ITEM USE

2 Triangular Bandage w safety pins For splints, slings, and wound dressings.

1 Large Absorbent sterile dressing For big wounds

1 Roll of 1” adhesive trainers tape For wounds and support wrap

12 Butterfly adhesive strips For wound closure

6 Large band aids For skinned knees, etc.

4x6” Moleskin pad For blisters

3” Roll of “cling gauze” For bandaging

3” Ace bandage For sprained ankles/knees, wound compression

6 Antiseptic wipes For cleansing wounds

2 – 4x4” sterile gauze pads For small wounds

Aspirin For mild pain and headache

Rolaids or Tums For freeze-dried dinners

1 Duct Tape 5-10 feet Multiple Uses

1 Space type blanket Protection from elements, other

1 Large Leaf Bag Long list of Uses

-OBTAIN WILDERNESS FIRST AID TRAINING

-Keep bandaging material in a plastic zip lock bag

-Don’t pack items you don’t know how to use

-Keep commonly needed items in a belt pouch (including calories)

-Inspect kit prior to trip to check for expired meds and familiarization

-OBTAIN WILDERNESS FIRST AID TRAINING

-Keep track of things you wish you had, or those you wanted more of

-If nothing is sticking to your blisters, try tincture of benzoin

-Don’t stash you kit in the deepest reaches of your pack

-Ultimately, a 1st aid kit doesn’t save life and limb: it’s skill

-OBTAIN WILDERNESS FIRST AID TRAINING

Purpose of Trip: Technical climbing, river rafting, hiking, mountaineering

Destination: Terrain, altitude, weather, disease exposure, animal exposure, remote

Length of Trip: more blister supplies, more meds, etc.

Time for Evacuation or Medical Rescue: if any

Size of Party: Best to equip each member with their own 1st aid kit. If going solo, pack a lot more.

Level of Medical Training: Take a wilderness first aid course

Considerations:

What is the % of O2 at Sea Level?

At the summit of Mt Whitney?

At the summit of Everest?

29,000’ 33% of sea level

18,000’ 50% of sea level

8,000’ 75% of sea level

Sea Level 100% O2

What is the available % of O2 molecules at Sea Level?

Near the top of the Palm Springs Tram?

Near the summit of Orizaba?

At the summit of Everest?

ALTITUDE ILLNESSESALTITUDE ILLNESSES

•AMS

•HACE

•HAPE

•HAFE

•AMS

•HACE

•HAPE

•HAFE

EVAL

Tx

Mild Headache “Hangover” Decreased appetite Sleep Disturbance

Pain Meds Rest Day Food and Fluids Acetazolamide

Severe Headache Nausea / vomiting More AMS S/Sx

AMS Tx – PLUS Stop ascent Descend 2k-3k’ PRN to where sx started Acetazolamide

ICP S/Sx Ataxia finger/nose, walk a fine line) Severe Headache Decreased Alertness

DESCENT!!! Gamow Bag Dexamethasone Oxygen

AMS Mod HACE Severe HACE

EVAL

Tx

Mild Headache Fatigue Decreased appetite Sleep Disturbance

Pain Meds Rest Day Food and Fluids Acetazolamide Inhaled beta-agonists as prevention? Theophylline (apnea only)

Severe Headache Decreased exercise performance/increased recovery time Lassitude Persistent Dry Cough HR > 100 p 20min rest

AMS Tx – PLUS Stop ascent Descend 2k-3k’ PRN to where sx started

Ataxia, decreased LOC mental changes Dyspnea at rest Audible chest rales Blue nail beds and lips Pink/blood tinged sputum

DESCENT!!! Gamow Bag Nifedipine 20mg sustained release q8hr Oxygen

Mild HAPE Mod HAPE Severe HAPESALMETEROL FOR THE PREVENTION OF HIGH-ALTITUDE PULMONARY EDEMA

• Intestines equalizing to lower atomospheric pressure as individual ascends

• Low mortality – high morbidity

• Blunt trauma from tent partners

• Cold exposure from being thrown out of the tent.

HAFE

HAFE

“While not as catastrophic as barotrauma noras debilitating as HAPE (high altitude pulmonary

edema), HAFE nonetheless represents a significant inconvenience to those who prefer to hike in company. Some experience from recent

Everest expeditions suggests that the use of digestive enzymes and simethicone may minimize

the hazard.”

Auerbach, P: The Western Journal of Medicine

Fluids (4-5 quarts daily)

Climb high, sleep low

Avoid sedatives/alcohol (decreases ventilation at night and slows acclimitization)

Ascend slowly (acclimitization stops at moderate HACE, now must go below level of 1st sx)

High carb/low fat diet (add drink mixes to your water) a 70% carb diet can reduce AMS Sx by 30% while fat requires more oxygen to digest (but produces longer internal heat source if hypothermia is a greater risk)

Stay Healthy (even a cold can put you at risk)

GOLDEN RULE I. It is OK to get altitude illness. It is not OK to die from it.

GOLDEN RULE II. Any illness at altitude is altitude illness until proven otherwise.

GOLDEN RULE III. Never ascend with symptoms of AMS.

GOLDEN RULE IV. If you are getting worse, go down at once.

GOLDEN RULE V. Never leave someone with AMS alone.

AMS GOLDEN RULES

Snow Blindness

Amount of light in candelas / M2

Comfort Range 350 – 2000

Outdoor Meadow 3000 – 7000

Bright Beach 6000 – 15000

Snow Covered Slope 15000 – 30000

UVB exposure increases 8 – 10% per 1000’

Can occur within 20-60 minutes of exposure on a snow covered Whitney

Signs and Symptoms• Severe pain (but usually

6 – 12 hours after the exposure

• Severe gritty sensation• Photophobia• Tearing• Red eyes• Swollen eye lids• Tiny blisters• Future Problems -

Cataracts

Treatment• Avoid further exposure• Healing will occur

naturally in 24 – 72 hours• Remove contact lenses• Pain control (aspirin or

NSAID preferred for its anti-inflammatory properties), narcotics if necessary.

• Cold compresses• Patch eye(s) – inspect for

resolution every 12 hours

Sunglass Selection• UV Abosorption 100%• Visible light transmittance 5 – 10%• Lens MaterialLens Material Polycarb or CR – 39Polycarb or CR – 39• Optical Quality - Clear image without Optical Quality - Clear image without

distortion distortion • Frame DesignFrame Design - Large lenses, side - Large lenses, side

shields or wraparound design, fit close shields or wraparound design, fit close to face, good stability on face during movement, lightweight, durable.

• Lens Gray, Polarized

Cold Injuries -Frostnip / Frostbite

Generally doesn’t develop unless ambient temperature is 23 degress F or below (salinity of serum and internal heat keeps parts of body from freezing at 32 degrees), even in wind.

Once this temperature is reached wind, wetness, and contact with cold items will hasten onset of frostbite.

Can occur with temperatures above freezing (ie exposed hand in contact with snow while sleeping)

The presence or possibility of hypothermia should be an ever present concern.

Frostnip / Superfiscial Bite

Numbness

Erythema (redness)

White or yellowish plaque

Edema (swelling)

Occasional blue mottling

Skin insensate and firm with equal or diminished pliability

No tissue loss

Hallmark is reversible tissue injury

TREATMENT

Protect exposed areas from the environmentProtect exposed areas from the environment

Replace constricting, wet clothing with loose, dry onesReplace constricting, wet clothing with loose, dry ones

Warm hands in armpits and place feet against someone’s Warm hands in armpits and place feet against someone’s abdomen (a really good friend).abdomen (a really good friend).

Keep Hydrated and fed (food generates heat)Keep Hydrated and fed (food generates heat)

Avoid rewarming using campfire, car exhaust, or any Avoid rewarming using campfire, car exhaust, or any radiant heat (victim can’t feel a burn)radiant heat (victim can’t feel a burn)

Leave blisters intact.Leave blisters intact.

Do not massage – if ice crystals present you’ll make Do not massage – if ice crystals present you’ll make hamburger of the tissues.hamburger of the tissues.

IF you can measure water temperature, immerse affected IF you can measure water temperature, immerse affected part in gently circulating water 90 to 106 degrees F.part in gently circulating water 90 to 106 degrees F.

PREVENTION• Avoid fatigue and sleep loss• Maintain an adequate diet and hydration• Wear properly fitting, nonconstricting

clothing (particularly footgear)• Avoid alcohol and smoking• Avoid handling cold liquids or metals• Avoid over washing. Let natural oils build

up. Dry, cracked skin is more susceptible.

• Waterproof your boots• Carry extra socks• Don’t wear too many pairs of socks• Change into dry socks before going to

bed• Extra socks can double as mittens if

gloves are lost, damaged, or soaked.• Remove jewelry (rings, bracelets,

watches etc.) that can constrict blood flow AND pull away heat.

• Waterproof your boots• Carry extra socks• Don’t wear too many pairs of socks• Change into dry socks before going to

bed• Extra socks can double as mittens if

gloves are lost, damaged, or soaked.• Remove jewelry (rings, bracelets,

watches etc.) that can constrict blood flow AND pull away heat.

PREVENTION

Full thickness frostbite should not be Full thickness frostbite should not be treated in the field. treated in the field.

Full thickness would feel like frozen meatFull thickness would feel like frozen meat

If you can’t remember which to treat and If you can’t remember which to treat and which not to which not to think of SEXthink of SEX

“…“…if it’s hard, keep it hard….if it’s soft, if it’s hard, keep it hard….if it’s soft, warm it up”warm it up”

PREVENTION

SPF UVB ABSORPTION(%)

2 50

4 75

8 87.5

15 93.3

30 96.7

50 98

Using Sunscreens

-most people only apply 20-60% of the necessary dose.

-this provides a SPF of only about 5% regardless of the SPF rating

-On the other hand, applying 50% more than needed doubles the delivered SPF

-thus there is an advantage to using two sunscreens (ie. a base moisturizer and one with insect repellent).

Other Tips

-Tanning is actually an injury response to UV damage

-Even properly applied, sunscreen is only a supplement to covering up: there are many forms of protective clothing now available.

-Apply sunscreen about 15-30 minutes BEFORE exposure to permit absorption to the proper depth