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Medicine for the Outdoors: The Essential Guide to First Aid and Medical Emergency, 5th Edition PDF

566 Pages·2009·8.34 MB·English
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Preview Medicine for the Outdoors: The Essential Guide to First Aid and Medical Emergency, 5th Edition

“When a crisis occurs in the backcountry, punching in 911 may not even get you a dial tone — you’re on your own. This book is your wilderness 911. Take the time to read it and know the principles of care provided within it. Medicine for the Out- doors just might save your life.” — Frank Hubbell, DO, Founder of Stonehearth Open Learning Opportunities (SOLO), Wilderness Medicine and Rescue Instructor, Conway, NH “Students with a broad range of experience take wilderness medicine courses. It’s not easy to fi nd a comprehensive text that accommodates all their needs. Medicine for the Outdoors engages the non-professional while keeping the most seasoned provider informed in the latest techniques for backcountry medical practice. Dr. Auerbach has written another book that will become the gold standard for anyone with an interest in health and safety outdoors.” — William Fred Baty, WEMT-P, Assistant Fire Chief, City of Knoxville Fire Department; Lead Wilderness Medicine Instructor, The Wilderness Medicine Program, Roane State Community College, Knoxville, TN “This manual contains a wealth of succinct, up-to-date, and practical advice. It is an indispensable medical guide for wilderness enthusiasts and health professionals.” — Kent R. Olson, MD, Medical Director, San Francisco Division, California Poison Control System “Most fi rst aid books describe a condition and sometimes advise simple fi rst aid measures, but ultimately end up with the admonition to ‘seek medical attention.’ This is safe advice when a clinic or hospital or ambulance is right around the corner. But what about when you’re on the adventure of a lifetime — in the wilds of Mongolia or the mountains of Tibet or several days out to sea? ‘Seek medical advice’ helps not a bit. In these situations, there is no better resource (including having a direct line to your hospital ER) than Medicine for the Outdoors. Dr. Paul Auerbach is to wilderness medicine what Bill Gates is to computers; he is the source, and so this book is a treasure trove of information not only for untrained laypeople but for most physicians. There is no more understandable or complete collection of information on what to do for anything that might befall an adventure traveler — from high altitude cerebral edema to soapfi sh dermatitis to cougar attack to how to stitch a laceration. Even better, Medicine for the Outdoors provides essential guidance in advance of an adventure to help with planning and prevention — from immunizations to equipment and clothing to dietary precautions. The handy appendices include a drug reference, conversion tables, and defi nitions of common medical terms. Contemplating an adventure? The old adage ‘Seek medical attention’ has been replaced with ‘Get Medicine for the Outdoors.’” — Luanne Freer, MD, FACEP, FAWM, Founder/Director, Everest Base Camp Medical Clinic; Medical Director, Yellowstone National Park; Past President, Wilderness Medical Society “You always hope for the best and plan for the worst. Being well prepared for the unexpected in the wilderness is greatly enhanced by our ‘survival bible,’ namely, Medicine for the Outdoors. Our guides, trip leaders, and clients never adventure without this well-written and easy-to-understand book, and we invariably benefi t from it. The common sense approach and complete coverage have helped us mitigate situations and avoid greater emergencies. In all reaches of the globe, with Medicine for the Outdoors, we’re much closer to defi nitive care.” — Laurence Alvarez-Roos, Co-founder, Bio Bio Expeditions World Wide “This new update of Medicine for the Outdoors is more impressive and indispens- able than ever. The uncomplicated, clear writing and illustrations are delightfully easy to understand, even though the book is remarkably thorough and superbly detailed. I highly recommend it to anyone who is serious about working and playing in the outdoors.” — Donald C. Cooper, PhD, Editor, Fundamentals of Search and Rescue; Chair, National Fire Protection Association Technical Search and Rescue Committee “This book provides invaluable guidance for both the medical teams that travel with us to remote areas around the world, and for the patients we treat there. Medicine for the Outdoors is a must-have medical manual for serious travelers who venture off the beaten path.” — Rachel Friday, MPH, MA, RD, Director, Medical Expeditions International “Auerbach’s much enhanced fi fth edition of Medicine for the Outdoors continues to serve as an ideal portable reference. Whether you are in the front country, exploring tropical reefs, or trekking at high altitude, Medicine for the Outdoors rapidly guides to solutions for the most important medical problems. I strongly rec- ommend this reference as a primary source for laypersons as well as a supplement for individuals with advanced wilderness medicine training.” — Brad L. Bennett, PhD, NREMT-P, FAWM, Captain, US Navy (Retired); Adjunct Faculty, Military and Emergency Medicine Department, Uniformed Services University of the Health Sciences “Traveling in the wilderness or abroad can be punctuated by unexpected illness or injury. If you plan to travel where medical care is not readily available, Medicine for the Outdoors is the resource you want to have with you. Dr. Auerbach, one of the foremost experts on wilderness medicine, covers topics from basic fi rst aid to major medical illnesses, trauma, medications, and medical kits. Medicine for the Outdoors provides knowledge that can help you survive until further assistance is available.” — Albert R. Wheeler III, MD, Emergency Medicine of Jackson Hole, WY; Medical Director, Grand Teton National Park EMS MEDICINE FOR THE OUTDOORS This page intentionally left blank MMEEDDIICCIINNEE FFOORR TTHHEE OOUUTTDDOOOORRSS TT EE GG HHEE SSSSEENNTTIIAALL UUIIDDEE TTOO FF AA MM EE IIRRSSTT IIDD AANNDD EEDDIICCAALL MMEERRGGEENNCCIIEESS FIFTH EDITION PAUL S. AUERBACH, MD, MS, FACEP, FAWM Professor of Surgery Division of Emergency Medicine Department of Surgery Stanford University School of Medicine Stanford, California 1600 John F. Kennedy Blvd. Ste 1800 Philadelphia, PA 19103-2899 MEDICINE FOR THE OUTDOORS ISBN: 978-0-323-06813-0 Copyright © 2009 by Mosby, Inc., an affi liate of Elsevier Inc. Copyright © 2003 by Paul S. Auerbach All rights reserved. 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. Permissions may be sought directly from Elsevier’s Rights Department: phone: (+1) 215 239 3804 (US) or (+44) 1865 843830 (UK); fax: (+44) 1865 853333; e-mail: [email protected]. You may also complete your request on-line via the Elsevier website at http://www.elsevier.com/permissions. Notice Knowledge and best practice in this fi eld are constantly changing. As new research and experi- ence broaden our knowledge, changes in research methods, professional practices, or medical treatment may become necessary or appropriate. Readers are advised to, whenever possible, 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 con- traindications. It is the responsibility of the reader, relying on their own experience, to determine the best treatment for each individual and to take all appropriate safety precautions. To the fullest extent of the law, neither the Publisher nor the Author assumes 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 con- tained in the material herein. The Publisher Library of Congress Cataloging-in-Publication Data Auerbach, Paul S. Medicine for the outdoors : the essential guide to fi rst aid and medical emergencies / Paul S. Auerbach. -- 5th ed. p. cm. Includes index. ISBN 978-0-323-06813-0 1. Outdoor medical emergencies. 2. First aid in illness and injury. I. Title. RC88.9.O95A94 2009 616.02’52--dc22 2009007883 Acquisitions Editor: Dolores Meloni Developmental Editor: Elena Pushaw Design Direction: Steven Stave Back cover photograph of Dr. Auerbach copyright Don Feria, with permission. Printed in the United States of America Last digit is the print number: 9 8 7 6 5 4 3 2 1 PREFACE The outdoor environment is beautiful, but it is ever changing and can become hostile in a moment. Good fortune favors the well prepared, and there are no more important considerations for a successful outdoor experience than safety and fi rst aid. Severe weather, wild animals, rugged terrain, and equipment failure all conspire to create or complicate medical hardships that must be diagnosed swiftly and remedied with certainty. The therapies can be integral to survival. Medical education is thus as compelling as any other form of learning. This revised fi fth edition of Medicine for the Outdoors has been updated and rewritten based on advances in medical knowledge, suggestions from readers, and reviews of the previous edition. I am indebted to my family and friends, who continue to support me in my writing endeavors. Brian, Lauren, and Danny will soon be writing their own books. This book is dedicated to all of the people who have given generously of their time to the Wilderness Medical Society and thereby advanced the specialty of wilderness medicine. With as much effort as we seek to maintain good health, let each of us seek to maintain the wilderness. It is my fervent hope that we can approach preservation of the planet Earth with the same passion that we have poured into the develop- ment of our vital medical missions; for without the wilderness, there can be no wilderness medicine. Paul Auerbach, MD Summer, 2009 vii This page intentionally left blank INTRODUCTION The purpose of this book is to provide you with brief explanations of a wide variety of medical problems and to offer practical solutions. The book is arranged to make information easy to retrieve. Part One outlines basic principles of health care that should be applied to all outdoor travel. Parts Two and Three describe medical situ- ations, beginning with life threats and covering, in turn, major and minor medical problems you might encounter. Part Four discusses disorders related to various wilderness settings. Part Five covers additional practical information, such as evacuation guidelines and techniques, water disinfection, useful knots and hitches, drug injection techniques, and recommendations for immunization. Appendix One lists medications and doses, with an emphasis on medications mentioned else- where in the book. Conversion tables for common measurements are found in Appendix Two. Appendix Three outlines guidelines for prevention of hepatitis, acquired immunodefi ciency syndrome (AIDS), and other diseases transmitted by human body fl uids. The glossary defi nes medical and technical terms. The index will guide you swiftly to any topic. To keep the book to a manageable size, I assume that you have a basic under- standing of how your body and organs are supposed to work. Thus, explanations are brief and to the point. This is neither a survival manual nor a sports medicine encyclopedia. Rather, the book is meant to be carried on a journey as a ready reference for a layperson who needs to medically rescue or aid an ill or injured victim. I have included information that is necessary to make simple, accurate diagnoses and to act on them. This book does not transform a layperson into a physician, but unfortunately, there are times when medical help is miles or even days away. No intervention is completely without risk; however, some familiarity with diseases and injuries can minimize that risk. Although some of the techniques and drugs described could worsen a situation if misapplied or incorrectly administered, the treatments pre- sented are current and well accepted. Still, the recommendations should not be considered substitutes for prompt evaluation by a trained medical professional. If at any time a diagnosis is uncertain, or a victim appears to be more than minimally ill, all efforts should be directed at seeking a professional medical opinion. The basic therapies recommended are not those that could be rendered by a physician with sophisticated equipment and a large armamentarium of drugs. I have not described every infectious or tropical disease that could possibly be contracted during a journey abroad. However, the diagnosis and management of illnesses such as schistosomiasis, malaria, Lyme disease, anaplasmosis, yellow fever, dengue fever, West Nile viral disease, and Rocky Mountain spotted fever are relevant to many people who travel domestically and overseas in wilderness ix

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Named a top 10 medical title in 2009 by the Wall Street Journal. Since 1986, Medicine for the Outdoors has been hailed as the definitive take-along manual on the subject. Packed with step-by-step instructions, how-to explanations, and practical approaches to outdoor and wilderness emergencies, it te
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