Sawyer Products

There are numerous manufacturers and distributors of outdoor safety and first aid products. Over time, I will mention many of them, because their products are important for injury and illness prevention, or for treatment.

Sawyer Products has been in the outdoor safety business for quite some time, and its product line continues to be expanded and revised. I have had the good fortune to know Kurt Avery, the President of Sawyer Products, for many years, and have, like many other persons, been the beneficiary of Sawyer Product innovations in sunscreens, insect repellents, water filters, and other products.

I have no financial interest in the company, so there is no conflict of interest when I state that I am very pleased with the product line and recommend that readers check it out if in need of any of the following:

Sunblock, for example:

SPF 30 or 45 sunblock, which are advertised to be waterproof, sweat resistant, PABA free, and to provide both UVA and UVB protection. The active ingredients are octinoxate, octisalate, homosalate, and oxybenzone. You can purchase this at Recreational Equipment Incorporated (REI).

Stay-Put Sun Block, which carries a SPF 45 rating, and contains ethylhexyl p-methoxycinnamate, 2-ethylhexyl salicylate, oxybenzone, and titanium dioxide. It also provides UVA and UVB protection and is advertised to be moisturizing, yet waterproof.

Insect repellent products, for example:

Insect repellent for clothing, which comes in a pump spray bottle or aerosol cannister and contains 0.5% permethrin. This is meant to be applied to clothing in a pre-treatment, not to skin, in order to repel and kill insects and arthropods, such as mosquitoes and ticks.

Insect repellent treatment (solution) for clothing, which comes as a liquid for soaking clothing in a pre-treatment. This is advertised to be effective through six subsequent clothing washings.

"Controlled release" DEET (N,N diethyl-m-toluamide), which contains 20% DEET and deploys a "sub micron encapsulation" techology reputed to even out the evaporation rate of the active component.

An interesting product is Sun Block with Insect Repellent, which carries a rating of SPF 30 for the sun block and utilizes IR 3535 (ethyl butylacetylaminopropionate) as the repellent. It is advertised to repel insects for up to 8 hours.

There are many other items in the Sawyer Products repertoire, so I encourage you to visit the website.

Tags: permethrin,insect repellent,sun block, DEET, mosquito, Sawyer Products, wilderness medicine, outdoor medicine, healthline

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Thank You to Running A Hospital for Grand Rounds

Thank you to Paul Levy, President and CEO of Beth Israel Deaconess Hospital in Boston, for including my post about how to survive a wildfire within his blog Running A Hospital, which is the host blog for the latest edition of Grand Rounds. Running a hospital is a blog in which Mr. Levy regularly shares thoughts about hospitals, medicine, and health care issues. Grand Rounds is a weekly compilation of posts related to health care compiled by a host, who makes a great effort to compile an interesting collection for readers. Running A Hospital is always very thoughtful and informative, and this week is no exception.

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Mountain & Wilderness Medicine World Congress Abstracts Part 3

As I noted in my first post about the Mountain & Wilderness Medicine World Congress, sponsored by the Wilderness Medical Society and the International Society for Mountain Medicine in Aviemore, Scotland from October 3-7, 2008, there were many excellent abstracts presented. The following is the third installment of some of the more interesting of these:

Chronic mountain sickness (CMS) is a syndrome in which person who reside for prolonged periods at high altitude develop symptoms and features that include a very high red blood cell count, enlargement of the right side of the heart (because of pressure in the pulmonary [lung] arterial system), and less efficiency of breathing. In “Hypoxic and hypercapnic responses in chronic mountain sickness,” Fabiola Leon-Velarde notes that residents living above 3000 m ( ft) in the Andes breathe less compared to acclimatized (to the altitude) newcomers, but more than sea-level natives at sea level. He further notes that persons with CMS who reside at altitude breathe like sea-level natives (e.g., they breathe less than non-CMS-stricken individuals at altitude). In a limited study, he looked at the effect of acetazolamide (Diamox), which is commonly used to prevent and/or treat high altitude illness in persons acutely ascending to altitude), on breathing in CMS persons. The preliminary observation is that acetazolamide may stimulate breathing in CMS persons.

Evan Lloyd and colleagues described, “A portable airway warming kit for use in the field.” In their abstract, they note that when hypothermia is encountered in the field, the first priority is to provide insulation to prevent further heat loss. After insulation has been achieved, the major heat loss is through breathing, where the body inhales cold dry air and exhales warm moist air. They further note that while there are many ways of producing airway warming, the problem is to make equipment that can be readily used in the field. They propose a method that utilizes absorption of carbon dioxide (produced by the body) by soda lime in a compact, lightweight package – in their suggested configuration, weighing only 300 grams. An additional benefit for their system is that it can reduce the flow rate for oxygen administration from 8 to 10 liters per minute to ½ to 1 liter per minute.

There is ongoing discussion and controversy about the benefits and ethics of training in an environment of lower (than is present at sea level) oxygen content to improve performance in athletic competition. In “Application of intermittent hypoxication exposure (IHE) to improve rock climbing performance,” Audry Birute Morrison and colleagues used a specific 15-day protocol to investigate whether or not there would be improvement in sea level climbing to exhaustion in two different climbing conditions – on a 15-degree overhanging route and on a vertical route. While the subject numbers for the study were too low to draw any firm statistical conclusion, the preliminary results were felt to suggest that IHE can improve endurance time specific to climbing, particularly on vertical routes.

More abstracts to follow…

photo of Cairngorm autumn courtesy of www.ski-injury.com

Tags: Wilderness Medical Society, WMS, International Society for Mountain Medicine, mountain medicine, Aviemore, World Congress, wilderness medicine, outdoor medicine, healthline

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Surviving A Wildfire

There is a wildfire disaster occurring now in southern California, ranging from Solvang to the north to the Mexican border to the south, with at least 1,000 homes destroyed and hundreds of thousands of acres burning in and around San Diego alone. With the strong winds and dry weather, these fires may continue to rage for many days.

The following information was prepared by my friend Marty Alexander, who is a Senior Fire Behavior Research Officer with the Northern Forestry Centre of the Canadian Forest Service in Edmonton, Alberta, and senior author of the chapter entitled “Wildland Fires: Dangers and Survival” in the 5th edition of the textbook Wilderness Medicine. What follows is adapted from the citation, “Alexander ME, Surviving a wildfire entrapment or burnover. Canadian Silviculture August 2007:23.”

Would you know what to do if you were caught in a forest or grass fire? As we are all aware by the wildfires that are raging in California, the danger of being entrapped or burned over by a wildfire is a very real threat for people living, working, or visiting in rural areas and wildlands, as well as in the urban areas adjacent to wildlands. There are many actions that can be taken to protect a home against an approaching wildfire, but these powerful fires can rapidly overwhelm the best preventive efforts.

There are four main survival options if you ever become trapped by a wildfire:

• Retreat from the fire and reach a safe haven,
• Burn out a safety area,
• Hunker in place, or
• Pass through the fire edge into the burned-out area.

In considering these options, remember that the temperature of an approaching fire is sufficiently high to ignite a dwelling, so synthetic clothing (including undergarments) can readily melt and ignite.

A person’s initial reaction when faced with being entrapped or overrun by a wildland fire is to run, which is one of the available survival options - to retreat from the fire and reach a safe haven. A safe area is an area with light or
no fuels, such as a rocky surface, marshy area, large area of pavement, center of a sufficiently large body of water, or recently burnt area. This option only works if the distance between the fire and entry into the safety area
is short, the fire is advancing slowly, and it is easy to reach the safe area (e.g., there are no obstacles that would impede foot travel).

Fire travels more quickly than most people realize and can reach rates of 650 feet (approximately 200 meters) a minute (7 miles per hour, or approximately 12 kilometers per hour) in forests, and nearly twice this rate in grasslands. Even the fittest person cannot outrun a fire for long.

If there isn’t a safe area close by, another option is to burn out a safety area. Carrying wind-resistant matches is a good safety precaution when visiting, or if living in an area adjacent to, rural or wildland areas. This option only works well in a grassy area and when there is sufficient time to burn out a safety area. Burning away light fuels, such as grass, will provide a safe area for surviving being overrun by a wildfire. However, this option does not work well in forested locations because of the generally heavier fuel conditions, which in turn lead to prolonged smoldering combustion. This technique is not recommended to be used near a dwelling, because if the grassy area intentionally ignited is close to the dwelling (e.g., there is not a sufficient non-flammable safe zone around the dwelling), a wind shift can direct the flames onto the dwelling, and have precisely the opposite intended effect.

If you are caught in the open and about to be entrapped or burned over by a wildfire you may have no choice but to “hunker in place”. This involves trying to find an area that has little or no fuel - the bigger the better. It is important to lie completely flat, with your nose to the ground, while the fire is burning over and around you. Lying flat will minimize body exposure to radiant heat. If available, a fire-retardant blanket or shield is desirable.

Radiant heat is the “invisible heat” emitted from the flames of a fire. It will usually kill you long before flames directly reach you. When a fire passes over and around you, heating of body tissues from thermal radiation can be unbearable. Staying calm and not getting up until the fire has substantially dissipated is critical.

During the burnover, remember the following:

• Protect yourself from radiant heat at all costs
• Protect your airways from heat and minimize smoke exposure
• Try to stay as calm as possible

Although one will likely receive serious burns, many people have survived using this technique even under extremely arduous conditions. The alternative is almost certain death. People commonly use their hands to protect parts of the body from radiant heat - especially the face, neck, and ears. Thus, wearing leather gloves will decrease the severity of the burns suffered by the hands and in turn lessen the tendency to get up and aimlessly run about. Survivors of entrapments and burnovers have commonly concentrated on thinking about their family in order to get through the ordeal.

The fourth option to escape an entrapment or burnover by a wildland fire is to pass through the fire edge into the burned-out area. Generally, this technique should not be attempted if the flames are more than about 5 feet (approximately 1.5 meters) in height or depth. While running through the flame front of a fire is considered dangerous, people have survived by picking their spots and avoiding areas of intense or confluent flame development.

The survival options as outlined here are not presented in any particular order. Circumstances may dictate that you try more than one or all of them. Wildland fires are precarious phenomena and each situation is different. Use the best option that will, ultimately, get you out alive. Don’t ignore the obvious - safety could be nearby.

photo from the Los Angeles Times

Tags: wildfire, fire, fire survival, survival, wilderness medicine, outdoor medicine, healthline

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Acetazolamide (Diamox) to Reduce the Symptoms of High Altitude Illness

I’m very often asked about the role of acetazolamide (Diamox) in reducing the symptoms of high altitude. Acetazolamide (Diamox) can be a very useful drug to diminish or prevent acute mountain sickness (AMS). It stimulates breathing, which diminishes the sleep disorder associated with AMS. This enables the body to adjust (acclimatize) more rapidly to high altitude, and increases the amount of oxygen that gets into the bloodstream during sleep. It can also be used to treat mild AMS (headache, fitful or disturbed sleeping, fatigue, loss of appetite, nausea, dizziness, drowsiness). However, it is very important to be aware of acetazolamide-induced side effects, which include increased urination (the drug is a diuretic and can induce dehydration), numbness and tingling of the hands and feet on exposure to rapid temperature change, and altered taste of carbonated beverages – you can taste the carbon dioxide bubbles, and they are bitter.

I take acetazolamide with me when I ascend to high altitude, because I am prone to mountain sickness when I get above 10,000 feet. In Nepal, I noticed that when I washed my hands in hot water in the morning while in a frigid environment, the numbness and tingling were so bad that I developed spasm of my fingers, hand, and wrist muscles. Also, the beer didn’t taste very good. (I only tasted it – we weren’t allowed to drink alcohol during ascent and until after we were acclimatized at the highest altitude where we were intended to sleep.) The dehydration can sneak up on a person, so it’s important to drink lots of liquids and observe copious output of clear (non-concentrated), light-colored (not dark yellow) urine.

The most important aspect of this discussion is recognition that high altitude illness is probably more common than we suspect. Any person traveling from low altitude (usually, sea level) to an altitude at or above 6,000 feet (1,830 meters) should anticipate the possibility of high altitude ilness, specifically acute mountain sickness (AMS). I have recently heard of a few persons who reported symptoms, including headache and nausea, that appeared to have been caused by rapid ascent to altitudes as low as 4,500 feet (1,372 meters), so they might also be amenable to acetazolamide use if their affliction is recurrent. Please remember - ascend slowly, stay well hydrated, and gradually increase your exertion when traveling to high altitudes.

Tags: high altitude, acetazolamide, medical, Diamox, acute mountain sickness, wilderness medicine, outdoor medicine, healthline

photo by Janice Weixelman

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Mountain & Wilderness Medicine World Congress Abstracts Part 2

As I noted in my first post about the Mountain & Wilderness Medicine World Congress, sponsored by the Wilderness Medical Society and the International Society for Mountain Medicine in Aviemore, Scotland from October 3-7, 2008, there were many excellent abstracts presented. The following are mentions of more of these:

A large proportion of the indigenous and traveling populations in South America chew or drink a tea of the coca leaf to abate the symptoms of altitude sickness. In “An investigation into the use of coca for altitude sickness,” Robert Conway and colleagues performed a survey to attempt to determine if a traveling population from the West to Peru or Bolivia had knowledge of coca and/or used coca tea to prevent or treat altitude sickness. While they were able to gather responses that might indicate (1) that there may be a trend toward higher does of coca tea being associated with less mountain sickness (an effect not associated with chewing the leaf), and (2) that there does not appear to be an addiction to the leaf in the quantities taken, the project failed to find sufficient significant evidence to support the hypothesis that coca is protective or an effective treatment for altitude sickness. It is possible that a randomized, blinded study with sufficiently high numbers of individuals might determine different conclusions.

One abstract was an announcement by Chris Smith and Denzil Broadhurst from Medex and Medical Expeditions that the “Travel at High Altitude” booklet, written for laypersons, is now available. The booklet may be downloaded free of charge from the Medex website. It is intended to be relevant to all persons who might travel to high altitude – family holidays, adventure challenges, and expeditions. It covers the world’s high altitude regions, altitude related illnesses, things to do before traveling, and what to do once at altitude.

Persons with diabetes may wish to travel to high altitudes. Depending on the type and severity of diabetes, a diabetic may need to self-inject with insulin. In “Acute hypobaric hypoxia does not affect the insulin requirement in well-controlled diabetics,” Xonzita Leal and colleagues investigated a small number of type 1 diabetics. Using a hypobaric pressure chamber to experimentally increase the altitude to the equivalent of 5,000 meters (16,400 ft) for a few hours, the study subjects were evaluated for levels of body chemistries and hormones to determine if the effects of insulin were different than those observed at sea level. No significant differences were found in any of the parameters measured between a condition of normal oxygen content in the blood and lowered oxygen content (due to the simulated ascent). The investigators very importantly noted that the study has an important limitation imposed by its design, in that the exposure to hypoxia was intense and of a brief duration, so can not be extrapolated to a real mountain situation, where there are additional variables of diet, exercise, individual acclimatization, cold, and fatigue. I very much agree – until a study is done that realistically approximates the true alpine environment for a much longer period of time, no effective clinical conclusion should be drawn about insulin requirement at altitude.

Dominique Jean and colleagues reported on “Climbing Everest with type 1 diabetes.” This account of a single well-trained and experienced climber who lead his expedition without any adverse medical event, maintaining excellent glycemic control. There does not appear to be any a priori reason why diabetes should preclude a person from high altitude adventures, although as the presenters noted, all cases should be individualized.

More abstracts to follow…

photo of bagpiper courtesy of www.alumni.buffalo.edu

Tags: Wilderness Medical Society, WMS, International Society for Mountain Medicine, mountain medicine, Aviemore, World Congress, wilderness medicine, outdoor medicine, healthline

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Thank You to NY Emergency Medicine for Grand Rounds

Thank you to NY Emergency Medicine for publishing my post about the territoriality of fishes in the latest edition of Grand Rounds. Grand Rounds is a weekly compilation of posts related to health care compiled by a host, who makes a great effort to create an interesting collection for readers. This week's theme is emergencies, and it makes for very interesting reading.

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The Territoriality of Fishes

A reader commented in response to my post about triggerfish bites, "Well, it certainly wasn't the fish pictured here that produced the bite....look at her, so innocent. Why her picture just screams 'Who me? I didn't do anything.'" This raises the important issue of wild marine animals versus domesticated animals, and how their behaviors differ. From wilderness medicine and emergency medicine perspectives, this is quite important, because animal bites are a common cause of medical emergencies.

Wild animals are often characterized as "unpredictable." They are, of course, very predictable with regard to many behaviors, such as predation, mating, feeding, migration, physical development, and so forth. What most people mean when they invoke the "unpredictable" moniker is that, no matter how tame or friendly a wild animal may appear, it is nearly impossible to predict when it make become hostile toward humans. We are very familiar with episodes in which tamed animals, such as big cats, have turned on their trainers, brutally attacking them and inflicting serious, sometimes, fatal, injuries.

Many animals have territories (areas) that they protect. These range from the immediate vicinity when they are feeding to an extended area when guarding their young. Some animals display threat gestures, such as puffing out skin, displaying colorful plumage, changing colors, erecting fur, growling, or barking. Others appear unperturbed until the moment that they charge and attack the perceived threat.

In the marine environment, some animals are "territorial." The triggerfish falls into this category when guarding a "nest." Other animals, such as mantis shrimp, will become aggressive if their domiciles are approached. Seemingly friendly animals, such as schooling dolphins, will occasionally become defensive and actively seek to repel invaders.

Animals raised in captivity or trained from infancy are more likely to be tolerant of humans and to accept their intrusion. Over time, wild animals can become habituated to human presence, but that should not be equated with transforming them into household pets. While stingrays handled repeatedly in a location like "Stingray City" in the Cayman Islands may carry a lower incidence of defensive attacks upon humans, they have the potential to inflict nasty stings, and have bitten more than a few persons who placed body parts close to their mouths. Sharks can become accustomed to being fed by humans and thereby not be as prone to flee in their presence, but under no circumstance should that be interpreted to mean that they will not attack given the appropriate stimulus.

One should adhere to the usual rules for avoiding unnecessarily injurious encounters with wild marine animals:

1. Never corner an animal in such a manner that it does not have an easy escape route.
2. Do not handle animals. Do not attempt to ride upon animals.
3. Do not flash bright lights in the eyes of animals.
4. Do not tempt animals with food products.
5. Do not come between a mother and its young.
6. Do not interrupt an animal when it is feeding.
7. Do not reach blindly into holes and crevices.
8. If it is necessary to settle on the bottom (e.g., upon sand or rocks), take great care to inspect the area carefully so that you do not inadvertently trod upon a stingray, scorpionfish, or other animal with venomous spines.
9. When removing a captured marine animal from a net or a hook, take extreme care. The animal will often struggle with great strength.
10. Do not put your fingers anywhere near the mouth of a fish or other marine creature. Some of these animals have razor-sharp teeth or crushing grinding plates.

photo copyright Peter Lange at www.ecodivers.com

ags: fishes,marine attack, wilderness medicine, outdoor medicine, healthline

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Mountain & Wilderness Medicine World Congress

I just returned from Aviemore, Scotland, where I attended the Mountain & Wilderness Medicine World Congress, sponsored by the Wilderness Medical Society and the International Society for Mountain Medicine. I have been to many similar meetings over the past three decades, and I cannot recall a more interesting and informative gathering. The experts gathered to present their knowledge and experience were nothing less than phenomenal. Furthermore, we were hosted by the Highland Council and Cairngorms National Park Authority, which treated us to a traditional opening performance by a Scottish bagpiper, drummer and dancer, and then a delightful reception. The closing dinner was emotional and uplifting, featuring presentation of the World Congress Awards to Doctors Jim Milledge from the United Kingdom and Robert “Brownie” Schoene from the United States. Each has made extremely essential contributions to our understanding of high altitude physiology and medicine, and more important, continue to serve as inspirational role models and mentors to researchers, doctors, and explorers. The dinner was festive indeed, as we clapped in rhythm to the traditional march of a kilted Scotsman who ceremonially presented the haggis, toasted old and new friends with superb single malt scotch donated by the nearby Dalwhinnie distillery, and did our best to keep up with the young medical students as they danced with exuberance during the Ceilidh.

The educational sessions were too numerous to mention here, but here are some of the highlights: low altitude medical problems at high altitude; high altitude training for the competitive athlete – pros, cons, and individual differences (including a discussion about whether or not this practice should be banned); diving medicine – a North Sea perspective; the brain at altitude; the lungs at altitude; history of mountain medicine; hypothermia; update on frostbite; education in wilderness and mountain medicine; extreme altitude and the Caudwell Xtreme Everest expedition; medical problems of mountain guides and porters; infectious diarrhea; controversies with commercial expeditions; mountain rescue; cave rescue; anthropology, physiology, and illness in the Andes: youth expeditions; creating accessible challenge with disabled adventurers; avalanche rescue; wilderness dentistry; and a remarkable presentation about climate change and social problems observed within Inuit communities during a kayak adventure into the Northwest Passage.

As has been the case at previous wilderness medicine world congresses, there were quite a few scientific abstracts presented. Beginning with this post and a few subsequent posts, I will report to you some of what we learned from the abstract presentations.

In “Observation on ultra-microstructure of chorionic villi of placenta in low birth weight neonate in high-altitude districts,” Xin-Hua Bai and colleagues described the observation that low oxygen environments in high-altitude districts may be linked to low weight at birth, correlated with demonstrable changes in the size and structure of the placenta, which indicate that the placenta may not function differently than it does at lower altitudes.

A persistent difficulty in high altitude research is that quantifying subjective symptoms of acute mountain sickness (AMS) is difficult, due to variability in interpretation of questions asked to victims. The most commonly used method, the Lake Louise Consensus Questionnaire, allows determination of a diagnostic threshold for symptons, but does not provide for sensitive comparisons of symptom severity. In “Characterisation of the symptoms of acute mountain sickness using a seven-part visual analogue scale,” J. Kenneth Baillie and colleagues described a visual analogue scale (VAS) in comparison to the Lake Louise Score (LLS). They noted that the VAS and LLS did not correlate well, and felt that the VAS would be at least as good, if not better than the LLS, in that it was reproducible and did quite well in the areas of identifying an incriminating headache, observation that “I feel my worst,” and to a certain extent, difficulty with sleep.

Baillie and colleagues also presented an abstract entitled “Oral antioxidant supplementation does not prevent acute mountain sickness.” Their research was based on the notion that reactive oxygen species may have an effect on the blood-brain barrier that would allow fluid to leak into brain tissue, thus perhaps causing the symptoms of AMS. To investigate this notion, they compared a treatment group that ingested a daily dose of antioxidants (including ascorbic acid, tocopherol acetate, and lipoic acid) with a control group that ingested a placebo, during an expedition to 5200 meters (17,056 feet). There was not difference in AMS incidence or severity between the treatment and placebo groups.

More abstracts to follow…

photo of loch from summit of Cairn Gorm by Armin Grewe

Tags: Wilderness Medical Society, WMS, International Society for Mountain Medicine, mountain medicine, Aviemore, World Congress, wilderness medicine, outdoor medicine, healthline

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High Altitude Medicine and Physiology

Three wonderful physicians and high altitude medicine and physiology experts, with whom I just completed a delightful week in Scotland teaching and studying wilderness and mountain medicine, Drs. John B. West, Robert B. Schoene, and James S. Milledge, have recently published the 4th edition of High Altitude Medicine and Physiology (Hodder Arnold, 2007), which is a definitive text on the subject. Given the increasing rate at which persons are attaining summits, including, of course, Mt. Everest, and the popularity of high altitude recreation, such as skiing and trekking, the more we can learn about the medical concerns of high altitude, the better.

The authors of this book are not merely doctors. Each has been a mountaineer and explorer, so they write from first-hand experience. These are the world's experts, and I admit, my role models in so many ways. Therefore, it is an honor to review (and recommend) this book. It is not a volume written for laypeople, but I believe it would be of great interest to anyone with an interest in the technical aspects of how the human body adapts and responds to high altitude.

Attaining the fourth edition of a book is no mean feat. Compared to the previous edition, this book contains major updates to scientific content, increased coverage of genetics and advances in molecular biology and medicine, and additional tables summarizing features and treatments of important high-altitude diseases. The authors point out that they have also worked diligently to update coverage on women and children at high altitude, neurological disorders at high altitude, athletic training using high altitude, recent work on high altitude pulmonary edema, and the problems of persons with existing diseases who plan to go to high altitude. To make space for all of the improvements with creating a significantly larger book, they trimmed certain discussions, such as cold injury. The book is very appropriately dedicated to Michael Ward, who for many years was a pillar of the mountain medicine community, and who served as the lead author of the previous three editions of this book.

As Editor of a larger volume entitled Wilderness Medicine, I rely upon the expertise and wisdom that emanates from books such as High Altitude Medicine and Physiology. The coverage in this volume is extensive and, for a wilderness medicine enthusiast such as me, quite fascinating. I am particularly appreciative for the innovative discussions of such topics as "History," "Commuting to high altitude for commercial and other activities," "Athletes and altitude," and "Practicalities of field studies." The book is adequately illustrated and well organized. The litmus test question is whether it is sufficiently improved over the previous edition to warrant its purchase. In my opinion, the answer is a resounding, "Yes!"

Tags: High Altitude Medicine and Physiology,high altitude, wilderness medicine, outdoor medicine, healthline

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Killer Bees in New Orleans

Africanized honey bees ("killer bees") have been identified in New Orleans, the furthest east that they have been found in the state of Louisiana. This is not an unexpected event, as this variety of stinging insect appears to be spreading across the United States and will likely eventually reside across the entire nation, unless contained by some environmental factor.

“Killer bees” are an Africanized race of honeybees created by interbreeding of the African honeybee Apis mellifera scutellata (brought for experiments into Brazil) with common European honeybees. The hazard from these bees is that they tend to be more irritable, sense threat at a distance greater than their European counterparts, swarm more readily, defend their nests more aggressively and stay agitated around the nest for days, and impose mass attacks upon humans. The venom of an Africanized bee is not of greater volume or potency than that of a European honeybee. However, the personality of the Africanized bees is such that they may pursue a victim for up to 2/3 mile (1 km), and may recruit other attacking bees by the hundreds or thousands. A victim may be stung 200 to more than 1,000 times; it is estimated that 500 stings achieves the lethal threshold. The bees unfortunately appear to be adapting to colder temperatures.

The sting mechanism for a honeybee is composed of a doubly barbed stinger attached to a venom sac that pumps venom into the victim. When the bee attempts to escape after a sting, the stinger and sac remain in the victim (this kills the bee) and continue to inject venom. Thus, the honeybee can sting only once, whereas a wasp, with a smooth stinger that does not become entrapped, can sting multiple times, as can yellow jackets, hornets, and bumblebees.

Pain from a bee, wasp, or hornet sting is immediate, with rapid swelling, redness, warmth, and itching at the site of the sting. Blisters may occur. Sometimes the victim will become nauseated, vomit, and/or suffer abdominal cramping and diarrhea. If the person is allergic to the insect venom, a dangerous reaction may follow rapidly (within minutes, but occasionally delayed by up to 2 hours). This consists of hives, shortness of breath, difficulty breathing, swelling of the tongue, weakness, vomiting, low blood pressure, and collapse. People have swallowed bees (undetected in beverage bottles) and sustained stings of the esophagus, which are enormously painful.

photo courtesy of library.thinkquest.org

Tags: bees, insect, killer bees, Louisiana, wilderness medicine, outdoor medicine, healthline

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