Wilderness Medicine Updates

In this episode, Dr. Patrick Fink reviews accidental hypothermia for wilderness providers, building on Ep. 27 Thermoregulation, explaining physiologic changes as core temperature falls  and why accurate core temperatures are difficult to obtain in the field. 
We learn the modified Swiss staging system (0–4) based on signs and symptoms and outlines field management: 
- 0 cold stress (shelter, dry/insulate, warm calories; avoid alcohol), 
- 1 mild hypothermia (ataxia/fine motor impairment; passive plus active external rewarming with a hypothermia wrap and heat near axilla/groin; frequent reassessment), 
- 2 moderate hypothermia (confusion/lethargy; active external rewarming, evaluate hypoglycemia, gentle handling and no exertion to avoid afterdrop, cardiac monitoring, expedite evacuation), 
- 3 severe hypothermia (unresponsive with vital signs; airway/ventilation support, extremely gentle transport)
- 4 hypothermic cardiac arrest (60-second pulse check, CPR, limited shocks under 30°C, withhold epinephrine/amiodarone under 30°C, consider intermittent CPR per protocol, and note potassium’s role in termination decisions). 
We also briefly contrasts slow non-extracorporeal warming with ECMO/cardiopulmonary bypass, previewing a future episode on advanced care and the HOPE score
Links

Episode 27: Thermoregulation
WMS 2019 Accidental Hypothermia Guideline
AHA Hypothermia Guidelines
European Resuscitation Council Hypothermia Algorithm
Chapters:
00:00 Welcome and Overview
00:48 Hypothermia Basics
01:12 Cooling Physiology
04:06 Severe Effects and Arrhythmias
06:38 Field Temp Challenges
07:41 Swiss Staging Intro
08:35 Stage 0 Cold Stress
11:40 Stage 1 Mild Hypothermia
16:04 Stage 2 Moderate Hypothermia
20:44 Afterdrop and Handling
22:54 Stage 3 Severe Hypothermia
27:00 Stage 4 Cardiac Arrest
27:57 CPR Shocks and Drugs
37:01 Advanced Rewarming ECMO
43:26 Key Takeaways Summary
46:57 Wrap Up and Support

As always, thanks for listening to Wilderness Medicine Updates, hosted by Patrick Fink MD FAWM.

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Reevaluating Spinal Motion Restriction: Evidence Update
In this episode of Wilderness Medicine Updates, host Dr. Patrick Fink delves into the evolving guidelines and practices concerning spinal motion restriction. Drawing from historical dogma and modern research, Patrick explores the inefficacies and potential harms of traditional spinal immobilization tools like rigid spine boards and cervical collars. Instead, he advocates for more flexible, evidence-based approaches such as using well-padded surfaces and coaching patients to minimize their own motion. Key points from a comprehensive literature review by the National Association of EMS Physicians and other authoritative bodies are discussed, highlighting the shift from immobilization to motion restriction and its practical implications. Listeners are urged to stay updated with current evidence and consult medical directors before altering their practices.

Links
Ep. 14 - Spinal Immobilization Guidelines Update
2018 ACEP/NAEMSP Sminal Motion Restriction Position Statement
Prehospital Trauma Compendium: Prehospital Management of Spinal Cord Injuries - A NAEMSP Comprehensive Review and Analysis of the Literature

Chapters
00:00 Introduction to Wilderness Medicine Updates
00:42 Historical Perspective on Spinal Immobilization
01:44 Transition to Spinal Motion Restriction
03:30 Review of Recent Literature
05:40 Key Findings on Spinal Motion and Neurological Outcomes
09:30 Effectiveness of Backboards and Cervical Collars
12:10 Potential Harms of Immobilization Tools
16:38 Practical Recommendations and Future Directions
21:48 Conclusion and Final Thoughts

As always, thanks for listening to Wilderness Medicine Updates, hosted by Patrick Fink MD FAWM.

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Wilderness Orthopedics: Managing Trauma in Remote Environments with Dr. Chris Healy
In this episode of Wilderness Medicine Updates, host Dr. Patrick Fink tackles orthopedic injuries in the wilderness with Dr. Chris Healy, an orthopedic surgeon and outdoor enthusiast. They explore the management of long bone fractures, traction for femur, pelvic binders, and the nuances of treating injuries in limited-resource environments. The episode covers strategies for handling common injuries like shoulder dislocations, tibia fractures, knee injuries, and how to prioritize care. They also emphasize the importance of timely evacuation and when and how to safely attempt reductions in the field.
Links:
Donate to the Tina Biddle Memorial Scholarship
Sulcus sign / Squaring of the shoulder
Chapters:
00:00 Introduction and Episode Overview
01:36 Tribute to Tina Biddle
04:09 Meet Dr. Chris Healy
05:11 Ski Patrol Background and Pre-Hospital Care
08:12 Approaching Orthopedic Injuries in the Field
17:50 Managing Tibia and Fibula Fractures
21:40 Understanding Compartment Syndrome
27:50 Femur Fractures and Traction Splinting
36:57 Pelvic Fractures: Identification and Management
38:41 Understanding Pelvic Fractures and Binders
39:53 The Role of Pelvic Binders in Pre-Hospital Care
41:11 Challenges with Pelvic Binders in the Field
43:15 Proper Placement of Pelvic Binders
46:36 Field Management of Shoulder Dislocations
50:43 Techniques for Reducing Shoulder Dislocations
54:17 Managing Upper Extremity Injuries
57:51 Handling Knee Injuries in the Field
01:00:37 Patella vs. Knee Dislocations
01:08:06 Evacuation Priorities for Knee Dislocations
01:10:53 Common Issues in Pre-Hospital Orthopedic Care
01:15:36 Final Thoughts and Listener Engagement
As always, thanks for listening to Wilderness Medicine Updates, hosted by Patrick Fink MD FAWM.

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Understanding Stress Injuries in First Line Responders with Laura McGladrey
This episode of Wilderness Medicine Updates, hosted by Patrick Fink, features a conversation with Laura McGladrey, founder of the Responder Alliance. They discuss the critical issue of stress injuries among first line responders, including professional ski patrollers, healthcare workers, and rescue team members. Through personal stories and expert insights, Laura explains the concept of stress injuries, how they develop, and the importance of early detection and mitigation. The episode highlights the need for both individual and organizational strategies to support resilience and manage stress. Listeners are introduced to practical tools, cultural shifts, and personal anecdotes to help maintain a long, healthy, and fulfilling career in high-stress environments.
Links
Responder Alliance Home Page
Access all that the organization has to offer.
Responder Alliance: Resource Hub
Easy access to critical tools and offerings.
The Stress Continuum
See the visual continuum that we discuss on the show.
Scholarships: Responder Alliance Foundation
Apply for aid for an individual or team training.
Make a Donation to Responder Alliance Foundation!
Join me in making a tax-deductible donation to support the valuable work of the Responder Alliance and bring this work to those who need it, regardless of cost.
Chapters
00:00 Introduction and Guest Welcome
02:11 Laura's Background and Work
06:00 Understanding Stress Injuries
10:02 Responder Alliance Mission and Challenges
20:55 Critical Incident Stress Management
30:49 Empowering First Responders
32:13 Daily Investments in Resilience
37:26 Recognizing and Managing Stress
38:14 Organizational Support for Stress Management
39:45 Building Resilient Teams
46:12 Learning from Resilient Leaders
52:42 Resources for Stress Mitigation
57:54 Conclusion and Final Thoughts
As always, thanks for listening to Wilderness Medicine Updates, hosted by Patrick Fink MD FAWM.

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In this episode of Wilderness Medicine Updates, host Patrick Fink delves into the topic of thermoregulation, explaining how our bodies regulate temperature in response to environmental changes. Listeners will learn about methods of heat exchange (conduction, convection, radiation, and evaporation), how to measure core temperature, and the body's physiological responses—such as shivering, sweating, and blood flow control. 
The episode also touches on the effects of age, metabolic stressors, and pregnancy on thermoregulation, as well as the importance of understanding these principles in the context of treating conditions like hypothermia and heat-related illnesses.

00:00 Introduction and Episode Overview
01:29 Importance of Thermoregulation
03:12 Human Thermoregulation Mechanisms
04:20 Measuring Core Temperature
07:55 Heat Exchange Methods
14:52 Behavioral and Physiological Responses
24:48 Sex and Age Differences in Thermoregulation
27:14 Conclusion and Next Steps
As always, thanks for listening to Wilderness Medicine Updates, hosted by Patrick Fink MD FAWM.

Connect with us by email at [email protected].
You can pay us a compliment and share the show with a new listener on any popular platform here.