Additional Information
Book Details
Abstract
Quickly and decisively manage any medical emergency you encounter in the great outdoors with Wilderness Medicine! World-renowned authority and author, Dr. Paul Auerbach, and a team of experts offer proven, practical, visual guidance for effectively diagnosing and treating the full range of emergencies and health problems encountered in situations where time and resources are scarce. Every day, more and more people are venturing into the wilderness and extreme environments, or are victims of horrific natural disasters...and many are unprepared for the dangers and aftermath that come with these episodes. Whether these victims are stranded on mountaintops, lost in the desert, injured on a remote bike path, or ill far out at sea, this indispensable resource--now with online access at www.expertconsult.com for greater accessibility and portability-- equips rescuers and health care professionals to effectively address and prevent injury and illness in the wilderness! This textbook is widely referred to as "The Bible of Wilderness Medicine."
- Be able to practice emergency medicine outside of the traditional hospital/clinical setting whether you are in remote environments, underdeveloped but highly populated areas, or disaster areas, are part of search and rescue operations, or dealing with casualties from episodes of extreme sports and active lifestyle activities.
- Face any medical challenge in the wilderness with expert guidance: Dr. Auerbach is a noted author and the world's leading authority on wilderness medicine. He is a founder and Past President of the Wilderness Medical Society, consultant to the Divers Alert Network and many other agencies and organizations, and a member of the National Medical Committee for the National Ski Patrol System.
- Handle everything from frostbite to infection by marine microbes, not to mention other diverse injuries, bites, stings, poisonous plant exposures, animal attacks, and natural disasters.
- Grasp the essential aspects of search and rescue.
- Respond quickly and effectively by improvising with available materials.
- Improve your competency and readiness with the latest guidance on volcanic eruptions, extreme sports, splints and slings, wilderness cardiology, living off the land, aerospace medicine, mental health in the wilderness, tactical combat casualty care, and much more.
- Meet the needs and special considerations of specific patient populations such as children, women, elders, persons with chronic medical conditions, and the disabled.
Make smart decisions about gear, navigation, nutrition, and survival.
- Be prepared for everything with expanded coverage on topics such as high altitude, cold water immersion, and poisonous and venomous plants and animals.
- Get the skills you need now with new information on global humanitarian relief and expedition medicine, plus expanded coverage of injury prevention and environmental preservation.
- Get guidance on the go with fully searchable online text, plus bonus images, tables and video clips - all available on ExpertConsult.com.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front cover | cover | ||
| Wilderness Medicine, 6/e | i | ||
| Copyright page | iv | ||
| Contributors | v | ||
| Foreword | xv | ||
| Preface | xix | ||
| Table of Contents | xxi | ||
| Video Contents | xxiv | ||
| Photo credits for cover images and part openers | xxv | ||
| 1 Mountain Medicine | 1 | ||
| 1 High-Altitude Medicine and Physiology | 2 | ||
| The Population | 2 | ||
| Definitions | 2 | ||
| High Altitude (1500 to 3500 m [4921 to 11,483 Feet]) | 2 | ||
| Very High Altitude (3500 to 5500 m [11,483 to 18,045 Feet]) | 2 | ||
| Extreme Altitude (HIGHER THAN 5500 m [18,045 Feet]) | 2 | ||
| The Environment of High Altitude | 2 | ||
| Acclimatization to High Altitude | 2 | ||
| Ventilation | 3 | ||
| Circulation | 4 | ||
| Systemic Circulation | 4 | ||
| Pulmonary Circulation | 5 | ||
| Cerebral Circulation | 5 | ||
| Blood | 5 | ||
| Hematopoietic Responses to Altitude | 5 | ||
| Oxyhemoglobin Dissociation Curve | 5 | ||
| Tissue Changes | 6 | ||
| Sleep at High Altitude | 6 | ||
| Periodic Breathing | 7 | ||
| Pharmaceutical Aids | 8 | ||
| Exercise | 8 | ||
| Training at High Altitude | 8 | ||
| High-Altitude Syndromes | 9 | ||
| Neurologic Syndromes | 9 | ||
| Acute Cerebral Hypoxia | 9 | ||
| High-Altitude Headache | 10 | ||
| Acute Mountain Sickness | 11 | ||
| Epidemiology and Risk Factors | 11 | ||
| Diagnosis | 12 | ||
| Differential Diagnosis | 12 | ||
| Pathophysiology | 13 | ||
| Brain Swelling in AMS. | 13 | ||
| Intracranial Pressure and AMS. | 14 | ||
| The Tight-Fit Hypothesis and AMS. | 14 | ||
| New Concepts. | 14 | ||
| Natural Course of Acute Mountain Sickness | 14 | ||
| Treatment | 14 | ||
| Prevention | 15 | ||
| Acetazolamide Prophylaxis. | 16 | ||
| Dexamethasone Prophylaxis. | 17 | ||
| Other Agents for AMS Prevention. | 17 | ||
| High-Altitude Cerebral Edema | 17 | ||
| 2 Cold and Heat | 103 | ||
| 4 Thermoregulation | 104 | ||
| Conceptualizing the Thermoregulatory System | 104 | ||
| Basics of Core Temperature | 104 | ||
| Consequences of Altered Core Temperature | 105 | ||
| Monitoring the Temperature of the Core and Other Sites | 105 | ||
| Monitoring the Core Temperature | 105 | ||
| Measuring Instruments | 105 | ||
| Measurement Sites | 106 | ||
| Estimating Mean Body Temperature | 106 | ||
| Physical Factors That Govern Heat Exchange: The Heat Balance Equation | 107 | ||
| Conductive Heat Exchange | 107 | ||
| Convective Heat Exchange | 107 | ||
| Radiative Heat Exchange | 107 | ||
| Evaporative Heat Exchange | 108 | ||
| Thermoregulatory Network | 108 | ||
| Peripheral Thermal Sensors | 108 | ||
| Central Thermal Sensors | 109 | ||
| Regulator | 109 | ||
| Effector Responses | 110 | ||
| Vascular Adjustments | 110 | ||
| 3 Burns, Fire, and Radiation | 239 | ||
| 12 Wildland Fires: | 240 | ||
| Wildland Fire Management and Technology | 241 | ||
| Wildland Fire Management Policies | 242 | ||
| Prescribed Fire And Wildland Fire Use | 243 | ||
| Wildland–Urban Interface: New Look of a Historical Problem | 244 | ||
| Nature Of The Problem | 244 | ||
| Wildland Fire Lessons | 250 | ||
| What Some Organizations Have To Offer | 250 | ||
| Fire Behavior | 251 | ||
| Urban And Wildland Fire Threats | 251 | ||
| Fire Behavior Knowledge: A Wildland Fire Early-Warning System | 252 | ||
| Physical Principles of Heat Transfer | 252 | ||
| Fundamental Wildland Fire Behavior Characteristics | 254 | ||
| Environmental Factors Influencing Wildland Fire Behavior | 254 | ||
| Fuel. | 255 | ||
| Weather. | 256 | ||
| Topography. | 257 | ||
| Extreme Fire Behavior | 258 | ||
| Wind-Driven Crown Fire. | 260 | ||
| Plume-Dominated or Convection-Dominated Crown Fire. | 260 | ||
| Value of Fire Danger Ratings | 260 | ||
| Fire-Related Injuries and Fatalities | 261 | ||
| Common Denominators Of Fire Behavior On Fatality Fires | 262 | ||
| Nature Of Injuries And Fatalities | 263 | ||
| Wildland Fires, Air Toxins, And Human Health | 264 | ||
| Wildland–Urban Interface Fire Survival Principles and Techniques | 265 | ||
| Lces: The Key To Safe Procedures In Wildland Fire Environments | 266 | ||
| Eighteen “Watch Out!” Situations in the Wildland Fire Environment | 267 | ||
| Fifteen Structural “Watch Out!” Situations for the Wildland–Urban Interface | 267 | ||
| Taking Refuge In Vehicles, Buildings, And Protective Fire Shelters Used By Wildland Firefighters | 268 | ||
| Vehicles | 268 | ||
| Buildings | 269 | ||
| Protective Fire Shelters Used By Wildland Firefighters | 270 | ||
| Emergency Procedures During A Wildland Fire Entrapment Or Burnover | 272 | ||
| Survival Option 1: Retreat From the Fire and Reach a Safe Haven | 273 | ||
| Survival Option 2: Burn Out a Safety Area | 274 | ||
| Survival Option 3: Hunker in Place | 274 | ||
| Survival Option 4: Pass Through the Fire Edge Into the Burned-Out Area | 274 | ||
| Wildland Fires and Human Behavior | 275 | ||
| Proper Clothing | 277 | ||
| Water Intake | 277 | ||
| Personal Gear | 277 | ||
| How To Report A Wildland Fire To Local Fire Protection Authorities | 277 | ||
| Portable Fire Extinguishers | 278 | ||
| Basic Wildland Fire Materials, Training Courses, And Other Information Resources | 278 | ||
| Concluding Remarks | 279 | ||
| Acknowledgments. | 280 | ||
| References | 280.e1 | ||
| References | 280 | ||
| 13 Emergency Care of the Burned Victim | 280 | ||
| Epidemiology | 280 | ||
| Physiology | 280 | ||
| Types of Burns | 281 | ||
| Scald Burns | 281 | ||
| Flame Burns | 281 | ||
| Flash Burns | 281 | ||
| Contact Burns | 282 | ||
| Electrical Burns | 282 | ||
| Chemical Burns | 282 | ||
| Clinical Presentation | 282 | ||
| Estimation Of Burn Size | 282 | ||
| Depth Of Burn | 283 | ||
| First-Degree Burns | 284 | ||
| Superficial Partial-Thickness Burns | 284 | ||
| Deep Partial-Thickness Burns | 284 | ||
| Full-Thickness Burns | 284 | ||
| Fourth-Degree Burns | 284 | ||
| Treatment | 285 | ||
| Care At The Scene | 285 | ||
| Flame Burns | 285 | ||
| Scalds and Grease Burns | 285 | ||
| Airway | 285 | ||
| Other Injuries and Transport | 285 | ||
| Cold Application | 285 | ||
| Swelling | 285 | ||
| Electrical Burns | 285 | ||
| Chemical Burns | 285 | ||
| First Aid at the Scene for Smaller Burns | 286 | ||
| Technique of Burn Wound Debridement. | 286 | ||
| Emergency Department Care | 287 | ||
| Resuscitation | 287 | ||
| Escharotomy | 288 | ||
| Burn Wound Management | 289 | ||
| Outpatient Burns | 289 | ||
| First-Degree Burns | 289 | ||
| Superficial Partial-Thickness Burns | 289 | ||
| Deep Partial-Thickness and Full-Thickness Burns | 289 | ||
| Rehabilitation | 290 | ||
| Inhalation Injury | 290 | ||
| Carbon Monoxide Poisoning | 290 | ||
| 4 Injuries and Medical Interventions | 333 | ||
| 16 Injury Prevention: | 334 | ||
| Principles of Wilderness Injury and Prevention | 334 | ||
| The Injury Field: Basic Principles | 334 | ||
| The Continuum of Injury Prevention | 335 | ||
| Epidemiologic Factors: Human or Host, Agent, and Environment | 335 | ||
| Conceptual Models | 335 | ||
| Haddon’s 10 Strategies for Reducing Injuries | 335 | ||
| Environmental, Educational, and Enforcement Approaches to Injury Prevention | 335 | ||
| Environmental Approach | 336 | ||
| Educational Approach | 336 | ||
| Enforcement Approach | 336 | ||
| Social-Ecologic Model | 336 | ||
| Risk and Effect Modification in Injury Prevention Epidemiology | 337 | ||
| Active Versus Passive Injury Prevention Strategies | 337 | ||
| Morbidity and Mortality Statistics for Wilderness Injury | 337 | ||
| Putting Injury Prevention into Practice | 337 | ||
| Planning | 337 | ||
| Preparation | 338 | ||
| Physical Preparation. | 338 | ||
| Mental Preparation. | 338 | ||
| Equipment Preparation. | 338 | ||
| Problem Anticipation | 338 | ||
| Physical Disabilities (see Chapter 102) | 338 | ||
| Individual Factors and Injury Prevention | 338 | ||
| Specific Tools for Planning and Preparation in the Wilderness | 338 | ||
| Maps and Orienteering | 338 | ||
| Global Positioning System Devices | 339 | ||
| Communication Devices | 339 | ||
| Protective Gear | 340 | ||
| Clothing. | 340 | ||
| Foot and Hand Wear. | 340 | ||
| Helmets. | 341 | ||
| Goggles. | 341 | ||
| Body Armor. | 341 | ||
| Mouth Guards. | 342 | ||
| Avalanche-Specific Protective Gear. | 342 | ||
| Training and Education | 342 | ||
| Supervision and Buddy Systems. | 342 | ||
| Problem Anticipation: Acute Illness and Injury | 343 | ||
| First-Aid Training. | 343 | ||
| Medical Clearance. | 344 | ||
| Vaccinations and Prophylaxis. | 344 | ||
| First-Aid/Emergency Medical Supplies. | 344 | ||
| Medications. | 344 | ||
| Improvisation in Treatment. | 344 | ||
| Injury Prevention for the Genitourinary Tract. | 344 | ||
| Injury Prevention for the Feet. | 344 | ||
| The Physical Environment and Injury Prevention | 345 | ||
| Ultraviolet Exposure | 345 | ||
| Temperature Extremes | 345 | ||
| Cold Injury | 345 | ||
| Heat Illness | 346 | ||
| Immersion (Trench) Foot and Pernio (Chilblains) | 346 | ||
| Wind and Rain | 346 | ||
| Water | 347 | ||
| Snow | 349 | ||
| Hydration | 349 | ||
| Altitude | 350 | ||
| Bites and Stings | 350 | ||
| Toxic Exposures | 352 | ||
| Water, Germs, and Hygiene | 352 | ||
| Unique Risks of Select Wilderness Activities | 352 | ||
| Backpacking | 352 | ||
| Backpacks With External Frames | 353 | ||
| Backpacks With Internal Frames | 353 | ||
| Backpack Lifting | 353 | ||
| Backpacks and Children | 353 | ||
| Hiking | 353 | ||
| Hammock Safety | 353 | ||
| Hunting | 353 | ||
| Horseback Riding | 353 | ||
| Climbing | 354 | ||
| References | 354.e2 | ||
| References | 354 | ||
| 17 Principles of Pain Management | 354 | ||
| Anatomy and Physiology of Acute Nociceptive Pain | 354 | ||
| Pain Measurement | 355 | ||
| Types of Pain | 355 | ||
| Pretravel Preparation | 356 | ||
| Treatment Modalities | 356 | ||
| Physical Modalities | 356 | ||
| Compression Analgesia | 356 | ||
| Topical Therapies | 357 | ||
| Regional Therapy | 357 | ||
| Trigger Point Injections | 357 | ||
| Nerve Blocks | 357 | ||
| Axillary Block | 358 | ||
| Wrist Block | 358 | ||
| Digital Block | 358 | ||
| Femoral Block | 358 | ||
| Common Peroneal Block | 359 | ||
| Ankle Block | 359 | ||
| Systemic Therapy | 360 | ||
| Opioids | 360 | ||
| Nonsteroidal Antiinflammatory Drugs | 360 | ||
| Anti-Neuropathic Drugs | 360 | ||
| Ketamine | 360 | ||
| Muscle Relaxants | 361 | ||
| Alternative Therapies | 362 | ||
| Acupuncture | 362 | ||
| Psychological Techniques | 362 | ||
| References | 362.e1 | ||
| suggested readings | 362.e1 | ||
| References | 362 | ||
| 18 Taping and Bandaging | 363 | ||
| Taping | 363 | ||
| Types of Tape | 363 | ||
| Skin Preparation | 363 | ||
| Ankle Taping | 363 | ||
| Toe Taping | 363 | ||
| Lower-Leg Taping | 363 | ||
| Knee Taping | 365 | ||
| Patella Taping | 365 | ||
| Finger Taping | 365 | ||
| Thumb Taping | 367 | ||
| Wrist Taping | 367 | ||
| Elbow Taping | 367 | ||
| Shoulder Taping | 367 | ||
| Bandaging | 367 | ||
| Types of Bandages | 367 | ||
| Securing Bandages | 368 | ||
| Ankle and Foot Bandaging | 368 | ||
| Knee Bandaging | 368 | ||
| Thigh and Groin Bandaging | 368 | ||
| Wrist and Hand Bandaging | 369 | ||
| Finger Bandaging | 369 | ||
| Thumb Bandaging | 369 | ||
| Shoulder Bandaging | 369 | ||
| Scalp Bandaging | 369 | ||
| Ear or side of head Bandaging | 369 | ||
| Eye Bandaging | 369 | ||
| References | 375.e1 | ||
| References | 375 | ||
| 19 Splints and Slings | 375 | ||
| Spinal Immobilization | 375 | ||
| Indications for Spinal Immobilization | 375 | ||
| Cervical Spine Immobilization | 376 | ||
| Cervical Spine Application | 377 | ||
| Special Considerations | 377 | ||
| Improvisational techniques | 377 | ||
| Complications of Cervical spine stabilization | 377 | ||
| Thoracolumbar Immobilization | 377 | ||
| Full Spine Immobilization | 377 | ||
| Upper-Extremity Splinting | 377 | ||
| Lower-Extremity Splinting | 377 | ||
| Rigid Splints | 380 | ||
| Soft Splints | 383 | ||
| SAM Splints | 383 | ||
| Improvised Extremity Splints | 386 | ||
| Pelvic Splinting | 386 | ||
| Hip and Femur Splinting | 388 | ||
| Ankle Splinting | 388 | ||
| Shoulder Dislocation | 388 | ||
| Humeral Shaft Injury | 389 | ||
| Elbow Dislocation | 389 | ||
| Elbow Fracture | 389 | ||
| Wrist Fracture | 389 | ||
| Metatarsal Fractures | 389 | ||
| Thumb Injuries | 389 | ||
| Finger Injuries | 389 | ||
| Femur Fracture | 389 | ||
| Knee Injuries | 389 | ||
| Leg Fractures | 389 | ||
| Ankle and Foot Injuries | 392 | ||
| References | 392.e1 | ||
| References | 392 | ||
| 20 Emergency Airway Management | 392 | ||
| Airway Anatomy | 392 | ||
| Assessment of the Airway and Recognition of Airway Compromise | 394 | ||
| Opening the Airway | 394 | ||
| Head Positioning | 394 | ||
| Manual Airway Techniques | 395 | ||
| Head Tilt With Chin Lift | 395 | ||
| Jaw Thrust With Head Tilt | 395 | ||
| Jaw Thrust Without Head Tilt | 395 | ||
| Tongue Traction | 395 | ||
| Mechanical Airway Adjuncts | 395 | ||
| Oropharyngeal Airway | 395 | ||
| Technique for insertion: | 396 | ||
| Nasopharyngeal Airway | 396 | ||
| Technique for insertion: | 397 | ||
| Recovery Position | 397 | ||
| Foreign-Body Airway Obstruction | 397 | ||
| Suction | 397 | ||
| Supplemental Oxygen | 399 | ||
| Ventilation | 399 | ||
| Rescue Breathing | 399 | ||
| Mouth-to-Mouth Ventilation | 399 | ||
| 5 Rescue and Survival | 673 | ||
| 36 Wilderness Emergency Medical Services and Response Systems | 674 | ||
| Safety | 674 | ||
| Shelter | 674 | ||
| Sustenance | 674 | ||
| Sanitation | 674 | ||
| Staying Well | 675 | ||
| Stress and Sanity | 675 | ||
| First Response | 675 | ||
| Prehospital Emergency Care | 675 | ||
| Extended Emergency Care | 675 | ||
| Remote Medicine | 675 | ||
| Sequence of Events During Backcountry Rescue | 677 | ||
| Occurrence of the Critical Event | 677 | ||
| Making the Decision to Get Help | 678 | ||
| Notifying the Emergency Medical System | 678 | ||
| Activating the Emergency Medical System | 678 | ||
| Notifying and Mobilizing the Extended Rescue Team | 678 | ||
| Assembling and Organizing the Rescue Team | 678 | ||
| Locating the Victim | 678 | ||
| Providing Appropriate Extended Emergency Care | 678 | ||
| Evacuating the Victim to the Appropriate Facility | 679 | ||
| Returning to Base | 679 | ||
| Team Organization and Function | 679 | ||
| Personal Knowledge, Experience, and Expertise | 680 | ||
| Extended Rescue Techniques and Skills | 680 | ||
| Wilderness and Mountain Rescue Team Organization | 680 | ||
| Training of Wilderness Emergency Medical Technicians | 680 | ||
| Introduction to Emergency Care | 682 | ||
| Patient Assessment Systems | 682 | ||
| Airways, Oxygen, and Mechanical Aids to Breathing | 682 | ||
| Bleeding and Shock | 683 | ||
| Soft-Tissue Injuries | 684 | ||
| Principles of Musculoskeletal Care | 684 | ||
| Injuries of the Head, Face, Eyes, Neck, and Spine | 684 | ||
| Injuries to the Chest, Abdomen, and Genitalia | 684 | ||
| Medical Emergencies | 684 | ||
| Environmental Emergencies | 684 | ||
| Lifting and Moving Patients | 685 | ||
| Ambulance Operations | 685 | ||
| Self-Preservation | 685 | ||
| APPENDIX | 685 | ||
| Disaster Preparedness in the United States | 686 | ||
| Office of the U.S. Surgeon General | 686 | ||
| Suggested Readings | 686.e1 | ||
| Suggested Readings | 686 | ||
| 37 Search and Rescue | 687 | ||
| Search and Rescue: An Overview | 687 | ||
| International Agreements | 688 | ||
| International Stages of SAR Operations | 688 | ||
| Awareness Stage | 688 | ||
| Initial Action Stage | 688 | ||
| Planning Stage | 688 | ||
| Operations Stage | 688 | ||
| Conclusion Stage | 688 | ||
| Cospas-Sarsat | 688 | ||
| Distress Radio Beacons | 689 | ||
| Emergency Position-Indicating Radio Beacons. | 689 | ||
| Emergency Locator Transmitters. | 689 | ||
| Personal Locator Beacons. | 689 | ||
| Search and Rescue in the United States | 689 | ||
| U.S. National Search and Rescue Plan | 689 | ||
| National Response Framework | 690 | ||
| The National SAR Supplement | 690 | ||
| Catastrophic Incident SAR Addendum to the National SAR Supplement | 691 | ||
| U.S. Rescue Coordination Centers | 691 | ||
| U.S. Air Force Rescue Coordination Center. | 691 | ||
| Search. | 691 | ||
| Rescue. | 691 | ||
| Medivac. | 691 | ||
| Mercy. | 691 | ||
| U.S. Coast Guard Rescue Coordination Centers. | 692 | ||
| Federal Aviation Administration. | 692 | ||
| Civil Air Patrol. | 693 | ||
| U.S. Coast Guard Auxiliary. | 693 | ||
| The State’s Role in SAR: Coordination and Support | 693 | ||
| Local SAR Response | 694 | ||
| Organization of a Search and Rescue Event | 694 | ||
| Incident Command System | 694 | ||
| National Incident Management System | 695 | ||
| Incident Management Teams | 695 | ||
| Four Phases of a Search and Rescue Event: The Incident Cycle | 695 | ||
| Locate Phase | 696 | ||
| First Notice | 696 | ||
| Planning Data and Their Uses | 696 | ||
| Search Tactics | 696 | ||
| Clues and Their Value | 696 | ||
| Search Resources | 696 | ||
| Dogs. | 698 | ||
| Human Trackers. | 698 | ||
| Ground Search Teams. | 698 | ||
| Hasty Teams. | 698 | ||
| Grid Teams. | 698 | ||
| Aircraft. | 698 | ||
| Search Planning Considerations | 698 | ||
| Search Theory. | 699 | ||
| Lost Subject Behavior. | 699 | ||
| Access Phase | 702 | ||
| Stabilization Phase | 702 | ||
| Transport Phase | 702 | ||
| Rescue Equipment | 702 | ||
| Personal Equipment. | 702 | ||
| Special Gear. | 702 | ||
| Software | 703 | ||
| Rope. | 703 | ||
| Webbing. | 703 | ||
| Harnesses. | 703 | ||
| Hardware | 703 | ||
| Carabiners. | 703 | ||
| Descending (Friction) Devices. | 704 | ||
| Ascenders. | 705 | ||
| Pulleys. | 705 | ||
| Litters. | 706 | ||
| Anatomy of a Search and Rescue Incident | 706 | ||
| Search and Rescue Environments Within the Wilderness Setting | 707 | ||
| Special Environments in Search and Rescue | 708 | ||
| Technical Rock | 708 | ||
| Caves and Mines (See Chapter 46) | 708 | ||
| White-Water River | 709 | ||
| White-Water Surf | 709 | ||
| Runout. | 709 | ||
| Rip. | 709 | ||
| Undertow. | 709 | ||
| Cold, Snow, and Ice | 710 | ||
| References | 710.e1 | ||
| References | 710 | ||
| 38 Technical Rescue, Self-Rescue, and Evacuation | 710 | ||
| Accident on Mt Kenya—1970 | 710 | ||
| Definitions | 711 | ||
| Technical Terrain | 711 | ||
| Self-Rescue | 712 | ||
| Evacuation | 712 | ||
| Epidemiology | 712 | ||
| Risks of Wilderness Travel | 712 | ||
| Injuries and Illnesses in Mountain Rescue Victims | 712 | ||
| Preventive Decision Making | 712 | ||
| Risk Reduction | 712 | ||
| Planning | 713 | ||
| Leadership | 713 | ||
| Communications | 714 | ||
| Decision Making in Self-Rescue | 714 | ||
| Improvised Searches | 714 | ||
| Wilderness Medicine Technical Rescue | 714 | ||
| Anchors | 714 | ||
| Descent | 716 | ||
| Ascent | 718 | ||
| Haul Systems | 718 | ||
| Knot Pass | 719 | ||
| Belay/Backup Systems | 720 | ||
| Personal Escape | 720 | ||
| One-On-One Pickoff | 720 | ||
| Belays | 721 | ||
| Highlines in Rescue | 721 | ||
| Establishing a Main Line | 721 | ||
| Tensioning the Main line | 722 | ||
| The Load | 722 | ||
| Tag Lines and Haul Lines | 722 | ||
| General Principles | 722 | ||
| Improvised Methods for Carrying an Ill or Injured Patient | 722 | ||
| The Rucksack Stretcher | 722 | ||
| Improvised Over-Snow Transport | 723 | ||
| Litters and Vacuum Mattresses for Organized Rescue | 723 | ||
| Vacuum Matresses | 723 | ||
| Commercial Litters | 723 | ||
| Patient Packaging | 724 | ||
| Fixed-Wing Aircraft in Mountain Rescue | 724 | ||
| Helicopter Rescue in the Wilderness Environment (see also Chapter 40) | 725 | ||
| Capabilities of Helicopters | 725 | ||
| Safe Use of Helicopters | 725 | ||
| Types of Helicopters | 725 | ||
| Aeromedical Helicopters | 725 | ||
| Law-Enforcement Helicopters | 726 | ||
| Commercial Helicopters | 726 | ||
| Media Helicopters | 726 | ||
| Military Helicopters | 726 | ||
| Limitations of Helicopters | 726 | ||
| Visibility Minimums | 726 | ||
| Weather Conditions | 726 | ||
| Fuel | 726 | ||
| Safety Precautions on the Ground | 726 | ||
| Landing Zones (Helispots) | 726 | ||
| Landing Zones in Confined Spaces | 727 | ||
| Landings and Takeoffs | 727 | ||
| Loading and Unloading | 727 | ||
| Approaching the Helicopter | 727 | ||
| Loading and Unloading Safety Procedures | 727 | ||
| One-Skid Landings | 728 | ||
| Loading and Unloading Without Moving Toward or Away From the Helicopter | 728 | ||
| Hover Load and Hover Jump Operations | 728 | ||
| External Loads | 728 | ||
| Hoist Operations | 728 | ||
| Short-Haul (or Long-Line) Operations | 729 | ||
| Heli-Rappel | 729 | ||
| Patient Care in Helicopter Operations | 729 | ||
| Hazards in Wilderness Travel and Rescue | 729 | ||
| Natural Hazards | 730 | ||
| High Altitude | 730 | ||
| Extremes of Temperature and Humidity | 730 | ||
| Weather | 730 | ||
| Lightning | 730 | ||
| Rockfall | 731 | ||
| Icefall | 731 | ||
| Avalanches | 731 | ||
| Cornice Failures | 731 | ||
| Terrain Features | 731 | ||
| Glacier Hazards | 731 | ||
| Equipment | 732 | ||
| Training | 732 | ||
| Human Factors | 732 | ||
| Physical Conditioning and Skills | 732 | ||
| Food, Water, and Sleep | 732 | ||
| Human Factors of Victims | 732 | ||
| Experience in the Environment | 733 | ||
| Mission Planning and Risk Assessment | 733 | ||
| Team Safety | 733 | ||
| Aircraft Safety | 733 | ||
| External Influences | 733 | ||
| Planning for Rescue | 733 | ||
| Team Training | 733 | ||
| Role of the Medical Director | 734 | ||
| Patient Care in Wilderness and Technical Environments | 734 | ||
| Priorities | 734 | ||
| Limitations | 734 | ||
| Initial Patient Assessment and Treatment | 734 | ||
| Resuscitation | 734 | ||
| Airway and Breathing | 734 | ||
| Circulation and Control Of Bleeding | 734 | ||
| Treatment of Pain | 735 | ||
| Prolonged Care and Transport | 735 | ||
| Altitude Considerations During Rescue | 736 | ||
| Suspension Trauma | 736 | ||
| Use of Extrication Devices for Crevasse Rescue | 736 | ||
| Afterword | 737 | ||
| Mountain Rescue Resources | 738 | ||
| APPENDIX Technical Rescue Medical Kit | 737 | ||
| Technical Rescue Medical Kit (15 kg [33 lbs]) | 737 | ||
| Medication Bag: | 737 | ||
| Intravenous Bag: | 737 | ||
| Miscellaneous Bag: | 737 | ||
| Front and Top Pockets: | 737 | ||
| Bandaging Side Pocket: | 737 | ||
| Miscellaneous Side Pocket: | 737 | ||
| Main Compartment: | 737 | ||
| Airway Bag: | 738 | ||
| Oxygen Kit (10 kg [22 lbs]): | 738 | ||
| Further Reading | 738.e1 | ||
| References | 738.e1 | ||
| References | 738 | ||
| 39 Litters and Carries | 738 | ||
| Size-Up | 738 | ||
| Drags and Carries | 738 | ||
| Litter Improvisation | 740 | ||
| Rescue Litters and Stretchers | 744 | ||
| Desirable Characteristics of a Wilderness Stretcher | 744 | ||
| Stretchers | 744 | ||
| Basket-Style Stretchers | 744 | ||
| Flat Stretchers | 746 | ||
| Mountain Rescue Stretchers | 746 | ||
| Flexible, Wrap-Around Stretchers | 747 | ||
| Hybrid Devices | 749 | ||
| Transportation Hardware Accessories | 749 | ||
| Carrying a Loaded Litter | 750 | ||
| Patient Packaging | 750 | ||
| References | 751.e1 | ||
| References | 751 | ||
| 40 Helicopter Rescue and Aeromedical Transport* | 751 | ||
| Aeromedical Evolution | 751 | ||
| Types of Aeromedical Transport Programs | 753 | ||
| Hospital-Based Programs | 753 | ||
| Non–Hospital-Based Programs | 753 | ||
| Public Safety, Police, or State Services | 753 | ||
| the Military Assistance to Safety and Traffic Program | 753 | ||
| Other Military Resources | 753 | ||
| Patient Mission Types | 753 | ||
| Primary Response | 753 | ||
| Secondary Response | 754 | ||
| Tertiary Response | 754 | ||
| Medical Mission Types | 754 | ||
| Trauma Patients | 754 | ||
| Patients with Cardiac Disease | 754 | ||
| Patients with Medical, Noncardiac Conditions | 754 | ||
| Pediatric Patients | 755 | ||
| Perinatal Patients | 755 | ||
| Neonates | 755 | ||
| Search and Rescue | 755 | ||
| Hoist Operations | 757 | ||
| International Aeromedical Evacuation | 757 | ||
| Flight Crew | 757 | ||
| Crew Configuration | 757 | ||
| Emergency Medical Technician–Paramedic | 757 | ||
| Flight Nurse | 757 | ||
| Flight Physician | 757 | ||
| Crew Member Stress | 758 | ||
| Appropriate Use of Aeromedical Services | 758 | ||
| Dispatch and Communications | 759 | ||
| Pretransport Preparation | 760 | ||
| Common Aeromedical Transport Problems | 760 | ||
| Patient Comfort | 760 | ||
| Patient Movement | 760 | ||
| Noise | 760 | ||
| Eye Protection | 760 | ||
| Respiratory Distress | 760 | ||
| Cardiopulmonary Resuscitation and Cardiac Defibrillation | 761 | ||
| Patient Combativeness | 761 | ||
| Endotracheal Intubation | 762 | ||
| Thrombolysis | 762 | ||
| Flight Safety | 762 | ||
| Approaching the Aircraft | 762 | ||
| Safety Belt Use | 763 | ||
| Proper Use of Aircraft Equipment | 763 | ||
| In-Flight Obstacle Reporting | 763 | ||
| Ground Coordination and Control | 763 | ||
| Emergency Procedures | 763 | ||
| Survival | 763 | ||
| Ground-to-Air Signaling | 763 | ||
| Landing Zone Operations | 763 | ||
| Night Operations | 764 | ||
| Ground Guide | 764 | ||
| Aeromedical Aircraft | 764 | ||
| Cabin Space | 765 | ||
| Access for Patient Loading | 765 | ||
| Useful Load | 766 | ||
| Weight and Balance | 766 | ||
| Cruise Speed | 766 | ||
| Range | 766 | ||
| Pressurization | 767 | ||
| Service Ceiling | 767 | ||
| Runway Length | 768 | ||
| Weather Operations | 768 | ||
| Performance | 768 | ||
| Aircraft for Search and Rescue | 768 | ||
| Pilot Requirements | 769 | ||
| Communications | 769 | ||
| Medical Equipment and In-Flight Monitoring | 769 | ||
| Power | 769 | ||
| Stretcher | 769 | ||
| Climate Control | 769 | ||
| Lighting | 769 | ||
| Suction | 769 | ||
| Oxygen | 770 | ||
| Ventilators | 770 | ||
| Infusion Devices | 770 | ||
| Monitor-Defibrillator and External Pacemaker | 770 | ||
| Oximetry and End-Tidal Carbon Dioxide Monitoring | 770 | ||
| Mechanical Resuscitators | 770 | ||
| Flight Physiology | 770 | ||
| Hypoxia and Altitude | 770 | ||
| Effects of Pressure Changes | 772 | ||
| Trapped Gas | 772 | ||
| Dysbarism | 772 | ||
| Motion and Acceleration | 772 | ||
| Noise and Vibration | 773 | ||
| Aeromedical Accidents | 773 | ||
| Special Problems in Aeromedical Transport | 775 | ||
| Trauma | 775 | ||
| Burns | 775 | ||
| Infectious Disease Patients | 775 | ||
| Air Medical Services Resources | 777 | ||
| References | 777.e1 | ||
| References | 777 | ||
| 41 Essentials of Wilderness Survival | 777 | ||
| Oxygen | 779 | ||
| Regulation of Body Temperature | 779 | ||
| Cold Weather Survival | 780 | ||
| Decreasing Body Heat Loss | 780 | ||
| Dressing for Cold Weather | 781 | ||
| First Layer | 781 | ||
| Long underwear. | 781 | ||
| Socks. | 781 | ||
| Thin gloves (glove liners). | 781 | ||
| Second Layer | 781 | ||
| Shirt. | 781 | ||
| Pants. | 781 | ||
| Foot gear. | 781 | ||
| Hat. | 781 | ||
| Third Layer | 781 | ||
| Parka. | 781 | ||
| Wind pants. | 781 | ||
| Hand gear. | 782 | ||
| Gaiters and overboots. | 782 | ||
| Fourth Layer | 782 | ||
| Rain gear. | 782 | ||
| Vapor barrier systems. | 782 | ||
| Shelter | 782 | ||
| Summer Emergency Shelters | 782 | ||
| Space Blankets and Bags | 782 | ||
| Thermal Blankets | 782 | ||
| Tube Tents | 783 | ||
| Tarpaulins | 783 | ||
| Plastic Bag Shelters | 784 | ||
| Winter and Cold Weather Emergency Shelters | 784 | ||
| Natural Shelters | 784 | ||
| Constructed Shelters | 785 | ||
| Snow Shelters | 785 | ||
| Snow Caves | 785 | ||
| Snow Domes | 787 | ||
| Igloos | 787 | ||
| Tents | 787 | ||
| Bivouac Sacks and Other Small and Portable Emergency Shelters | 787 | ||
| Increasing Body Heat Production | 788 | ||
| Adding Heat From the Outside | 788 | ||
| Heat Sources | 789 | ||
| Matches | 789 | ||
| Safety Matches | 789 | ||
| Waterproof Matches | 789 | ||
| Windproof Matches | 789 | ||
| Strike-Anywhere Matches | 789 | ||
| Storm Matches | 790 | ||
| Match Containers | 790 | ||
| Boy-Scout Style | 790 | ||
| Military Style | 790 | ||
| Orange Military-Style Match Cases | 790 | ||
| Multipurpose Match Case | 791 | ||
| Other Methods of Igniting Tinder | 791 | ||
| Building Fires | 793 | ||
| Tools that Make Firecrafting Easier | 794 | ||
| Saws | 794 | ||
| Wire survival saws. | 794 | ||
| Linked-style survival saws. | 794 | ||
| Bow saw style. | 795 | ||
| Pruning saw style. | 795 | ||
| Fire-Starting Aids | 795 | ||
| Commercial fire-starting aids. | 795 | ||
| Food | 797 | ||
| Water | 798 | ||
| Emergency Snow Travel | 798 | ||
| Survival in Special Instances, Including Natural Catastrophes | 798 | ||
| Stalled or Wrecked Automobiles | 798 | ||
| Aircraft Accidents | 799 | ||
| Floods | 799 | ||
| Thunderstorms | 799 | ||
| Tornados | 799 | ||
| Hurricanes | 799 | ||
| Navigation (see Chapter 96) | 800 | ||
| Backcountry Weather Forecasting (see Chapter 42) | 800 | ||
| Important Tips for Backcountry Weather Forecasting | 800 | ||
| Sanitation | 800 | ||
| Psychological and Organizational Aspects of Survival | 801 | ||
| Protection From Wild Animals | 802 | ||
| Summary of Preparations for a Possible Survival Situation | 802 | ||
| APPENDIX A Suggested Basic Contents of a Temperate to Cold-Weather Survival Kit | 802 | ||
| APPENDIX B Suggested Additions for Winter Survival Kit (When Cold Weather or Snow Is Present or Expected) | 802 | ||
| Optional Items | 804 | ||
| Mandatory for Avalanche Country | 804 | ||
| APPENDIX C Vehicle Cold-Weather Survival Kit | 804 | ||
| APPENDIX D Minimal Equipment for Survival First-Aid Kit | 804 | ||
| Basic Items | 804 | ||
| Small-Bag Items | 804 | ||
| Other Items | 804 | ||
| Additional Items for Consideration | 804 | ||
| Suggested Readings | 804.e1 | ||
| Suggested Readings | 804 | ||
| 42 Principles of Meteorology and Weather Prediction | 805 | ||
| General Circulation and Atmospheric Profile | 805 | ||
| Climate Controls and Radiation Balance | 805 | ||
| Atmospheric Profile | 805 | ||
| Lapse Rate | 805 | ||
| Moisture | 805 | ||
| Climatic Regions Controlled by Latitude: Tropics, Midlatitudes, and Poles | 806 | ||
| Midlatitude and Polar Climates | 806 | ||
| Subtropical and Tropical Climates | 806 | ||
| Monsoons | 806 | ||
| tropical cyclones | 806 | ||
| Thunderstorms | 806 | ||
| Types of Thunderstorms | 807 | ||
| Arid Climates | 807 | ||
| Mountain Climates | 807 | ||
| Marine/Coastal Climates | 807 | ||
| Weather Phenomena | 807 | ||
| Human Comfort | 808 | ||
| Weather Forecasting | 809 | ||
| Obtaining Data and Forecasts and Predicting Weather in the Near Term | 809 | ||
| Portable Weather Instruments of Use in the Wilderness | 809 | ||
| Barometer | 809 | ||
| Thermometer | 809 | ||
| Lightning Detector | 809 | ||
| Types of Forecasts | 809 | ||
| Skill | 809 | ||
| How to Interpret Forecasts | 810 | ||
| Accessing Forecasts | 810 | ||
| North America | 810 | ||
| International Forecasts | 810 | ||
| Forecast Variables | 810 | ||
| Seasonal Precipitation Forecasts | 810 | ||
| Temperature Forecasts | 810 | ||
| Humidity | 810 | ||
| Wind Direction and Speed | 810 | ||
| Precipitation | 810 | ||
| Forecast Products | 810 | ||
| United States | 810 | ||
| International | 810 | ||
| How to Obtain Surface Observations | 811 | ||
| United States | 811 | ||
| Global Data | 811 | ||
| How to Access and Interpret Weather Satellite and Radar Data | 811 | ||
| Weather Prediction in the Wilderness | 811 | ||
| Clouds | 811 | ||
| Clouds and Weather | 812 | ||
| Boundary Layer Stability | 812 | ||
| Backing and Veering | 815 | ||
| References | 815.e1 | ||
| References | 815 | ||
| 43 Jungle Travel and Survival | 815 | ||
| Tropical Environment | 815 | ||
| Trip Preparation | 816 | ||
| Reading | 816 | ||
| Attitude | 816 | ||
| Relationship Considerations | 816 | ||
| Conditioning | 816 | ||
| Immunizations | 817 | ||
| Medical Kit | 817 | ||
| Gear | 818 | ||
| Footwear | 818 | ||
| Trail Shoes. | 818 | ||
| Camp Boots. | 819 | ||
| Other Options. | 819 | ||
| Socks | 819 | ||
| Clothing | 819 | ||
| Hat | 819 | ||
| Pullover | 819 | ||
| Shirts | 819 | ||
| Pants | 819 | ||
| Undergarments | 819 | ||
| Poncho | 819 | ||
| Bedding | 819 | ||
| Flannel Sheet | 819 | ||
| Hammock | 819 | ||
| Therm-a-Rest | 820 | ||
| Mosquito Netting | 820 | ||
| Backpacks | 820 | ||
| Backpack for Porter | 820 | ||
| Personal Pack | 820 | ||
| Pack for River Trips | 820 | ||
| Other Useful Items | 820 | ||
| Antifogging Solution for Eyeglasses | 820 | ||
| Batteries | 820 | ||
| Binoculars | 820 | ||
| Camera Equipment | 820 | ||
| Camera Case or Bag | 820 | ||
| Camp Soap | 821 | ||
| Candles | 821 | ||
| Cup and Plate | 821 | ||
| Duct Tape | 821 | ||
| Ear Plugs | 821 | ||
| Fishing Supplies | 821 | ||
| Garbage Bags | 821 | ||
| Dry Bags | 821 | ||
| Headlamp | 821 | ||
| Inflatable Cushion or Pillow | 821 | ||
| Insect Repellent | 821 | ||
| Laminated Map | 821 | ||
| Machete | 821 | ||
| Matches or Cigarette Lighter | 822 | ||
| Pen | 822 | ||
| Pocket Tool | 822 | ||
| Wide-Mouth Water Bottles | 822 | ||
| Razor or Battery-Operated Shaver | 822 | ||
| Spoon | 822 | ||
| Sport Sponge | 822 | ||
| Sunglasses | 822 | ||
| Toilet Paper | 822 | ||
| Umbrella | 822 | ||
| Whistle | 822 | ||
| Coping With the Jungle Environment | 822 | ||
| Wetness | 822 | ||
| Health Issues | 822 | ||
| Health Risks | 822 | ||
| Duration of Travel and Emotional Response | 822 | ||
| Preventing Heat-Related Illness | 823 | ||
| Unexpected Isolation | 823 | ||
| Camp Life | 823 | ||
| Shelter | 823 | ||
| Food | 824 | ||
| Potable Water | 826 | ||
| Jungle Hazards | 826 | ||
| Arthropods | 826 | ||
| Ants. | 826 | ||
| Chiggers. | 826 | ||
| Jigger Flea. | 826 | ||
| Myiasis. | 826 | ||
| Scorpions and Spiders. | 826 | ||
| Venomous Moths, Butterflies, and Caterpillars. | 826 | ||
| Wasp and Bee Stings. | 826 | ||
| Fish | 826 | ||
| Stingray. | 826 | ||
| Electric Eel. | 826 | ||
| Candirú. | 827 | ||
| Piranha. | 827 | ||
| Mammals | 827 | ||
| Bats. | 827 | ||
| Dogs. | 827 | ||
| Jaguars. | 827 | ||
| Reptiles | 827 | ||
| Snakes. | 827 | ||
| Alligators and Crocodiles. | 827 | ||
| Plants | 827 | ||
| Armed or Spine-Bearing Plants. | 827 | ||
| Chicha. | 827 | ||
| Saw Grass. | 828 | ||
| Hallucinogenic Plants | 828 | ||
| Ayahuasca. | 828 | ||
| Brugmansia. | 828 | ||
| Virolas. | 828 | ||
| Yopo. | 828 | ||
| Miscellaneous Hazards | 828 | ||
| Poison-Dart Frogs | 828 | ||
| Falling Trees | 829 | ||
| Fording Rivers | 829 | ||
| Canoe Travel | 829 | ||
| Log Bridges | 829 | ||
| Mercury Contamination | 829 | ||
| Rising Rivers | 829 | ||
| Traveling With Children in the Tropics | 829 | ||
| Survival | 829 | ||
| Rescue Strategies | 829 | ||
| Food | 831 | ||
| Edibility Test | 831 | ||
| Caveats: | 831 | ||
| Water | 832 | ||
| Shelter | 832 | ||
| Fire | 833 | ||
| Tinder and Kindling | 833 | ||
| Bamboo Fire Saw | 833 | ||
| Bamboo Container | 834 | ||
| Palm Spathe Container | 834 | ||
| Psychology of Survival | 834 | ||
| Cultural Factors | 835 | ||
| Infanticide | 835 | ||
| Intertribal and Intratribal Warfare, Revenge Killings, Homicide | 835 | ||
| Survival in Hostage Situations | 835 | ||
| Prevention | 835 | ||
| Categories of Hostage Takers | 835 | ||
| Behavior at the Moment of Capture | 836 | ||
| Hostage Rules of Behavior | 836 | ||
| Stress Management in Captivity | 836 | ||
| Adjusting to Captivity | 836 | ||
| Stockholm Syndrome | 836 | ||
| Escape | 836 | ||
| Rescue | 836 | ||
| Release | 837 | ||
| References | 837.e1 | ||
| References | 837 | ||
| 44 Desert Travel and Survival | 837 | ||
| The Desert Environment | 837 | ||
| Preparation | 839 | ||
| Clothing | 839 | ||
| Survival Kit | 840 | ||
| Priorities | 840 | ||
| Water | 840 | ||
| Shelter | 842 | ||
| Food | 843 | ||
| Hazards | 843 | ||
| Travel | 844 | ||
| Suggested Readings | 845.e1 | ||
| References | 845 | ||
| 45 Whitewater Medicine and Rescue | 846 | ||
| Demographics | 846 | ||
| Historical Perspective | 846 | ||
| Morbidity and Mortality | 847 | ||
| Paddling Equipment | 848 | ||
| River Hazards | 849 | ||
| Submersion Accidents | 851 | ||
| Trauma | 852 | ||
| Riverside Shoulder Reduction Technique | 853 | ||
| head, facial, and dental trauma | 853 | ||
| spine injuries | 855 | ||
| fractures and improvised splinting | 855 | ||
| Applying an Improvised Pelvic Sling | 855 | ||
| Hair-Tying a Scalp Laceration | 856 | ||
| Infections | 856 | ||
| Environmental Hazards | 857 | ||
| Swift-Water Rescue | 857 | ||
| Rescue Equipment | 857 | ||
| Throw Ropes | 857 | ||
| Carabiners and Pulleys | 858 | ||
| Prusik Loops | 858 | ||
| Webbing | 858 | ||
| Knives | 858 | ||
| Whistles | 858 | ||
| Rapidly Deployed Rescue Techniques | 858 | ||
| Wading and Strong Swimmer Rescues | 858 | ||
| Tag Line Rescue | 859 | ||
| Rescuing Pinned Boats | 859 | ||
| APPENDIX A Whitewater First-Aid Kits | 860 | ||
| Rafting Kit | 860 | ||
| Kayaking Kit | 861 | ||
| APPENDIX B Universal River Signals | 861 | ||
| APPENDIX C Organizations | 861 | ||
| References | 861.e1 | ||
| References | 861 | ||
| 46 Caving and Cave Rescue | 862 | ||
| Environment | 863 | ||
| Personal Safety | 864 | ||
| Cave Navigation | 865 | ||
| Cave Search | 865 | ||
| Basic Evacuation | 865 | ||
| Equipment—Vertical Evacuation | 867 | ||
| Logistics | 867 | ||
| Cave Access | 867 | ||
| Environmental Hazards | 868 | ||
| Medical Hazards | 869 | ||
| Patient Care | 869 | ||
| The Caving Expedition | 870 | ||
| Closing Comments | 870 | ||
| References | 870.e1 | ||
| References | 870 | ||
| 6 Animals, Insects, and Zoonoses | 871 | ||
| 47 Protection From Blood-Feeding Arthropods | 872 | ||
| Mosquitoes (Family Culicidae) | 872 | ||
| Blackflies (Family Simuliidae) | 872 | ||
| Biting Midges (Family Ceratopogonidae) | 873 | ||
| Tabanids (Family Tabanidae) | 873 | ||
| Sand Flies (Family Psychodidae) | 873 | ||
| Tsetse Flies (Family Glossinidae) | 873 | ||
| Stable Flies (Family Muscidae) | 875 | ||
| Kissing Bugs (Family Reduviidae) | 875 | ||
| Fleas (Family Pulicidae) | 875 | ||
| Chigger Mites (Family Trombiculidae) | 875 | ||
| Ticks (Families Ixodidae and Argasidae) | 875 | ||
| Personal Protection | 876 | ||
| Habitat Avoidance | 876 | ||
| Physical Protection | 876 | ||
| Repellents | 876 | ||
| Chemical Repellents | 877 | ||
| DEET. | 877 | ||
| Picaridin. | 879 | ||
| IR3535 (ethyl-butylacetylaminoproprionate). | 879 | ||
| Botanical Repellents | 879 | ||
| Citronella. | 880 | ||
| BiteBlocker. | 881 | ||
| BioUD (2-Undecanone). | 881 | ||
| Lemon Eucalyptus. | 881 | ||
| Efficacy of DEET Versus Botanical Repellents | 881 | ||
| Alternative Repellents | 881 | ||
| Insecticides | 881 | ||
| Permethrin | 881 | ||
| Reducing Local Mosquito Populations | 882 | ||
| Integrated Approach to Personal Protection | 882 | ||
| References | 882.e1 | ||
| References | 882 | ||
| 48 Mosquitoes and Mosquito-Borne Diseases | 883 | ||
| Mosquitoes | 883 | ||
| Mosquito Anatomy | 883 | ||
| Mosquito Life Cycle | 883 | ||
| Mechanism of Mosquito Bites | 883 | ||
| Pathophysiology and Clinical Manifestations of Mosquito Bites | 884 | ||
| Diseases | 885 | ||
| Dengue | 885 | ||
| Epidemiology and Transmission | 885 | ||
| Clinical Presentation | 886 | ||
| Diagnosis | 888 | ||
| Treatment and Prevention | 888 | ||
| Yellow Fever | 889 | ||
| Epidemiology and Transmission | 889 | ||
| Clinical Presentation | 890 | ||
| Diagnosis | 890 | ||
| Treatment and Prevention | 890 | ||
| Japanese Encephalitis | 891 | ||
| Epidemiology and Transmission | 891 | ||
| Clinical Presentation | 892 | ||
| Diagnosis | 892 | ||
| Treatment and Prevention | 892 | ||
| West Nile Virus | 893 | ||
| Epidemiology and Transmission | 893 | ||
| Clinical Presentation | 894 | ||
| Diagnosis | 895 | ||
| Treatment and Prevention | 895 | ||
| Surveillance and Reporting | 896 | ||
| St Louis Encephalitis | 896 | ||
| 7 Plants | 1223 | ||
| 62 Seasonal and Acute Allergic Reactions | 1224 | ||
| Allergic Rhinitis | 1224 | ||
| Pathophysiology | 1224 | ||
| Allergens | 1224 | ||
| Pollens. | 1225 | ||
| Fungi. | 1225 | ||
| Dust Mites. | 1226 | ||
| Animals. | 1226 | ||
| Functions of the Nose | 1226 | ||
| Clinical Evaluation | 1226 | ||
| Allergy Testing | 1227 | ||
| Differential Diagnosis | 1227 | ||
| Treatment | 1228 | ||
| Avoidance. | 1228 | ||
| Antihistamines and Decongestants. | 1228 | ||
| Nasal Corticosteroids. | 1229 | ||
| Leukotriene-Receptor Antagonists. | 1229 | ||
| Other Medications. | 1229 | ||
| Immunotherapy. | 1229 | ||
| Anaphylaxis | 1230 | ||
| Etiology | 1230 | ||
| Pathophysiology | 1230 | ||
| Clinical Features and Diagnosis | 1231 | ||
| Treatment | 1231 | ||
| References | 1232.e1 | ||
| References | 1232 | ||
| 63 Plant-Induced Dermatitis | 1232 | ||
| Irritant Contact Dermatitis | 1232 | ||
| Treatment | 1238 | ||
| Allergic Contact Dermatitis | 1238 | ||
| Toxicodendron Family | 1238 | ||
| Immunology of Poison Ivy and Poison Oak Dermatitis | 1242 | ||
| Treatment | 1243 | ||
| Prevention | 1244 | ||
| Compositae Family | 1245 | ||
| Contact Urticaria: Immunologic and Nonimmunologic Subtypes | 1247 | ||
| Phytophotodermatitis | 1249 | ||
| Phytophototoxic Contact Dermatitis | 1250 | ||
| Phytophotoallergic Contact Dermatitis | 1251 | ||
| References | 1251.e1 | ||
| References | 1251 | ||
| 64 Toxic Plant Ingestions | 1251 | ||
| General Considerations | 1252 | ||
| Plant Toxins | 1252 | ||
| Alkaloids. | 1252 | ||
| Glycosides. | 1252 | ||
| Resins. | 1252 | ||
| Oxalates. | 1252 | ||
| Phytotoxins. | 1252 | ||
| Central Nervous System Toxins | 1252 | ||
| Anticholinergic Plants (Tropane Alkaloids) | 1252 | ||
| Anticholinergic Syndrome. | 1252 | ||
| Jimsonweed. | 1254 | ||
| Deadly Nightshade. | 1255 | ||
| Treatment. | 1255 | ||
| Nicotinic Plants (Pyridine and Piperidine Alkaloids) | 1256 | ||
| Tobacco Plants. | 1257 | ||
| Nicotinic Syndrome. | 1257 | ||
| Poison Hemlock. | 1257 | ||
| Betel Nut. | 1258 | ||
| Blue Cohosh. | 1258 | ||
| Golden Chain Tree. | 1258 | ||
| Treatment. | 1258 | ||
| Hallucinogenic Plants (Indoles, Phenylalkylamines) | 1258 | ||
| Ergot. | 1259 | ||
| Morning Glory. | 1259 | ||
| Nutmeg. | 1259 | ||
| Cannabis. | 1260 | ||
| Peyote. | 1260 | ||
| Mescal Bean Bush. | 1260 | ||
| Tabernanthe iboga. | 1260 | ||
| Khat. | 1260 | ||
| Anticholinergic Plants | 1261 | ||
| Treatment. | 1261 | ||
| Sedating Plants (Isoquinoline Alkaloids) | 1261 | ||
| Poppy. | 1261 | ||
| Neuromuscular Blocking Plants (Indole Alkaloids) | 1261 | ||
| Yellow Jasmine. | 1261 | ||
| Convulsant Plants (Indoles, Resins) | 1261 | ||
| Strychnine. | 1261 | ||
| Wild Wisteria. | 1261 | ||
| Water Hemlock. | 1262 | ||
| Myrtle-leaved Coriaria. | 1262 | ||
| Other Convulsants. | 1262 | ||
| Cardiovascular Toxins | 1262 | ||
| Cardiotoxins that Inhibit Na+/K+ Atpase (Cardiac Glycosides) | 1262 | ||
| Foxglove. | 1263 | ||
| Oleander. | 1263 | ||
| Squill. | 1263 | ||
| Sea Mango. | 1263 | ||
| Clinical Presentation. | 1264 | ||
| Treatment. | 1265 | ||
| Cardiotoxins that Open Sodium Channels (Steroid Alkaloids, Resins) | 1265 | ||
| Aconite. | 1265 | ||
| Veratrum Alkaloids. | 1266 | ||
| Grayanotoxins. | 1266 | ||
| Treatment. | 1266 | ||
| Other Cardiotoxins | 1266 | ||
| Taxine Alkaloids. | 1266 | ||
| Oral and Gastrointestinal Toxins | 1267 | ||
| Oral Irritants (Glycosides, Oxalates) | 1267 | ||
| Daphne. | 1267 | ||
| Insoluble Oxalates. | 1267 | ||
| Gastrointestinal Irritants (Resins, Alkaloids) | 1267 | ||
| Chinaberry Trees. | 1267 | ||
| Solanum. | 1268 | ||
| Saponin Glycosides (Pokeweed). | 1268 | ||
| Toxins that Inhibit Protein Synthesis (Phytotoxins) | 1269 | ||
| Toxalbumins (Ricin, Abrin, Curcin, Robin, Phasin). | 1269 | ||
| Treatment. | 1269 | ||
| Hepatotoxic Agents | 1270 | ||
| Pyrrolizidine Alkaloids. | 1270 | ||
| Kava Kava. | 1270 | ||
| Renal Toxins | 1270 | ||
| Soluble Oxalates. | 1270 | ||
| Other Nephrotoxins. | 1270 | ||
| Hematopoietic Toxins | 1270 | ||
| Plants with Anticoagulant Properties (Lactone Glycosides) | 1270 | ||
| Toxins that Inhibit Cell Division and Bone Marrow | 1270 | ||
| Colchicine. | 1270 | ||
| Podophyllum. | 1271 | ||
| Plants that Induce Hemolysis | 1271 | ||
| Fava Beans. | 1271 | ||
| Endocrine and Metabolic Toxins | 1271 | ||
| Plants that Induce Hypoglycemia | 1271 | ||
| Ackee Fruit. | 1271 | ||
| Wild Yams. | 1271 | ||
| Cocklebur. | 1271 | ||
| Bird-Lime/Blue Thistle. | 1272 | ||
| Ox-Eye Daisy. | 1272 | ||
| Plants that Interfere with Steroid Metabolism | 1272 | ||
| Licorice. | 1272 | ||
| Cyanogenic Plants | 1272 | ||
| Treatment. | 1272 | ||
| Reproductive Toxins | 1272 | ||
| Other Toxins | 1273 | ||
| Oils | 1273 | ||
| Clove. | 1273 | ||
| Eucalyptus. | 1273 | ||
| Lavender. | 1273 | ||
| Pennyroyal. | 1273 | ||
| Pine. | 1273 | ||
| Wintergreen. | 1273 | ||
| Wormwood. | 1274 | ||
| Elements and Nitrates | 1274 | ||
| Acknowledgments. | 1274 | ||
| APPENDIX A Common Toxic Plants | 1274 | ||
| APPENDIX B Nontoxic Plants | 1275 | ||
| References | 1276.e1 | ||
| References | 1276 | ||
| 65 Toxic Mushroom Ingestions | 1276 | ||
| Nontoxic Mushrooms | 1279 | ||
| Types of Mushroom Toxicity | 1280 | ||
| Gastrointestinal Toxins | 1280 | ||
| Causative Mushrooms | 1280 | ||
| Toxins | 1286 | ||
| Clinical Presentation | 1288 | ||
| Treatment | 1288 | ||
| Disulfiram-Like Toxins | 1288 | ||
| Causative Mushrooms | 1288 | ||
| Toxin | 1289 | ||
| Clinical Presentation | 1289 | ||
| Treatment | 1289 | ||
| Neurologic Toxins | 1289 | ||
| Muscarine | 1289 | ||
| Causative Mushrooms | 1290 | ||
| Toxin | 1290 | ||
| Clinical Presentation | 1291 | ||
| Treatment | 1291 | ||
| Isoxazole Reactions | 1292 | ||
| Causative Mushrooms | 1292 | ||
| Toxin | 1292 | ||
| Clinical Presentation | 1293 | ||
| Treatment | 1293 | ||
| Hallucinogenic Mushrooms | 1293 | ||
| Causative Mushrooms | 1293 | ||
| Toxin | 1294 | ||
| Clinical Presentation | 1294 | ||
| Treatment | 1295 | ||
| Protoplasmic Poisons | 1295 | ||
| Gyromitra Toxin | 1295 | ||
| Causative Mushrooms | 1295 | ||
| Toxin | 1296 | ||
| Clinical Presentation | 1296 | ||
| Treatment | 1296 | ||
| Renal Toxicity | 1296 | ||
| 8 Food and Water | 1323 | ||
| 67 Field Water Disinfection | 1324 | ||
| Benefits of Water Treatment | 1324 | ||
| Risk and Etiology | 1324 | ||
| Developing Countries | 1325 | ||
| the United States and Developed Countries | 1326 | ||
| Recreational Contact | 1326 | ||
| Specific Etiologic Agents | 1327 | ||
| Viruses | 1327 | ||
| Protozoa | 1327 | ||
| Giardia and Cryptosporidium. | 1327 | ||
| Parasitic Organisms | 1327 | ||
| Bacterial Spores | 1328 | ||
| Algae | 1328 | ||
| Chemical Hazards | 1328 | ||
| Persistence of Enteric Pathogens in the Environment | 1328 | ||
| Natural Purification Mechanisms | 1329 | ||
| Standards | 1329 | ||
| Standards for Portable Disinfection Products | 1329 | ||
| EPA Registration | 1329 | ||
| Mechanical Filters. | 1329 | ||
| Filter Testing. | 1329 | ||
| Chemical Methods | 1330 | ||
| Disinfection Methods | 1330 | ||
| Definitions (Box 67-5) | 1330 | ||
| Heat | 1330 | ||
| Boiling Time | 1331 | ||
| Hot Tap Water | 1332 | ||
| Solar Heat | 1332 | ||
| Physical Removal | 1332 | ||
| Turbidity and Clarification | 1332 | ||
| Sedimentation | 1333 | ||
| Coagulation–Flocculation | 1333 | ||
| Toxicity | 1333 | ||
| Alternative Agents | 1333 | ||
| Adsorption | 1333 | ||
| Granular Activated Carbon | 1333 | ||
| Filtration | 1334 | ||
| Reverse Osmosis | 1335 | ||
| Forward Osmosis | 1335 | ||
| Choice of Filter (See Preferred Technique and Appendix A) | 1335 | ||
| Improvised Filters | 1335 | ||
| Biosand Filters | 1336 | ||
| Chemical Disinfectants | 1336 | ||
| Halogens (Chlorine and Iodine) | 1336 | ||
| Variables With Chemical Agents | 1336 | ||
| Concentration and Contact Time. | 1336 | ||
| Contaminants. | 1336 | ||
| Halogen Demand and Residual Concentration. | 1337 | ||
| Temperature. | 1337 | ||
| pH. | 1338 | ||
| Susceptibility of Microorganisms. | 1338 | ||
| Bacteria. | 1338 | ||
| Viruses. | 1339 | ||
| Cysts and Parasites. | 1339 | ||
| Disinfection Constant. | 1339 | ||
| Chlorine | 1339 | ||
| Chemistry | 1340 | ||
| Toxicity | 1340 | ||
| Products and Techniques for Chlorination | 1340 | ||
| Superchlorination–Dechlorination. | 1341 | ||
| Iodine | 1341 | ||
| Chemistry | 1341 | ||
| Toxicity | 1342 | ||
| Thyroid Effects of Iodine Ingestion. | 1342 | ||
| Dose-Response or Threshold Level. | 1342 | ||
| Recommendations. | 1342 | ||
| Products and Techniques for Iodination | 1343 | ||
| Resins. | 1343 | ||
| Iodine Resin Filters. | 1343 | ||
| Chlorine Versus Iodine | 1344 | ||
| Taste | 1344 | ||
| Minimizing Dose. | 1344 | ||
| Dehalogenation. | 1344 | ||
| Alteration of Chemical Species (Reduction). | 1344 | ||
| Miscellaneous Disinfectants | 1345 | ||
| Chlorine Dioxide | 1345 | ||
| Mixed Species Disinfection (Electrolysis) | 1345 | ||
| Solar Photocatalytic Disinfection | 1345 | ||
| Ozone | 1345 | ||
| Silver | 1345 | ||
| Potassium Permanganate | 1346 | ||
| Hydrogen Peroxide | 1346 | ||
| Peracetic Acid | 1346 | ||
| Citrus | 1346 | ||
| Ultraviolet Light | 1346 | ||
| Solar Irradiation | 1347 | ||
| Copper and Zinc | 1347 | ||
| Comparative Studies and Preferred Techniques | 1347 | ||
| Preferred Technique | 1348 | ||
| Prevention and Sanitation | 1349 | ||
| Hand Washing | 1349 | ||
| Kitchen and Food Sanitation | 1349 | ||
| References | 1359.e1 | ||
| References | 1359 | ||
| APPENDIX A Water Disinfection Devices and Products for Field Use | 1350 | ||
| APPENDIX B Chemical Disinfection Products | 1356 | ||
| Iodination | 1356 | ||
| Iodine Solutions | 1356 | ||
| Iodophors (Povidone–Iodine) | 1356 | ||
| Crystals (Saturated Solution) | 1356 | ||
| Product | 1356 | ||
| Polar Pure | 1356 | ||
| Formulation | 1356 | ||
| 9 Marine Medicine | 1481 | ||
| 74 A Brief Introduction to Oceanography | 1482 | ||
| Ocean Statistics | 1482 | ||
| Brief Appreciation of the Ocean’s History and Modern Ocean Tools | 1482 | ||
| Water Characteristics | 1482 | ||
| Ocean Structure | 1484 | ||
| Ocean Circulation | 1485 | ||
| Ocean Movement: Waves, Tides, and Tsunamis | 1487 | ||
| Conditions for Oceanic Life | 1489 | ||
| Marine Primary Productivity | 1490 | ||
| Important Planktonic Autotrophs | 1492 | ||
| Harmful Algal Blooms | 1493 | ||
| Biogeochemical Cycles | 1493 | ||
| 75 Submersion Injuries and Drowning | 1494 | ||
| Classification and Types of Submersion Injuries and Drowning | 1494 | ||
| Incidence and Epidemiology | 1495 | ||
| Risk Factors | 1496 | ||
| Age | 1496 | ||
| Gender | 1496 | ||
| Race | 1496 | ||
| Location | 1496 | ||
| Ability to Swim | 1497 | ||
| Alcohol and Drugs | 1497 | ||
| Preexisting Disease | 1497 | ||
| Child Abuse, Homicide, And Suicide | 1497 | ||
| Boating-Related Drowning | 1497 | ||
| Pathophysiology | 1498 | ||
| The Human Body and Water | 1498 | ||
| The Initial Event | 1499 | ||
| Pulmonary system | 1499 | ||
| Central Nervous System | 1500 | ||
| Cardiovascular system | 1501 | ||
| Hematologic and Electrolyte Disturbances | 1501 | ||
| Hypothermia | 1501 | ||
| Cold-Shock Response Time: 0 to 3 Minutes | 1502 | ||
| Loss of Decision-Making Ability: 3 to 30 Minutes | 1502 | ||
| Swim Failure: 45 to 90 Minutes | 1502 | ||
| Management: The Element of Time | 1502 | ||
| Clinical Presentation: A Case History | 1502 | ||
| On-Scene Management | 1503 | ||
| The Asymptomatic Patient: Grades 0 and 1 | 1503 | ||
| The Symptomatic Patient: Grades 2, 3, and 4 | 1504 | ||
| The Patient in Respiratory or Cardiopulmonary Arrest: Grades 5 and 6 | 1504 | ||
| Cervical Spine Injury | 1505 | ||
| The Obviously Dead or Still-Submerged Patient | 1505 | ||
| Terminating Resuscitation Efforts | 1505 | ||
| En Route to Definitive Care | 1505 | ||
| Emergency Department Treatment of Submersion Injuries | 1505 | ||
| In-Hospital Treatment of Submersion Injuries | 1506 | ||
| Pulmonary Management | 1506 | ||
| Cardiovascular System and Hemodynamics | 1507 | ||
| Central Nervous System | 1507 | ||
| Hypothermia | 1508 | ||
| Renal system | 1508 | ||
| Decompression Illness | 1508 | ||
| Infectious Diseases | 1508 | ||
| Prognosis and Termination of Resuscitation | 1509 | ||
| Submersion Prevention and Survival | 1510 | ||
| Preimmersion Interventions | 1510 | ||
| Preimmersion Interventions by Age | 1510 | ||
| Pools | 1510 | ||
| Supervision and Lifeguards | 1511 | ||
| Prehospital Personnel | 1511 | ||
| Swimming Techniques and Boating Instruction | 1511 | ||
| Personal Flotation Devices | 1512 | ||
| Preventive Equipment | 1512 | ||
| Alcohol and Drugs | 1512 | ||
| Postimmersion Actions | 1512 | ||
| References | 1513.e1 | ||
| References | 1513 | ||
| 76 Emergency Oxygen Administration | 1513 | ||
| Indications | 1513 | ||
| Contraindications | 1514 | ||
| Pulmonary Oxygen Toxicity | 1514 | ||
| Central Nervous System Oxygen Toxicity | 1514 | ||
| Equipment | 1514 | ||
| Cylinders | 1514 | ||
| Valves | 1514 | ||
| Regulators | 1515 | ||
| Devices for Ventilation of Nonbreathing Patients | 1515 | ||
| Bag-Valve-Mask Device | 1515 | ||
| Resuscitation Mask | 1516 | ||
| FROPV/Positive-Pressure Demand Valve | 1516 | ||
| Demand-Only, or Fropvs in Demand Mode | 1517 | ||
| Constant Flow Devices for Adequately Breathing Patients | 1518 | ||
| The Nonrebreather Mask | 1518 | ||
| Nasal Cannula | 1518 | ||
| Oxygen Rebreathers | 1519 | ||
| Oxygen Generator Systems | 1519 | ||
| how to administer oxygen in general | 1519 | ||
| Special Considerations in Nonbreathing or Inadequately Breathing Patients | 1519 | ||
| Hazards | 1520 | ||
| Legal Issues | 1520 | ||
| References | 1520.e1 | ||
| References | 1520 | ||
| 77 Diving Medicine | 1520 | ||
| Historical Perspective | 1521 | ||
| Types of Diving and Diving Equipment | 1522 | ||
| Breath-Hold Diving | 1522 | ||
| Medical Problems of Breath-Hold Diving | 1523 | ||
| Scuba Diving | 1523 | ||
| Rebreather Diving | 1524 | ||
| Surface-Supplied or Tethered Diving | 1524 | ||
| Mixed-Gas Diving | 1524 | ||
| Enriched Air Nitrox | 1524 | ||
| Heliox | 1525 | ||
| Trimix | 1525 | ||
| Technical Diving | 1525 | ||
| Saturation Diving | 1525 | ||
| One-Atmosphere Diving | 1526 | ||
| Diving Physics | 1526 | ||
| Barotrauma | 1527 | ||
| Barotrauma of Descent | 1527 | ||
| Mask Barotrauma | 1527 | ||
| Sinus Barotrauma | 1528 | ||
| External Auditory Canal Barotrauma. | 1528 | ||
| Middle Ear Barotrauma (Barotitis Media). | 1529 | ||
| Inner Ear Barotrauma | 1530 | ||
| Suit Squeeze | 1530 | ||
| Dental Barotrauma | 1530 | ||
| Lung Squeeze | 1531 | ||
| Underwater Blast Injury | 1531 | ||
| Barotrauma of Ascent | 1531 | ||
| Reverse Sinus or Ear Barotrauma (Reverse Squeeze) | 1531 | ||
| Alternobaric Vertigo | 1531 | ||
| Alternobaric Facial Palsy | 1531 | ||
| Gastrointestinal Barotrauma | 1531 | ||
| Pulmonary Barotrauma | 1532 | ||
| Clinical Manifestations of Pulmonary Barotrauma. | 1532 | ||
| Local Injury. | 1532 | ||
| Arterial Gas Embolism | 1533 | ||
| Pathophysiology | 1533 | ||
| Sudden Death | 1533 | ||
| Clinical Manifestations | 1534 | ||
| Treatment | 1534 | ||
| Prehospital Care | 1535 | ||
| Recompression Treatment | 1535 | ||
| Adjunctive Treatment | 1535 | ||
| Prevention of Pulmonary Barotrauma and ARTERIAL GAS EMBOLISM | 1535 | ||
| Indirect Effects of Pressure | 1536 | ||
| Dalton’s Law of Partial Pressures | 1536 | ||
| Nitrogen Narcosis | 1536 | ||
| Oxygen Toxicity | 1536 | ||
| Pulmonary Oxygen Toxicity | 1537 | ||
| Central Nervous System Oxygen Toxicity | 1537 | ||
| Contaminated Breathing Gas (Carbon Monoxide Poisoning, Hypercarbia) | 1537 | ||
| Hyperventilation and Shallow Water Blackout | 1537 | ||
| Decompression Sickness | 1538 | ||
| Etiology | 1538 | ||
| Pathophysiology | 1538 | ||
| Biochemical Effects of Bubbles | 1538 | ||
| Clinical Manifestations | 1539 | ||
| Musculoskeletal Decompression Sickness | 1539 | ||
| Fatigue | 1539 | ||
| Skin Bends or Cutaneous Decompression Sickness | 1540 | ||
| Chokes or Pulmonary Decompression Sickness | 1540 | ||
| Neurologic Decompression Sickness | 1540 | ||
| Inner Ear or Vestibular Decompression Sickness | 1540 | ||
| Vasomotor Decompression Sickness | 1540 | ||
| Long-Term Sequelae | 1540 | ||
| Dysbaric Osteonecrosis | 1541 | ||
| Dysbaric Retinopathy | 1541 | ||
| Diagnosis | 1541 | ||
| Treatment | 1541 | ||
| Adjunctive Treatment | 1542 | ||
| Corticosteroids. | 1542 | ||
| Anticoagulants and Nonsteroidal Antiinflammatory Drugs. | 1542 | ||
| Prevention | 1542 | ||
| Decompression Sickness in Breath-Hold Divers | 1542 | ||
| Long-Term Health Effects of Diving | 1543 | ||
| Unusual Post-diving Conditions of Uncertain Etiology | 1543 | ||
| Immersion Pulmonary Edema | 1543 | ||
| Internal Carotid Artery Dissection | 1543 | ||
| Medical Fitness for Diving | 1544 | ||
| General Considerations | 1544 | ||
| Medical Clearance for Diving | 1544 | ||
| Specific Conditions of Concern with Regard to Diving | 1544 | ||
| Neurologic Disorders | 1544 | ||
| Seizures. | 1544 | ||
| Head Injury. | 1544 | ||
| Unexplained Syncope. | 1544 | ||
| Migraine Headaches. | 1544 | ||
| Cardiovascular Disorders | 1544 | ||
| Atrial Septal Defect. | 1544 | ||
| Patent Foramen Ovale. | 1544 | ||
| Coronary Artery Disease. | 1545 | ||
| Dysrhythmias. | 1545 | ||
| Hypertension. | 1545 | ||
| Pulmonary Disorders | 1545 | ||
| Spontaneous Pneumothorax. | 1545 | ||
| Asthma. | 1546 | ||
| Bullous Lung Disease. | 1546 | ||
| Diabetes. | 1546 | ||
| Pregnancy. | 1546 | ||
| Ear, Nose, and Throat Disorders. | 1546 | ||
| Sickle-Cell Disease or Trait. | 1546 | ||
| Panic Disorders. | 1546 | ||
| Abdominal Hernias. | 1546 | ||
| Poor Physical Condition. | 1546 | ||
| Medications and Diving | 1546 | ||
| Diving With Disabilities | 1547 | ||
| Flying After Diving | 1547 | ||
| Safe Scuba Diving | 1547 | ||
| Dive Accident Investigation | 1548 | ||
| References | 1549.e1 | ||
| References | 1549 | ||
| 78 Hyperbaric Medicine | 1549 | ||
| History of Hyperbaric Medicine | 1549 | ||
| Mechanisms of Hyperbaric Oxygen | 1549 | ||
| Effects of Hbo on Oxygen Content | 1549 | ||
| Effects of Elevated PO2 | 1550 | ||
| Vasoconstriction | 1550 | ||
| Antibacterial Effect | 1550 | ||
| Wound Healing | 1551 | ||
| Ischemia–Reperfusion Injury | 1551 | ||
| Types of Chambers | 1551 | ||
| Monoplace Chambers | 1551 | ||
| Multiplace Chambers | 1551 | ||
| Portable Recompression Chambers | 1551 | ||
| Altitude Illness | 1551 | ||
| Diving Injuries | 1552 | ||
| Contraindications to HBOT | 1553 | ||
| Absolute | 1553 | ||
| Relative | 1553 | ||
| Complications of HBOT | 1553 | ||
| Oxygen Toxicity | 1553 | ||
| CNS Oxygen Toxicity | 1553 | ||
| Pulmonary Oxygen Toxicity | 1553 | ||
| Barotrauma | 1553 | ||
| Claustrophobia | 1553 | ||
| Visual Refractive Changes | 1553 | ||
| Practical Aspects of Hyperbaric Treatment | 1554 | ||
| Evaluating the Patient for Hbot | 1554 | ||
| Preparation for Hyperbaric Treatment | 1554 | ||
| Manifestations of CNS Oxygen Toxicity | 1554 | ||
| Management of Oxygen-Induced Seizures | 1554 | ||
| Pediatric Considerations | 1554 | ||
| Approved Clinical Applications of HBOT | 1555 | ||
| Arterial Gas Embolism | 1555 | ||
| Decompression Sickness | 1555 | ||
| Carbon Monoxide and Cyanide Poisoning | 1556 | ||
| Necrotizing Soft Tissue Infections | 1556 | ||
| Clostridial Myonecrosis (Gas Gangrene) | 1556 | ||
| Necrotizing Fasciitis | 1556 | ||
| Crush Injuries, Compartment Syndrome, and Acute Ischemias | 1557 | ||
| Central Retinal Artery Occlusion | 1557 | ||
| Exceptional Anemia | 1557 | ||
| Compromised Skin Grafts and Flaps | 1558 | ||
| Problem Wound Healing | 1558 | ||
| Delayed Radiation Injuries (Soft Tissue and Bony Necrosis) | 1559 | ||
| Refractory Osteomyelitis | 1559 | ||
| Thermal Burns | 1559 | ||
| Intracranial Abscess | 1560 | ||
| Emerging Research | 1560 | ||
| Acute Myocardial Ischemia | 1560 | ||
| Acute Cerebral Ischemia | 1560 | ||
| Organ Transplantation | 1561 | ||
| Wilderness Medicine Applications of HBOT | 1561 | ||
| Frostbite | 1561 | ||
| Brown Recluse Spider Bite | 1561 | ||
| Heatstroke | 1561 | ||
| Field Treatment of Combat Trauma | 1561 | ||
| References | 1562.e1 | ||
| References | 1562 | ||
| 79 Injuries From Nonvenomous Aquatic Animals | 1562 | ||
| Divisions and Definitions | 1562 | ||
| In Defense of the Fish | 1562 | ||
| General Principles of First Aid | 1563 | ||
| Wound Management | 1563 | ||
| Wound Irrigation | 1563 | ||
| Wound Debridement | 1563 | ||
| Wound Closure | 1563 | ||
| Prophylaxis against Tetanus | 1563 | ||
| Bacteriology of the Aquatic Environment | 1563 | ||
| Marine Bacteriology | 1564 | ||
| Marine Environment | 1564 | ||
| Diversity of Organisms | 1564 | ||
| Wound Infections Caused by Vibrio Species | 1565 | ||
| Vibrio parahaemolyticus. | 1565 | ||
| Vibrio vulnificus. | 1565 | ||
| Vibrio mimicus. | 1566 | ||
| Vibrio alginolyticus. | 1566 | ||
| Photobacterium damsela. | 1567 | ||
| Vibrio cholerae. | 1567 | ||
| Growth in Culture. | 1567 | ||
| Antibiotic Therapy. | 1567 | ||
| Freshwater Bacteriology | 1568 | ||
| Diversity of Organisms | 1568 | ||
| Wound Infections Caused by Aeromonas Species. | 1568 | ||
| Infections Caused by a Fish Pathogen, Streptococcus iniae. | 1569 | ||
| A General Approach to Antibiotic Therapy. | 1569 | ||
| Sharks | 1569 | ||
| Life and Habits | 1571 | ||
| Shark Feeding and Attack | 1575 | ||
| Clinical Aspects | 1578 | ||
| Treatment | 1582 | ||
| Prevention | 1583 | ||
| Barracuda | 1585 | ||
| Life and Habits | 1585 | ||
| 10 Travel, Environmental Hazards, and Disasters | 1693 | ||
| 84 Travel Medicine | 1694 | ||
| Sources of Information | 1694 | ||
| Travel Health Risk Assessment | 1694 | ||
| Hazards of Air Travel | 1695 | ||
| Jet Lag | 1696 | ||
| Before Travel | 1696 | ||
| In Flight | 1696 | ||
| On Arrival | 1696 | ||
| Deep VEIN Thrombosis | 1696 | ||
| Immunizations for Travel | 1696 | ||
| Required Travel Vaccines | 1699 | ||
| Yellow Fever Vaccine. | 1699 | ||
| Cholera Vaccine. | 1699 | ||
| Smallpox Vaccine. | 1699 | ||
| Recommended Travel Vaccines | 1699 | ||
| Hepatitis A Vaccine. | 1699 | ||
| Hepatitis B Vaccine. | 1700 | ||
| Typhoid Fever Vaccine. | 1700 | ||
| Meningococcal Vaccine. | 1700 | ||
| Japanese Encephalitis Virus Vaccine. | 1700 | ||
| Rabies Vaccine (see Chapter 60). | 1701 | ||
| Tick-Borne Encephalitis Vaccine. | 1701 | ||
| BCG Vaccine. | 1701 | ||
| Varicella Zoster Virus (chickenpox). | 1701 | ||
| Influenza. | 1701 | ||
| Other Vaccines. | 1701 | ||
| Routine Vaccines | 1702 | ||
| Diphtheria, Tetanus, and Pertussis Vaccine. | 1702 | ||
| Poliomyelitis Vaccine. | 1702 | ||
| Measles, Mumps, and Rubella Vaccine. | 1702 | ||
| Haemophilus influenzae B Vaccine. | 1702 | ||
| Pneumococcal Vaccine. | 1702 | ||
| Malaria | 1702 | ||
| Malaria Risk Assessment | 1702 | ||
| Insect Precautions | 1703 | ||
| Malaria Chemoprophylaxis | 1703 | ||
| Standby Self-Diagnosis and Drug Treatment | 1705 | ||
| Traveler’s Diarrhea (see Chapter 68) | 1706 | ||
| Chemoprophylaxis of Traveler’s Diarrhea | 1706 | ||
| Symptomatic Treatment of Traveler’s Diarrhea | 1706 | ||
| Antibiotic Treatment of Traveler’s Diarrhea | 1707 | ||
| High-Altitude Illness (see Chapter 1) | 1707 | ||
| Sun (see Chapter 14) | 1708 | ||
| Motion Sickness (see Chapter 77) | 1708 | ||
| Travel Medical Kit | 1708 | ||
| Post-travel Medical Care and Screening | 1708 | ||
| References | 1709.e1 | ||
| References | 1709 | ||
| APPENDIX Resources for Travel Medicine Information | 1708 | ||
| 85 Non–North American Travel and Exotic Diseases | 1709 | ||
| Major Viral Infections | 1709 | ||
| Major Viral Hemorrhagic Fevers | 1709 | ||
| Yellow Fever | 1709 | ||
| Virology and Pathophysiology. | 1709 | ||
| 11 Equipment and Special Knowledge | 1811 | ||
| 90 Global Crimes, Incarceration, and Quarantine | 1812 | ||
| Hostile Geopolitical Environments and Political Insecurity | 1812 | ||
| Danger by Geography: The World’s Most Dangerous Places | 1812 | ||
| Reasons for Enhanced Personal Risk in Politically Unstable Regions | 1812 | ||
| Increasing Civilian Nongovernmental Organization Involvement in Unstable Regions | 1812 | ||
| Targeting of Civilians on the Basis of Nationality | 1813 | ||
| Targeting Aid Workers | 1813 | ||
| Restricted Access in Politically Unstable Regions | 1813 | ||
| Weapons | 1813 | ||
| Risk Reduction Strategies for Situations in Which There Are Armed Combatants | 1814 | ||
| Land Mines and Unexploded Ordnance | 1814 | ||
| Mine Types | 1814 | ||
| Effects of Land Mines on Populations and Health | 1814 | ||
| Risk-Reduction Strategies When Traveling in Regions That Are Mined | 1815 | ||
| Banning Land Mines | 1815 | ||
| High-Risk Situations for International Travelers | 1815 | ||
| Checkpoints | 1815 | ||
| Informal Roadblocks | 1815 | ||
| Demonstrations | 1815 | ||
| Risk-Reduction Strategies for Travel between Borders and Military Checkpoints | 1815 | ||
| Global Crimes: Patterns and Implications for Travelers | 1816 | ||
| The Scope and Array of Global Crime | 1816 | ||
| Human Trafficking and Sex Slavery | 1816 | ||
| Terrorism | 1816 | ||
| Risk-Reduction Strategies | 1816 | ||
| Kidnapping and Hostage Situations | 1816 | ||
| Risk-Reduction Strategies in Kidnapping or Hostage Situations | 1817 | ||
| Piracy and Threats While Traveling at Sea | 1817 | ||
| Incarceration and Quarantine | 1817 | ||
| Incarceration and Detention: A Global Perspective | 1817 | ||
| Drug Offenses Abroad | 1818 | ||
| Quarantine | 1818 | ||
| Quarantine Abroad | 1818 | ||
| Safety and Security Strategies for Travelers | 1818 | ||
| Traveling and Working in a Conflict Zone: Individual Considerations | 1819 | ||
| Assistance for Victims of Crime Overseas | 1819 | ||
| Summary: Traveling and Working in Politically Insecure Regions | 1819 | ||
| References | 1819.e1 | ||
| References | 1819 | ||
| 91 Wilderness Preparation, Equipment, and Medical Supplies | 1820 | ||
| Epidemiology | 1820 | ||
| General Preparation | 1820 | ||
| Planning Strategies, Preventive Measures, and Risk Factors for Wilderness Travel | 1820 | ||
| Before the Trip | 1821 | ||
| Factors in Trip Planning | 1822 | ||
| Healthy Participants | 1822 | ||
| People with Preexisting Medical Problems | 1822 | ||
| Education in First Aid and Wilderness Safety | 1823 | ||
| Trip Duration and Availability of Medical Care | 1823 | ||
| Environmental Risks: Clothing, Fabrics, and Activities | 1823 | ||
| Planning for Terrain and Risks of Activity | 1824 | ||
| Medical Kits and Equipment | 1824 | ||
| Personal Medical Kit | 1824 | ||
| Comprehensive Community Medical Kit | 1824 | ||
| Medical Kits for Expeditions and the Medically Trained | 1824 | ||
| Specialized Equipment for Environmental and Recreational Hazards | 1827 | ||
| High-Altitude Exposure (see also Chapter 1) | 1828 | ||
| Cold Exposure | 1828 | ||
| A Note on “Space Blankets” and Plastic Yard Refuse Bags | 1829 | ||
| Water Disinfection | 1829 | ||
| Bicycling | 1829 | ||
| Mountain Climbing and Hiking | 1829 | ||
| Items Stored in the Vehicle | 1829 | ||
| Medications | 1829 | ||
| Passing Through Customs with Medications | 1837 | ||
| Preparing for Common Medical Problems | 1837 | ||
| Gastrointestinal and Genitourinary Care | 1837 | ||
| Diarrhea and Abdominal Pain | 1837 | ||
| Sexually Transmitted Infections | 1838 | ||
| Oral Hygiene and Health | 1838 | ||
| Fractures and Dislocations | 1838 | ||
| Sleeping and Staying Awake | 1839 | ||
| Blisters and Foot Care | 1839 | ||
| Wounds | 1839 | ||
| Bites and Stings | 1840 | ||
| Sunburn, Snowblindness, and Sunglasses | 1840 | ||
| Pain | 1841 | ||
| Special Considerations | 1841 | ||
| Strategies for Assembling Medical Kits | 1841 | ||
| How Much to Bring? | 1841 | ||
| A Sample Journey | 1842 | ||
| References | 1844.e1 | ||
| References | 1844 | ||
| APPENDIX A Health Questionnaire for Wilderness Travel | 1842 | ||
| Medical Data | 1842 | ||
| APPENDIX B Sources of Information About Wilderness Emergencies and Suggested Readings | 1843 | ||
| APPENDIX C Suppliers Listed in the Text and Tables | 1843 | ||
| 92 Ultrasound and Telemedicine in the Wilderness | 1845 | ||
| Ultrasound | 1845 | ||
| Ultrasound for Wilderness Clinical Care And Research | 1846 | ||
| Advantages | 1846 | ||
| Portability. | 1846 | ||
| Safety/Noninvasiveness. | 1846 | ||
| Versatility. | 1846 | ||
| Cost. | 1846 | ||
| Limitations. | 1847 | ||
| Research-Specific Concerns | 1847 | ||
| Introduction to Clinical Imaging | 1847 | ||
| Common Clinical Imaging Techniques | 1847 | ||
| Focused Assessment with Sonography for Trauma (fast) | 1847 | ||
| Thoracic Ultrasound for Pneumothorax and Pulmonary Edema | 1850 | ||
| Fracture Assessment | 1852 | ||
| Optic Nerve Sheath Ultrasonography | 1853 | ||
| Doppler and Blood Flow Studies | 1854 | ||
| Inferior Vena Cava Assay | 1854 | ||
| Cardiac: Echocardiography | 1855 | ||
| Pregnancy | 1855 | ||
| Right Upper Quadrant Ultrasonography | 1856 | ||
| Right Lower Quadrant Ultrasonography | 1857 | ||
| Technique | 1858 | ||
| Peripheral Veins | 1858 | ||
| Telemedicine | 1859 | ||
| Power Supply Considerations | 1861 | ||
| Acknowledgments. | 1862 | ||
| References | 1862.e1 | ||
| References | 1862 | ||
| 93 Outdoor Clothing for the Wilderness Professional | 1862 | ||
| Fabrics and Fibers | 1863 | ||
| Natural Fibers | 1863 | ||
| Down | 1863 | ||
| Fur, Leather, and Hides | 1864 | ||
| Synthetic Fibers | 1864 | ||
| Blends | 1864 | ||
| Waterproof/Breathable Fabrics | 1864 | ||
| Laminates. | 1864 | ||
| Coated Fabrics. | 1865 | ||
| Soft-Shell Fabrics. | 1865 | ||
| Durable Water-Repellent Finish. | 1866 | ||
| Layering | 1866 | ||
| Base Layer | 1866 | ||
| Middle Layer | 1867 | ||
| Outer Layer | 1867 | ||
| Multilayered Garments | 1867 | ||
| Accessories | 1867 | ||
| Headgear | 1867 | ||
| Neckwear | 1868 | ||
| Eyewear | 1868 | ||
| Handwear | 1868 | ||
| Footwear | 1868 | ||
| Care and Storage of Clothing | 1870 | ||
| Laundering | 1871 | ||
| Drying | 1871 | ||
| Durable Water-Repellent Finish | 1871 | ||
| Footwear | 1871 | ||
| Storage | 1871 | ||
| Repair | 1871 | ||
| Special-Use Clothing | 1871 | ||
| Sun Protection Clothing | 1871 | ||
| Insect-Repellent Clothing | 1871 | ||
| Fire-Resistant Clothing | 1872 | ||
| Vapor Barrier Clothing | 1872 | ||
| Sport-Specific Clothing | 1872 | ||
| Climate-Specific Clothing | 1872 | ||
| Hot | 1872 | ||
| Temperate | 1873 | ||
| Cold | 1873 | ||
| Extreme Cold | 1873 | ||
| Water/Ocean and River | 1873 | ||
| Selected Resources | 1873.e2 | ||
| Selected Resources | 1873 | ||
| 94 Nonmedical Backcountry Equipment for Wilderness Professionals | 1874 | ||
| General Concepts for Choosing Equipment | 1874 | ||
| Choosing Gear | 1874 | ||
| Essential Emergency Equipment | 1874 | ||
| Who? | 1875 | ||
| What and Where? | 1875 | ||
| When? | 1875 | ||
| How Far? How Long? | 1875 | ||
| Navigation | 1875 | ||
| Sun Protection | 1876 | ||
| Sunglasses and Goggles | 1876 | ||
| Lights | 1877 | ||
| Headlamps | 1877 | ||
| Flashlights | 1878 | ||
| Lanterns | 1878 | ||
| Lantern Safety | 1878 | ||
| Tools | 1878 | ||
| Multifunction Tools | 1878 | ||
| Knives | 1879 | ||
| Blade Shapes | 1879 | ||
| Construction | 1880 | ||
| Handles | 1880 | ||
| Care | 1880 | ||
| Shovels and Trowels | 1880 | ||
| Saws and Axes | 1880 | ||
| Gear Repair | 1880 | ||
| First-Aid Kit | 1880 | ||
| Fire-Starting Materials | 1880 | ||
| Food | 1880 | ||
| Water | 1881 | ||
| Heat Packs and Heaters | 1882 | ||
| Optics | 1882 | ||
| Packs | 1882 | ||
| Lumbar Packs | 1882 | ||
| Day Packs | 1882 | ||
| Backpacks | 1882 | ||
| Duffels, Stuff Sacks, and Dry Bags | 1884 | ||
| Electronics | 1885 | ||
| Power | 1885 | ||
| Overnight Gear | 1885 | ||
| Stoves | 1886 | ||
| Accessories | 1887 | ||
| Cook Sets | 1887 | ||
| Personal Toiletries | 1887 | ||
| Sleeping Bags | 1887 | ||
| Insulation | 1887 | ||
| Down. | 1887 | ||
| Synthetics. | 1888 | ||
| Temperature | 1888 | ||
| Sleeping Pads | 1889 | ||
| Shelters | 1890 | ||
| Construction and Design | 1890 | ||
| Shape and Size | 1890 | ||
| Bivouac Sack | 1890 | ||
| Tarps | 1890 | ||
| Tents | 1891 | ||
| Accessories | 1891 | ||
| Care of Outdoor Equipment | 1891 | ||
| Selected Resources | 1891.e2 | ||
| Selected Resources | 1891 | ||
| 95 Ropes and Knot Tying | 1892 | ||
| Rope for Life Safety | 1892 | ||
| Strength | 1892 | ||
| Impact Force | 1892 | ||
| Number of Falls Held | 1893 | ||
| Elongation | 1893 | ||
| Diameter | 1893 | ||
| Abrasion Resistance | 1893 | ||
| Compatibility with Other Equipment | 1893 | ||
| Hand | 1893 | ||
| Quality | 1893 | ||
| Life-Safety Rope Construction | 1893 | ||
| Materials | 1893 | ||
| Polyolefin | 1894 | ||
| Aramids | 1894 | ||
| Ultra-High–Modulus Polyethylene | 1894 | ||
| Polyester | 1894 | ||
| Nylon | 1894 | ||
| Rope Type | 1894 | ||
| Dynamic Kernmantle Rope | 1894 | ||
| Static Kernmantle Rope | 1894 | ||
| Low-Stretch Kernmantle Rope | 1894 | ||
| Rope Selection Considerations | 1894 | ||
| Fall Factors | 1895 | ||
| Rope Diameter | 1895 | ||
| Rope Strength | 1895 | ||
| Safety Factors | 1895 | ||
| Service Life | 1895 | ||
| Knots in Life-Safety Ropes | 1896 | ||
| Uses | 1896 | ||
| How Knots Work | 1896 | ||
| Rope and Knot Terminology | 1896 | ||
| Categories of Knots | 1896 | ||
| Stopper Knots | 1896 | ||
| End-of-Line Knots | 1897 | ||
| Midline Knots | 1898 | ||
| Knots That Join Two Ropes | 1900 | ||
| Hitches | 1900 | ||
| Lashing | 1902 | ||
| Emergency Harness | 1903 | ||
| Knot Safety | 1903 | ||
| Knots and Rope Strength | 1903 | ||
| Learning More About Ropes and Knots | 1904 | ||
| 96 Wilderness Navigation Techniques and Communication Methods | 1904 | ||
| Navigation With the Global Positioning System | 1905 | ||
| The Geodetic Coordinate System | 1906 | ||
| The Universal Transverse Mercator Coordinate System | 1907 | ||
| Compass Navigation | 1909 | ||
| Magnetic Dip, Deviation, and Declination | 1909 | ||
| Compass Types | 1910 | ||
| Compass Use | 1910 | ||
| Makeshift Compasses | 1911 | ||
| Celestial Navigation | 1911 | ||
| Celestial Coordinates | 1913 | ||
| Horizon Coordinate System | 1913 | ||
| Celestial Lines of Position: Methods for Latitude | 1914 | ||
| Celestial Lines of Position: Methods for Longitude | 1914 | ||
| Celestial Methods for Direction Finding | 1915 | ||
| Shadow Methods | 1915 | ||
| Direction by Amplitudes | 1916 | ||
| Direction by Observation of Circumpolar Stars | 1916 | ||
| Direction by Observation of Other Stars | 1917 | ||
| Practical Field-Expedient Celestial Navigation | 1918 | ||
| Navigation With a Pocket Radio | 1918 | ||
| Orienteering and Geocaching | 1919 | ||
| The Orienteering Meet | 1919 | ||
| Orienteering for Children | 1920 | ||
| Geocaching | 1921 | ||
| Wilderness Communication Methods | 1921 | ||
| Two-way Local Communication | 1921 | ||
| Family Radio Service | 1921 | ||
| General Mobile Radio Service | 1922 | ||
| 900-MHz Band | 1922 | ||
| 2-Meter and 70-Centimeter Amateur Radio Service | 1922 | ||
| Emergency Beacons | 1923 | ||
| Two-way Long-distance Communication | 1924 | ||
| Iridium | 1924 | ||
| Globalstar | 1924 | ||
| Inmarsat | 1924 | ||
| Thuraya | 1924 | ||
| Satellite Internet | 1925 | ||
| Conclusion | 1925 | ||
| References | 1925.e2 | ||
| References | 1925 | ||
| 12 Special Populations and Considerations | 1927 | ||
| 97 Training for Wilderness Adventure | 1928 | ||
| Mental Awareness | 1928 | ||
| Physical Conditioning | 1928 | ||
| Aerobic Fitness | 1928 | ||
| Maximum Oxygen Consumption | 1928 | ||
| Sustainable Threshold | 1929 | ||
| Improving Human Performance | 1930 | ||
| Malleability of the Lactate Threshold | 1930 | ||
| Training Effect on the Lactate Threshold | 1930 | ||
| Efficiency of Movement | 1932 | ||
| Aging and Training | 1933 | ||
| High Altitude and Exercise | 1933 | ||
| Effect of High Altitude on Exercise | 1934 | ||
| Hypoxic Training | 1935 | ||
| Artificial Training Methods: Blood Transfusion | 1936 | ||
| References | 1936.e1 | ||
| References | 1936 | ||
| 98 Exercise, Conditioning, and Performance Training | 1936 | ||
| Fitness as a Lifestyle | 1936 | ||
| Specificity | 1936 | ||
| Strength, Muscular Endurance, AND Power | 1937 | ||
| Abdominal Muscles and the Core | 1937 | ||
| Flexibility | 1937 | ||
| Conditioning | 1938 | ||
| Functional Conditioning | 1938 | ||
| Strength, Endurance, Power for Wilderness Preparedness | 1938 | ||
| Upper Body | 1938 | ||
| Push-Ups. | 1938 | ||
| Pull-Ups. | 1938 | ||
| Lower Body | 1939 | ||
| Lunges. | 1939 | ||
| Squats. | 1939 | ||
| Abdominal and Core Muscle Conditioning | 1939 | ||
| Hands and Wrists | 1940 | ||
| Feet and Ankles | 1940 | ||
| Power and Plyometrics | 1941 | ||
| Stretching for Wilderness Preparedness | 1941 | ||
| Anterior Shoulder and Chest | 1941 | ||
| Hip and Thigh | 1942 | ||
| Hamstrings | 1942 | ||
| Achilles Tendon and Foot | 1942 | ||
| Flexibility-Enhancing Techniques | 1942 | ||
| Balance Skills for the Trail | 1942 | ||
| Developing Speed for Wilderness Situations | 1943 | ||
| Brain Conditioning for the Wilderness | 1943 | ||
| Aerobic and Anaerobic Conditioning | 1943 | ||
| Conditioning for Special Environments | 1943 | ||
| Heat | 1944 | ||
| Cold | 1944 | ||
| Altitude | 1944 | ||
| Scuba Diving | 1944 | ||
| Performance and Injury | 1944 | ||
| Avoiding Exercise Injuries | 1945 | ||
| Safer Back Positioning | 1945 | ||
| Lifting Loads. | 1945 | ||
| Carrying loads. | 1945 | ||
| Walking and Running. | 1945 | ||
| Safer Knee Positioning. | 1945 | ||
| Safer Neck Positioning. | 1946 | ||
| Avoiding Stretching Injuries | 1946 | ||
| Back Pain Prevention during Long Travel to the Wilderness | 1946 | ||
| Long Sitting in an Automobile | 1946 | ||
| Buses and Flights | 1946 | ||
| Soreness after Exertion | 1947 | ||
| Fitness Myths | 1947 | ||
| Performance Enhancement | 1948 | ||
| Performance-Enhancing Drugs and Nutrients for Exercise and Expeditions | 1948 | ||
| Methylxanthines. | 1949 | ||
| Caffeine. | 1949 | ||
| Theophylline. | 1949 | ||
| Theobromine. | 1949 | ||
| Guarana. | 1949 | ||
| Yerba Mate. | 1949 | ||
| Cholinergic Stimulants (Tobacco, Areca, and Lobelia) | 1949 | ||
| Nicotine. | 1949 | ||
| Betel Nut. | 1949 | ||
| Lobelia. | 1949 | ||
| Sympathomimetic Stimulants—Monoaminergic (Amphetamines, Coca, Khat, and Ephedra) | 1950 | ||
| Amphetamine. | 1950 | ||
| Coca. | 1950 | ||
| Khat. | 1950 | ||
| Ephedra (Ma Huang). | 1950 | ||
| Other Stimulants | 1950 | ||
| Ginseng. | 1950 | ||
| Anabolic Steroids | 1950 | ||
| Anabolic (Growth-Promoting) Nonsteroids | 1951 | ||
| DHEA. | 1951 | ||
| Androstenedione. | 1951 | ||
| Creatine. | 1951 | ||
| Foods | 1951 | ||
| Carbohydrate. | 1951 | ||
| Vitamins and Minerals. | 1951 | ||
| Bee Pollen. | 1951 | ||
| Water | 1951 | ||
| Fitness Water, Fitness Carbo, and/or Protein Drinks with “Buzz.” | 1951 | ||
| Alerting and Wakefulness Adjuncts. | 1951 | ||
| References | 1951.e1 | ||
| References | 1951 | ||
| 99 Children in the Wilderness | 1952 | ||
| What Makes Children Different? | 1952 | ||
| Size and Shape | 1952 | ||
| Musculoskeletal System | 1952 | ||
| Cardiovascular and Respiratory Systems | 1952 | ||
| Thermoregulation | 1953 | ||
| Immunology and Infections | 1953 | ||
| Trauma | 1954 | ||
| General Considerations and Expectations | 1954 | ||
| First 2 Years | 1954 | ||
| Travel Expectations | 1954 | ||
| Safety | 1954 | ||
| Food and Drink | 1954 | ||
| Diapers | 1955 | ||
| Equipment | 1955 | ||
| 2 to 4 Years | 1956 | ||
| Travel Expectations | 1956 | ||
| Safety | 1956 | ||
| Food | 1957 | ||
| Toileting | 1957 | ||
| School Age (5 Years and Up) | 1957 | ||
| Travel Expectations | 1957 | ||
| Safety | 1957 | ||
| Equipment | 1957 | ||
| Environmental Illnesses | 1957 | ||
| Dehydration | 1957 | ||
| Symptoms | 1957 | ||
| Treatment | 1957 | ||
| Hypothermia | 1957 | ||
| Prevention | 1958 | ||
| 13 The Wilderness | 2133 | ||
| 109 The Changing Environment | 2134 | ||
| Issues of Environmental Change | 2135 | ||
| Climate Change | 2135 | ||
| Stratospheric Ozone Depletion | 2136 | ||
| Erosion of Biodiversity (See Chapter 110) | 2137 | ||
| Population Growth | 2137 | ||
| Pollution | 2138 | ||
| Impacts of Environmental Change on Wilderness Areas | 2139 | ||
| Conversion of Wilderness | 2139 | ||
| Human Penetration of Wilderness Areas | 2140 | ||
| Direct Impacts | 2140 | ||
| Indirect Impacts | 2140 | ||
| High-Risk Technologies | 2141 | ||
| Consequences of Environmental Change | 2141 | ||
| Environmental Change and Medical Emergencies | 2141 | ||
| Complexity and Uncertainty | 2142 | ||
| What Might Be Done About Limiting Environmental Change? | 2143 | ||
| Changes in Environmental Science and Policy Making | 2143 | ||
| International Actions | 2143 | ||
| National Actions | 2144 | ||
| Local Actions | 2144 | ||
| References | 2145.e1 | ||
| References | 2145 | ||
| 110 Biodiversity and Human Health | 2145 | ||
| Understanding the Etiology of the Biodiversity Crisis | 2145 | ||
| Threatened Ecosystems | 2146 | ||
| Species Decline | 2147 | ||
| Loss of Genetic Diversity | 2147 | ||
| Invasive Species | 2148 | ||
| Altered Epidemiology Of Diseases | 2148 | ||
| Loss Of Biologic Raw Materials | 2149 | ||
| Loss Of Models For Medical Research | 2149 | ||
| Threatened Food Production | 2149 | ||
| Threatened Water Resources | 2150 | ||
| Case Study | 2150 | ||
| Conclusion | 2151 | ||
| References | 2151.e1 | ||
| References | 2151 | ||
| 111 Health Implications of Environmental Change | 2152 | ||
| Climate Change | 2152 | ||
| Climate Change and Weather Effects | 2152 | ||
| Extreme Heat Events. | 2152 | ||
| Mean Temperature Increases. | 2153 | ||
| Extreme Weather Events. | 2153 | ||
| Climate Change and Infectious Disease | 2154 | ||
| Infectious Agents and Their Vectors. | 2154 | ||
| Public Health Conditions Favoring Disease. | 2154 | ||
| Climate Change and Ozone Depletion | 2154 | ||
| Dermatologic and Ocular Effects. | 2154 | ||
| Immune Systems and Infectious Disease. | 2156 | ||
| CLIMATE CHANGE AND LOSS OF BIODIVERSITY (See Chapter 110) | 2156 | ||
| Biodiversity and Epidemics. | 2156 | ||
| Biodiversity and Medicines. | 2156 | ||
| Water Pollution | 2156 | ||
| Water Pollution and Viruses | 2156 | ||
| Hepatitis A virus. | 2157 | ||
| Polio. | 2157 | ||
| Water Pollution and Bacteria | 2157 | ||
| Cholera. | 2157 | ||
| Dysentery. | 2157 | ||
| Typhoid. | 2157 | ||
| Trachoma. | 2157 | ||
| Water Pollution and Parasites | 2157 | ||
| Protozoa. | 2157 | ||
| Helminths. | 2157 | ||
| Other Parasitic Infections. | 2157 | ||
| Water Pollution By Natural Toxins | 2158 | ||
| Arsenicosis. | 2158 | ||
| Fluorosis. | 2158 | ||
| Lead. | 2158 | ||
| Organic and Nonorganic Compounds. | 2158 | ||
| Air Pollution | 2158 | ||
| Air Pollution and Particulate Matter | 2158 | ||
| Air Pollution, Sulfur Dioxide, and Nitrogen Oxides | 2158 | ||
| Air Pollution and Ozone | 2159 | ||
| Air Pollution and Aeroallergens | 2159 | ||
| Soil Pollution | 2159 | ||
| Soil Pollution and Pesticides | 2159 | ||
| Acute Pesticide Exposure. | 2159 | ||
| Chronic Pesticide Exposure. | 2159 | ||
| Soil Pollution, Sewage, and Rotting Organic Material | 2160 | ||
| Soil Pollution and Bioaccumulation | 2160 | ||
| Dichlorodiphenyltrichloroethane (DDT). | 2160 | ||
| Endocrine Disrupting Chemicals. | 2160 | ||
| Conclusions on Human Health and Environmental Change | 2160 | ||
| References | 2161.e1 | ||
| Suggested Readings | 2161.e1 | ||
| Climate Change | 2161.e1 | ||
| Water, Air, and Soil Pollution | 2161.e2 | ||
| References | 2161 | ||
| 112 Wilderness Management and Preservation | 2161 | ||
| Historical Development of the Wilderness Concept | 2161 | ||
| Wilderness Legislation and Policy in the United States | 2161 | ||
| Wilderness Stewardship Philosophy | 2163 | ||
| Potential Threats to Wilderness | 2163 | ||
| Wilderness Management Agencies in the United States | 2164 | ||
| Distribution of Wilderness in the United States | 2164 | ||
| Wilderness Values and Public Perceptions | 2165 | ||
| Wilderness Visitors | 2165 | ||
| Distribution of Wilderness Visitor Use | 2165 | ||
| Wilderness Management Principles | 2166 | ||
| Wilderness Preservation as a National and International Movement | 2166 | ||
| References | 2167.e1 | ||
| References | 2167 | ||
| 113 Leave No Trace | 2167 | ||
| Sustainability | 2167 | ||
| Energy | 2167 | ||
| Renewable Energy | 2168 | ||
| Biomass | 2168 | ||
| Wind Power | 2168 | ||
| Solar Power | 2168 | ||
| Geothermal | 2169 | ||
| Nuclear Energy | 2169 | ||
| Sustainable Living | 2169 | ||
| Sustainable Hospitals | 2169 | ||
| Sustainable Travel | 2170 | ||
| The Challenge | 2170 | ||
| Sustainability in the Wilderness | 2170 | ||
| Sustainability In Special Environs | 2171 | ||
| The Mountains | 2171 | ||
| Snow | 2171 | ||
| Water | 2171 | ||
| Tundra | 2172 | ||
| The Desert | 2172 | ||
| Suggested Resources | 2172.e1 | ||
| Leave No Trace | 2172.e1 | ||
| Our Choice website by Al Gore | 2172.e1 | ||
| Intergovernmental Panel on Climate Change | 2172.e1 | ||
| The United Nations Environmental Programme | 2172.e1 | ||
| Carbon Offsets | 2172.e1 | ||
| Nuclear | 2172.e1 | ||
| Green Hospitals | 2172.e1 | ||
| References | 2172.e1 | ||
| References | 2172 | ||
| 114 Space Medicine: | 2172 | ||
| Historical Perspective—X-15 To The Iss And Beyond | 2173 | ||
| Medical Challenges of Spaceflight | 2174 | ||
| Time Course Of Changes And Adaptation To Microgravity | 2174 | ||
| Short-Term Effects | 2174 | ||
| Long-Term Effects | 2174 | ||
| Effects On Human Physiology | 2174 | ||
| Effects on the Cardiovascular and Pulmonary Systems | 2174 | ||
| Effects on the Neurovestibular and Sensory Systems | 2175 | ||
| Effects on the Musculoskeletal System | 2176 | ||
| Effects on the Gastrointestinal and Genitourinary Systems | 2177 | ||
| Effects on the Endocrine System | 2177 | ||
| Effects on the Immune System | 2178 | ||
| Effects on the Blood, Fluid, and Electrolyte Balance | 2178 | ||
| Stressful Environment: Psychological and Behavioral Issues | 2178 | ||
| Lack of Privacy. | 2179 | ||
| Monotony and Boredom. | 2179 | ||
| Circadian Patterns and Sleep Disturbances. | 2179 | ||
| Workload Issues. | 2180 | ||
| Future Research | 2180 | ||
| Analog Environments | 2180 | ||
| Artificial Gravity | 2180 | ||
| Space Environment | 2181 | ||
| Micrometeoroids And Space Debris | 2181 | ||
| Approaches to Minimize Micrometeoroids and Space Debris | 2181 | ||
| Protection Against Micrometeoroids and Space Debris During EVA | 2181 | ||
| Impact Emergency Procedures | 2182 | ||
| Radiation | 2182 | ||
| Operational Concerns | 2183 | ||
| Microgravity | 2183 | ||
| Partial-Gravity Environment | 2183 | ||
| Starting Out With “The Right Stuff:” Planning The Expedition | 2183 | ||
| Crew Selection—Medical Criteria | 2183 | ||
| Psychological Factors in Crew Selection | 2184 | ||
| Preflight/Mission Planning | 2185 | ||
| Medical System Design | 2185 | ||
| Predicting Likely Illnesses And Injuries | 2187 | ||
| Deciding What To Bring (Benefit Vs. Burden) | 2187 | ||
| Designing The Vehicle | 2188 | ||
| Training The Crew | 2188 | ||
| Crew Medical Training (Initial, Sustainment, and “Just in Time”) | 2188 | ||
| Treating The Casualties | 2188 | ||
| Issues for Therapeutic Intervention | 2188 | ||
| Routes of Drug Administration | 2189 | ||
| Crew Medical Officer Training and Pharmaceuticals | 2189 | ||
| In-Flight Support on Long-Duration Missions | 2189 | ||
| Keeping Them Healthy: Creating A Home | 2189 | ||
| Contaminants | 2190 | ||
| Temperature | 2190 | ||
| Humidity | 2191 | ||
| Waste Management | 2192 | ||
| Medical Waste | 2192 | ||
| What To Wear? | 2193 | ||
| Personal Hygiene | 2193 | ||
| “Marching On Their Stomachs” | 2194 | ||
| In-Flight Exercise Countermeasures Programs | 2195 | ||
| Psychological Support | 2196 | ||
| “Are We There Yet? I’m Bored!” Personal Recreation | 2197 | ||
| Postflight Rehabilitation | 2197 | ||
| Survival | 2197 | ||
| Hazards: What They Are And How To Control Them | 2197 | ||
| Crew Safety Equipment | 2197 | ||
| Launch/Landing Stresses And Surface Concerns | 2198 | ||
| Decompression Hazards | 2199 | ||
| Spacewalk Concerns | 2200 | ||
| Vehicle Hazards | 2200 | ||
| Fire Hazards | 2200 | ||
| Electrical Hazards | 2201 | ||
| Chemical Hazards | 2201 | ||
| Case Study | 2201 | ||
| Mechanical Hazards | 2202 | ||
| Vehicle Survival | 2202 | ||
| Challenger And Columbia Disasters | 2202 | ||
| Human Error | 2202 | ||
| Issues of Survivability | 2203 | ||
| Exploration-Class Missions | 2203 | ||
| References | 2204.e4 | ||
| References | 2204 | ||
| Appendix Drug Stability in the Wilderness | 2205 | ||
| Environmental Factors Influencing Drug Stability | 2205 | ||
| Evidence-Based Research | 2205 | ||
| Expiration Dates | 2205 | ||
| Packaging | 2205 | ||
| Sterility | 2206 | ||
| Storage | 2206 | ||
| Drug Stability | 2207 | ||
| Drugs for a Basic Field Kit | 2207 | ||
| How to Read the Drug List | 2207 | ||
| Drug List | 2207 | ||
| Acetaminophen Capsules, Tablets, Oral Solution, and Suppositories (OTC) | 2207 | ||
| Acetaminophen with Codeine Tablets and Oral Solution (S III) | 2207 | ||
| Acetaminophen with Hydrocodone Tablets and Oral Solution (S III) | 2207 | ||
| Acetazolamide Tablets, Extended-Release Capsules, Injection, and Solution (Rx) | 2207 | ||
| Acetic Acid Solution (OTC) | 2208 | ||
| Albuterol Tablets, Syrup, and Inhaled Formulations (Rx) | 2208 | ||
| Aloe vera Gel, Ointment, and Laxatives (OTC) | 2208 | ||
| Aluminum Acetate Topical and Otic Solutions (OTC) | 2208 | ||
| Amiodarone Tablets, Solutions, Inhalants, and Injections (Rx) | 2208 | ||
| Antacids (OTC) | 2208 | ||
| Aspirin Tablets, Solution, and Suppositories (OTC) | 2208 | ||
| Atenolol Tablets, Injection, and Solution (Rx) | 2208 | ||
| Atropine Ophthalmic and Ointment Injection (Rx) | 2208 | ||
| Azithromycin Tablets, Solution, Injection, and Ophthalmic Solutions (Rx) | 2208 | ||
| Bacitracin Topical (OTC) and Injection (Rx) | 2209 | ||
| Bismuth Subsalicylate Tablets and Suspension (OTC) | 2209 | ||
| Bretylium Tosylate (Rx) | 2209 | ||
| Bupivacaine Injection (Rx) | 2209 | ||
| Butorphanol Tartrate Nasal Spray and IM and IV Injection (S IV) | 2209 | ||
| Calcium Chloride Oral and Injection (Rx) | 2209 | ||
| Ceftriaxone Injection (Rx) | 2209 | ||
| Cephalexin Capsules, Tablets, and Suspension (Rx) | 2209 | ||
| Charcoal, Activated (OTC) | 2209 | ||
| Ciprofloxacin Tablets, Capsules, Injection, and Oral, Ophthalmic, and Otic Solutions (Rx) | 2209 | ||
| Crotalidae Antivenom (Rx) | 2209 | ||
| Cyclopentolate Hydrochloride Ophthalmic Solution (Rx) | 2209 | ||
| DEET (N,N-Diethyl-meta-toluamide, Diethyltoluamide)–Containing Insect Repellent (OTC) | 2209 | ||
| 2-Octyl Cyanoacrylate (Dermabond) Topical Skin Adhesive (Rx) | 2209 | ||
| Dexamethasone Tablets; Oral, Implantation, Intravitreal, and Ophthalmic Solutions; and Injection (Rx) | 2209 | ||
| Dextroamphetamine Tablets, Elixir, and Capsules (S II) | 2210 | ||
| Dextrose Oral (OTC) and Injection (Rx) | 2210 | ||
| Diazepam Tablets, Oral Solution, Suppositories, and Injection (S IV) | 2210 | ||
| Digoxin Injection (Rx) | 2210 | ||
| Diltiazem Tablets, Solution, and Injection (Rx) | 2210 | ||
| Diphenhydramine Tablets, Elixir (OTC), and Injection (Rx) | 2210 | ||
| Acetic Acid and Aluminum Acetate (Domeboro) Otic Solutions (OTC) | 2210 | ||
| Dopamine Hydrochloride Injection (Rx) | 2210 | ||
| Doxycycline Capsules, Tablets, Syrup, Suspension, and Injection (Rx) | 2210 | ||
| Epinephrine Inhalant, Injection, and Topical (Rx) | 2210 | ||
| Erythromycin Tablets, Suspension, Topical, and Injection (Rx) | 2210 | ||
| Estazolam Tablets (S IV) | 2210 | ||
| Fluocinolone Acetonide Intraocular Implant, Ointment, and Shampoo (Rx) | 2210 | ||
| Furazolidone Tablets and Liquid (NA) | 2210 | ||
| Furosemide Tablets, Solution, and Injection (Rx) | 2210 | ||
| Glucagon Injection (Rx) | 2210 | ||
| Hydrocortisone Tablets, Cream, Solution, and Injection (Rx) | 2211 | ||
| Hydromorphone Tablets, Solution, Suppositories, and Injection (S II) | 2211 | ||
| Ibuprofen Tablets, Solution, and Injection (OTC) | 2211 | ||
| Intravenous Solutions (D5W, D5NS, NS, Etc.) | 2211 | ||
| Isoproterenol Hydrochloride Inhalant and Injection (Rx) | 2211 | ||
| Ketoconazole Tablets and Shampoo (Rx) | 2211 | ||
| Hydroxypropyl Methylcellulose (Lacrisert) Topical Ocular Solution (Rx) | 2211 | ||
| Levofloxacin Tablets, Solution, Injection, and Ophthalmic Route (Rx) | 2211 | ||
| Lidocaine Topical, Intradermal, Ophthalmic Route, and Injection (Rx) | 2211 | ||
| Lidocaine/Epinephrine/Tetracaine (LET) Topical (Rx) | 2211 | ||
| Gamma-Hexachlorocyclohexane (Lindane) Lotion and Shampoo (Rx) | 2211 | ||
| Loperamide Hydrochloride Capsules (OTC) | 2211 | ||
| Lorazepam Tablets and Injection (S IV) | 2211 | ||
| Mannitol Injection (Rx) | 2211 | ||
| Meperidine Hydrochloride Oral Solution and Injection (S II) | 2211 | ||
| Metoprolol Tablets, Injection, and Oral Solution (Rx) | 2211 | ||
| Midazolam Oral Solution and Injection (S IV) | 2211 | ||
| Modafinil Tablets (S IV) | 2212 | ||
| Morphine Sulfate Epidural and Injection (S II) | 2212 | ||
| Moxifloxacin Tablets, Injection, and Ophthalmic Route (Rx) | 2212 | ||
| Nalbuphine Hydrochloride Injection (Rx) | 2212 | ||
| Naloxone Hydrochloride Injection (Rx) | 2212 | ||
| Neosporin Ointment (OTC) | 2212 | ||
| Nifedipine Capsules, Tablets, and Injection (Rx) | 2212 | ||
| Nitroglycerin Capsules, Sublingual Tablets, Patches, Topical, and Injection (Rx) | 2212 | ||
| Norfloxacin Tablets and Ophthalmic Solution (Rx) | 2212 | ||
| Ofloxacin Tablets, Injection, Otic Solution, and Ophthalmic Route (Rx) | 2212 | ||
| Penicillin G Procaine Injection (Rx) | 2212 | ||
| Penicillin GK and G Sodium Injection (Rx) | 2212 | ||
| Phenobarbital Tablets, Solution, and IM and IV Injections (S IV) | 2213 | ||
| Phenylephrine Nasal (OTC), Ophthalmic Solution and Injection (Rx) | 2213 | ||
| Phenytoin Capsules, Tablets, Oral Solution, and Injection (Rx) | 2213 | ||
| Polysporin Ointment (Rx) | 2213 | ||
| Potassium Permanganate Astringent Solution (OTC) | 2213 | ||
| Povidone Iodine Solution (OTC) | 2213 | ||
| Prednisone Tablets, Oral Solution (Rx) | 2213 | ||
| Prochlorperazine Capsules, Tablets, Solution, and Injection (Rx) | 2213 | ||
| Promethazine Capsules, Tablets, Solution, Suppositories, and Injection (Rx) | 2213 | ||
| Pseudoephedrine and Pseudoephedrine/Triprolidine Capsules and Tablets (OTC) | 2213 | ||
| Sildenafil Tablets (Rx) | 2213 | ||
| Simethicone Capsules, Tablets, Drops, and Ultrasound Suspension (OTC) | 2213 | ||
| Sodium Bicarbonate Suppositories and Injection (Rx) | 2213 | ||
| Sodium Sulfacetamide Tablets, Cream, Lotion, Ointment, and Ophthalmic Route (Rx) | 2213 | ||
| Temazepam Capsules (S IV) | 2213 | ||
| Tetanus Toxoid, Tetanus Toxoid/Diphtheria/Acellular Pertussis, and Hyperimmune Tetanus Globulin Vaccine Solutions (Rx) | 2213 | ||
| Tetracaine Hydrochloride Ophthalmic Solution (Rx) | 2214 | ||
| Tetracycline Tablets, Topical Solution, and Injection (Rx) | 2214 | ||
| Tolnaftate Topical Antifungal (OTC) | 2214 | ||
| Triazolam Tablets (S IV) | 2214 | ||
| Trimethoprim/Sulfamethoxazole Tablets, Suspensions, and Injection (Rx) | 2214 | ||
| Verapamil Hydrochloride Capsules, Tablets, and Injection (Rx) | 2214 | ||
| Zinc Salts (OTC) | 2214 | ||
| Zolpidem Sublingual and Immediate- and Extended-Release Tablets and Spray (S IV) | 2214 | ||
| References | 2214 | ||
| References | 2214.e1 | ||
| Index | 2215 | ||
| A | 2215 | ||
| B | 2220 | ||
| C | 2222 | ||
| D | 2228 | ||
| E | 2231 | ||
| F | 2235 | ||
| G | 2238 | ||
| H | 2239 | ||
| I | 2243 | ||
| J | 2245 | ||
| K | 2246 | ||
| L | 2246 | ||
| M | 2248 | ||
| N | 2251 | ||
| O | 2253 | ||
| P | 2254 | ||
| Q | 2259 | ||
| R | 2259 | ||
| S | 2262 | ||
| T | 2268 | ||
| U | 2272 | ||
| V | 2273 | ||
| W | 2274 | ||
| Y | 2277 | ||
| Z | 2277 |