Mechanism & Pathophsiology
Carbon monoxide (CO) is colorless, odorless, tasteless, and initially non-irritating; signs and symptoms of CO poisoning are delayed and often accumulative. CO binds to hemoglobin on red blood cells and is carried as carboxyhemoglobin (COHb) in the blood. Bound CO prevents oxygen uptake by hemoglobin and significantly reduces the blood's oxygen carrying capacity. CO also binds to other molecules in the body and reduces the function of all high oxygen-demand organs (heart, brains, & lungs) even after the CO has been cleared from the blood. In a wilderness environment, CO is typically generated as a byproduct of incomplete fuel combustion in a stove or lantern. Signs and symptoms of CO poisoning vary widely based on exposure level, duration, and the general health and age of an individual.
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(How to avoid, and if necessary treat, dry, chapped, and cracked skin on an outdoor trip.) The skin is the largest organ of the body; it varies greatly in thickness offering both physical protection from minor traumatic injury and denying access to potentially dangerous microorganisms. The outer layer of the skin (epidermis) is extremely tough and contains melanin while the more sensitive underlying layers—dermis and subcutaneous tissue (or hypodermis)—contain blood vessels, nerve endings, subcutaneous fat, and connective tissue. The skin on your hands and feet is much thicker than the skin on the rest of your body, and therefore tougher; it can take up to six months for severely chapped hands and feet to heal sufficiently and regain its barrier strength. Aside from your lips (a notable and important exception), your skin contains melanin to help protect it from excessive ultraviolet (UV) radiation and has glands that excrete water, electrolytes, and oils. Blood vessels within the skin layers aid in thermoregulation as they contract to conserve heat or dilate to release it. Sensory nerves transmit environmental messages to the brain. Winter is here...and in many places it brings snow to the mountains. Lots of it. And with lots of mountain snow comes avalanches. Some of them are fatal. As a former ski patroller and an avid back country skier, I'm familiar with avalanches. I've watched friends go for rides, recovered bodies, and even been fully buried myself. I have lots of stories. When I was caught and buried we did all the "right" stuff (dug multiple pits, were familiar with the snowpack and terrain, cut the hill numerous times) but none-the-less I got caught. It was a wild and scary ride. I'm quite glad my friend was well trained, had years of rescue experience, and there to dig me out. Although I managed to create a small air hole with my left hand before the snow completely settled, I don't think I could have gotten free by myself. I lost some gear, broke a brand new ski (it could easily have been my leg), and gained increased respect for the power of sliding snow. Later that winter I overheard a ski buddy with years of ski guiding, patrolling, and avy control experience say to a new backcountry skier: "If you spend enough time skiing in the high mountains, you'll eventually get caught in a sluff or avalanche." Whoa! Not particularly reassuring, yet I've found it to be true....
Introduction
Whether you are traveling alone, taking part in an expedition, or responding as a member of a search & rescue (SAR) team, you will need a first aid kit. What you should take and how you should package it depends on many things. There is no generic first aid kit. Below are a few basic concepts that you will need to know in order to begin building a kit that meets your needs.
As the size of the expedition group gets bigger or the trip longer, you will need to carry more of the basic first aid kit contents and additional drugs to treat medical problems that typically don't arise on shorter trips due to the one to three week, or longer, incubation period required for most infectious diseases. Our Expedition Pack can typically hold enough supplies for a group of 8-12 people for up to three weeks, more with resupplies. The needs of larger groups (typically found on commercial raft trips) can be met by using multiple packs.
A good guide has excellent self- and situational awareness, a complete understanding of the terrain and environmental hazards they may encounter and strategies for mitigating their associated risk, together with a reasonable assessment of their clients skills. Despite their training and skill, risk cannot be completely eliminated, and injuries and illnesses can occur. The prudent guide will carry supplies to address both common and unlikely, but possible, scenarios. As the terrain increases in difficulty, the potential for both stable and unstable musculoskeletal injuries increases; and, it makes good sense to add a padded aluminum splint, self-adhering bandages, and perhaps kinesiology tape to the contents of the basic first aid kit. In conjunction with a cloth roll cut from a T-shirt, a padded aluminum splint can be used to stabilize most common extremity fractures—forearm, wrist, knee, and ankle. Self adhering bandages may be used in lieu of a cloth roll to secure the splint or by itself, to support a strain or sprain or hold a dressing in place. Kinesiology tape is a specialized tape with an adhesive backing, and when combined with with Tincture of Benzoin, can also be used to protect against or support a strain or sprain. Maxi-pads can be added as emergency trauma dressings and OTC medications to treat common medical problems like diarrhea, constipation, sinus congestion, acid stomach, etc.
Statistically, playing in the backcountry is pretty safe; life-threatening injuries and illnesses are rare. Most traumatic injuries are simple cuts, scrapes, and blisters. Environmental injuries, like dehydration, heat exhaustion, sunburn, and cold, are common, uncomfortable, and typically easily treated (and preventable). Since wilderness travelers are healthy, medical problems are minimal and tend to focus on headaches and general aches & pains. Problems in longer trips tend to be related to poor hygiene.
Taking a course in wilderness medicine is an investment in your future and requires both time and money. Wilderness medicine providers teach the same type of courses—WFA, WAFA, WFR, & WEMT—but…we all teach them differently. And that difference may be vitally important to you. It's worth doing some research to make sure you take the right course from the right provider. This article is devoted to helping you reach your goals. And, when all is said and done, we hope you choose to take a course from us. Questions to ask yourself:
If you are looking for a good education, consider these things:
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Our public YouTube channel has educational and reference videos for many of the skills taught during our courses. Check it out!
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