, DipCSc, ACCAM Athens, Georgia Senior Lecturer, Medicine University of Queensland Paul D. Biddinger, MD Brisbane, Queensland, Australia Vice Chairman for Emergency Preparedness Department of Emergency Medicine E. Wayne Askew, PhD Massachusetts General Hospital Professor Emeritus Director Department of Nutrition and Integrative Physiology Emergency Preparedness Research, Evaluation and Practice University of Utah Program Salt Lake City, Utah Harvard T.H. Chan School of Public Health Boston, Massachusetts Dale Atkins, BA President, American Avalanche Association Greta J. Binford, PhD Vice President, Avalanche Rescue Commission Associate Professor International Commission for Alpine Rescue, North America Department of Biology Training and Education Manager, RECCO, AB Lewis & Clark College Boulder, Colorado Portland, Oregon v S Rebecca S. Blue, MD, MPH George H. Burgess, MSc R O Assistant Professor Director T Department of Preventive Medicine and Community Health Florida Program for Shark Research U B University of Texas Medical Branch at Galveston Curator RI Galveston, Texas International Shark Attack File T Florida Museum of Natural History N O Ryan Blumenthal, MBChB (Pret), MMed (Forens) FC University of Florida C Path (SA), Dip Med (SA), PhD (Wits) Gainesville, Florida Senior Specialist Department of Forensic Medicine Sean P. Bush, MD, FACEP University of Pretoria Professor Pretoria, Gauteng, South Africa Department of Emergency Medicine Brody School of Medicine Jolie Bookspan, PhD East Carolina University Philadelphia, Pennsylvania Greenville, North Carolina Ralph S. Bovard, MD, MPH, FACSM Frank K. Butler Jr, MD Director Chairman, Committee on Tactical Combat Casualty Care Occupational and Environmental Medicine Residency Director, Prehospital Trauma Care Program Joint Trauma System Midwest Center for Occupational Health and Safety San Antonio, Texas; HealthPartners Medical Group Adjunct Professor St. Paul, Minnesota Department of Military and Emergency Medicine F. Edward Hébert School of Medicine Warren D. Bowman Jr, MD Uniformed Services University of the Health Sciences Clinical Associate Professor Emeritus Bethesda, Maryland Department of Internal Medicine University of Washington School of Medicine Dale J. Butterwick, MSc, CAT(C) Seattle, Washington Associate Professor Emeritus Faculty of Kinesiology Leslie V. Boyer, MD University of Calgary Associate Professor Calgary, Alberta, Canada Department of Pathology Director Christopher R. Byron, DVM, MS, DACVS Venom Immunochemistry, Pharmacology, and Emergency Associate Professor of Large Animal Surgery Response Institute Large Animal Clinical Sciences University of Arizona Virginia-Maryland College of Veterinary Medicine Tucson, Arizona Blacksburg, Virginia Michael B. Brady, MA Michael D. Cardwell, MS Department of Geography Adjunct Faculty Rutgers University Department of Biological Sciences Piscataway, New Jersey California State University Sacramento, California Mark A. Brandenburg, MD Medical Director Steven C. Carleton, MD, PhD Bristow Medical Center Professor and W. Brian Gibler Chair of Emergency Medicine Bristow, Pennsylvania Education Department of Emergency Medicine Beau A. Briese, MD University of Cincinnati College of Medicine Director Cincinnati, Ohio International Emergency Medicine Department of Emergency Medicine Christopher R. Carpenter, MD, MSc, FACEP, Houston Methodist Hospital FAAEM, AGSF Houston, Texas Associate Professor Division of Emergency Medicine Millicent M. Briese, MA Department of Medicine Chief Executive Officer Washington University in St. Louis School of Medicine Emergen International LLC St. Louis, Missouri; Houston, Texas President, Academy for Geriatric Emergency Medicine Chicago, Illinois Calvin A. Brown III, MD Department of Emergency Medicine Scott P. Carroll, PhD Brigham and Women’s Hospital Research Associate Assistant Professor of Emergency Medicine Department of Entomology and Nematology Harvard Medical School University of California, Davis Boston, Massachusetts Davis, California Colin M. Bucks, MD John W. Castellani, PhD Clinical Assistant Professor Research Physiologist Department of Emergency Medicine Thermal and Mountain Medicine Division Stanford University School of Medicine US Army Research Institute of Environmental Medicine Stanford, California Natick, Massachusetts vi Michael J. Caudell, MD, FACEP, FAWM, DiMM Mary Ann Cooper, MD C O Professor Professor Emerita N Department of Emergency Medicine and Hospitalist Services University of Illinois at Chicago T Medical Director Chicago, Illinois; R I Wilderness and Survival Medicine Founding Director B U Medical College of Georgia at Augusta University African Centres for Lightning and Electromagnetics T O Augusta, Georgia; Kampala, Uganda R President S Appalachian Center for Wilderness Medicine Kevin Coppock, MSc Morganton, North Carolina Head of Mission—Myanmar Médecins Sans Frontières (Doctors Without Borders) Steven Chalfin, MD, FACS Professor Larry I. Crawshaw, PhD Department of Ophthalmology Professor Emeritus University of Texas Health Science Center at San Antonio Biology Department San Antonio, Texas Portland State University Professor Emeritus Nisha Charkoudian, PhD Department of Behavioral Neuroscience Research Physiologist Oregon Health & Science University Thermal and Mountain Medicine Division Portland, Oregon US Army Research Institute of Environmental Medicine Natick, Massachusetts Gregory A. Cummins, DO, MS Adjunct Instructor Samuel N. Cheuvront, PhD, RD Division of Primary Care Research Physiologist Department of Internal Medicine Thermal and Mountain Medicine Kansas City University of Medicine and Biosciences US Army Research Institute of Environmental Medicine Kansas City, Missouri Natick, Massachusetts Tracy A. Cushing, MD, MPH Richard F. Clark, MD Associate Professor Professor of Clinical Medicine Department of Emergency Medicine Division of Medical Toxicology University of Colorado School of Medicine Department of Emergency Medicine Aurora, Colorado University of California, San Diego San Diego, California Jon Dallimore, MBBS, MSc Specialty Doctor Kenneth S. Cohen, MA Emergency Department Traditional Healer Bristol Royal Infirmary Sacred Earth Circle Bristol, United Kingdom; Nederland, Colorado Co-Director, International Diploma in Expedition and Wilderness Medicine Richard W. Cole, MD, MPH, FACEP Royal College of Physicians and Surgeons of Glasgow Assistant Professor Glasgow, United Kingdom; Division of Aerospace Medicine General Practitioner Department of Preventive Medicine and Community Health Vauxhall Practice University of Texas Medical Branch at Galveston Chepstow, United Kingdom Galveston, Texas; Clinical Instructor Shawn D’Andrea, MD, MPH Ultrasound Division Instructor of Emergency Medicine Department of Emergency Medicine Harvard Medical School The University of Texas Health Science Center at Houston Boston, Massachusetts; Houston, Texas Chief Emergency Medicine Benjamin B. Constance, MD, FACEP, FAWM Tsehootsooi Medical Center Clinical Instructor Fort Defiance, Arizona Department of Family Medicine University of Washington School of Medicine Daniel F. Danzl, MD Chief and Medical Director Professor and Chair Tacoma Emergency Care Physicians Department of Emergency Medicine Tacoma General Hospital University of Louisville Tacoma, Washington Louisville, Kentucky Daniel G. Conway, DO, FACEP Kathleen M. Davis, BS, MS Medical Corps Superintendent (Retired) United States Army Medical Department Montezuma Castle and Tuzigoot National Monument Department of Emergency Medicine National Park Service, Department of the Interior Fort Belvoir, Virginia Camp Verde, Arizona Donald C. Cooper, PhD, MBA Kevin Davison, ND, LAc President and Chief Executive Officer Director National Rescue Consultants, Inc. Maui Regenerative Medicine Cuyahoga Falls, Ohio Haiku, Hawaii vii S Chad P. Dawson, MPS, PhD Thomas Eglin, MD R O Professor Emeritus Assistant Professor of Family Medicine T Department of Forest and Natural Resources Management Regional Assistant Dean U B State University of New York College of Environmental Science Pacific Northwest University of Health Sciences RI and Forestry Attending Physician T Syracuse, New York Emergency Department N O Yakima Valley Memorial Hospital C George R. Deeb, DDS, MD, FAWM Yakima, Washington Associate Professor Division of Oral and Maxillofacial Surgery Timothy B. Erickson, MD, FACEP, FACMT, FAACT Department of Surgery Professor Virginia Commonwealth University Division of Toxicology Richmond, Virginia Department of Emergency Medicine Director, UIC Center for Global Health Janice A. Degan, RN, MS University of Illinois College of Medicine at Chicago Assistant Director of Research Chicago, Illinois Venom Immunochemistry, Pharmacology, and Emergency Response Institute Thomas Evans, PhD Arizona Health Sciences Center Chief Executive Officer University of Arizona SAR3 Tucson, Arizona Mountain View, California Thomas G. DeLoughery, MD, MACP, FAWM Andrew J. Eyre, MD Professor Clinical Fellow Division of Hematology and Medical Oncology Harvard Medical School Departments of Medicine, Pathology, and Pediatrics Attending Physician Knight Cancer Institute Department of Emergency Medicine Oregon Health & Science University Brigham and Women’s Hospital Portland, Oregon Boston, Massachusetts Arlene E. Dent, MD, PhD Joanne Feldman, MD, MS, UHM Assistant Professor Assistant Clinical Professor Division of Pediatric Infectious Diseases and Rheumatology Department of Emergency Medicine Department of Pediatrics University of California, Los Angeles Case Western Reserve University Los Angeles, California Cleveland, Ohio D. Nelun Fernando, PhD Alexandra E. DiTullio, MD Hydrologist Attending Physician Surface Water Resources Department of Emergency Medicine Water Science and Conservation The Queen’s Medical Center Texas Water Development Board Honolulu, Hawaii Austin, Texas Katherine R. Dobbs, MD Paul G. Firth, MD Instructor Assistant Professor Division of Pediatric Infectious Diseases Harvard University Department of Pediatrics Pediatric Anesthesiologist Case Western Reserve University Department of Anesthesia, Critical Care, and Pain Medicine Cleveland, Ohio Massachusetts General Hospital Boston, Massachusetts Eric L. Douglas, BA, EMT, DMT Staff Instructor, Instructor Development Course Mark S. Fradin, MD Emeritus Medic First Aid Master Trainer Clinical Associate Professor Professional Association of Diving Instructors Department of Dermatology Pinch, West Virginia University of North Carolina School of Medicine Private Practice, Chapel Hill Dermatology, P.A. Jennifer Dow, MD Chapel Hill, North Carolina Medical Director National Park Service—Alaska Region Bryan L. Frank, MD, FAAMA, FAAPM, FAAARM Director President Emergency Department Global Mission Partners, Inc. Alaska Regional Hospital Yukon, Oklahoma Anchorage, Alaska Esther E. Freeman, MD, PhD, FAAD Herbert L. DuPont, MD, MACP Assistant Professor Mary W. Kelsey Distinguished Chair in Medical Sciences Department of Dermatology Director, Center for Infectious Diseases Massachusetts General Hospital School of Public Health and McGovern Medical School Harvard Medical School The University of Texas Health Science Center at Houston Boston, Massachusetts Clinical Professor Department of Medicine Baylor College of Medicine Houston, Texas viii Luanne Freer, MD Donald L. Grebner, PhD C O Medical Director Professor N Medcor at Yellowstone Department of Forestry T Yellowstone National Park Mississippi State University R I Yellowstone, Wyoming; Starksville, Mississippi B U Founder and Director T O Everest ER Colin K. Grissom, MD R Himalayan Rescue Association Professor S Mt Everest, Nepal Department of Internal Medicine University of Utah School of Medicine Tom Garrison, PhD Salt Lake City, Utah; Professor Emeritus Associate Medical Director Marine Science Department Shock Trauma Intensive Care Unit Orange Coast College Intermountain Medical Center Costa Mesa, California; Murray, Utah Adjunct Professor of Higher Education Rossier School of Education Peter H. Hackett, MD University of Southern California Director, Institute for Altitude Medicine Los Angeles, California Telluride, Colorado; Clinical Professor Alan Gianotti, MD, MS Department of Emergency Medicine Department of Emergency Medicine University of Colorado Denver School of Medicine Mills-Peninsula Medical Center Aurora, Colorado Burlingame, California; Volunteer Physician Charles Handford, MBChB (Hons), MRCS Himalayan Rescue Association Nepal General Duties Medical Officer Kathmandu, Nepal Royal Army Medical Corps British Army Robert V. Gibbons, MD, MPH Task Area Manager N. Stuart Harris, MD, MFA, FRCP (Edin) Battlefield Pain Management Associate Professor of Emergency Medicine United States Army Institute of Surgical Research Harvard Medical School Joint Base San Antonio Chief, Division of Wilderness Medicine Fort Sam Houston, Texas Department of Emergency Medicine Massachusetts General Hospital Gordon G. Giesbrecht, PhD, FAsMA Boston, Massachusetts Professor Faculty of Kinesiology and Recreation Management; Seth C. Hawkins, MD, EMD Department of Anesthesia Assistant Professor Director, Laboratory for Exercise and Environmental Medicine Department of Emergency Medicine Health, Leisure and Human Performance Research Institute Wake Forest University University of Manitoba Winston-Salem, North Carolina Winnipeg, Manitoba, Canada Charles G. Hawley, BS Alina Goldenberg, MD, MAS Chairman Department of Dermatology Safety at Sea Committee University of California, San Diego United States Sailing Association San Diego, California Portsmouth, Rhode Island Craig Goolsby, MD David M. Heimbach, MD, FACS Associate Professor Professor Emeritus Department of Military and Emergency Medicine Department of Surgery F. Edward Hébert School of Medicine University of Washington Uniformed Services University of the Health Sciences Seattle, Washington Bethesda, Maryland; Director, Hybrid Simulation Lab Carlton E. Heine, MD, PhD, FACEP, FAWM Val G. Hemming Simulation Center Clinical Associate Professor Silver Spring, Maryland; Elson S. Floyd College of Medicine Attending Emergency Physician Washington State University Howard County General Hospital Spokane, Washington Columbia, Maryland Lawrence E. Heiskell, MD, FACEP, FAAFP Kimberlie A. Graeme, MD, FACMT Emergency Physician Clinical Associate Professor Founder and Director Department of Emergency Medicine International School of Tactical Medicine University of Arizona College of Medicine Rancho Mirage, California Medical Toxicologist Department of Medical Toxicology John C. Hendee, PhD Banner—University Medical Center Phoenix Professor Emeritus Phoenix, Arizona Department of Conservation Social Sciences College of Natural Resources University of Idaho Moscow, Idaho ix S Andrew A. Herring, MD Kirsten N. Johnson, MD, MPH R O Director Assistant Professor T Pain and Addiction Treatment Division of Emergency Medicine U B Department of Emergency Medicine Department of Family Medicine RI Highland Hospital McGill University T Oakland, California CEO, Humanitarian U N O Montréal, Québec, Canada C Ronald L. Holle, MS Meteorologist Hemal K. Kanzaria, MD, MS Holle Meteorology and Photography Assistant Professor Oro Valley, Arizona Department of Emergency Medicine University of California, San Francisco John R. Hovey, BS San Francisco, California Senior Instructor Wilderness Medicine Institute Misha R. Kassel, MD National Outdoor Leadership School Department of Emergency Medicine Lander, Wyoming Pali Momi Medical Center Aiea, Hawaii Martin R. Huecker, MD Assistant Professor and Research Director Stephanie Kayden, MD, MPH, CEDE Department of Emergency Medicine Assistant Professor University of Louisville Harvard Medical School Louisville, Kentucky Chief Division of International Emergency Medicine and Christopher H. E. Imray, MB BS, DiMM, MSc, PhD, Humanitarian Programs FRCS, FRCP, FRGS Department of Emergency Medicine Professor Brigham and Women’s Hospital Department of Vascular Surgery Boston, Massachusetts University Hospital Coventry and Warwickshire NHS Trust Warwick Medical School and Coventry University Katherine M. Kemen, MBA Coventry, United Kingdom Program Manager Emergency Preparedness Hillary R. Irons, MD, PhD Partners HealthCare Assistant Professor Boston, Massachusetts Department of Emergency Medicine University of Massachusetts Medical School Robert W. Kenefick, PhD UMass Memorial Medical Center Research Physiologist Worcester, Massachusetts Thermal and Mountain Medicine Division US Army Research Institute of Environmental Medicine Kenneth V. Iserson, MD, MBA Natick, Massachusetts Professor Emeritus Department of Emergency Medicine Michael L. Kent, MD University of Arizona Commander Tucson, Arizona Medical Corps, United States Navy Assistant Professor Michael E. Jacobs, MD, MFAWM Department of Anesthesiology Martha’s Vineyard, Massachusetts F. Edward Hébert School of Medicine Uniformed Services University of the Health Sciences Ramin Jamshidi, MD, FACS Staff Anesthesiologist Assistant Professor Bethesda, Maryland Department of Surgery Department of Child Health Minjee Kim, MD University of Arizona College of Medicine Assistant Professor Medical Director of Pediatric Trauma Division of Neurocritical Care Surgical Director of Pediatric Intensive Care Ken and Ruth Davee Department of Neurology Maricopa Medical Center Northwestern University Feinberg School of Medicine Phoenix, Arizona Chicago, Illinois Joshua M. Jauregui, MD Alexa B. Kimball, MD, MPH Acting Assistant Professor Professor Division of Emergency Medicine Department of Dermatology University of Washington School of Medicine Harvard Medical School Seattle, Washington Boston, Massachusetts James M. Jeffers, BA, LLB, LLM, MPhil, PhD W. Taylor Kimberly, MD, PhD Senior Lecturer in Human Geography Assistant Professor of Neurology College of Liberal Arts Harvard Medical School Bath Spa University Division of Neurocritical Care and Emergency Neurology Bath, United Kingdom Department of Neurology Massachusetts General Hospital Amber M.H. Johnson, DO, DMD Boston, Massachusetts Department of Oral and Maxillofacial Surgery Virginia Commonwealth University Richmond, Virginia x
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