Archive for the Technical Rescue Category

Quote of the Week – June 16th

Posted in Quote of the Week, Technical Rescue with tags , , on June 16, 2010 by The Beaver Medic

Scene assessment is a dynamic and continuous reevaluation.

This burn injury quote is the second from a great July, 2008 podcast by Dr. Jeffrey Guy. The first quote, posted the week of April 26th, was that what may present initially as a first degree burn today may be a third degree burn tomorrow. If you have not checked out this specific podcast I strongly encourage you to do so.

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Pathology of the Week – High-altitude illness

Posted in Neurological, Pathology of the Week, Respiratory, Technical Rescue with tags , , , on May 7, 2010 by The Beaver Medic

During the past few years I had the opportunity to learn mountaineering and ice/rock climbing from a few storied guides. I even got to climb one of Canada’s sixteen 10,000′-plus peaks. Although neither of us developed any form of high-altitude illness the trip prompted me to research the disease. High-altitude illness encompasses a group of acute pathologies which affect the bodies of individuals not accustomed to altitudes over 2,500m (8,202 feet) above sea level. These are acute mountain sickness (AMS), high-altitude cerebral oedema (HACE) and high-altitude pulmonary oedema (HAPE). AMS is far more common than HAPE and HACE with the latter two occurring in less than 0.1 to 4.0% of ascent cases. AMS equally affects both men & women as well as paediatric & adult patients. Strangely individuals over 50 seem to have a lower risk of developing AMS.  I will reference Basnyat & Murdoch, 2003 (free public access) as well as the Merck page on Altitude Sickness. See also BaseCamp MD.

Signs and Symptoms

Climbing Mt. Baldwin, summit: 10,682 ft

We in Canada actually contributed to the diagnosis of AMS!  The Lake Louise Consensus Group defines AMS as a new onset headache, in an unacclimatized person, who has recently travelled above 2500m as well as at least one of the following: fatigue, nausea, vomiting, loss of appetite, dizziness, and/or sleep disturbances. The symptoms typically begin 6 to 10 h after ascent and spontaneously subside after one to two days. Continue reading

Pathology of the Week – Rhabdomyolysis

Posted in Pathology of the Week, Renal, Technical Rescue with tags , , , on April 22, 2010 by The Beaver Medic

Medicalese: rhabdos – rod shaped; myo – related to muscle cells; lysis – break down of cells (greek for to separate). Short forms: rhabdo.

Rhabdomyolysis occurs when certain types of muscle cells (striated ones) break down allowing their contents to spill out into the bloodstream (the extracellular space). One of the contents of the cell is myoglobin which can damage a sensitive part of the kidneys called the tubules. The blood can handle some myoglobin floating around because it binds it to proteins which are too large to fit through the porous membranes of the glomeruli. When too much myoglobin is floating around in blood plasma not all of it becomes bound to protein and some passes into the sensitive renal tubules. A part of the myoglobin, heme, accumulates in the tubules and creates casts that cause tubule death and resultant acute renal failure. I will reference nephrologist Dr. Joel Topf’s 2009 case study as well as this 2000 Van Holder et al review (free public access). See also this physical therapist oriented video.

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“In god we trust, all others must bring data.”

Posted in Assessments / Interventions, Technical Rescue with tags , , , on March 27, 2010 by The Beaver Medic

The quote comes from a man named W. Edwards Deeming, a noted management expert circa 1950s. It sums the bane of my existence as an undergrad psychology student. If it cannot be studied, proven beyond a 5% reasonable doubt and peer reviewed then it ceases to exist. There is good reason for this strict empirical approach to research. Bad things can happen when we believe good public speakers with little evidence. Consider spinal immobilization.

Boarded until proven otherwise. Such is the attitude for most spinal immobilization training in the pre-hospital environment. If the mechanism of injury suggests potential spinal involvement we break out the velcro. If the Px thinks about the words pain and neck in the same sentence we lunge to take C-spine. Our otherwise stable Px with no neurological deficits is then tightly strapped onto a rigid backboard, hands and feet bound.

There is growing evidence which suggests this all-encompassing practice has evolved not from empirical research but from dogma and fear of litigation. Dr. John Burton, of the Albany Medical Centre, discussed the over utilization of spinal immobilization in a 2008 Podcast. Among his points was a candid look at the anatomy of a spinal injury.

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