OAUSA Net - July 13, 2023 - Outdoor Summertime Medicine

[toms]

This is a good time to refresh our outdoor First Aid knowledge related to some of the common issues we might face during summer activities.

There are a myriad of problems we can encounter. Some more serious then others. A big one is heat related illness and perhaps the first one we think of. While it is good to review heat related issues we should not over look others.

I have address a few common problems and ask each of you to add others. If you can, tell us a story of a personal experience you, someone with you or someone you helped had with the medical problem.

Some suggestions:
Ears - foreign bodies
Swimmers ear
Heat rash
Lightning
Snakes
Poison Ivy / Oak / Sumac
Scorpions
Jelly Fish
Mushroom
Giardia disease
CO - tent heater
Hantavirus
Cuts and wounds
Impaled objects
Nose bleeds
Constipation

[toms]

Ticks:

Though small, these buggers can pack a punch. Rocky Mountain Spotted Fever, ehrlichiosis, babesiosis and Lyme disease are just some of the nasties they can transmit.

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Ticks are present just about everywhere. One day I was leading a group on the Mojave Road.

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The Mojave Road was an important wagon road in the late 1800s. The key to the Mojave Roads existence is a water source about every 18 – 20 miles. When the U.S. mail was put on the road in 1868, the Army built forts to protect each water source. We stopped at each watering spot to look at the redoubts the Army built.

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One of those stops was Marl Spring. While walking through a small grassy area, I picked up several ticks. Even out in the desert you have to be mindful of ticks.
Prevention
Check yourself thoroughly after every trip into the woods or fields. Pay particular attention to your arms, around your ears, back of the knees, in your hair, between your legs, and along your waist. Deer ticks are tiny – about the size of a pinhead – so look carefully.
The best level of prevention is avoidance. Wear light-colored clothing, with long sleeves and pants. Use bug spray that contains DEET or similar chemical.

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Sawyer Insect Repellent can be sprayed and imbedded in the cloths pants, shirts, socks, undies, tents, chairs, hammocks. It is very effective.
No smell after it dries, and it can remain effective through 6 washes. Between protecting the body with deet and gear, equipment and cloths with Permethrin one should be pretty safe.

The EPA has concluded that the normal use of DEET and Permethrin does not present a health concern. Studies have shown Permethrin to be as effective as DEET in repelling mosquitoes. Unlike DEET, however, Permethrin is odorless, non-greasy, and does not dissolve plastics or other synthetics.


Removal

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Proper removal of the tick is essential. Using a fine-tipped tweezers, grab the tick as close to the skin as possible. Pull straight up and away in a steady, fluid motion. Don’t jerk or twist. You risk breaking off the body and leaving its head in your skin.
Afterwards, wash the area with soap and water, or apply disinfectant alcohol or hand sanitizer. Watch the bite wound for at least three weeks. Visit a doctor if you experience redness at the bite location, aches and pains, or flu-like symptoms.

Avoid old wives solutions such as “painting” the tick with petroleum jelly, or using heat to make the tick detach from the skin. Your goal is to remove the tick as quickly as possible–not waiting for it to detach.

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Don’t squash the tick you removed with your fingers. Treat all ticks as if infected with a bloodborne pathogen. Flushing a tick down the toilet may not kill it. Ticks can survive three to four days in water. It’s best to put it in a container with alcohol. Don’t waste your good drinking whiskey, however.

For more details check The Center for Disease Control. https://www.cdc.gov/ticks/tickbornediseases/index.html

Breaking News!
Jul 1, 2023 6:05 PM EDT
NEW YORK (AP) — Hungry ticks have some slick tricks. They can zoom through the air using static electricity to latch onto people, pets and other animals, new research shows.
Humans and animals naturally pick up static charges as they go about their days. And those charges are enough to give ticks a boost to their next blood meal, according to a study published Friday in the journal Current Biology.
While the distance is tiny, “it’s the equivalent of us jumping three or four flights of stairs in one go,” said study author Sam England, an ecologist now at Berlin’s Natural History Museum.
They can’t jump or fly onto their hosts, he said. Instead, they hang out on a branch or a blade of grass with their legs outstretched — a behavior known as “questing” — and wait for people or animals to pass by so they can grab on and bite.
“They can now actually end up latching onto hosts that don’t make direct contact with them,” he said.
In the future, there might be ways developed to reduce that static, experts said. But for now, Rich said people should keep using classic tick prevention measures, including repellents, to keep themselves safe from bites.

Most ticks go through four life stages:
egg, six-legged larva, eight-legged nymph, and adult. After hatching from the eggs, ticks must eat blood at every stage to survive. Ticks that require this many hosts can take up to 3 years to complete their full life cycle, and most will die because they don’t find a host for their next feeding.

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Ticks can feed on mammals, birds, reptiles, and amphibians. Most ticks prefer to have a different host animal at each stage of their life but some prefer the same animal at all stages.

[toms]

Toxins

How toxins can enter your body

Toxins enter the body through four ways. Exposure can take place anywhere. The following examples focus on activities in outdoors settings.

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Injected: Includes bites and stings from bugs and animals. Some critters that carry toxins include rattlesnakes, scorpions, ticks and jelly fish. West Nile virus-infected mosquito bite is another danger.



Ingested: The most common cause is eating tainted food. Eggs, milk and ground beef are particularly susceptible to delivering pathogens such as salmonella and E. coli.

Remember, anything containing eggs and dairy products must be handled carefully. That includes egg salad, mayonnaise, yogurt and more. Keep chilled to the proper temperature before eating.

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Proteins (meat and fish) must also be kept chilled until cooked, then cooked properly. Try to ensure internal temperature of the meat reaches at least 160 degrees.

Water from streams and lakes can contain giardia disease. Treat properly before drinking. Failing to sanitize the water can have nasty consequences for your GI tract.

Less common, though still noteworthy, is poisoning from inedible plants. Mushrooms (fungi) are probably number one here. But even green, leafy plants can make you sick. Foraging is fun – and adds interesting and tasty greens to a meal. But don’t pick anything you’re not sure of.

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Absorbed: Think poison ivy, poison oak and poison sumac. But the effects depend on the person. Some people simply aren’t allergic to the active agent (urushiol) found in the sap.

Another way to absorb a toxin involves siphoning gas the old-fashioned way (sucking on a hose). Gasoline can quickly be absorbed in the soft tissues of the mouth, and particularly under the tongue. Yes, if it’s swallowed, the gas is then ingested. And the results are equally bad.

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Inhaled: Biggest risk is carbon monoxide (CO) poisoning from improperly vented space heaters. Be careful when using in a small space, such as a tent. The furnace in an RV or camper can also cause a build-up of CO if the unit is not functioning properly or not vented well.

Hantavirus is another deadly inhaled disease. It’s contracted from the dust of mice/rat droppings. For that reason I recommend staying out of abandoned cabin and structures we encounter on the trail.

How toxins affect the body

Each situation is unique. The effect on the person depends on several factors, including the type and amount of toxin, the person’s age and overall physical condition, and to what extent the person is allergic to the toxin.

In many cases, symptoms are mild to moderate. They can include pain, swelling, and redness at the point of contact. Bug bites and stings are like this (unless the person is allergic).

Food poisoning, the result of spoiled or improperly cooked food, can cause a host of symptoms, primarily in the GI tract. Those include an upset stomach, cramps, gas, diarrhea and overall discomfort. Nausea and vomiting may also be present.

Those symptoms, while initially mild, bear watching. Often the food poisoning will run its course. That’s not a problem if you can control it.

But if symptoms persist – especially more than 24 hours – seek medical attention. If in a remote area, you may need to evacuate.

Constant diarrhea and vomiting cause a loss of fluids, which can lead to volume shock. That’s why it’s important keep the person well hydrated during this period.

Different levels of shock to watch for

Exposure to a toxin can have severe consequences. Effects can be loss of perfusion pressure due to vascular shock, respiratory distress, and sometimes impact to the nervous system.

Vascular shock: A severe drop in blood volume. This can be bleeding caused by traumatic injury, but also through a significant loss from diarrhea or vomiting.

Acute diarrhea and vomiting remove so much liquid, the body is unable to maintain a sufficient level of blood pressure.

Anaphylactic shock: Respiratory distress that severely affects a person’s ability to breathe. It’s caused by an allergic reaction, typically from bee or wasp stings, but some food items, like peanuts, produce the same reaction.

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People with those allergies usually carry an epinephrine (or “eppie”) pen of medication. These situations are serious, and require urgent medical care and an evacuation if epinephrine is administered.

Poison Control a good resource

Staffed 24 hours a day, the National Capital Poison Center (commonly known as Poison Control) provides useful advice during an emergency. The agency focuses on poisonings due to prescription drugs, household chemicals, and other products. Keep this number handy:

Poison Control Centers: 1-800-222-1222.

As with any emergency call, gather as much useful information as you can. Some details to gather:

Type of toxin and its source. Was it from a chemical (cleaning fluid, for example) or drug? If a drug, its name (brand or generic); how much was consumed.
Symptoms and vital signs. Is the person conscious? Skin condition (noticeable off-color to skin and nails); any trouble breathing?
Information on the person. Age, gender, pertain prior history, allergies (food, medication, environmental), medical conditions, medications taken
What were the circumstances surrounding the exposure? When (how much time has elapsed?), where and how?
Helpful additions to a first-aid kit

A good first aid kit typically contains supplies for many injuries or situations likely to occur. To address the issues raised in this article, include these items if not present.

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Antihistamine for allergy symptoms (runny nose, watery eyes), but it’s also available in cream or liquid form for itchy skin.

Calamine also relieves painful and itchy skin. It’s particularly useful against poison ivy, poison oak and poison sumac. Hydrocortisone, a topic steroid, works on all these, as well as many bug bites.

Ibuprofen (Advil, Motrin IB and others) is a general pain killer. Useful for mild pain from cramps, minor injuries, muscle aches and others.

Loperamide (Imodium A-D, for example) is effective against mild diarrhea.

I also recommend carrying a pair of tweezers specifically designed to remove ticks. But learn how to properly remove ticks and stinging bugs.

Many outdoor activities present opportunities to be exposed to toxins. Symptoms generally are mild and don’t affect the event. But some cases cause severe reactions in the person. Knowing what to do can make a big difference in the outcome.

If you can treat the person, do so. But if you cannot stabilize the situation in the field an evacuation is necessary.

As we say before any off-road adventure: Prepare, and be aware.

[toms]

Acute mountain sickness (AMS).

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It was the second day of a three-day excursion to the Sweetwater Mountains, just north of Bridgeport, California. We stopped for some sightseeing high on the peak of Mt. Patterson. At 11,674 feet, we marveled at the incredible views. East looking into Nevada are the Bodie Hills and Corey Peak and looking west provides an extensive view of the Sierra Range.

Unfortunately, not everyone enjoyed the stop. One guest complained of a headache and brief spell of dizziness when making a quick move to exit the vehicle. Talking with the others, I learned that everyone experienced shortness of breath while setting up camp the night before.

My group had succumbed to a mild version of acute mountain sickness. (I know it sounds odd that something called acute could be mild. But it was.) Symptoms tend to mimic a hangover: headache, fatigue, sluggishness, insomnia, lack of appetite and nausea.

Mild AMS occurs when the body experiences thinner air without the chance to acclimate. The brief time spent at elevation doesn’t give your blood time to build up a sufficient supply of extra red blood cells to offset the reduction in oxygen. Most of the group drove up from sea level just the day before! In essence, your body is saying, I don’t like it here!

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Treating Mild Acute Mountain Sickness

Mild AMS isn’t as common with four-wheelers as it is for other outdoors types, mountain climbers in particular. We rarely go to extreme elevations but we get there very fast. Here in California, Mt. Patterson is the highest peak we can drive to. There are a few roads in California (not peaks) that achieve about another 250 feet. Even so, as noted above, it can hit.

If you or anyone in your group is experiencing symptoms of Mild AMS, follow these suggestions.

Get some rest. Knock off work or sightseeing. That’s what my group did while on Mt. Patterson. We stopped for lunch early and rested for longer than normal.
Drink fluids and eat something. The body easily becomes dehydrated in the dryer air. Also, you may not feel hungry even though your body needs energy.
Take a mild pain killer. The individual with the headache took 400 mg of ibuprofen. You may find 200 mg sufficient.
If these steps don’t lessen the symptoms within a reasonable time, consider moving to a lower elevation. Anything under 8,000 feet should be fine. I realize that means changing your plans, but at least you and your friends will be able to enjoy the trip.

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Camping in the Sweetwater Mountains

More-serious conditions you should be aware of

Though rare for four-wheelers, two other conditions can occur at higher altitudes. A mild bout of acute mountain sickness can evolve into more serious issues. In both cases, fluids leaking from individual cells build up in the lungs and the brain. Immediate action is required.

High-altitude cerebral edema (HACE) involves swelling of the brain. Symptoms include:

extreme drowsiness
confusion and irritability
difficulty walking
Think of someone who has suffered trauma to the head. Leaking fluid causes the brain to swell. In the hospital, doctors insert a shunt in the brain to relieve that pressure. HACE is similar, and should not be taken lightly.

The other condition is high altitude pulmonary edema (HAPE). With HAPE, fluid builds up in the lungs. Symptoms include:

increased breathlessness during exertion
severe coughing; the person may spit up blood
weakness
Someone with HACE or HAPE must be moved. Quickly descend 2,000 to 3,000 feet; the lower the better. First aid steps follow the PROP formula:

Position: Get the person to find a position that gives them the most relief. This may be sitting rather than laying down.
Provide Reassurance
Oxygen: Provide oxygen if you have a tank
Positive Pressure Ventilation: Ambu (Artificial Manual Breathing Unit) bag or mouth to mouth

Along the way, make sure someone is calling for help. Those suffering from HACE and HAPE must get medical attention. Don’t wait it out hoping the condition will improve. HACE can literally be a killer.

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On the way down

Prepare properly for higher elevations

Several steps will minimize the onset of AMS.

If you are responsible for planning the trip, consider picking a campsite at a lower elevation. 7,500 feet can still provide a nice temperature relief from the desert heat in the summer.

Advise everyone before the trip of the expected altitudes and the symptoms of Mild AMS. Request that they make a self-evaluation of their fitness for the trip particularly if they have had a recent illness.

Climb slowly: If above 10,000 feet, limit your rate of ascent to 2,000 feet per day. Take a rest day every 2 -3 days.

Load up on carbs: A medical guide I have recommends a diet consisting of 70% carbs. Feel free to load up on the pastries and bread during breakfast. (Chow on a few energy bars during the day for good measure.)

Be mindful of your health: Have you experienced an upper respiratory condition recently? Perhaps you should avoid high altitudes for a while. Talk with your doctor if you have any concerns.

Stay briefly: Limit your experience at elevation to just an hour or two. Take some pictures, marvel at the scenery, then head back down. Campers and mountain climbers are more at risk than short-term visitors.

Pack cold-weather gear: This is for comfort in general. The temps are much lower at higher elevations. You may even encounter snow. Prepare for those conditions.

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